You have a patient with achalasia (incomplete muscle relaxation of the GI tract, especially sphincter muscles). Which medications do you anticipate to administer?

Correct Answer: A

Rationale: In the case of a patient with achalasia, the correct medication to anticipate administering is Isosorbide dinitrate (Isordil). Isosorbide dinitrate is a vasodilator that helps to relax smooth muscles, including the muscles of the gastrointestinal (GI) tract. In achalasia, where there is incomplete muscle relaxation in the GI tract, using a medication like Isosorbide dinitrate can help to alleviate symptoms by promoting muscle relaxation and improving the passage of food through the esophagus. The other options provided (B) Digoxin (Lanoxin), (C) Captopril (Capoten), and (D) Propranolol (Inderal) are not appropriate for achalasia. Digoxin is a cardiac glycoside used for heart conditions, Captopril is an ACE inhibitor used for hypertension and heart failure, and Propranolol is a beta-blocker used for various cardiovascular conditions. These medications do not target the smooth muscle relaxation issues seen in achalasia and would not be effective in treating this specific condition. In an educational context, understanding the rationale behind choosing the correct medication for a specific condition like achalasia is crucial for nursing practice. It demonstrates the importance of matching the mechanism of action of a medication to the pathophysiology of the patient's condition, ensuring optimal outcomes and safe patient care. Additionally, this knowledge enhances critical thinking skills and promotes evidence-based practice in nursing.

Correct Answer: C

Rationale: In the case of a patient with acute pancreatitis like Britney, the correct laboratory findings that are expected to be abnormal are serum amylase and lipase (Option C). Amylase and lipase are pancreatic enzymes, and their elevation in the blood indicates damage to the pancreas, which is a hallmark of acute pancreatitis. Option A, Serum creatinine and BUN, are markers of kidney function and are not specifically related to pancreatitis. Options B and D, Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and cardiac enzymes, are associated with liver and heart function respectively, and are not typically elevated in acute pancreatitis. In an educational context, understanding the specific laboratory findings associated with different conditions is crucial for accurate diagnosis and appropriate treatment. By knowing which markers to look for, nurses can provide better care, monitor patient progress, and collaborate effectively with the healthcare team to manage the patient's condition.

Correct Answer: D

Rationale: In a patient with Crohn's disease experiencing prolonged diarrhea, the correct answer is D) 1.03 for urine specific gravity. This high specific gravity indicates concentrated urine due to dehydration from fluid loss through diarrhea. Dehydration leads to increased solute concentration in the urine, raising its specific gravity. Option A) 1.005 is too low for a dehydrated patient with diarrhea. Option B) 1.011 and C) 1.02 are also lower values, indicating less concentrated urine compared to option D. In a dehydrated state, urine specific gravity tends to be higher than normal due to the body conserving water. In an educational context, understanding how dehydration affects urine specific gravity is crucial for nurses caring for patients with gastrointestinal conditions like Crohn's disease. Monitoring urine specific gravity helps assess hydration status and guide fluid replacement therapy. Nurses must recognize abnormal values to intervene promptly and prevent complications related to dehydration.

Correct Answer: C

Rationale: In this scenario, the correct answer is option C: Splint the incision if he can't avoid sneezing or coughing. This instruction is crucial after a herniorrhaphy (surgical repair of a hernia) to minimize the risk of complications. By splinting the incision during sneezing or coughing, David can prevent excessive strain on the surgical site, reducing the chances of wound dehiscence or hernia recurrence. Option A, which suggests avoiding pain medication, is incorrect because adequate pain management is essential postoperatively to promote patient comfort and mobility, ultimately improving outcomes. Pain control also helps prevent complications such as atelectasis due to shallow breathing. Option B, coughing and deep breathing Q2H, is incorrect immediately after a herniorrhaphy as it can increase intra-abdominal pressure and strain on the incision, potentially leading to complications like wound dehiscence or hernia recurrence. Option D, applying heat to scrotal swelling, is unrelated to the patient's risk of complications post-herniorrhaphy and does not address the specific care needed to minimize complications following this surgical procedure. Educationally, this rationale emphasizes the importance of proper postoperative care after a herniorrhaphy to prevent complications and promote optimal healing. By understanding the rationale behind each option, students can grasp the significance of specific nursing interventions in the context of surgical procedures, enhancing their clinical decision-making skills.

Correct Answer: C

Rationale: In the context of Janice post-herniorrhaphy, the correct instruction to include in her discharge plan is option C) Lose weight, if obese. This is because obesity can increase the risk of hernia recurrence, delay wound healing, and overall impact surgical outcomes. By addressing obesity, Janice can improve her overall health and reduce the likelihood of complications. Option A) Eat a low-fiber diet is incorrect as a high-fiber diet is generally recommended post-operatively to prevent constipation and promote healing. Option B) Resume heavy lifting in 2 weeks is incorrect as strenuous activities should be avoided for a longer period to prevent strain on the surgical site. Option D) Resume sexual activity once discomfort is gone is incorrect as it is essential to wait for clearance from the healthcare provider to ensure that the incision has healed adequately to avoid complications. In an educational context, it is crucial for nursing students to understand the importance of providing tailored discharge instructions based on the individual patient's needs and the specific surgical procedure they underwent. Understanding the rationale behind each instruction helps students develop critical thinking skills and apply evidence-based practices in their nursing care.