Nursing Elites

1. A patient with an anxiety disorder is prescribed alprazolam. What is the primary action of this medication?

• A. Increase energy levels
• B. Induce sedation
• C. Elevate mood
• D. Reduce anxiety

Correct answer: D

Rationale: Alprazolam is a benzodiazepine that primarily works by reducing anxiety. It achieves this by enhancing the inhibitory effects of the neurotransmitter GABA in the brain, which leads to a calming effect on the individual. Therefore, the primary action of alprazolam is to decrease anxiety levels rather than increase energy, induce sedation, or elevate mood.

2. A patient with a diagnosis of peptic ulcer disease is prescribed omeprazole. When should the patient take this medication for optimal effectiveness?

• A. With meals
• B. At bedtime
• C. Before meals
• D. After meals

Correct answer: C

Rationale: Omeprazole is best taken before meals for optimal effectiveness in reducing stomach acid production and promoting ulcer healing. Taking it before meals allows the medication to act on the proton pumps before food intake triggers acid production, thereby maximizing its therapeutic benefits. Choices A, B, and D are incorrect because taking omeprazole with meals, at bedtime, or after meals may not align with its mechanism of action, potentially reducing its effectiveness in managing peptic ulcer disease.

3. The patient described in the preceding question has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?

• A. She is at low risk for reinfection with H. pylori
• B. A positive serum IgG indicates that eradication of H. pylori was successful
• C. The urease breath test is an ideal test to document failure of eradication
• D. Dyspepsia typically worsens with H. pylori eradication

Correct answer: C

Rationale: Reinfection with H. pylori is rare, and the persistence of infection usually indicates poor compliance with the medical regimen or antibiotic resistance. The serum IgG may remain positive indefinitely and cannot be used to determine failure of eradication; however, a decrease in quantitative IgG levels has been utilized to indicate treatment success. If available, either the stool antigen or urease breath test is ideal to document treatment failure due to their high sensitivity, specificity, and ease of performance. The relationship between dyspepsia and H. pylori is controversial, but generally, dyspepsia does not typically improve with H. pylori eradication.

4. A 70-year-old man presents with sudden onset of severe abdominal pain. He has a history of atrial fibrillation. Physical examination reveals a soft abdomen with minimal tenderness. What is the most likely diagnosis?

• A. Acute pancreatitis
• B. Mesenteric ischemia
• C. Peptic ulcer disease
• D. Diverticulitis

Correct answer: B

Rationale: The sudden onset of severe abdominal pain in a patient with atrial fibrillation, along with a soft abdomen and minimal tenderness on examination, suggest mesenteric ischemia due to embolic occlusion of the mesenteric arteries. This condition is characterized by a sudden and severe decrease in blood flow to the intestines, leading to abdominal pain and tenderness. Acute pancreatitis typically presents with epigastric pain that may radiate to the back, accompanied by elevated serum amylase and lipase levels. Peptic ulcer disease and diverticulitis usually do not manifest with the sudden onset of severe abdominal pain as described in the case.

5. A client in labor states, 'I think my water just broke!' The nurse notes that the umbilical cord is on the perineum. What action should the nurse perform first?

• A. Administer oxygen via face mask.
• B. Notify the operating room team.
• C. Place the client in Trendelenburg.
• D. Administer a fluid bolus of 500 ml.

Correct answer: C

Rationale: In this scenario, the priority action for the nurse is to place the client in Trendelenburg position. This position helps alleviate pressure on the umbilical cord, preventing compression and ensuring continued blood flow to the fetus. Administering oxygen, notifying the operating room team, or administering a fluid bolus are not the initial priority actions in a cord prolapse situation.

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