Nursing Elites

1. What skin care instructions should the nurse give to a patient receiving external beam radiation therapy for cancer treatment?

• A. Use a heating pad to relieve any pain in the treated area.
• B. Apply alcohol-based lotions to the treated area daily.
• C. Avoid exposing the treated area to sunlight.
• D. Wash the treated area with hot water and strong soap.

Correct answer: C

Rationale: Patients undergoing external beam radiation therapy should be advised to avoid exposing the treated area to sunlight to prevent further skin damage. Heat sources like heating pads should be avoided to prevent burns and irritation to the skin. Alcohol-based lotions can be irritating to the skin and are not recommended. Washing the treated area with lukewarm water and mild soap is preferable to maintain skin integrity and prevent irritation. Therefore, the correct instruction for the patient is to avoid exposing the treated area to sunlight.

2. A client is being educated about type 2 diabetes. The educator can confirm that the client understands the primary treatment for type 2 diabetes when the client states what?

• A. I read that a pancreas transplant will provide a cure for my diabetes.
• B. I will take my oral antidiabetic agents when my morning blood sugar is high.
• C. I will make sure to follow the weight loss plan designed by the dietitian.
• D. I will make sure I call the diabetes educator when I have questions about my insulin.

Correct answer: C

Rationale: The primary treatment approach for managing type 2 diabetes includes following a weight loss plan. Weight loss can improve insulin sensitivity and glycemic control in individuals with type 2 diabetes. Making dietary changes and maintaining a healthy weight are crucial components of managing this condition.

3. 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.

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. During an assessment, a healthcare professional suspects a client has cholecystitis. What is a common symptom of this condition?

• A. Right upper quadrant pain
• B. Left lower quadrant pain
• C. Generalized abdominal pain
• D. Epigastric pain

Correct answer: A

Rationale: Right upper quadrant pain is a hallmark symptom of cholecystitis, indicating inflammation of the gallbladder. The gallbladder is typically located in the right upper quadrant of the abdomen, so pain in this area is characteristic of cholecystitis. This pain may be sharp or cramp-like and can be accompanied by other symptoms such as nausea, vomiting, and fever. Left lower quadrant pain (choice B) is more commonly associated with diverticulitis, generalized abdominal pain (choice C) can be seen in various conditions, and epigastric pain (choice D) is typically related to issues in the upper central part of the abdomen, such as gastritis or peptic ulcers, rather than cholecystitis.

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