Nursing Elites

1. A client with newly diagnosed diabetes mellitus is receiving teaching on foot care. Which instruction should the nurse include?

• A. Walk barefoot whenever possible to toughen your feet.
• B. Soak your feet in hot water daily to improve circulation.
• C. Trim your toenails straight across to prevent ingrown toenails.
• D. Use a heating pad to keep your feet warm.

Correct answer: C

Rationale: Correctly trimming toenails straight across is crucial in preventing ingrown toenails and potential infections in individuals with diabetes. Ingrown toenails can lead to complications, so it is essential for diabetic clients to practice proper nail care to avoid these issues. Choices A, B, and D are incorrect. Walking barefoot can increase the risk of foot injuries, soaking feet in hot water can cause burns or skin damage, and using a heating pad can lead to burns or injuries due to decreased sensation in the feet, which is common in diabetes.

2. A 55-year-old man presents with jaundice, pruritus, and dark urine. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: The clinical presentation of jaundice, pruritus, dark urine, elevated bilirubin and alkaline phosphatase, along with imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are characteristic of primary biliary cirrhosis. Primary biliary cirrhosis is an autoimmune liver disease that leads to destruction of intrahepatic bile ducts, causing cholestasis and liver damage. This condition typically presents in middle-aged women but can also affect men, as seen in this case.

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 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?

• A. Refer her for an exploratory laparotomy
• B. Measure serum gastrin in response to secretin infusion
• C. Treat her for H. pylori
• D. Obtain a dedicated small bowel series

Correct answer: B

Rationale: The next step after finding an elevated fasting serum gastrin level is to perform a secretin stimulation test. This test helps differentiate between gastrinoma and other causes of elevated gastrin levels, such as proton-pump inhibitor therapy or H2 antagonists. In gastrinoma, the serum gastrin level should further increase after secretin infusion, while in other conditions, the levels would not significantly rise. Exploratory laparotomy would be premature without confirming the diagnosis. Treating for H. pylori is not indicated as the diagnosis of gastrinoma is under consideration and not Helicobacter pylori infection. A dedicated small bowel series is not the next appropriate step in this scenario.

5. A client with liver cirrhosis is prescribed lactulose. What is the purpose of this medication?

• A. To lower blood sugar levels
• B. To reduce ammonia levels
• C. To treat liver inflammation
• D. To improve bile flow

Correct answer: B

Rationale: Lactulose is prescribed to reduce ammonia levels in clients with liver cirrhosis. Elevated ammonia levels can lead to hepatic encephalopathy, a serious complication of liver cirrhosis. Lactulose works by acidifying the colon, which in turn traps ammonia in the colon and helps its elimination from the body through stool, thereby reducing the risk of hepatic encephalopathy. Choice A is incorrect because lactulose does not lower blood sugar levels. Choice C is incorrect as lactulose is not used to treat liver inflammation. Choice D is incorrect as lactulose does not improve bile flow.

Similar Questions