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 has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?

• A. Two to three soft bowel movements daily
• B. Significant increase in appetite and food intake
• C. Absence of nausea and vomiting
• D. Absence of blood or mucus in stool

Correct answer: A

Rationale: Lactulose is used in hepatic encephalopathy to reduce blood ammonia levels by promoting bowel movements. The desired outcome of lactulose therapy is typically two to three soft bowel movements daily, which helps in eliminating excess ammonia from the body, thus improving the client's condition.

3. 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.

4. A 60-year-old male client is admitted to the hospital with the complaint of right knee pain for the past week. His right knee and calf are warm and edematous. He has a history of diabetes and arthritis. Which neurological assessment action should the nurse perform for this client?

• A. Glasgow Coma Scale
• B. Assess pulses, paresthesia, and paralysis distal to the right knee
• C. Assess pulses, paresthesia, and paralysis proximal to the right knee
• D. Optic nerve using an ophthalmoscope

Correct answer: B

Rationale: In this scenario, the nurse should assess pulses, paresthesia, and paralysis distal to the right knee to evaluate for neurovascular compromise. This assessment helps determine the perfusion and sensation of the lower extremity, which is crucial in identifying potential vascular or nerve damage that may be causing the client's symptoms.

5. The healthcare provider is planning care for a non-potty-trained child with nephrotic syndrome. Which intervention provides the best means of determining fluid retention?

• A. Weigh the child daily.
• B. Observe the lower extremities for pitting edema.
• C. Measure the child's abdominal girth weekly.
• D. Weigh the child's wet diapers.

Correct answer: A

Rationale: Daily weighing is the most accurate method to monitor fluid retention in a child with nephrotic syndrome. Changes in weight can indicate fluid retention or loss, which is crucial in managing nephrotic syndrome. Observing for pitting edema and measuring abdominal girth are also important assessments, but daily weighing provides more immediate and precise information about fluid status.

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