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. A client who is 2 days postoperative reports severe pain and swelling in the right leg. The nurse notes that the leg is warm and red. What is the nurse's priority action?

• A. Apply a warm compress to the affected leg.
• B. Elevate the leg on pillows.
• C. Measure the circumference of the leg.
• D. Notify the healthcare provider immediately.

Correct answer: D

Rationale: The nurse's priority action in this situation is to notify the healthcare provider immediately. These symptoms, including severe pain, swelling, warmth, and redness in the leg, are indicative of deep vein thrombosis (DVT), a potentially serious condition. Prompt notification of the healthcare provider is crucial to initiate appropriate diagnostic tests and interventions to prevent complications associated with DVT. Applying a warm compress (Choice A) could worsen the condition by increasing blood flow. Elevating the leg (Choice B) might be contraindicated in DVT as it can dislodge a clot. Measuring the circumference of the leg (Choice C) is not the priority at this time compared to promptly involving the healthcare provider.

3. A client with a new diagnosis of myasthenia gravis is prescribed pyridostigmine (Mestinon). Which instruction should the nurse include in the client's teaching?

• A. Take the medication with food to prevent gastrointestinal upset.
• B. Take the medication 30 minutes before meals.
• C. Avoid dairy products while taking this medication.
• D. Take the medication at bedtime.

Correct answer: B

Rationale: The correct instruction for a client with myasthenia gravis prescribed pyridostigmine (Mestinon) is to take the medication 30 minutes before meals. This timing is crucial as it helps improve muscle strength for eating and swallowing. By taking the medication before meals, the client can experience enhanced muscle function during mealtime, which is especially important for managing the symptoms of myasthenia gravis. Choices A, C, and D are incorrect. Taking the medication with food may decrease its effectiveness, avoiding dairy products is not necessary, and taking the medication at bedtime does not coincide with the optimal timing for enhancing muscle function during meals.

4. Which of the following statements about Helicobacter pylori (H. pylori) is false?

• A. H. pylori does not invade the gastric or duodenal epithelium
• B. H. pylori stimulates gastric acid secretion
• C. Eradication of H. pylori prevents adenocarcinoma of the stomach
• D. H. pylori produces a urease that splits urea into ammonia and CO2

Correct answer: C

Rationale: H. pylori is known to reside in the mucus layer of the stomach and does not invade the epithelium. It produces urease that splits urea into ammonia and CO2. This action helps in neutralizing the acidic environment and allows H. pylori to survive. Additionally, urease activity can be detected in diagnostic tests for H. pylori. The stimulation of gastric acid secretion and disruption of the protective mucus layer are mechanisms by which H. pylori promotes injury. While eradicating H. pylori infection has been associated with a decreased risk of developing gastric cancer, it does not prevent adenocarcinoma of the stomach entirely.

5. An 82-year-old woman with no past medical history presents to your clinic complaining of arthritic symptoms. She is not taking any medications but needs something for her arthritis. You want to start her on a nonsteroidal anti-inflammatory drug (NSAID) but are concerned about her age and the risk of peptic ulcers. As she has to pay for her medications out-of-pocket and requests the most cost-effective option, what is the most appropriate treatment plan?

• A. Prescribe an inexpensive NSAID alone
• B. Prescribe an inexpensive NSAID and misoprostol
• C. Prescribe celecoxib
• D. Prescribe an inexpensive NSAID and sucralfate

Correct answer: A

Rationale: In this scenario, the most appropriate treatment plan would be to prescribe an inexpensive NSAID alone. While the elderly woman is at a higher risk of developing NSAID-related toxicity, prophylaxis with misoprostol or sucralfate is not recommended in the absence of a history of peptic ulcer disease or abdominal symptoms. Celecoxib, a selective COX-2 inhibitor, may be a more expensive option than traditional NSAIDs. Considering the patient's preference for the most inexpensive option and the lack of specific risk factors, starting with a standalone NSAID is the most suitable approach.

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