Nursing Elites

1. 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.

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 patient with chronic pain is prescribed gabapentin. What is the primary purpose of this medication?

• A. Relieve neuropathic pain
• B. Reduce inflammation
• C. Enhance opioid analgesia
• D. Suppress cough

Correct answer: A

Rationale: Gabapentin is primarily prescribed to relieve neuropathic pain. It works by stabilizing electrical activity in the nerves, making it effective in managing conditions such as diabetic neuropathy, postherpetic neuralgia, and other forms of chronic pain originating from nerve damage.

4. A patient with asthma is prescribed a corticosteroid inhaler. What is the most important instruction to give to the patient?

• A. Use the inhaler only during asthma attacks.
• B. Rinse the mouth after using the inhaler.
• C. Take a double dose if symptoms worsen.
• D. Avoid using a spacer with the inhaler.

Correct answer: B

Rationale: The most important instruction to give to a patient using a corticosteroid inhaler is to rinse the mouth after each use. This is crucial to prevent the development of oral thrush, a common side effect of corticosteroid inhalers. Failure to rinse the mouth can lead to the overgrowth of yeast in the mouth, causing oral thrush, which can be uncomfortable and require additional treatment. Therefore, reminding patients to rinse their mouth after using the inhaler is essential in preventing this potential complication. Choices A, C, and D are incorrect. Using the inhaler only during asthma attacks may lead to uncontrolled asthma symptoms. Taking a double dose without healthcare provider instruction can result in overdose or side effects. Avoiding a spacer with the inhaler can reduce the effectiveness of delivering the medication to the lungs.

5. A client's telemetry monitor indicates the sudden onset of ventricular fibrillation. Which assessment finding should the nurse anticipate?

• A. Bounding erratic pulse.
• B. Regularly irregular pulse.
• C. Thready irregular pulse.
• D. No palpable pulse.

Correct answer: D

Rationale: Ventricular fibrillation is a life-threatening arrhythmia characterized by chaotic, asynchronous contractions of the ventricles, resulting in ineffective cardiac output. This leads to the absence of a palpable pulse. Nurses should be prepared to initiate immediate interventions such as defibrillation to restore normal cardiac rhythm in a client experiencing ventricular fibrillation.

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