Nursing Elites

1. 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 combination of symptoms including recurrent mouth ulcers, perianal fistula, abdominal pain, diarrhea, and weight loss strongly suggests Crohn's disease. These extra-intestinal manifestations are characteristic of Crohn's disease, a chronic inflammatory condition that can affect any part of the gastrointestinal tract. Ulcerative colitis primarily involves the colon, while irritable bowel syndrome is a functional disorder without the inflammatory component seen in Crohn's disease. Diverticulitis typically presents with localized left lower quadrant pain and is less likely to cause mouth ulcers and perianal fistulas.

2. A 45-year-old woman 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 presentation of low TSH and high free T4 levels is characteristic of hyperthyroidism, which is consistent with the symptoms of fatigue, weight gain, and constipation described in the case. In hyperthyroidism, the thyroid gland produces an excess of thyroid hormone leading to a hypermetabolic state, which can manifest with these symptoms.

3. A patient with glaucoma is prescribed timolol eye drops. What is the primary action of this medication?

• A. Reduce intraocular pressure
• B. Dilate the pupils
• C. Constrict the pupils
• D. Enhance tear production

Correct answer: A

Rationale: Timolol eye drops are prescribed to reduce intraocular pressure in patients with glaucoma. By decreasing the pressure within the eye, timolol helps prevent damage to the optic nerve, which is crucial in managing glaucoma and preserving vision. Dilating or constricting the pupils or enhancing tear production are not the primary actions of timolol eye drops.

4. A client with newly diagnosed diabetes mellitus is being discharged home. Which statement indicates the client understands the instructions about managing blood glucose levels?

• A. I will test my blood glucose level once a week.
• B. I should eat a snack if my blood glucose is 70 mg/dl.
• C. If I feel shaky, I should take another dose of insulin.
• D. It's okay to skip a meal if I'm not hungry.

Correct answer: B

Rationale: Choice B is the correct answer. Eating a snack when blood glucose is low (70 mg/dl) can help prevent hypoglycemia. It is important for clients with diabetes to manage their blood glucose levels to prevent complications, and consuming a snack when glucose levels drop can help maintain the balance.

5. After performing a paracentesis on a client with ascites, 3 liters of fluid are removed. Which assessment parameter is most critical for the nurse to monitor following the procedure?

• A. Pedal pulses.
• B. Breath sounds.
• C. Gag reflex.
• D. Vital signs.

Correct answer: D

Rationale: Following a paracentesis where a significant amount of fluid is removed, it is crucial to monitor the client's vital signs. This helps in detecting any signs of hypovolemia, such as changes in blood pressure, heart rate, and respiratory rate, which could indicate complications post-procedure. Monitoring the vital signs allows for prompt intervention if there are any deviations from the baseline values.

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