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 40-year-old woman presents with fatigue, polyuria, and polydipsia. Laboratory tests reveal hyperglycemia and ketonuria. What is the most likely diagnosis?

• A. Type 1 diabetes mellitus
• B. Type 2 diabetes mellitus
• C. Diabetes insipidus
• D. Hyperthyroidism

Correct answer: A

Rationale: The combination of symptoms including fatigue, polyuria, polydipsia, along with laboratory findings of hyperglycemia and ketonuria strongly suggest type 1 diabetes mellitus. In type 1 diabetes mellitus, there is a deficiency of insulin leading to high blood sugar levels (hyperglycemia) and the breakdown of fats producing ketones, causing ketonuria. Type 2 diabetes mellitus typically presents differently and is more common in older individuals. Diabetes insipidus is characterized by excessive thirst and urination due to a deficiency of antidiuretic hormone, distinct from the provided clinical scenario. Hyperthyroidism may present with some overlapping symptoms like fatigue, but it does not account for the specific laboratory findings of hyperglycemia and ketonuria seen in this case.

3. A client with a cold is taking the antitussive benzonatate (Tessalon). Which assessment data indicates to the nurse that the medication is effective?

• A. Reports reduced nasal discharge.
• B. Denies having coughing spells.
• C. Able to sleep through the night.
• D. Expectorating bronchial secretions.

Correct answer: B

Rationale: The correct answer is B. Denying having coughing spells indicates the effectiveness of benzonatate, an antitussive that suppresses coughing. The goal of antitussive medications like benzonatate is to reduce or eliminate coughing, so the absence of coughing spells signifies the drug's efficacy. The other options do not directly reflect the medication's intended effect and are not specific indicators of benzonatate's effectiveness.

4. The healthcare professional is caring for a client with a chest tube following a thoracotomy. Which assessment finding requires immediate intervention?

• A. Continuous bubbling in the water seal chamber.
• B. Serosanguineous drainage in the collection chamber.
• C. Intermittent bubbling in the suction control chamber.
• D. Chest tube secured to the client's chest wall.

Correct answer: A

Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which requires immediate intervention to prevent complications such as pneumothorax. An air leak can lead to ineffective lung expansion, respiratory distress, and compromised gas exchange. Therefore, prompt action is necessary to maintain the integrity of the closed drainage system and prevent further complications. Choices B, C, and D are incorrect because serosanguineous drainage is an expected finding post-thoracotomy, intermittent bubbling in the suction control chamber is normal, and having the chest tube secured to the client's chest wall is essential for stability and proper functioning.

5. A 60-year-old man presents with fatigue, weight gain, and constipation. Laboratory tests reveal low TSH and high free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: B

Rationale: The combination of low TSH and high free T4 levels is characteristic of hyperthyroidism, not hypothyroidism. Hyperthyroidism is associated with symptoms such as fatigue, weight loss, and diarrhea, contrasting with the typical presentation of hypothyroidism. Therefore, in this case, the most likely diagnosis is hyperthyroidism.

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