Nursing Elites

1. 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.

2. A client with chronic obstructive pulmonary disease (COPD) is receiving prednisone (Deltasone). Which side effect should the nurse monitor for?

• A. Hypoglycemia
• B. Infection
• C. Hypotension
• D. Weight loss

Correct answer: B

Rationale: The correct answer is B: Infection. Prednisone is an immunosuppressant medication commonly used in COPD to reduce inflammation. Due to its immunosuppressive effects, clients are at an increased risk of developing infections. Therefore, nurses should closely monitor clients receiving prednisone for signs and symptoms of infections to provide timely interventions.

3. 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.

4. The healthcare provider is caring for a patient who is taking warfarin (Coumadin). Which laboratory value should the healthcare provider monitor closely?

• A. Platelet count.
• B. Prothrombin time (PT).
• C. Hemoglobin level.
• D. White blood cell count.

Correct answer: B

Rationale: Corrected Rationale: When caring for a patient on warfarin, monitoring prothrombin time (PT) is crucial. PT helps assess the blood's ability to clot properly, ensuring the patient maintains therapeutic anticoagulation levels while minimizing bleeding risks. Platelet count (Choice A) is important but not the most critical for warfarin therapy. Hemoglobin level (Choice C) and white blood cell count (Choice D) are not directly related to monitoring the effects of warfarin.

5. A healthcare professional is assessing a client with severe dehydration. Which finding indicates a need for immediate intervention?

• A. Heart rate of 110 beats per minute.
• B. Blood pressure of 90/60 mm Hg.
• C. Urine output of 20 ml/hour.
• D. Dry mucous membranes.

Correct answer: C

Rationale: A urine output of 20 ml/hour indicates severe dehydration and impaired renal function. This finding suggests a critical state where the kidneys are conserving water, leading to reduced urine output. Immediate intervention is required to restore fluid balance and prevent further complications associated with severe dehydration. Choice A, a heart rate of 110 beats per minute, may indicate dehydration but is not as severe as the critically low urine output. Choice B, a blood pressure of 90/60 mm Hg, can be seen in dehydration but is not as concerning as the extremely low urine output. Choice D, dry mucous membranes, is a common sign of dehydration but does not require immediate intervention compared to the severely reduced urine output.

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