Nursing Elites

1. A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?

• A. Refer her for an exploratory laparotomy
• B. Measure serum gastrin in response to secretin infusion
• C. Treat her for H. pylori
• D. Obtain a dedicated small bowel series

Correct answer: B

Rationale: The next step after finding an elevated fasting serum gastrin level is to perform a secretin stimulation test. This test helps differentiate between gastrinoma and other causes of elevated gastrin levels, such as proton-pump inhibitor therapy or H2 antagonists. In gastrinoma, the serum gastrin level should further increase after secretin infusion, while in other conditions, the levels would not significantly rise. Exploratory laparotomy would be premature without confirming the diagnosis. Treating for H. pylori is not indicated as the diagnosis of gastrinoma is under consideration and not Helicobacter pylori infection. A dedicated small bowel series is not the next appropriate step in this scenario.

2. A patient who is receiving chemotherapy for breast cancer develops thrombocytopenia. What should the nurse include in the care plan?

• A. Encourage light exercise.
• B. Avoid intramuscular injections.
• C. Do not administer aspirin.
• D. Use a soft toothbrush for oral care.

Correct answer: B

Rationale: Thrombocytopenia is a condition characterized by a low platelet count, which can lead to an increased risk of bleeding. To minimize this risk, patients with thrombocytopenia should avoid activities that can cause injury or bleeding, such as intramuscular injections. Encouraging light exercise can be beneficial, as it promotes circulation without increasing the risk of trauma. However, avoiding intramuscular injections is crucial to prevent bleeding episodes. Aspirin should be avoided as it can further impair platelet function, exacerbating the condition. Using a soft toothbrush for oral care is recommended to prevent gum bleeding in patients with thrombocytopenia.

3. The nurse is planning care for a client with cirrhosis of the liver. Which intervention should the nurse include to reduce the risk of bleeding?

• A. Monitor for signs of infection.
• B. Limit the client's dietary protein intake.
• C. Administer vitamin K as prescribed.
• D. Encourage the client to increase fluid intake.

Correct answer: C

Rationale: Administering vitamin K as prescribed can help reduce the risk of bleeding in clients with cirrhosis by promoting clotting factor production. Cirrhosis often leads to impaired liver function, affecting the synthesis of clotting factors. Vitamin K supplementation helps in the production of these essential clotting factors, thus reducing the risk of bleeding in clients with cirrhosis. Monitoring for signs of infection (Choice A) is important for overall care but not directly related to reducing the risk of bleeding in cirrhosis. Limiting dietary protein intake (Choice B) may be necessary in some cases of cirrhosis but does not directly address the risk of bleeding. Encouraging increased fluid intake (Choice D) is beneficial for various aspects of health but does not specifically target the risk of bleeding in cirrhosis.

4. A client with rheumatoid arthritis is prescribed methotrexate. Which instruction should the nurse include in the client's teaching?

• A. Avoid alcohol while taking this medication.
• B. Take the medication with a full meal.
• C. Increase your intake of high-fiber foods.
• D. Avoid exposure to sunlight.

Correct answer: A

Rationale: The correct instruction for the client prescribed with methotrexate is to avoid alcohol while taking this medication. Methotrexate can cause liver toxicity, and alcohol consumption can further exacerbate this risk. It is crucial for patients to abstain from alcohol to prevent adverse effects on the liver. Therefore, instructing the client to avoid alcohol is a key component of safe medication use and management of rheumatoid arthritis.

5. A client diagnosed with dementia is disoriented, wandering, has a decreased appetite, and is having trouble sleeping. What is the priority nursing problem for this client?

• A. Disturbed thought processes.
• B. Altered sleep pattern.
• C. Imbalanced nutrition: less than.
• D. Risk for injury.

Correct answer: D

Rationale: The correct answer is 'Risk for injury.' In a client with dementia who is disoriented, wandering, and experiencing sleep disturbances, the priority nursing problem is the risk for injury. Disorientation and wandering behavior can lead to accidents, falls, or other harmful situations, making it crucial for the nurse to address the safety concerns first to prevent any potential harm to the client.

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