Nursing Elites

1. When working with a client who has chronic constipation, what should be included in client teaching to promote normal bowel function?

• A. Use glycerin suppositories on a regular basis
• B. Limit physical activity in order to promote bowel peristalsis
• C. Consume high-residue, high-fiber foods
• D. Resist the urge to defecate until the urge becomes intense

Correct answer: C

Rationale: Consuming high-residue, high-fiber foods is essential in promoting normal bowel function and preventing constipation. These foods help add bulk to the stool, making it easier to pass and preventing constipation. Glycerin suppositories may provide short-term relief but are not a long-term solution for chronic constipation. Physical activity actually helps promote bowel peristalsis, so limiting it would not be beneficial. Delaying defecation can lead to stool hardening and worsening constipation.

2. A client is receiving chemotherapy and is at risk for neutropenia. Which precaution should the nurse implement?

• A. Encourage regular visitors to boost morale.
• B. Ensure the client receives live vaccines.
• C. Place the client in a private room.
• D. Provide a diet high in fresh fruits and vegetables.

Correct answer: C

Rationale: Placing the client in a private room is crucial to protect them from infections due to their compromised immune system. Neutropenia, a common side effect of chemotherapy, decreases white blood cell count, making the client more susceptible to infections. By placing the client in a private room, exposure to pathogens from other individuals is minimized, reducing the risk of infection and helping maintain the client's health during this vulnerable period.

3. Which of the following statements about Helicobacter pylori (H. pylori) is false?

• A. H. pylori does not invade the gastric or duodenal epithelium
• B. H. pylori stimulates gastric acid secretion
• C. Eradication of H. pylori prevents adenocarcinoma of the stomach
• D. H. pylori produces a urease that splits urea into ammonia and CO2

Correct answer: C

Rationale: H. pylori is known to reside in the mucus layer of the stomach and does not invade the epithelium. It produces urease that splits urea into ammonia and CO2. This action helps in neutralizing the acidic environment and allows H. pylori to survive. Additionally, urease activity can be detected in diagnostic tests for H. pylori. The stimulation of gastric acid secretion and disruption of the protective mucus layer are mechanisms by which H. pylori promotes injury. While eradicating H. pylori infection has been associated with a decreased risk of developing gastric cancer, it does not prevent adenocarcinoma of the stomach entirely.

4. A 9-year-old female client was recently diagnosed with diabetes mellitus. Which symptom will her parents most likely report?

• A. Refuses to eat her favorite meals at home.
• B. Drinks more soft drinks than previously.
• C. Voids only one or two times per day.
• D. Gained 10 pounds within one month.

Correct answer: B

Rationale: The correct answer is B. Increased thirst and fluid intake, such as drinking more soft drinks than previously, is a common symptom of diabetes mellitus in children. This increased thirst is due to the body trying to eliminate excess sugar through urination, leading to dehydration and the need for more fluids. The other choices are less likely to be directly related to the diagnosis of diabetes mellitus in this scenario.

5. 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.

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