Nursing Elites

1. A 34-year-old woman presents with intermittent abdominal pain, bloating, and diarrhea. She notes that her symptoms improve with fasting. She has a history of iron deficiency anemia. What is the most likely diagnosis?

• A. Irritable bowel syndrome
• B. Celiac disease
• C. Lactose intolerance
• D. Crohn's disease

Correct answer: B

Rationale: The patient's symptoms of intermittent abdominal pain, bloating, and diarrhea that improve with fasting, along with a history of iron deficiency anemia, are highly suggestive of celiac disease. In celiac disease, gluten ingestion leads to mucosal damage in the small intestine, causing malabsorption of nutrients like iron, leading to anemia. The improvement of symptoms with fasting can be explained by the temporary avoidance of gluten-containing foods. Irritable bowel syndrome typically does not improve with fasting. Lactose intolerance usually presents with symptoms after dairy consumption, not with fasting. Crohn's disease typically presents with more chronic symptoms and is not commonly associated with improvement on fasting.

2. A client with hypertension is receiving dietary education from a nurse. Which recommendation should the nurse include?

• A. Increase your intake of saturated fats.
• B. Limit your sodium intake to less than 2 grams per day.
• C. Avoid foods high in potassium.
• D. Consume at least three alcoholic beverages daily.

Correct answer: B

Rationale: The correct recommendation for a client with hypertension is to limit sodium intake to less than 2 grams per day. High sodium intake can worsen hypertension by increasing blood pressure. Choices A, C, and D are incorrect. Increasing saturated fats (Choice A) can be detrimental to heart health and exacerbate hypertension. Avoiding foods high in potassium (Choice C) is not recommended as potassium-rich foods can actually be beneficial for managing blood pressure. Consuming three alcoholic beverages daily (Choice D) can also have a negative impact on blood pressure and overall health.

3. A client is on a mechanical ventilator. Which client response indicates that the neuromuscular blocker tubocurarine chloride (Tubarine) is effective?

• A. The client's extremities are paralyzed.
• B. The peripheral nerve stimulator causes twitching.
• C. The client clenches fist upon command.
• D. The client's Glasgow Coma Scale score is 14.

Correct answer: A

Rationale: The correct answer is A. Tubocurarine chloride is a neuromuscular blocker that works by causing paralysis of skeletal muscles. Therefore, if the client's extremities are paralyzed, it indicates that the medication is effective in achieving the desired muscle relaxation necessary for mechanical ventilation. Choices B and C are incorrect as they suggest muscle activity, which would not be expected with the administration of a neuromuscular blocker. Choice D is unrelated to the effectiveness of tubocurarine chloride.

4. A 45-year-old woman with occasional indigestion has had episodes of chest pain and dysphagia to both solids and liquids. An upper GI series and EGD fail to disclose any structural abnormalities. What is the most appropriate initial therapy?

• A. Sucralfate
• B. Proton pump inhibitor
• C. Prokinetic agent
• D. Benzodiazepine

Correct answer: B

Rationale: The patient's symptoms of chest pain and dysphagia suggest esophageal spasm, often related to underlying gastroesophageal reflux. The initial therapy should focus on acid suppression. Proton pump inhibitors are the preferred choice to reduce acid production and alleviate symptoms. If proton pump inhibitors are ineffective, other options like smooth muscle relaxants or antidepressants may be considered. A Heller myotomy is not indicated in this case as the patient does not have achalasia.

5. A client with a history of chronic alcohol abuse is at risk for which of the following conditions?

• A. Liver cirrhosis
• B. Renal failure
• C. Chronic obstructive pulmonary disease (COPD)
• D. Peptic ulcer disease

Correct answer: A

Rationale: Chronic alcohol abuse can lead to liver cirrhosis due to long-term liver damage. Alcohol consumption over time can cause inflammation and scarring of the liver, eventually leading to cirrhosis. This condition can severely impact liver function and may progress to liver failure if not addressed.

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