Nursing Elites

1. The patient described in the preceding questions 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 high risk for reinfection with H. pylori.
• B. A positive serum IgG indicates that eradication of H. pylori was unsuccessful.
• C. The urease breath test is an ideal test to document failure of eradication.
• D. Dyspepsia usually improves 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. A positive serum IgG may persist indefinitely and cannot alone determine the failure of eradication. However, a decrease in quantitative IgG levels has been used to confirm treatment success. The urease breath test is recommended to assess the failure of eradication as it can detect the presence of H. pylori in the stomach, indicating treatment failure if positive.

2. A client with chronic obstructive pulmonary disease (COPD) is receiving prednisone (Deltasone). Which side effect should the nurse monitor for?

• A. Hypoglycemia
• B. Infection
• C. Hypotension
• D. Weight loss

Correct answer: B

Rationale: The correct answer is B: Infection. Prednisone is an immunosuppressant medication commonly used in COPD to reduce inflammation. Due to its immunosuppressive effects, clients are at an increased risk of developing infections. Therefore, nurses should closely monitor clients receiving prednisone for signs and symptoms of infections to provide timely interventions.

3. A patient with diabetes insipidus is prescribed desmopressin. What is the primary purpose of this medication?

• A. Increase urine output
• B. Reduce blood sugar levels
• C. Decrease urine output
• D. Lower blood pressure

Correct answer: C

Rationale: Desmopressin is prescribed to decrease urine output in patients with diabetes insipidus. It works by increasing water reabsorption in the kidneys, helping to control fluid balance in the body.

4. A patient with heart failure is prescribed digoxin. What is the most important instruction the nurse should provide?

• A. Take an extra dose if you miss one.
• B. Avoid high-potassium foods.
• C. Report any visual disturbances.
• D. Stop taking the medication if your pulse is normal.

Correct answer: C

Rationale: The correct answer is C: 'Report any visual disturbances.' Patients taking digoxin should be instructed to report any visual disturbances, as this can be a sign of digoxin toxicity. Visual disturbances like changes in color vision, blurred vision, or seeing halos around lights can indicate an overdose of digoxin. Choices A, B, and D are incorrect. Instructing a patient to take an extra dose if they miss one can lead to overdose. Avoiding high-potassium foods is important for patients on potassium-sparing diuretics, not digoxin. Stopping the medication if the pulse is normal is incorrect, as the pulse rate alone is not an indicator of digoxin effectiveness or toxicity.

5. What action should the nurse take to prevent tracheal tissue damage in a client with a tracheostomy?

• A. Secure the tracheostomy ties firmly.
• B. Change the tracheostomy tube daily.
• C. Use the minimal leak technique when inflating the cuff.
• D. Clean the stoma with hydrogen peroxide.

Correct answer: C

Rationale: To prevent tracheal tissue damage in a client with a tracheostomy, the nurse should use the minimal leak technique when inflating the cuff. This method helps avoid excessive pressure on the tracheal tissue, thereby reducing the risk of damage. Choice A is incorrect because securing the tracheostomy ties too tightly can cause pressure and tissue damage. Choice B is incorrect as changing the tracheostomy tube daily is not necessary unless there is a specific clinical indication. Choice D is incorrect as cleaning the stoma with hydrogen peroxide can irritate the skin and mucous membranes, potentially leading to damage.

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