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 client with a history of hypertension is prescribed lisinopril (Prinivil). Which side effect should the nurse monitor for?

• A. Dry cough.
• B. Weight gain.
• C. Tachycardia.
• D. Hyperglycemia.

Correct answer: A

Rationale: The correct answer is A: Dry cough. Lisinopril is an ACE inhibitor, and a common side effect of ACE inhibitors is a dry cough. This occurs due to the accumulation of bradykinin in the lungs, leading to irritation and subsequent cough. It is important for the nurse to monitor the client for this side effect as it can affect adherence to the medication regimen. Weight gain, tachycardia, and hyperglycemia are not typically associated with lisinopril. Therefore, choices B, C, and D are incorrect.

3. A client with heart failure is receiving digoxin (Lanoxin). Which finding indicates that the medication is effective?

• A. Increased heart rate.
• B. Decreased pedal edema.
• C. Elevated blood pressure.
• D. Improved urine output.

Correct answer: B

Rationale: In a client with heart failure, decreased pedal edema is a positive indicator of improved cardiac output and reduced fluid retention. Digoxin works by increasing the strength of the heart's contractions, leading to improved circulation and reduced symptoms of heart failure, such as edema. Monitoring for decreased pedal edema is essential to assess the effectiveness of digoxin therapy. Choices A, C, and D are incorrect because an increased heart rate, elevated blood pressure, and improved urine output are not specific indicators of digoxin's effectiveness in managing heart failure. Instead, the focus should be on improvements related to fluid retention and cardiac function, like decreased pedal edema.

4. The client has acute pancreatitis. Which nursing intervention is the highest priority?

• A. Administer pain medication as prescribed.
• B. Monitor the client's serum amylase and lipase levels.
• C. Encourage oral intake of clear liquids.
• D. Assess the client's bowel sounds every 4 hours.

Correct answer: A

Rationale: Administering pain medication as prescribed is the highest priority when caring for a client with acute pancreatitis. Acute pancreatitis is often associated with severe abdominal pain, and alleviating this pain is crucial for the client's comfort and well-being. Pain management can also help reduce stress on the pancreas and promote recovery. Monitoring serum amylase and lipase levels, encouraging oral intake of clear liquids, and assessing bowel sounds are important interventions but addressing the client's pain takes precedence to provide immediate relief and improve outcomes.

5. In a 45-year-old woman with a history of arthritis experiencing severe heartburn and indigestion refractory to antacids, which findings on an esophageal manometry study are consistent with her diagnosis?

• A. Vigorous peristalsis and elevated lower esophageal sphincter (LES) pressure
• B. Absent peristalsis and elevated LES pressure
• C. Absent peristalsis and decreased LES pressure
• D. Vigorous peristalsis and decreased LES pressure

Correct answer: C

Rationale: The correct answer is C: Absent peristalsis and decreased lower esophageal sphincter (LES) pressure. The patient in this scenario has scleroderma esophagus, characterized by atrophy of esophageal smooth muscle, leading to the loss of peristalsis and LES tone. These changes contribute to severe symptoms of gastroesophageal reflux disease (GERD) and esophagitis. Absent peristalsis and decreased LES pressure are typical findings in scleroderma esophagus, contributing to the refractory nature of the patient's symptoms despite antacid use.

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