Nursing Elites

1. 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.

2. A patient with hyperthyroidism is prescribed propylthiouracil (PTU). What is the primary purpose of this medication?

• A. Increase thyroid hormone production
• B. Suppress thyroid hormone production
• C. Enhance iodine absorption
• D. Stimulate the thyroid gland

Correct answer: B

Rationale: Propylthiouracil (PTU) is a medication used to treat hyperthyroidism by suppressing the production of thyroid hormones. It works by inhibiting the enzyme responsible for the synthesis of thyroid hormones, thereby reducing their levels in the body. This helps to alleviate the symptoms of hyperthyroidism and restore thyroid hormone levels to normal range.

3. The client has a nasogastric (NG) tube and is receiving enteral feedings. What intervention should the nurse implement to prevent complications associated with the NG tube?

• A. Flush the NG tube with water before and after feedings.
• B. Check gastric residual volume every 6 hours.
• C. Keep the head of the bed elevated at 30 degrees.
• D. Replace the NG tube every 24 hours.

Correct answer: C

Rationale: Keeping the head of the bed elevated at 30 degrees is crucial in preventing aspiration, a common complication associated with nasogastric (NG) tubes and enteral feedings. This position helps reduce the risk of reflux and aspiration of gastric contents into the lungs, promoting client safety and preventing respiratory complications. Flushing the NG tube with water before and after feedings (Choice A) is not the primary intervention to prevent complications. Checking gastric residual volume every 6 hours (Choice B) is important but not directly related to preventing complications associated with the NG tube. Replacing the NG tube every 24 hours (Choice D) is not a standard practice and is not necessary to prevent complications if the tube is functioning properly.

4. A client with hepatic encephalopathy exhibits confusion, difficulty arousing from sleep, and rigid extremities. Based on these clinical findings, what stage of hepatic encephalopathy should the nurse document?

• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

Correct answer: C

Rationale: Stage 3 hepatic encephalopathy is characterized by confusion, difficulty arousing from sleep, and rigidity of extremities. These symptoms indicate advanced manifestations of hepatic encephalopathy, requiring prompt intervention and monitoring to prevent further neurological deterioration.

5. Which client's laboratory value requires immediate intervention by a nurse?

• A. A client with GI bleeding who is receiving a blood transfusion and has a hemoglobin of 7 grams.
• B. A client with pancreatitis who has a fasting glucose of 190 mg/dl today and had 160 mg/dl yesterday.
• C. A client with hepatitis who is jaundiced and has a bilirubin level that is 4 times the normal value.
• D. A client with cancer who has an absolute neutrophil count < 500 today and had 2,000 yesterday.

Correct answer: D

Rationale: The correct answer is D. A sudden drop in neutrophil count to below 500 indicates severe neutropenia, putting the client at high risk for infections. Neutrophils are essential for fighting off infections, and a significant decrease in their count can compromise the client's immune response. Immediate intervention is necessary to prevent the development of serious infections in the client with neutropenia.

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