Nokea
A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?
- A. Proton-pump inhibitors and H2-blockers are equally effective in prophylaxis against NSAID-related GI toxicity.
- B. Misoprostol is superior to an H2-blocker in prophylaxis against NSAID-related GI toxicity.
- C. Sucralfate is not the drug of choice for prophylaxis in this patient.
- D. H. pylori infection can alter the risk for an NSAID-induced ulcer.
Correct Answer: B
Rationale: Step 1: Misoprostol is a prostaglandin analog that helps protect the gastric mucosa by increasing mucus production. This mechanism of action makes it effective in preventing NSAID-related GI toxicity.
Step 2: H2-blockers (Choice A) and PPIs are not as effective as misoprostol in preventing NSAID-related GI toxicity.
Step 3: Sucralfate (Choice C) is not as effective as misoprostol in preventing NSAID-related GI toxicity due to its different mechanism of action.
Step 4: H. pylori infection (Choice D) can increase the risk of NSAID-induced ulcers but is not directly related to the prophylactic treatment with misoprostol.
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A client with a history of myocardial infarction (MI) is prescribed nitroglycerin (Nitrostat) for chest pain. Which instruction should the nurse provide?
- A. Take the medication with food.
- B. Swallow the tablet whole.
- C. Take the medication at bedtime.
- D. Place the tablet under your tongue.
Correct Answer: D
Rationale: The correct answer is D: Place the tablet under your tongue. Nitroglycerin is a vasodilator used to relieve chest pain in patients with MI. Placing the tablet under the tongue allows for rapid absorption through the oral mucosa, providing quick relief. Taking it with food (A) may delay absorption. Swallowing the tablet whole (B) would result in slower absorption through the GI tract. Taking it at bedtime (C) is not necessary for immediate relief of chest pain.
When teaching a client postoperative breathing techniques with an incentive spirometer (IS), what should the nurse encourage the client to do to maintain sustained maximal inspiration?
- A. Exhale forcefully into the tubing for 3 to 5 seconds.
- B. Inspire deeply and slowly over 3 to 5 seconds.
- C. Breathe into the spirometer using normal breath volumes.
- D. Perform IS breathing exercises every 6 hours.
Correct Answer: B
Rationale: The correct answer is B: Inspire deeply and slowly over 3 to 5 seconds. This technique is recommended for using an incentive spirometer (IS) to maintain sustained maximal inspiration. Slow, deep inhalation helps fully expand the lungs and improve lung function postoperatively.
A: Exhaling forcefully into the tubing is incorrect because the purpose of using an IS is to promote deep inhalation, not forceful exhalation.
C: Breathing into the spirometer using normal breath volumes is incorrect as it does not promote maximal inspiration and may not fully expand the lungs.
D: Performing IS breathing exercises every 6 hours is incorrect as regular, consistent practice throughout the day is recommended for optimal lung recovery.
A 46-year-old man with a history of cirrhosis is brought in by his wife because he has been acting strangely. On examination, he is disoriented, ataxic, and has slurred speech. He is also hyperreflexic. His white blood cell count is normal. His hematocrit is 34%. Coagulation times are elevated. His ammonia level is normal. Which of the following statements regarding his management is correct?
- A. He should be treated with a low-protein diet and lactulose
- B. Lorazepam is not the drug of choice to control his behavior
- C. He should not be placed on gentamicin prophylactically to prevent the development of peritonitis
- D. If the patient complains of pain, acetaminophen should be avoided and nonsteroidal anti-inflammatory agents should be used
Correct Answer: A
Rationale: The correct answer is A: He should be treated with a low-protein diet and lactulose. This patient is presenting with hepatic encephalopathy, as evidenced by his altered mental status, ataxia, slurred speech, hyperreflexia, and normal ammonia level. The management of hepatic encephalopathy involves reducing the production of ammonia in the gut. Lactulose is a non-absorbable disaccharide that helps trap ammonia in the gut and promote its excretion in the feces. A low-protein diet is also recommended to decrease ammonia production.
Option B is incorrect because lorazepam is not the drug of choice for managing hepatic encephalopathy; it can worsen the condition. Option C is incorrect because gentamicin is not indicated in this scenario. Option D is incorrect because acetaminophen should be avoided in patients with liver disease due to the risk of hepatotoxicity; nonsteroidal anti-inflammatory drugs
A client with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium (Spiriva). Which instruction should the nurse include in the client's teaching?
- A. Use this medication only during acute exacerbations.
- B. Rinse your mouth after using the inhaler.
- C. Take this medication with food.
- D. Increase your fluid intake to at least 3 liters per day.
Correct Answer: B
Rationale: The correct answer is B: Rinse your mouth after using the inhaler. This instruction is important because tiotropium is an inhaled medication that can cause dry mouth and increase the risk of oral thrush. Rinsing the mouth after each use helps reduce these side effects.
A: Using the medication only during acute exacerbations is incorrect because tiotropium is a maintenance medication for COPD to improve lung function and reduce symptoms.
C: Taking the medication with food is unnecessary as tiotropium can be taken with or without food.
D: Increasing fluid intake to at least 3 liters per day is not specifically related to tiotropium use and is not necessary for all COPD patients.
Which regimen is most effective for treating H. pylori infection?
- A. Metronidazole, bismuth subsalicylate, amoxicillin for 14 days
- B. Clarithromycin and omeprazole for 14 days
- C. Metronidazole, lansoprazole, and clarithromycin for 14 days
- D. Metronidazole, clarithromycin, and omeprazole for 7 days
Correct Answer: C
Rationale: The correct answer is C - Metronidazole, lansoprazole, and clarithromycin for 14 days. This regimen includes a proton pump inhibitor (lansoprazole) to reduce stomach acid, clarithromycin to kill the bacteria, and metronidazole as an alternative antibiotic. This combination therapy is recommended by guidelines as it targets H. pylori effectively, reducing the risk of resistance.
Choice A is incorrect as bismuth subsalicylate is not included in the recommended regimen. Choice B is incorrect because omeprazole is not the preferred proton pump inhibitor, and using clarithromycin alone can lead to resistance. Choice D is incorrect as the duration of treatment is insufficient for eradication. Overall, choice C is the most effective option based on current guidelines and best practices for treating H. pylori infection.