Nursing Elites

1. A 56-year-old white male complains of intermittent dysphagia for the past three months, particularly with the ingestion of meat. He has no difficulties swallowing liquids. He has no history of smoking, uses no medications, and has had no weight loss. What test would be best to evaluate him?

• A. Upper endoscopy
• B. Chest/abdominal CT scan
• C. Barium swallow
• D. Esophageal manometry

Correct answer: C

Rationale: For a patient presenting with intermittent dysphagia, especially with solids like meat, a barium swallow is the most appropriate initial test. In this case, the classic presentation suggests a Schatzki’s ring, which is best visualized through a barium study. Upper endoscopy may not always visualize Schatzki’s rings effectively. Chest/abdominal CT scan and esophageal manometry are not the preferred tests for diagnosing Schatzki’s rings. Treatment for Schatzki’s rings often involves bougie dilatation, and no further therapy may be necessary.

2. A patient with asthma is prescribed a corticosteroid inhaler. What is the most important instruction to give to the patient?

• A. Use the inhaler only during asthma attacks.
• B. Rinse the mouth after using the inhaler.
• C. Take a double dose if symptoms worsen.
• D. Avoid using a spacer with the inhaler.

Correct answer: B

Rationale: The most important instruction to give to a patient using a corticosteroid inhaler is to rinse the mouth after each use. This is crucial to prevent the development of oral thrush, a common side effect of corticosteroid inhalers. Failure to rinse the mouth can lead to the overgrowth of yeast in the mouth, causing oral thrush, which can be uncomfortable and require additional treatment. Therefore, reminding patients to rinse their mouth after using the inhaler is essential in preventing this potential complication. Choices A, C, and D are incorrect. Using the inhaler only during asthma attacks may lead to uncontrolled asthma symptoms. Taking a double dose without healthcare provider instruction can result in overdose or side effects. Avoiding a spacer with the inhaler can reduce the effectiveness of delivering the medication to the lungs.

3. A client with liver failure is at an increased risk of bleeding due to the inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

• A. Alterations in glucose metabolism
• B. Retention of bile salts
• C. Inadequate production of albumin by hepatocytes
• D. Inability of the liver to use vitamin K

Correct answer: D

Rationale: The correct answer is D. The liver's inability to use vitamin K is the most likely factor contributing to the loss of prothrombin synthesis in liver failure. Vitamin K is essential for the synthesis of prothrombin, a crucial clotting factor. In liver failure, impaired utilization of vitamin K leads to decreased production of prothrombin, increasing the risk of bleeding in affected individuals.

4. The mother of a 9-month-old who was diagnosed with respiratory syncytial virus (RSV) yesterday calls the clinic to inquire if it will be all right to take her infant to the first birthday party of a friend's child the following day. What response should the nurse provide this mother?

• A. The child can be around other children but should wear a mask at all times.
• B. The child will no longer be contagious, no need to take any further precautions.
• C. Make sure there are no children under the age of 6 months around the infected child.
• D. Do not expose other children. RSV is very contagious even without direct oral contact.

Correct answer: D

Rationale: The correct response is to advise the mother not to expose other children to the infected child. RSV is highly contagious, and transmission can occur even without direct oral contact. It is crucial to prevent the spread of the virus to protect other children from getting infected.

5. When creating a care plan for a 70-year-old obese client admitted to the postsurgical unit following a colon resection, the client's age and increased body mass index put them at increased risk for which complication in the postoperative period?

• A. Hyperglycemia
• B. Azotemia
• C. Falls
• D. Infection

Correct answer: D

Rationale: Infection is a significant risk in obese, elderly clients due to decreased immunity and increased healing time, making them more susceptible to postoperative infections. Proper infection prevention measures should be a priority in the care plan for this client to minimize this risk.

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