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A 68-year-old man with a history of diabetes, hypertension, and coronary artery disease (s/p coronary artery bypass graft two years ago) presents to the emergency room with fevers and left-sided abdominal pain. His physical examination reveals a temperature of 101.5°F, pulse 96, and blood pressure of 135/80. His abdomen is soft with moderate left lower quadrant tenderness. There is no rebound or guarding. Bowel sounds are present. A CT scan is done which reveals inflammation around an area of the left colon. The next step in his workup/management should be
- A. Antibiotic therapy with ciprofloxacin and metronidazole
- B. Referral for urgent colonoscopy
- C. Referral to a surgeon for immediate hemicolectomy
- D. Barium enema
Correct Answer: A
Rationale: The correct answer is A: Antibiotic therapy with ciprofloxacin and metronidazole. This patient likely has diverticulitis given his age, comorbidities, symptoms, and imaging findings. Antibiotic therapy is the initial management for uncomplicated diverticulitis to cover for common pathogens. Surgical intervention is not indicated in the absence of complications like perforation or abscess. Urgent colonoscopy or barium enema are contraindicated during an acute episode of diverticulitis due to the risk of perforation. Antibiotic therapy aims to resolve the infection and prevent complications.
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A client in acute renal failure has a serum potassium level of 6.3 mEq/L. What intervention can the nurse expect the healthcare provider to prescribe?
- A. Nitrofurantoin (Macrodantin) orally.
- B. Erythropoietin (Epogen) intravenously.
- C. Kayexalate retention enema.
- D. Azathioprine (Imuran) orally.
Correct Answer: C
Rationale: The correct answer is C: Kayexalate retention enema. In acute renal failure with high serum potassium levels, the priority is to lower potassium levels to prevent cardiac complications. Kayexalate works by exchanging sodium ions for potassium ions in the intestines, promoting potassium excretion in the feces. This intervention helps reduce serum potassium levels quickly.
A: Nitrofurantoin is an antibiotic used to treat urinary tract infections, unrelated to managing hyperkalemia.
B: Erythropoietin is a hormone used to stimulate red blood cell production, not indicated for reducing potassium levels.
D: Azathioprine is an immunosuppressant used for various conditions like autoimmune diseases, not for managing hyperkalemia.
In summary, the correct intervention is to administer a Kayexalate retention enema to lower serum potassium levels effectively in acute renal failure. Other options are not appropriate for managing hyperkalemia.
A 56-year-old woman presents to discuss the results of her recent upper endoscopy. She was having some mild abdominal pain, so she underwent the procedure, which revealed an ulcer in the antrum of the stomach. Biopsy of the lesion revealed the presence of H. pylori. All of the following statements regarding her condition are correct except
- A. H. pylori has been associated with gastric MALT (mucosa-associated lymphoid tissue)
- B. Reinfection is rare despite adequate treatment
- C. Triple drug therapy has been shown to be more effective than dual drug therapy
- D. If her H. pylori IgG antibody titer was elevated prior to therapy, it can be used to monitor treatment efficacy
Correct Answer: B
Rationale: The correct answer is B: Reinfection is rare despite adequate treatment. H. pylori reinfection can occur, especially in high-prevalence areas or due to poor hygiene. A: Correct - H. pylori is associated with gastric MALT lymphoma. C: Correct - Triple therapy (usually with a proton pump inhibitor, clarithromycin, and amoxicillin) is more effective than dual therapy. D: Correct - H. pylori IgG antibody titer can be used to assess treatment response. Reinfection is not rare and can happen, making option B incorrect.
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 56-year-old white male complains of intermittent dysphagia for the past three months, particularly with the ingestion of meat. He has no difficulties swallowing liquids. He has no history of smoking, uses no medications, and has had no weight loss. What test would be best to evaluate him?
- A. Upper endoscopy
- B. Chest/abdominal CT scan
- C. Barium swallow
- D. Esophageal manometry
Correct Answer: C
Rationale: The correct answer is C: Barium swallow. In this case, the patient's symptoms suggest a possible esophageal disorder affecting solid food ingestion. Barium swallow is a non-invasive test that can detect structural abnormalities in the esophagus, such as strictures or tumors, that may be causing dysphagia. It is the best initial test to evaluate the patient's symptoms as it provides a detailed visualization of the esophagus and can identify the cause of dysphagia. Upper endoscopy (choice A) would be appropriate if structural abnormalities are suspected. Chest/abdominal CT scan (choice B) may not provide as detailed information about esophageal function. Esophageal manometry (choice D) is more useful for evaluating motor function of the esophagus, which is not the primary concern in this case.
A 32-year-old woman presents with a 10-month history of an intermittent burning sensation in the epigastrium that is sometimes related to eating. She has heard about bacteria that can cause gastrointestinal (GI) symptoms. She has had no change in her weight and denies dysphagia. Her laboratory tests are normal. Which of the following would you recommend?
- A. Serum qualitative test for H. pylori
- B. Refer for endoscopy
- C. Obtain an upper GI series
- D. Treat her for H. pylori infection
Correct Answer: A
Rationale: Rationale:
1. Given the symptoms of epigastric burning, testing for H. pylori is appropriate as it is a common cause of such symptoms.
2. The serum qualitative test for H. pylori can detect the presence of the bacteria in the patient's system.
3. If positive, treatment for H. pylori (such as antibiotics) would be indicated.
4. Referral for endoscopy or upper GI series is not the initial step as they are more invasive and costly.
Summary:
- A: Correct, as it targets the potential cause of the symptoms.
- B: Not recommended initially, as it is more invasive and not necessary as the first step.
- C: Not recommended initially, as it is less specific for H. pylori detection.
- D: Premature without confirming the presence of H. pylori.