Nursing Elites

1. A client with a history of chronic alcohol abuse is at risk for which of the following conditions?

• A. Liver cirrhosis
• B. Renal failure
• C. Chronic obstructive pulmonary disease (COPD)
• D. Peptic ulcer disease

Correct answer: A

Rationale: Chronic alcohol abuse can lead to liver cirrhosis due to long-term liver damage. Alcohol consumption over time can cause inflammation and scarring of the liver, eventually leading to cirrhosis. This condition can severely impact liver function and may progress to liver failure if not addressed.

2. The mental health nurse observes that a female client with delusional disorder carries some of her belongings with her because she believes that others are trying to steal them. Which nursing action will promote trust?

• A. Explain that distrust is related to feeling anxious.
• B. Initiate short, frequent contacts with the client.
• C. Explain that these beliefs are related to her illness.
• D. Offer to keep the belongings at the nurse's desk.

Correct answer: B

Rationale: Initiating short, frequent contacts with the client is the most appropriate action to promote trust. This approach helps build trust and rapport, addressing the client's need for security. By maintaining regular contact, the nurse can provide reassurance and support, which can help alleviate the client's anxiety related to her delusional beliefs. Choice A does not directly address the client's need for trust and security. Choice C focuses on the client's illness but does not actively address building trust. Choice D, offering to keep the belongings at the nurse's desk, may not be well-received by the client and could potentially worsen her anxiety and distrust.

3. A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?

• A. Proton-pump inhibitors and H2-blockers are equally effective in prophylaxis against NSAID-related GI toxicity.
• B. Misoprostol is superior to an H2-blocker in prophylaxis against NSAID-related GI toxicity.
• C. Sucralfate is not the drug of choice for prophylaxis in this patient.
• D. H. pylori infection can alter the risk for an NSAID-induced ulcer.

Correct answer: B

Rationale: In this scenario, the patient's history of peptic ulcer disease puts her at risk for NSAID-related GI toxicity. Misoprostol and proton-pump inhibitors have shown superiority over H2-blockers in preventing NSAID-related GI toxicity. H. pylori infection can indeed increase the risk of an NSAID-induced ulcer in infected patients who are starting NSAID therapy. Sucralfate has not been proven to be effective in prophylaxis against NSAID-related GI toxicity. Therefore, the correct choice is B, as misoprostol is the preferred option over an H2-blocker in this context.

4. A client with chronic kidney disease (CKD) is scheduled for hemodialysis. Which pre-dialysis assessment finding should the nurse report to the healthcare provider?

• A. Serum potassium of 5.5 mEq/L.
• B. Blood pressure of 180/90 mm Hg.
• C. Heart rate of 80 beats per minute.
• D. Serum sodium of 140 mEq/L.

Correct answer: B

Rationale: The correct answer is B. A blood pressure of 180/90 mm Hg is elevated and should be reported to the healthcare provider before hemodialysis. Hypertension can have a significant impact on the effectiveness and safety of the dialysis treatment. Controlling blood pressure before the procedure is crucial to prevent complications during the dialysis session.

5. The healthcare provider is caring for a client with a chest tube. Which assessment finding requires immediate intervention?

• A. Intermittent bubbling in the water seal chamber.
• B. Drainage of 75 ml in the first hour post-insertion.
• C. Crepitus around the insertion site.
• D. Fluctuation of the water level in the water seal chamber with respiration.

Correct answer: C

Rationale: Crepitus (subcutaneous emphysema) around the insertion site can indicate air leakage, requiring immediate intervention to prevent complications such as pneumothorax. This assessment finding suggests that there may be a break in the chest tube system, leading to air entering the pleural space. Prompt intervention is crucial to prevent respiratory compromise and further complications.

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