Nursing Elites

1. An 82-year-old woman with no past medical history presents to your clinic complaining of arthritic symptoms. She is not taking any medications but needs something for her arthritis. You want to start her on a nonsteroidal anti-inflammatory drug (NSAID) but are concerned about her age and the risk of peptic ulcers. As she has to pay for her medications out-of-pocket and requests the most cost-effective option, what is the most appropriate treatment plan?

• A. Prescribe an inexpensive NSAID alone
• B. Prescribe an inexpensive NSAID and misoprostol
• C. Prescribe celecoxib
• D. Prescribe an inexpensive NSAID and sucralfate

Correct answer: A

Rationale: In this scenario, the most appropriate treatment plan would be to prescribe an inexpensive NSAID alone. While the elderly woman is at a higher risk of developing NSAID-related toxicity, prophylaxis with misoprostol or sucralfate is not recommended in the absence of a history of peptic ulcer disease or abdominal symptoms. Celecoxib, a selective COX-2 inhibitor, may be a more expensive option than traditional NSAIDs. Considering the patient's preference for the most inexpensive option and the lack of specific risk factors, starting with a standalone NSAID is the most suitable approach.

2. What is/are the possible cause(s) of acute pancreatitis in this patient?

• A. HIV
• B. Cytomegalovirus
• C. Dideoxyinosine (ddI)
• D. Pentamidine

Correct answer: B

Rationale: This patient presents with symptoms and lab findings consistent with acute pancreatitis. Cytomegalovirus is a common viral infection associated with pancreatitis. In patients with AIDS, the pancreas can be affected by various infections (e.g., cryptococcus, Mycobacterium tuberculosis, candida, Toxoplasma gondii) and medications (such as ddI, pentamidine, trimethoprim/sulfamethoxazole, metronidazole) can also lead to acute pancreatitis. While HIV infection predisposes individuals to various opportunistic infections, in this case, the most likely cause of the acute pancreatitis is cytomegalovirus infection.

3. Which intervention should the nurse implement to enhance the efficacy of the client's asthma medication therapy?

• A. Administer the albuterol inhaler before other inhaled medications.
• B. Provide oxygen via nasal cannula at 2 liters/minute.
• C. Encourage the client to drink three liters of fluids daily.
• D. Keep the client upright during nebulizer therapy.

Correct answer: A

Rationale: Administering a bronchodilator such as albuterol as the first step is crucial to open the airways, allowing better penetration of subsequent inhaled medications and enhancing their overall efficacy in managing asthma symptoms.

4. The client has acute pancreatitis. Which nursing intervention is the highest priority?

• A. Administer pain medication as prescribed.
• B. Monitor the client's serum amylase and lipase levels.
• C. Encourage oral intake of clear liquids.
• D. Assess the client's bowel sounds every 4 hours.

Correct answer: A

Rationale: Administering pain medication as prescribed is the highest priority when caring for a client with acute pancreatitis. Acute pancreatitis is often associated with severe abdominal pain, and alleviating this pain is crucial for the client's comfort and well-being. Pain management can also help reduce stress on the pancreas and promote recovery. Monitoring serum amylase and lipase levels, encouraging oral intake of clear liquids, and assessing bowel sounds are important interventions but addressing the client's pain takes precedence to provide immediate relief and improve outcomes.

5. The nurse is caring for a client with hyperthyroidism. Which intervention should the nurse implement to manage the client's condition?

• A. Provide a high-calorie diet.
• B. Encourage frequent rest periods.
• C. Restrict fluid intake.
• D. Administer a stool softener.

Correct answer: B

Rationale: Encouraging frequent rest periods is essential in managing hyperthyroidism as it helps address the fatigue and hypermetabolic state commonly associated with this condition. Rest is crucial to support the body's recovery and reduce the stress on the thyroid gland. While nutrition is important in managing hyperthyroidism, providing a high-calorie diet is not the priority intervention. Restricting fluid intake is not typically necessary unless there are specific indications such as heart failure. Administering a stool softener is not directly related to managing hyperthyroidism.

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