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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.
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A 28-year-old woman at 34 weeks of gestation presents with elevated liver enzymes and pruritus. Labs reveal total bilirubin to be 4.2 mg/dL, AST 480 U/L, ALT 640 U/L, and alkaline phosphatase 232 U/L. Viral hepatitis serologies and ANA are negative. On physical examination, she is jaundiced, but has a normal blood pressure, no edema, and a soft abdomen. The fetus is in no distress. Which of the following is true?
- A. The baby should be delivered immediately
- B. Symptoms will resolve promptly after delivery
- C. There is little risk of recurrence with subsequent pregnancies
- D. The mother should be screened for long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency
Correct Answer: B
Rationale: The correct answer is B: Symptoms will resolve promptly after delivery. The presentation of elevated liver enzymes, pruritus, and jaundice in a pregnant woman at 34 weeks with no signs of severe preeclampsia suggests cholestasis of pregnancy. This condition typically resolves after delivery. The absence of fetal distress and normal maternal blood pressure indicate that immediate delivery is not necessary. There is a risk of recurrence in subsequent pregnancies, so choice C is incorrect. Screening for LCHAD deficiency is not indicated in this scenario, as the presentation is more consistent with cholestasis of pregnancy.
A 35-year-old woman presents with abdominal pain, diarrhea, and weight loss. She has a history of recurrent mouth ulcers and a perianal fistula. What is the most likely diagnosis?
- A. Ulcerative colitis
- B. Irritable bowel syndrome
- C. Crohn's disease
- D. Diverticulitis
Correct Answer: C
Rationale: The most likely diagnosis is Crohn's disease (Choice C). This is supported by the symptoms of abdominal pain, diarrhea, weight loss, mouth ulcers, and perianal fistula, which are characteristic of Crohn's disease. These symptoms are not typically seen in irritable bowel syndrome (Choice B) or diverticulitis (Choice D). While ulcerative colitis (Choice A) may also present with similar symptoms, the presence of perianal fistula and mouth ulcers is more indicative of Crohn's disease. Crohn's disease is a chronic inflammatory condition that can affect any part of the gastrointestinal tract, leading to the diverse range of symptoms seen in this patient.
When assessing a client with a chest tube connected to suction, which observation indicates that the chest tube is functioning properly?
- A. Continuous bubbling in the water seal chamber.
- B. Intermittent bubbling in the suction control chamber.
- C. No fluctuation in the water seal chamber.
- D. Steady bubbling in the suction control chamber.
Correct Answer: D
Rationale: The correct answer is D: Steady bubbling in the suction control chamber. This indicates proper functioning as it shows that the suction is maintaining a consistent pressure, which is essential for effective drainage and lung re-expansion. Continuous bubbling in the water seal chamber (choice A) indicates an air leak. Intermittent bubbling in the suction control chamber (choice B) could suggest fluctuating pressure. No fluctuation in the water seal chamber (choice C) indicates either a blockage or disconnection. Steady bubbling in the suction control chamber (choice D) indicates the suction is working consistently, ensuring proper drainage and lung re-expansion.
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.
A 45-year-old man with a history of chronic heartburn presents with progressive difficulty swallowing solids and liquids. He has lost 10 pounds in the past two months. What is the most likely diagnosis?
- A. Esophageal stricture
- B. Esophageal cancer
- C. Achalasia
- D. Peptic ulcer disease
Correct Answer: B
Rationale: The correct answer is B: Esophageal cancer. This patient's symptoms of difficulty swallowing solids and liquids, along with unintentional weight loss, are concerning for a malignancy like esophageal cancer. The progressive nature of dysphagia and significant weight loss are red flags for cancer. Esophageal stricture (A) can cause dysphagia but typically presents with a history of chronic inflammation or injury. Achalasia (C) is characterized by dysfunction of the lower esophageal sphincter, leading to dysphagia, but it is less likely in this case due to the weight loss. Peptic ulcer disease (D) usually presents with epigastric pain and can cause weight loss, but it is less likely to cause progressive dysphagia.