Nursing Elites

1. The client with a duodenal ulcer may exhibit which of the following findings on assessment?

• A. Hematemesis
• B. Malnourishment
• C. Melena
• D. Pain with eating

Correct answer: C

Rationale: Melena (black, tarry stools) can be an indication of a duodenal ulcer.

2. Which of the following expected outcomes would be most appropriate for a client with peptic ulcer disease? The client will:

• A. verbalize absence of epigastric pain.
• B. accept the need to inject himself with vitamin B12 for the rest of his life.
• C. understand the need to increase his exercise activity.
• D. eliminate stress from his life.

Correct answer: A

Rationale: A realistic goal for this client would be to gain relief from epigastric pain. There is no need for vitamin B12 injections because this client has not had any gastric surgery that would lead to vitamin B12 deficiency. Exercise should be modified, not increased, because it can stimulate further production of gastric acid. It is not possible to eliminate stress from a client's life. Instead, the client should be assisted to develop effective coping and problem-solving strategies as necessary.

3. The nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute appendicitis. Which of the following laboratory results would the nurse expect to note if the client indeed has appendicitis?

• A. Leukopenia with a shift to the right
• B. Leukocytosis with a shift to the right
• C. Leukocytosis with a shift to the left
• D. Leukopenia with a shift to the left

Correct answer: C

Rationale: Laboratory findings do not establish the diagnosis of appendicitis, but often moderate elevation of the white blood cell count (leukocytosis) to 10,000 to 18,000 cells/mm3 occurs with a “shift to the left” (an increased number of immature white blood cells.).

4. The nurse is scheduling diagnostic tests for a client. If all of the following diagnostic tests are ordered, which would be performed last?

• A. Gallbladder series
• B. Barium enema
• C. Barium swallow
• D. Oral cholecystogram

Correct answer: C

Rationale: The correct answer is C, 'Barium swallow.' A barium swallow should be done after a barium enema or gallbladder series to prevent the contrast used in the barium swallow from obstructing the view of other organs. It takes several days for swallowed barium to pass completely out of the gastrointestinal tract. Choices A, B, and D are incorrect because a barium swallow should be the last test performed to ensure clear imaging without interference from residual contrast material.

5. A client with ulcerative colitis is diagnosed with a mild case of the disease. The nurse doing dietary teaching gives the client examples of foods to eat that represent which of the following therapeutic diets?

• A. High-fat with milk
• B. High-protein without milk
• C. Low-roughage without milk
• D. Low-roughage with milk

Correct answer: C

Rationale: The client with a mild case of ulcerative colitis is often advised to follow a diet low in roughage and avoid milk. This dietary approach helps reduce the frequency of diarrhea in these clients. Therefore, the correct therapeutic diet for the client with ulcerative colitis in this scenario is a low-roughage diet without milk. Choices A, B, and D are incorrect because high-fat, high-protein, and low-roughage with milk diets are not typically recommended for clients with ulcerative colitis, especially those with mild cases.

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