Nursing Elites

1. A client with a history of gastric ulcer suddenly complains of a sharp-severe pain in the mid epigastric area, which then spreads over the entire abdomen. The client’s abdomen is rigid and board-like to palpation, and the client obtains most comfort from lying in the knee-chest position. The nurse calls the physician immediately suspecting that the client is experiencing which of the following complications of peptic ulcer disease?

• A. Perforation
• B. Obstruction
• C. Hemorrhage
• D. Intractability

Correct answer: A

Rationale: The signs and symptoms described in the question are consistent with perforation of the ulcer, which then progresses to peritonitis if the perforation is large enough. The client with intestinal obstruction most likely would complain of abdominal pain, distension, and nausea and vomiting. The client with hemorrhage would be vomiting blood or coffee-ground-like material or would be expelling black, tarry, or bloody stools. Intractability is a term that refers to continued symptoms of a disease process, despite ongoing medical treatment.

2. Matt is a 49 y.o. with a hiatal hernia that you are about to counsel. Health care counseling for Matt should include which of the following instructions?

• A. Restrict intake of high-carbohydrate foods.
• B. Increase fluid intake with meals.
• C. Increase fat intake.
• D. Eat three regular meals a day.

Correct answer: D

Rationale: For a patient with a hiatal hernia, it is important to eat three regular meals a day to prevent symptoms.

3. A nurse is giving dietary instructions to a client who has a new colostomy. The nurse encourages the client to eat foods representing which of the following diets for the first 4 to 6 weeks postoperatively?

• A. High-protein
• B. High-carbohydrate
• C. Low-calorie
• D. Low-residue

Correct answer: D

Rationale: For the first 4 to 6 weeks following colostomy formation, the client should take in a low-residue diet. Following this period, the client should eat a high-carbohydrate, high-protein diet. The nurse also instructs the client to add new foods, one at a time, to determine tolerance to that food.

4. Your patient Maria takes NSAIDS for her degenerative joint disease, has developed peptic ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease?

• A. Calcium carbonate (Tums)
• B. Famotidine (Pepcid)
• C. Misoprostol (Cytotec)
• D. Sucralfate (Carafate)

Correct answer: C

Rationale: Misoprostol (Cytotec) is useful in preventing NSAID-induced peptic ulcer disease.

5. A nurse is reviewing the results of serum laboratory studies drawn on a client who is suspected of having hepatitis. The nurse interprets that an elevation in which of the following studies is the most specific indicator of the disease?

• A. Erythrocyte sedimentation rate
• B. Serum bilirubin
• C. Hemoglobin
• D. Blood urea nitrogen

Correct answer: C

Rationale: Laboratory indicators of hepatitis include elevated liver enzymes, serum bilirubin level, and erythrocyte sedimentation rate is nonspecific test that indicates the presence of inflammation somewhere in the body. Elevated blood urea nitrogen may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.

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