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 healthcare provider is providing dietary teaching to a client with cholecystitis. Which type of diet should the healthcare provider recommend?

• A. High-fiber, low-fat diet
• B. Low-fiber, high-protein diet
• C. Low-fat, low-cholesterol diet
• D. High-protein, high-fat diet

Correct answer: C

Rationale: In cholecystitis, a low-fat, low-cholesterol diet is recommended to manage symptoms and reduce inflammation by reducing the workload on the gallbladder. This diet helps prevent gallbladder attacks and complications.

3. A client with chronic kidney disease is prescribed a low-protein diet. Which laboratory result should the nurse monitor to evaluate the effectiveness of the diet?

• A. Blood urea nitrogen (BUN)
• B. Serum potassium
• C. Serum calcium
• D. Creatinine clearance

Correct answer: A

Rationale: Blood urea nitrogen (BUN) levels should be monitored to assess the effectiveness of a low-protein diet in clients with chronic kidney disease. BUN levels reflect the breakdown of protein in the body, and a low-protein diet aims to reduce BUN levels to lessen the workload on the kidneys. Therefore, monitoring BUN levels is crucial in managing kidney function and evaluating the impact of dietary modifications. Serum potassium, serum calcium, and creatinine clearance are important parameters to monitor in clients with chronic kidney disease, but they are not specifically indicative of the effectiveness of a low-protein diet. Serum potassium levels are crucial in assessing electrolyte balance, serum calcium levels are important for bone health and nerve function, and creatinine clearance reflects kidney function overall, not just the impact of a low-protein diet.

4. A client is scheduled for a colonoscopy. Which instruction should the nurse provide?

• A. Eat a light breakfast on the day of the procedure.
• B. You will need to drink a bowel preparation solution before the procedure.
• C. Avoid all liquids for 24 hours before the procedure.
• D. You can continue taking your blood thinners until the day of the procedure.

Correct answer: B

Rationale: The correct instruction for a client scheduled for a colonoscopy is to drink a bowel preparation solution before the procedure. This solution helps cleanse the colon, ensuring clear visualization during the colonoscopy procedure. Choice A is incorrect because a light breakfast is usually recommended the day before the procedure, not on the day of the colonoscopy. Choice C is incorrect as it is important to stay hydrated and follow specific instructions regarding liquid intake. Choice D is incorrect as blood thinners may need to be adjusted or stopped before the colonoscopy to reduce the risk of bleeding during the procedure.

5. A client with a history of deep vein thrombosis (DVT) is receiving warfarin (Coumadin). Which laboratory value indicates a therapeutic effect of the medication?

• A. INR of 2.5.
• B. PTT of 45 seconds.
• C. Hemoglobin of 12 g/dL.
• D. Platelet count of 150,000/mm³.

Correct answer: A

Rationale: An INR (International Normalized Ratio) of 2.5 indicates a therapeutic level for clients receiving warfarin (Coumadin) to prevent thromboembolism. It is essential to monitor INR levels regularly when on warfarin therapy to ensure that the blood's ability to clot is within the desired range to prevent both clotting and excessive bleeding.

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