Nursing Elites

1. A 55-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: The presentation of fatigue, pruritus, and jaundice in a 55-year-old woman, along with elevated bilirubin and alkaline phosphatase levels, and imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are characteristic of primary biliary cirrhosis. Primary biliary cirrhosis is an autoimmune liver disease that typically affects middle-aged women, leading to progressive destruction of the intrahepatic bile ducts.

2. A 32-year-old woman presents with a 10-month history of an intermittent burning sensation in the epigastrium that is sometimes related to eating. She has heard about bacteria that can cause gastrointestinal (GI) symptoms. She has had no change in her weight and denies dysphagia. Her laboratory tests are normal. Which of the following would you recommend?

• A. Serum qualitative test for H. pylori
• B. Refer for endoscopy
• C. Obtain an upper GI series
• D. Treat her for H. pylori infection

Correct answer: A

Rationale: The patient presents with dyspepsia, described as an intermittent burning sensation in the epigastrium, sometimes related to eating. In individuals under 45 years without warning signs such as anemia, weight loss, or dysphagia, a serum qualitative test for H. pylori is recommended to document H. pylori infection, especially if the patient has not been previously treated. It's important to note that a serum IgG can remain positive post-eradication. If H. pylori-positive patients do not respond to treatment, an endoscopy would be the next step for evaluation. An upper GI series is less sensitive than endoscopy in detecting lesions of the upper GI tract and cannot specifically detect H. pylori. Empiric therapy for H. pylori without confirmation is not recommended.

3. A 40-year-old woman presents with a history of chronic constipation, bloating, and abdominal pain. She notes that the pain is relieved with defecation. She denies any weight loss, blood in her stools, or nocturnal symptoms. Physical examination and routine blood tests are normal. What is the most likely diagnosis?

• A. Inflammatory bowel disease
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Lactose intolerance

Correct answer: B

Rationale: The patient's symptoms of chronic constipation, bloating, abdominal pain relieved with defecation, absence of weight loss, blood in stools, or nocturnal symptoms, along with normal physical examination and routine blood tests, are indicative of irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits in the absence of any organic cause. It is a diagnosis of exclusion made based on symptom criteria, and the provided clinical scenario aligns with the typical presentation of IBS.

4. The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors should the nurse list that can be controlled or modified?

• A. Gender, obesity, family history, and smoking
• B. Inactivity, stress, gender, and smoking
• C. Cholesterol levels, hypertension, and smoking
• D. Stress, family history, and obesity

Correct answer: C

Rationale: Cholesterol levels, hypertension, and smoking are controllable risk factors for CAD. Managing these factors through lifestyle changes and medical interventions can help reduce the risk of developing coronary artery disease.

5. A client with newly diagnosed diabetes mellitus is being discharged home. Which statement indicates the client understands the instructions about managing blood glucose levels?

• A. I will test my blood glucose level once a week.
• B. I should eat a snack if my blood glucose is 70 mg/dl.
• C. If I feel shaky, I should take another dose of insulin.
• D. It's okay to skip a meal if I'm not hungry.

Correct answer: B

Rationale: Choice B is the correct answer. Eating a snack when blood glucose is low (70 mg/dl) can help prevent hypoglycemia. It is important for clients with diabetes to manage their blood glucose levels to prevent complications, and consuming a snack when glucose levels drop can help maintain the balance.

Similar Questions