Nursing Elites

1. Which regimen is most effective for treating H. pylori infection?

• A. Metronidazole, bismuth subsalicylate, amoxicillin for 14 days
• B. Clarithromycin and omeprazole for 14 days
• C. Metronidazole, lansoprazole, and clarithromycin for 14 days
• D. Metronidazole, clarithromycin, and omeprazole for 7 days

Correct answer: C

Rationale: Regimen C, which consists of metronidazole, lansoprazole, and clarithromycin for 14 days, is recommended by the FDA as an effective treatment for H. pylori infection. This regimen has been shown to have a high eradication rate and is a standard recommendation in clinical practice guidelines for the management of H. pylori-related conditions.

2. A client with cirrhosis of the liver is experiencing pruritus. Which intervention should the nurse implement to help relieve the client's symptoms?

• A. Administer acetaminophen (Tylenol).
• B. Apply lotion to the skin.
• C. Encourage a high-protein diet.
• D. Provide a warm bath.

Correct answer: B

Rationale: Pruritus is a common symptom in clients with cirrhosis due to bile salts accumulating in the skin. Applying lotion to the skin helps soothe the itching and can prevent skin breakdown. Acetaminophen can worsen liver damage in clients with cirrhosis as it is metabolized in the liver. Encouraging a high-protein diet is not directly related to relieving pruritus. Providing a warm bath may further dry the skin, exacerbating the itching. Therefore, the most appropriate intervention to help relieve pruritus in a client with cirrhosis is to apply lotion to the skin.

3. A 56-year-old woman presents to discuss the results of her recent upper endoscopy. She was having some mild abdominal pain, so she underwent the procedure, which revealed an ulcer in the antrum of the stomach. Biopsy of the lesion revealed the presence of H. pylori. All of the following statements regarding her condition are correct except

• A. H. pylori has been associated with gastric MALT (mucosa-associated lymphoid tissue)
• B. Reinfection is rare despite adequate treatment
• C. Triple drug therapy has been shown to be more effective than dual drug therapy
• D. If her H. pylori IgG antibody titer was elevated prior to therapy, it can be used to monitor treatment efficacy

Correct answer: B

Rationale: H. pylori is associated with a majority of peptic ulcer disease cases and has links to gastric MALT and adenocarcinoma. Triple drug therapy is more effective than dual therapy. Reinfection after adequate treatment is rare. While urea breath testing is a better diagnostic tool, quantitative serology can monitor treatment efficacy. A 30% decrease in IgG titer should occur post-therapy, indicating effectiveness.

4. 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.

5. A 65-year-old man presents with weight loss, jaundice, and a palpable mass in the right upper quadrant. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?

• A. Gallstones
• B. Hepatitis
• C. Pancreatic cancer
• D. Primary biliary cirrhosis

Correct answer: C

Rationale: The combination of weight loss, jaundice, a palpable mass in the right upper quadrant, and elevated bilirubin and alkaline phosphatase levels strongly suggests pancreatic cancer. The presentation is classic for pancreatic malignancy, which commonly presents with obstructive jaundice due to the tumor blocking the common bile duct, leading to elevated bilirubin and alkaline phosphatase levels. Weight loss is a common symptom of advanced pancreatic cancer. The palpable mass in the right upper quadrant corresponds to the location of the pancreas. Gallstones typically manifest with different symptoms, while hepatitis and primary biliary cirrhosis are less likely to present with a palpable mass and weight loss in this scenario.

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