Nursing Elites

1. A 45-year-old obese man arrives at a clinic reporting daytime sleepiness, difficulty falling asleep at night, and snoring. The nurse should recognize the manifestations of what health problem?

• A. Adenoiditis
• B. Chronic tonsillitis
• C. Obstructive sleep apnea
• D. Laryngeal cancer

Correct answer: C

Rationale: The symptoms described, including daytime sleepiness, difficulty falling asleep at night, and snoring, are classic signs of obstructive sleep apnea. This condition is commonly seen in obese individuals due to the relaxation of throat muscles during sleep, leading to airway obstruction. Adenoiditis and chronic tonsillitis are less likely as they don't typically present with the same symptoms mentioned.

2. What is the best therapy for a 65-year-old man with symptoms of regurgitation, chest pain, dysphagia, weight loss, dilated esophagus, and an absent gastric air bubble on CXR?

• A. Proton-pump inhibitor
• B. Endoscopic balloon dilatation
• C. Sucralfate
• D. Esophageal resection

Correct answer: B

Rationale: The patient's presentation and radiologic findings are consistent with achalasia. The absence of a mass on upper endoscopy and CT scan helps rule out secondary causes. Achalasia is best managed with endoscopic balloon dilatation or myotomy. Proton-pump inhibitors are not effective for achalasia. Sucralfate is not a primary treatment for achalasia. Esophageal resection is only considered if malignancy develops. Patients with achalasia may experience chest pain and weight loss due to food accumulation in the dilated esophagus. Endoscopic balloon dilatation is a safe and effective treatment option for improving symptoms in achalasia patients.

3. What is/are the possible cause(s) of acute pancreatitis in this patient?

• A. HIV
• B. Cytomegalovirus
• C. Dideoxyinosine (ddI)
• D. Pentamidine

Correct answer: B

Rationale: This patient presents with symptoms and lab findings consistent with acute pancreatitis. Cytomegalovirus is a common viral infection associated with pancreatitis. In patients with AIDS, the pancreas can be affected by various infections (e.g., cryptococcus, Mycobacterium tuberculosis, candida, Toxoplasma gondii) and medications (such as ddI, pentamidine, trimethoprim/sulfamethoxazole, metronidazole) can also lead to acute pancreatitis. While HIV infection predisposes individuals to various opportunistic infections, in this case, the most likely cause of the acute pancreatitis is cytomegalovirus infection.

4. A patient with systemic lupus erythematosus (SLE) is prescribed hydroxychloroquine. What is the most important instruction the nurse should give?

• A. Report any vision changes immediately.
• B. Take the medication with milk.
• C. Avoid high-fat foods.
• D. Increase intake of green leafy vegetables.

Correct answer: A

Rationale: The correct instruction for a patient prescribed hydroxychloroquine, especially in the context of systemic lupus erythematosus (SLE), is to report any vision changes immediately. Hydroxychloroquine can potentially cause retinal damage, so prompt reporting and ophthalmologic evaluation are essential in preventing irreversible eye complications. Choices B, C, and D are incorrect because they do not address the significant adverse effect of hydroxychloroquine on vision. Taking the medication with milk, avoiding high-fat foods, or increasing intake of green leafy vegetables are not relevant to the primary concern of monitoring for visual changes.

5. A patient with chronic pain is prescribed a fentanyl patch. What is the most important instruction for the nurse to provide?

• A. Apply the patch to a different site each time.
• B. Change the patch every 72 hours.
• C. Avoid using additional heating pads over the patch.
• D. Remove the patch before showering.

Correct answer: B

Rationale: The most important instruction for the nurse to provide to a patient prescribed a fentanyl patch is to change the patch every 72 hours. This ensures consistent pain control and prevents complications. It is crucial to rotate the application sites to prevent skin irritation or reactions. Using additional heating pads over the patch should be avoided as it can increase the absorption of the medication, leading to overdose or adverse effects. Removing the patch before showering is not necessary as long as the patch is securely in place.

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