Nursing Elites

1. A 60-year-old man presents with fatigue, polyuria, and polydipsia. Laboratory tests reveal hyperglycemia and ketonuria. What is the most likely diagnosis?

• A. Type 1 diabetes mellitus
• B. Type 2 diabetes mellitus
• C. Diabetes insipidus
• D. Hyperthyroidism

Correct answer: A

Rationale: The presentation of a 60-year-old man with fatigue, polyuria, polydipsia, hyperglycemia, and ketonuria strongly suggests type 1 diabetes mellitus. Type 1 diabetes typically presents with acute symptoms due to absolute insulin deficiency, leading to hyperglycemia and ketonuria. Conversely, type 2 diabetes often presents more insidiously and is associated with relative insulin deficiency and insulin resistance. Diabetes insipidus, a condition characterized by excessive thirst and excretion of large amounts of dilute urine, is due to problems with antidiuretic hormone (ADH) and is not associated with hyperglycemia or ketonuria. Hyperthyroidism, while also presenting with symptoms like fatigue, does not typically manifest with hyperglycemia or ketonuria. Therefore, based on the clinical presentation and laboratory findings, the most likely diagnosis in this case is type 1 diabetes mellitus.

2. A client with peptic ulcer disease is prescribed ranitidine (Zantac). Which statement by the client indicates the need for further teaching?

• A. I will take this medication at bedtime.
• B. I need to avoid smoking while taking this medication.
• C. I should take this medication with meals.
• D. This medication will help reduce stomach acid.

Correct answer: C

Rationale: The client's statement that they should take ranitidine with meals indicates a need for further teaching. Ranitidine is typically taken at bedtime or before meals to be most effective in reducing stomach acid. Taking it with meals may not provide the optimal therapeutic effect.

3. A 55-year-old man 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 constellation of symptoms including fatigue, pruritus, and jaundice, along with elevated bilirubin and alkaline phosphatase levels, and imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are classical features of primary biliary cirrhosis.

4. A client with hepatic encephalopathy is being treated with lactulose. What is an expected outcome of this treatment?

• A. Reduction in blood ammonia levels
• B. Improvement in liver enzyme levels
• C. Decrease in bilirubin levels
• D. Increase in urine output

Correct answer: A

Rationale: Lactulose is used to treat hepatic encephalopathy by reducing blood ammonia levels through promoting its excretion via the intestines. Elevated ammonia levels contribute to the development of encephalopathy symptoms, so by lowering them, the client's neurological status can improve.

5. A client with a diagnosis of schizophrenia is being treated with risperidone (Risperdal). Which side effect should the nurse monitor for?

• A. Hypertension
• B. Weight loss
• C. Hyperactivity
• D. Hyperglycemia

Correct answer: D

Rationale: The correct answer is D: Hyperglycemia. Risperidone (Risperdal) can lead to metabolic side effects, such as hyperglycemia, which requires monitoring. Choice A, Hypertension, is incorrect because risperidone is not typically associated with hypertension. Choice B, Weight loss, is less common with risperidone use as it can lead to weight gain. Choice C, Hyperactivity, is not a common side effect of risperidone; instead, it is more known for sedative effects.

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