Nursing Elites

1. A 48-year-old man presents with fatigue, weight gain, and cold intolerance. 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 scenario describes a classic presentation of hypothyroidism, supported by the laboratory findings of high TSH and low free T4 levels. In hypothyroidism, the body's thyroid hormone levels are inadequate, leading to symptoms like fatigue, weight gain, and cold intolerance. High TSH is a compensatory mechanism by the body to increase thyroid hormone production, which is deficient, resulting in a negative feedback loop. Therefore, the correct answer is hypothyroidism.

2. Aspirin is prescribed for a 9-year-old child with rheumatic fever to control the inflammatory process, promote comfort, and reduce fever. What intervention is most important for the nurse to implement?

• A. Instruct the parents to hold the aspirin until the child has first had a tepid sponge bath.
• B. Administer the aspirin with at least two ounces of water or juice.
• C. Notify the healthcare provider if the child complains of ringing in the ears.
• D. Advise the parents to question the child about seeing yellow halos around objects.

Correct answer: C

Rationale: In children, ringing in the ears (tinnitus) can be a sign of aspirin toxicity. Aspirin toxicity can be particularly concerning in children and can lead to serious complications. Therefore, it is crucial for the nurse to prioritize monitoring for signs of aspirin toxicity, such as tinnitus, and promptly notify the healthcare provider if such symptoms occur.

3. A 50-year-old man presents with progressive jaundice, dark urine, and pruritus. Imaging reveals a mass in the head of the pancreas. What is the most likely diagnosis?

• A. Pancreatic cancer
• B. Chronic pancreatitis
• C. Gallstones
• D. Primary sclerosing cholangitis

Correct answer: A

Rationale: The presentation of progressive jaundice, dark urine, and pruritus along with a pancreatic mass, particularly in the head of the pancreas, strongly suggests pancreatic cancer as the most likely diagnosis. These symptoms are classic for obstructive jaundice caused by a mass in the head of the pancreas, making pancreatic cancer the most fitting choice.

4. A patient with severe anemia is prescribed erythropoietin. What is the primary action of this medication?

• A. Stimulate white blood cell production
• B. Increase platelet count
• C. Promote red blood cell production
• D. Enhance clotting factor production

Correct answer: C

Rationale: Erythropoietin is a hormone that primarily stimulates the bone marrow to produce more red blood cells. By increasing red blood cell production, erythropoietin helps to improve oxygen delivery to tissues, which is essential in managing anemia. Choices A, B, and D are incorrect because erythropoietin specifically targets red blood cell production and does not have a direct effect on white blood cells, platelets, or clotting factors.

5. A client with heart failure is prescribed digoxin (Lanoxin). Which instruction should the nurse include in the client's teaching plan?

• A. Take your pulse before each dose and hold the medication if your pulse is below 60 beats per minute.
• B. Increase your intake of foods high in potassium.
• C. Take the medication with a high-fiber meal to enhance absorption.
• D. Skip a dose if you feel dizzy or lightheaded.

Correct answer: A

Rationale: The correct instruction for a client prescribed digoxin is to take their pulse before each dose and hold the medication if the pulse is below 60 beats per minute. This is crucial to prevent digoxin toxicity, as digoxin can cause adverse effects when the pulse rate is too low. Monitoring the pulse regularly ensures safety and appropriate management of the medication.

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