Nursing Elites

1. Following a CVA, the nurse assesses that a client has developed dysphagia, hypoactive bowel sounds, and a firm, distended abdomen. Which prescription for the client should the nurse question?

• A. Continuous tube feeding at 65 ml/hr via gastrostomy.
• B. Total parenteral nutrition to be infused at 125 ml/hour.
• C. Nasogastric tube connected to low intermittent suction.
• D. Metoclopramide (Reglan) intermittent piggyback.

Correct answer: A

Rationale: In a client with dysphagia and gastrointestinal symptoms such as hypoactive bowel sounds and a firm, distended abdomen, continuous tube feeding might exacerbate the symptoms. This can lead to complications and should be questioned by the nurse.

2. A client with liver failure is at an increased risk of bleeding due to the inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

• A. Alterations in glucose metabolism
• B. Retention of bile salts
• C. Inadequate production of albumin by hepatocytes
• D. Inability of the liver to use vitamin K

Correct answer: D

Rationale: The correct answer is D. The liver's inability to use vitamin K is the most likely factor contributing to the loss of prothrombin synthesis in liver failure. Vitamin K is essential for the synthesis of prothrombin, a crucial clotting factor. In liver failure, impaired utilization of vitamin K leads to decreased production of prothrombin, increasing the risk of bleeding in affected individuals.

3. A client with a history of atrial fibrillation is prescribed dabigatran (Pradaxa). Which instruction should the nurse include in the client's teaching?

• A. Take the medication with food to improve absorption.
• B. Avoid foods high in vitamin K.
• C. Take the medication at the same time each day.
• D. Increase your intake of high-potassium foods.

Correct answer: C

Rationale: The correct instruction for the nurse to include in the client's teaching regarding dabigatran (Pradaxa) is to take the medication at the same time each day. This ensures a consistent blood level and effectiveness of the medication, which is crucial in managing atrial fibrillation and preventing complications. It helps maintain a steady therapeutic effect and reduces the risk of erratic drug levels in the body.

4. What instructions should the nurse give to a patient with cervical cancer who is planned to receive external-beam radiation to prevent complications from the effects of the radiation?

• A. Test stools for the presence of blood.
• B. Maintain a low-residue, high-fiber diet.
• C. Clean the perianal area carefully after every bowel movement.
• D. Inspect the mouth and throat daily for signs of thrush.

Correct answer: C

Rationale: When a patient with cervical cancer is receiving external-beam radiation, the radiation to the abdomen can affect organs in its path, such as the bowel, leading to complications like frequent diarrhea. Cleaning the perianal area carefully after each bowel movement is crucial to decrease the risk of skin breakdown and infection. Testing stools for blood is not necessary since inflammation associated with radiation may lead to occult blood in stools. Maintaining a low-residue diet is actually recommended to prevent bowel irritation. Radiation to the abdomen does not cause stomatitis, so inspecting the mouth and throat for thrush is not directly related to the effects of external-beam radiation in this context.

5. A patient with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium. What is the primary action of this medication?

• A. Reduce inflammation
• B. Relieve bronchospasm
• C. Suppress cough
• D. Thin respiratory secretions

Correct answer: B

Rationale: Ipratropium is an anticholinergic bronchodilator that primarily works to relieve bronchospasm by dilating the airways and improving airflow in patients with COPD. It does not have a significant effect on reducing inflammation, suppressing cough, or thinning respiratory secretions.

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