Nursing Elites

1. A 34-year-old woman presents with intermittent abdominal pain, bloating, and diarrhea. She notes that her symptoms improve with fasting. She has a history of iron deficiency anemia. What is the most likely diagnosis?

• A. Irritable bowel syndrome
• B. Celiac disease
• C. Lactose intolerance
• D. Crohn's disease

Correct answer: B

Rationale: The patient's symptoms of intermittent abdominal pain, bloating, and diarrhea that improve with fasting, along with a history of iron deficiency anemia, are highly suggestive of celiac disease. In celiac disease, gluten ingestion leads to mucosal damage in the small intestine, causing malabsorption of nutrients like iron, leading to anemia. The improvement of symptoms with fasting can be explained by the temporary avoidance of gluten-containing foods. Irritable bowel syndrome typically does not improve with fasting. Lactose intolerance usually presents with symptoms after dairy consumption, not with fasting. Crohn's disease typically presents with more chronic symptoms and is not commonly associated with improvement on fasting.

2. A client with a diagnosis of schizophrenia is being treated with risperidone (Risperdal). Which finding should the nurse report to the healthcare provider immediately?

• A. Weight gain.
• B. Dry mouth.
• C. Muscle rigidity.
• D. Drowsiness.

Correct answer: C

Rationale: Muscle rigidity is a crucial finding to report immediately as it can indicate neuroleptic malignant syndrome (NMS), a rare but potentially life-threatening reaction to antipsychotic medications. NMS is characterized by muscle rigidity, high fever, autonomic dysfunction, and altered mental status. Prompt recognition and intervention are essential to prevent serious complications or death.

3. 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 patient's presentation is consistent with diverticulitis without evidence of perforation or abscess formation on CT scan. During acute infections, procedures like barium enema and colonoscopy should be avoided to prevent the risk of perforation. Urgent surgery is not indicated initially. The appropriate next step is to start antibiotic therapy aimed at gram-negative aerobes and anaerobes, such as ciprofloxacin and metronidazole, which are the initial treatment of choice for diverticulitis.

4. A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be

• A. Liver biopsy
• B. Magnetic resonance cholangiopancreatography
• C. Hepatitis B surface antigen and hepatitis C RNA assay
• D. Colonoscopy with biopsies

Correct answer: B

Rationale: The patient's presentation with right upper quadrant pain, fever, and jaundice, along with abnormal liver function tests, suggests a biliary tract problem. Given the suspicion of obstructed bile flow and the negative liver ultrasound for gallstones, magnetic resonance cholangiopancreatography (MRCP) is the next appropriate step to evaluate the biliary system and pancreatic ducts. MRCP is non-invasive and can provide detailed images for diagnosis. Liver biopsy is not the preferred initial diagnostic test in this context. Testing for hepatitis B and C would not address the current clinical scenario, and colonoscopy is not indicated for the presenting symptoms.

5. A client is admitted with diabetic ketoacidosis (DKA). Which assessment finding requires immediate intervention?

• A. Fruity breath odor.
• B. Blood glucose of 450 mg/dL.
• C. Deep, rapid respirations.
• D. Serum potassium of 5.2 mEq/L.

Correct answer: C

Rationale: The correct answer is C: Deep, rapid respirations (Kussmaul breathing). This is a sign of severe acidosis commonly seen in diabetic ketoacidosis (DKA) and requires immediate intervention. Kussmaul breathing helps to compensate for the metabolic acidosis by blowing off carbon dioxide. Prompt intervention is necessary to prevent further deterioration and potential respiratory failure. Fruity breath odor (Choice A) is a classic sign of DKA but does not require immediate intervention. While a blood glucose level of 450 mg/dL (Choice B) is high, it does not pose an immediate threat to the client's life. Serum potassium of 5.2 mEq/L (Choice D) is slightly elevated but not the most critical finding that requires immediate intervention in this scenario.

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