Nursing Elites

1. A 45-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. Imaging shows a normal common bile duct but dilated intrahepatic bile ducts. What is the most likely diagnosis?

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

Correct answer: A

Rationale: Based on the symptoms of fatigue, pruritus, and jaundice, along with elevated bilirubin and alkaline phosphatase levels, and imaging findings of a normal common bile duct but dilated intrahepatic bile ducts, the most likely diagnosis is primary biliary cirrhosis. Primary sclerosing cholangitis presents with different imaging findings, often showing strictures and beading of the bile ducts. Gallstones typically cause obstruction in the biliary system, leading to different symptoms and imaging findings. Pancreatic cancer would present with different clinical features and imaging characteristics.

2. A 40-year-old man presents with abdominal pain, diarrhea, and weight loss. He has a history of Crohn's disease. Laboratory tests reveal low hemoglobin and elevated ESR. What is the most likely diagnosis?

• A. Ulcerative colitis
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Crohn's disease flare

Correct answer: D

Rationale: The symptoms of abdominal pain, diarrhea, weight loss, along with the history of Crohn's disease, and the laboratory findings of low hemoglobin and elevated ESR, strongly suggest a Crohn's disease flare. These clinical manifestations are classic features of a flare-up in a patient with a known history of Crohn's disease.

3. An elderly client with congestive heart failure (CHF) is admitted to the hospital. Which laboratory test result should the nurse expect to find?

• A. Elevated serum sodium level.
• B. Decreased brain natriuretic peptide (BNP) level.
• C. Increased serum creatinine level.
• D. Elevated hemoglobin and hematocrit levels.

Correct answer: C

Rationale: In clients with congestive heart failure (CHF), impaired cardiac function can lead to decreased renal perfusion, resulting in elevated serum creatinine levels. Therefore, an increased serum creatinine level is a common laboratory finding in CHF clients, indicating possible renal impairment.

4. A 28-year-old woman presents with abdominal pain, diarrhea, and weight loss. She has a history of recurrent mouth ulcers and a perianal fistula. What is the most likely diagnosis?

• A. Ulcerative colitis
• B. Irritable bowel syndrome
• C. Crohn's disease
• D. Diverticulitis

Correct answer: C

Rationale: The combination of symptoms including recurrent mouth ulcers, perianal fistula, abdominal pain, diarrhea, and weight loss is characteristic of Crohn's disease. These extra-intestinal manifestations, along with the gastrointestinal symptoms, point towards Crohn's disease rather than ulcerative colitis, irritable bowel syndrome, or diverticulitis.

5. A patient with bipolar disorder is prescribed lithium. What dietary advice should the nurse provide?

• A. Increase intake of caffeine.
• B. Maintain a consistent salt intake.
• C. Avoid dairy products.
• D. Increase intake of green leafy vegetables.

Correct answer: B

Rationale: The correct answer is B: Maintain a consistent salt intake. Patients prescribed lithium should maintain a consistent salt intake to help stabilize lithium levels. Fluctuations in salt intake can affect the levels of lithium in the body, potentially leading to toxicity or reduced effectiveness of the medication. It is important for patients to be consistent with their salt intake and to avoid sudden increases or decreases. Choices A, C, and D are incorrect. Increasing intake of caffeine is not recommended as it can interfere with the effects of lithium. Avoiding dairy products is not necessary unless there are specific intolerances or interactions with other medications. While green leafy vegetables are generally healthy, there is no specific recommendation to increase their intake in relation to lithium therapy.

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