Nursing Elites

1. A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. Her thyroid function tests reveal low T3 and T4 levels and elevated TSH levels. Which of the following is the most likely diagnosis?

• A. Hyperthyroidism
• B. Hypothyroidism
• C. Euthyroid sick syndrome
• D. Subclinical hyperthyroidism

Correct answer: B

Rationale: The scenario describes a 45-year-old woman with fatigue, weight gain, cold intolerance, low T3 and T4 levels, and elevated TSH levels, which are indicative of hypothyroidism. In hypothyroidism, there is decreased production of thyroid hormones (T3 and T4) leading to elevated TSH levels as the pituitary gland tries to stimulate the thyroid gland to produce more hormones. Therefore, the correct answer is hypothyroidism (Choice B). Choice A, Hyperthyroidism, is incorrect as the patient's symptoms and thyroid function tests point towards decreased thyroid hormone levels, which is characteristic of hypothyroidism, not hyperthyroidism. Choice C, Euthyroid sick syndrome, is incorrect because this condition typically presents with normal to low T3 and T4 levels in the setting of non-thyroid illness, unlike the elevated TSH levels observed in this case. Choice D, Subclinical hyperthyroidism, is also incorrect as the patient has low T3 and T4 levels, which is not consistent with hyperthyroidism, whether clinical or subclinical.

2. What should the nurse assess in a patient experiencing breakthrough bleeding while taking oral contraceptives?

• A. Adherence to the medication schedule
• B. The possibility of pregnancy
• C. The need for an increased dosage
• D. The effectiveness of the current oral contraceptive

Correct answer: A

Rationale: When a patient on oral contraceptives experiences breakthrough bleeding, the nurse should assess the patient's adherence to the medication schedule. Breakthrough bleeding is often a sign of non-adherence, potentially reducing the effectiveness of the contraceptives. Assessing the adherence to the schedule helps in determining if the medication is being taken correctly. The possibility of pregnancy (choice B) is less likely if the patient has been taking the contraceptives as prescribed. Increasing the dosage (choice C) without assessing adherence first can lead to unnecessary medication adjustments. Evaluating the effectiveness of the current oral contraceptive (choice D) comes after assessing adherence to the schedule.

3. A 30-year-old male has been brought to the emergency department by his wife because of a severe headache, nausea, vomiting, and fever. A lumbar puncture is performed, and cerebrospinal fluid (CSF) analysis reveals a high protein count, low glucose, and numerous polymorphonuclear leukocytes (PMNs). Which organism is the most likely cause of these findings?

• A. Streptococcus pneumoniae
• B. Neisseria meningitidis
• C. Escherichia coli
• D. Listeria monocytogenes

Correct answer: A

Rationale: The cerebrospinal fluid (CSF) analysis findings of high protein count, low glucose, and numerous polymorphonuclear leukocytes (PMNs) are classic for bacterial meningitis. Among the choices, Streptococcus pneumoniae is the most likely cause in this case. Streptococcus pneumoniae is a common cause of bacterial meningitis in adults, especially presenting with symptoms such as severe headache, nausea, vomiting, and fever. Neisseria meningitidis is another common cause of bacterial meningitis but is more frequently associated with a different CSF profile. Escherichia coli is a common cause of neonatal meningitis, not typically seen in a 30-year-old male. Listeria monocytogenes is more commonly associated with meningitis in immunocompromised individuals and neonates, and typically presents differently in CSF analysis.

4. Interpret the following arterial blood gas results: PH = 7.30; PaCO2 = 55 mmHg; HCO3 = 24 mEq/L

• A. Respiratory acidosis
• B. Metabolic acidosis
• C. Respiratory alkalosis
• D. Metabolic alkalosis

Correct answer: A

Rationale: The correct answer is A: Respiratory acidosis. In respiratory acidosis, there is an accumulation of CO2 in the blood, leading to a decrease in pH. The elevated PaCO2 of 55 mmHg in the given results indicates hypoventilation, causing respiratory acidosis. Choices B, C, and D are incorrect because the provided data does not show metabolic acidosis, respiratory alkalosis, or metabolic alkalosis.

5. A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as 'like an electric shock.' The pain occurs only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain?

• A. Temporal arteritis
• B. Trigeminal neuralgia
• C. Migraine headache
• D. Cluster headache

Correct answer: B

Rationale: The correct answer is B: Trigeminal neuralgia. Trigeminal neuralgia is characterized by severe, stabbing pain in the distribution of the trigeminal nerve, often triggered by light touch, chewing, or brushing teeth. In this case, the patient's symptoms of sharp, intermittent facial pain triggered by activities like chewing and touching her face are classic for trigeminal neuralgia. Choices A, C, and D are incorrect. Temporal arteritis typically presents with unilateral headache, jaw claudication, and visual symptoms. Migraine headaches are usually throbbing in nature and often associated with nausea, vomiting, and sensitivity to light and sound. Cluster headaches are characterized by severe unilateral pain around the eye with autonomic symptoms like lacrimation and nasal congestion.

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