Nursing Elites

1. A client on an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is reporting intense, diffuse pain in her abdomen. Which physiologic phenomenon is most likely contributing to her complaint?

• A. Somatic pain resulting from pressure on the parietal peritoneum
• B. Referred pain from her small bowel
• C. Visceral pain resulting from distension and ischemia
• D. Neuropathic pain resulting from autonomic dysfunction

Correct answer: C

Rationale: Visceral pain is associated with distension, ischemia, and inflammation of internal organs. In the case of a small bowel obstruction, the intense, diffuse pain reported by the client is likely due to the distension and ischemia of the small bowel. Somatic pain (Choice A) would be more localized and sharp, typically arising from the parietal peritoneum. Referred pain (Choice B) is pain perceived at a site distant from the actual pathology. Neuropathic pain (Choice D) involves dysfunction or damage to the nervous system and is not typically associated with the described physiologic phenomenon of distension and ischemia in the context of a small bowel obstruction.

2. A patient is diagnosed with ischemic heart disease. She is prescribed filgrastim (Neupogen). What effect will this medication provide in the treatment of ischemic heart disease?

• A. Increase platelets
• B. Decrease platelets
• C. Promote angiogenesis
• D. Prevent thrombus formation

Correct answer: C

Rationale: Filgrastim (Neupogen) is a medication that promotes the growth of white blood cells. In the context of ischemic heart disease, promoting angiogenesis, the formation of new blood vessels, can improve blood flow to the heart muscle, reducing ischemia and potentially improving cardiac function. Therefore, the correct answer is C. Choices A and B are incorrect because filgrastim does not directly affect platelet levels. Choice D is also incorrect as filgrastim does not prevent thrombus formation.

3. When educating a patient starting on oral contraceptives, what should the nurse include in the teaching plan regarding potential side effects?

• A. Weight gain, mood changes, and nausea
• B. Increased appetite, insomnia, and fatigue
• C. Breast tenderness, headaches, and dizziness
• D. Fatigue, hair loss, and joint pain

Correct answer: A

Rationale: The correct answer is A: Weight gain, mood changes, and nausea are common side effects of oral contraceptives. Weight gain may occur due to fluid retention or changes in metabolism. Mood changes can be caused by hormonal fluctuations. Nausea is a common side effect that usually improves after a few months of use. Choices B, C, and D are incorrect because they do not reflect common side effects associated with oral contraceptives. Increased appetite, insomnia, breast tenderness, headaches, dizziness, fatigue, hair loss, and joint pain are not typically reported side effects of oral contraceptives.

4. A hemoglobin electrophoresis is done to evaluate for sickle cell disease. The report reveals the person has HbAS, which means the person:

• A. is normal with no sickle cell disease.
• B. is a sickle cell carrier.
• C. has sickle cell anemia.
• D. has thalassemia.

Correct answer: B

Rationale: The correct answer is that the person is a sickle cell carrier. In HbAS, 'Hb' stands for hemoglobin, 'A' indicates normal hemoglobin, and 'S' indicates the sickle cell trait. Individuals with HbAS are carriers of the sickle cell trait but do not have sickle cell disease. Choice A is incorrect because having the sickle cell trait means carrying the gene for sickle cell disease. Choice C is incorrect as sickle cell anemia is a different condition where individuals have two copies of the abnormal hemoglobin gene, resulting in the disease. Choice D is incorrect because thalassemia is a separate genetic disorder affecting the production of hemoglobin, not related to the sickle cell trait.

5. Which of the following statements characterizes irritable bowel syndrome?

• A. Typically does not cause anemia
• B. Not generally associated with intestinal E. coli
• C. Can be associated with anxiety and/or depression
• D. Not often associated with bloody diarrhea

Correct answer: C

Rationale: Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by abdominal pain, bloating, and changes in bowel habits. While IBS can lead to symptoms like diarrhea or constipation, it typically does not cause anemia (choice A), is not generally associated with intestinal E. coli (choice B), and is not often associated with bloody diarrhea (choice D). However, IBS can indeed be associated with anxiety and/or depression (choice C) due to the gut-brain axis, a bidirectional communication system between the gut and the brain. This association is well-documented in IBS patients, highlighting the importance of considering psychological factors in managing the condition.

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