Nursing Elites

1. A 45-year-old woman presents with fatigue, weight gain, and constipation. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?

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

Correct answer: A

Rationale: The combination of high TSH and low free T4 levels is consistent with hypothyroidism, which matches the patient's symptoms of fatigue, weight gain, and constipation. In hypothyroidism, the thyroid gland does not produce enough thyroid hormones, leading to a decrease in metabolic rate and resulting in these clinical findings.

2. The patient described in the preceding question has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?

• A. She is at low risk for reinfection with H. pylori
• B. A positive serum IgG indicates that eradication of H. pylori was successful
• C. The urease breath test is an ideal test to document failure of eradication
• D. Dyspepsia typically worsens with H. pylori eradication

Correct answer: C

Rationale: Reinfection with H. pylori is rare, and the persistence of infection usually indicates poor compliance with the medical regimen or antibiotic resistance. The serum IgG may remain positive indefinitely and cannot be used to determine failure of eradication; however, a decrease in quantitative IgG levels has been utilized to indicate treatment success. If available, either the stool antigen or urease breath test is ideal to document treatment failure due to their high sensitivity, specificity, and ease of performance. The relationship between dyspepsia and H. pylori is controversial, but generally, dyspepsia does not typically improve with H. pylori eradication.

3. A client is receiving chemotherapy and is at risk for neutropenia. Which precaution should the nurse implement?

• A. Encourage regular visitors to boost morale.
• B. Ensure the client receives live vaccines.
• C. Place the client in a private room.
• D. Provide a diet high in fresh fruits and vegetables.

Correct answer: C

Rationale: Placing the client in a private room is crucial to protect them from infections due to their compromised immune system. Neutropenia, a common side effect of chemotherapy, decreases white blood cell count, making the client more susceptible to infections. By placing the client in a private room, exposure to pathogens from other individuals is minimized, reducing the risk of infection and helping maintain the client's health during this vulnerable period.

4. A patient with chronic obstructive pulmonary disease (COPD) is experiencing severe dyspnea. What position should the nurse encourage the patient to assume?

• A. Supine
• B. Prone
• C. High Fowler's
• D. Trendelenburg

Correct answer: C

Rationale: The High Fowler's position is the most appropriate position for a patient with COPD experiencing severe dyspnea. This position helps improve lung expansion and reduce dyspnea by allowing the diaphragm to move more freely and increasing the efficiency of breathing. It also helps reduce the work of breathing and enhances oxygenation in patients with COPD. Supine position (Choice A) may worsen dyspnea by limiting lung expansion. Prone position (Choice B) is not ideal for COPD patients experiencing severe dyspnea as it may restrict breathing. Trendelenburg position (Choice D) is not recommended for COPD patients with dyspnea as it can further compromise breathing.

5. A client who is acutely ill has vigilant oral care included in their plan of care. What factor increases this client's risk for dental caries?

• A. Hormonal changes induced by the stress response leading to an acidic oral environment
• B. Systemic infections commonly affecting the teeth
• C. Intravenous hydration lacking fluoride
• D. Inadequate nutrition and reduced saliva production contributing to cavities

Correct answer: D

Rationale: Inadequate nutrition and decreased saliva production can lead to a conducive environment for the development of dental caries. Without proper nutrition and sufficient saliva, the protective mechanisms against cavities are compromised, making the individual more susceptible to tooth decay.

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