Nursing Elites

1. The healthcare provider formulates a nursing diagnosis of 'High risk for ineffective airway clearance' for a client with myasthenia gravis. What is the most likely cause for this nursing diagnosis?

• A. Pain during coughing.
• B. Diminished cough effort.
• C. Thick, dry secretions.
• D. Excessive inflammation.

Correct answer: B

Rationale: Clients with myasthenia gravis commonly experience muscle weakness, including in the muscles used for coughing. This diminished cough effort can lead to ineffective airway clearance, increasing the risk of respiratory complications. Therefore, the most likely cause for the nursing diagnosis 'High risk for ineffective airway clearance' in a client with myasthenia gravis is the diminished cough effort due to muscle weakness.

2. The patient described in the preceding question has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?

• A. She is at low risk for reinfection with H. pylori
• B. A positive serum IgG indicates that eradication of H. pylori was successful
• C. The urease breath test is an ideal test to document failure of eradication
• D. Dyspepsia typically worsens with H. pylori eradication

Correct answer: C

Rationale: Reinfection with H. pylori is rare, and the persistence of infection usually indicates poor compliance with the medical regimen or antibiotic resistance. The serum IgG may remain positive indefinitely and cannot be used to determine failure of eradication; however, a decrease in quantitative IgG levels has been utilized to indicate treatment success. If available, either the stool antigen or urease breath test is ideal to document treatment failure due to their high sensitivity, specificity, and ease of performance. The relationship between dyspepsia and H. pylori is controversial, but generally, dyspepsia does not typically improve with H. pylori eradication.

3. A 40-year-old woman presents with a history of chronic constipation, bloating, and abdominal pain. She notes that the pain is relieved with defecation. She denies any weight loss, blood in her stools, or nocturnal symptoms. Physical examination and routine blood tests are normal. What is the most likely diagnosis?

• A. Inflammatory bowel disease
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Lactose intolerance

Correct answer: B

Rationale: The patient's symptoms of chronic constipation, bloating, abdominal pain relieved with defecation, absence of weight loss, blood in stools, or nocturnal symptoms, along with normal physical examination and routine blood tests, are indicative of irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits in the absence of any organic cause. It is a diagnosis of exclusion made based on symptom criteria, and the provided clinical scenario aligns with the typical presentation of IBS.

4. Your patient has an order to receive Levothyroxine Sodium 75 mcg daily IV. You have a vial containing 100 mcg available from the pharmacy. According to the package insert, 5 mL of 0.9% sodium chloride is needed to reconstitute. You add the appropriate amount of sodium chloride to the vial. How many mcg of medication are in 1 mL of the vial?

• A. 20 mcg
• B. 15 mcg
• C. 25 mcg
• D. 30 mcg

Correct answer: A

Rationale: After reconstitution, the concentration of Levothyroxine Sodium in the vial is 100 mcg in 5 mL, which equals 20 mcg/mL. Therefore, in 1 mL of the vial, there are 20 mcg of medication.

5. A client with myelogenous leukemia is receiving an autologous bone marrow transplantation (BMT). What is the priority intervention that the nurse should implement when the bone marrow is repopulating?

• A. Administer sargramostim (Leukine, Prokine).
• B. Infuse PRBC and platelet transfusions.
• C. Give parenteral prophylactic antibiotics.
• D. Maintain a protective isolation environment.

Correct answer: D

Rationale: Maintaining a protective isolation environment is crucial during the repopulation of bone marrow post-transplant to reduce the risk of infections. The client's immune system is compromised during this period, making them highly susceptible to infections. By implementing protective isolation measures, the nurse can help prevent exposure to pathogens, safeguarding the client's health and supporting the success of the transplantation.

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