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 fai
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1. 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?

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.

2. A client with chronic renal failure is prescribed erythropoietin (Epogen). Which outcome indicates that the medication is effective?

Correct answer: B

Rationale: The correct answer is B: Improved hemoglobin levels. Erythropoietin (Epogen) stimulates red blood cell production, leading to an increase in hemoglobin levels in clients with chronic renal failure. Monitoring hemoglobin levels is crucial to assess the effectiveness of erythropoietin therapy in managing anemia associated with chronic renal failure. While increased urine output, decreased blood pressure, and stable potassium levels are important parameters to monitor in clients with renal failure, they are not direct indicators of the effectiveness of erythropoietin therapy.

3. The client has acute pancreatitis. Which nursing intervention is the highest priority?

Correct answer: A

Rationale: Administering pain medication as prescribed is the highest priority when caring for a client with acute pancreatitis. Acute pancreatitis is often associated with severe abdominal pain, and alleviating this pain is crucial for the client's comfort and well-being. Pain management can also help reduce stress on the pancreas and promote recovery. Monitoring serum amylase and lipase levels, encouraging oral intake of clear liquids, and assessing bowel sounds are important interventions but addressing the client's pain takes precedence to provide immediate relief and improve outcomes.

4. A client is receiving chemotherapy and is at risk for neutropenia. Which precaution should the nurse implement?

Correct answer: C

Rationale: Placing the client in a private room is crucial to protect them from infections due to their compromised immune system. Neutropenia, a common side effect of chemotherapy, decreases white blood cell count, making the client more susceptible to infections. By placing the client in a private room, exposure to pathogens from other individuals is minimized, reducing the risk of infection and helping maintain the client's health during this vulnerable period.

5. A client in acute renal failure has a serum potassium level of 6.3 mEq/L. What intervention can the nurse expect the healthcare provider to prescribe?

Correct answer: C

Rationale: In acute renal failure with high serum potassium levels, the healthcare provider is likely to prescribe a Kayexalate retention enema. Kayexalate is a medication used to lower elevated potassium levels by promoting potassium excretion through the gastrointestinal tract, thus aiding in the management of hyperkalemia in clients with renal failure.

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