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 sh
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1. 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?

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.

2. A patient with chronic obstructive pulmonary disease (COPD) is experiencing severe dyspnea. What position should the nurse encourage the patient to assume?

Correct answer: C

Rationale: The High Fowler's position is the most appropriate position for a patient with COPD experiencing severe dyspnea. This position helps improve lung expansion and reduce dyspnea by allowing the diaphragm to move more freely and increasing the efficiency of breathing. It also helps reduce the work of breathing and enhances oxygenation in patients with COPD. Supine position (Choice A) may worsen dyspnea by limiting lung expansion. Prone position (Choice B) is not ideal for COPD patients experiencing severe dyspnea as it may restrict breathing. Trendelenburg position (Choice D) is not recommended for COPD patients with dyspnea as it can further compromise breathing.

3. When implementing patient teaching for a patient admitted with hyperglycemia and newly diagnosed diabetes mellitus scheduled for discharge the second day after admission, what is the priority action for the nurse?

Correct answer: C

Rationale: The priority action for the nurse when time is limited is to focus on essential teaching. In this scenario, the patient should be educated on how to self-monitor glucose levels and administer medications to control glucose levels. This empowers the patient with immediate skills for managing their condition. Instructing about the increased risk of cardiovascular disease (choice A) is important but not as urgent as teaching self-monitoring and medication administration. Providing detailed information about dietary glucose control (choice B) can be beneficial but is secondary to ensuring the patient can monitor and manage their glucose levels. Teaching about the effects of exercise (choice D) is relevant but not as critical as immediate self-monitoring and medication administration education.

4. A 68-year-old man with a history of diabetes, hypertension, and coronary artery disease (s/p coronary artery bypass graft two years ago) presents to the emergency room with fevers and left-sided abdominal pain. His physical examination reveals a temperature of 101.5°F, pulse 96, and blood pressure of 135/80. His abdomen is soft with moderate left lower quadrant tenderness. There is no rebound or guarding. Bowel sounds are present. A CT scan is done which reveals inflammation around an area of the left colon. The next step in his workup/management should be

Correct answer: A

Rationale: The patient's presentation is consistent with diverticulitis without evidence of perforation or abscess formation on CT scan. During acute infections, procedures like barium enema and colonoscopy should be avoided to prevent the risk of perforation. Urgent surgery is not indicated initially. The appropriate next step is to start antibiotic therapy aimed at gram-negative aerobes and anaerobes, such as ciprofloxacin and metronidazole, which are the initial treatment of choice for diverticulitis.

5. A client with left-sided heart failure is experiencing dyspnea and orthopnea. Which position should the nurse place the client in to relieve these symptoms?

Correct answer: A

Rationale: Placing the client in High Fowler's position is beneficial for individuals with left-sided heart failure experiencing dyspnea and orthopnea. This position helps to reduce venous return, decrease preload, and enhance respiratory function, thereby relieving the symptoms mentioned. Choice B, the supine position, is not recommended as it may exacerbate dyspnea and orthopnea by increasing preload. Choice C, the Trendelenburg position, is incorrect as it involves the feet being positioned higher than the head, which is not suitable for heart failure patients. Choice D, the Sims' position, is a lateral position used for rectal examination and is not indicated for relieving dyspnea and orthopnea in heart failure.

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