Nursing Elites

1. A client with a new diagnosis of myasthenia gravis is prescribed pyridostigmine (Mestinon). Which instruction should the nurse include in the client's teaching?

• A. Take the medication with food to prevent gastrointestinal upset.
• B. Take the medication 30 minutes before meals.
• C. Avoid dairy products while taking this medication.
• D. Take the medication at bedtime.

Correct answer: B

Rationale: The correct instruction for a client with myasthenia gravis prescribed pyridostigmine (Mestinon) is to take the medication 30 minutes before meals. This timing is crucial as it helps improve muscle strength for eating and swallowing. By taking the medication before meals, the client can experience enhanced muscle function during mealtime, which is especially important for managing the symptoms of myasthenia gravis. Choices A, C, and D are incorrect. Taking the medication with food may decrease its effectiveness, avoiding dairy products is not necessary, and taking the medication at bedtime does not coincide with the optimal timing for enhancing muscle function during meals.

2. A client with osteoporosis is being discharged home. Which instruction should the nurse include in the discharge teaching?

• A. Avoid weight-bearing exercises.
• B. Take calcium supplements with meals.
• C. Limit vitamin D intake.
• D. Increase intake of caffeine-containing beverages.

Correct answer: B

Rationale: Taking calcium supplements with meals is a crucial instruction for a client with osteoporosis. Calcium absorption is enhanced when taken with food, and proper calcium intake is essential for managing osteoporosis effectively by promoting bone health and density. Avoiding weight-bearing exercises (Choice A) is incorrect because these exercises help improve bone strength. Limiting vitamin D intake (Choice C) is also incorrect as vitamin D is necessary for calcium absorption. Increasing caffeine intake (Choice D) is not recommended as caffeine can interfere with calcium absorption.

3. A 40-year-old man presents with abdominal pain, diarrhea, and weight loss. He has a history of Crohn's disease. Laboratory tests reveal low hemoglobin and elevated ESR. What is the most likely diagnosis?

• A. Ulcerative colitis
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Crohn's disease flare

Correct answer: D

Rationale: The symptoms of abdominal pain, diarrhea, weight loss, along with the history of Crohn's disease, and the laboratory findings of low hemoglobin and elevated ESR, strongly suggest a Crohn's disease flare. These clinical manifestations are classic features of a flare-up in a patient with a known history of Crohn's disease.

4. Which signs or symptoms are characteristic of an adult client diagnosed with Cushing's syndrome?

• A. Husky voice and complaints of hoarseness.
• B. Warm, soft, moist, salmon-colored skin.
• C. Visible swelling of the neck, with no pain.
• D. Central-type obesity, with thin extremities.

Correct answer: D

Rationale: Cushing's syndrome is characterized by central-type obesity with thin extremities, often referred to as 'truncal obesity.' This pattern of weight distribution is a key feature of Cushing's syndrome due to excessive cortisol levels, leading to fat accumulation in the face, neck, and abdomen, while the extremities remain relatively thin. The other options listed, such as husky voice, hoarseness, warm, soft, moist, salmon-colored skin, and visible swelling of the neck, are not typical findings associated with Cushing's syndrome.

5. A 46-year-old man with a history of cirrhosis is brought in by his wife because he has been acting strangely. On examination, he is disoriented, ataxic, and has slurred speech. He is also hyperreflexic. His white blood cell count is normal. His hematocrit is 34%. Coagulation times are elevated. His ammonia level is normal. Which of the following statements regarding his management is correct?

• A. He should be treated with a low-protein diet and lactulose
• B. Lorazepam is not the drug of choice to control his behavior
• C. He should not be placed on gentamicin prophylactically to prevent the development of peritonitis
• D. If the patient complains of pain, acetaminophen should be avoided and nonsteroidal anti-inflammatory agents should be used

Correct answer: A

Rationale: This patient presents with symptoms consistent with hepatic encephalopathy. Despite having a normal ammonia level, he should be treated with lactulose and a low-protein diet as recommended for stage 2 hepatic encephalopathy. The normal ammonia level does not exclude the diagnosis, as it lacks sensitivity and specificity. Medications like lorazepam, gentamicin, and NSAIDs should be avoided due to their potential adverse effects in patients with liver disease. Acetaminophen should also be avoided in such patients.

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