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. A 65-year-old woman presents with difficulty swallowing, weight loss, and a history of long-standing heartburn. She has been on proton-pump inhibitors for years, but her symptoms have worsened. What is the most likely diagnosis?

• A. Peptic stricture
• B. Esophageal cancer
• C. Achalasia
• D. Esophageal spasm

Correct answer: B

Rationale: The presentation of difficulty swallowing, weight loss, and worsening symptoms despite long-term use of proton-pump inhibitors raises suspicion for esophageal cancer, especially in a patient with a history of chronic heartburn. Esophageal cancer should be considered in this scenario due to the concerning symptoms and lack of improvement despite appropriate medical management.

3. A healthcare provider is providing dietary teaching to a client with cholecystitis. Which type of diet should the healthcare provider recommend?

• A. High-fiber, low-fat diet
• B. Low-fiber, high-protein diet
• C. Low-fat, low-cholesterol diet
• D. High-protein, high-fat diet

Correct answer: C

Rationale: In cholecystitis, a low-fat, low-cholesterol diet is recommended to manage symptoms and reduce inflammation by reducing the workload on the gallbladder. This diet helps prevent gallbladder attacks and complications.

4. A client with hepatic encephalopathy exhibits confusion, difficulty arousing from sleep, and rigid extremities. Based on these clinical findings, what stage of hepatic encephalopathy should the nurse document?

• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

Correct answer: C

Rationale: Stage 3 hepatic encephalopathy is characterized by confusion, difficulty arousing from sleep, and rigidity of extremities. These symptoms indicate advanced manifestations of hepatic encephalopathy, requiring prompt intervention and monitoring to prevent further neurological deterioration.

5. Prior to elective surgery, a patient taking warfarin should receive which instruction regarding warfarin therapy?

• A. Continue taking warfarin until the day of surgery.
• B. Stop taking warfarin three days before surgery.
• C. Switch to aspirin before surgery.
• D. Stop taking warfarin one week before surgery.

Correct answer: D

Rationale: Prior to elective surgery, a patient taking warfarin should be instructed to stop taking warfarin around one week before the procedure. This timeframe allows for the effects of warfarin to diminish, lowering the risk of excessive bleeding during surgery. Continuing warfarin until the day of surgery (Choice A) increases the risk of bleeding complications. Stopping warfarin three days before surgery (Choice B) may not provide enough time for the anticoagulant effects to subside. Switching to aspirin before surgery (Choice C) is not recommended as a substitute for warfarin in this context.

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