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. 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.

3. A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn disease, rather than ulcerative colitis, as the cause of the client's signs and symptoms?

• A. A pattern of distinct exacerbations and remissions
• B. Severe diarrhea
• C. An absence of blood in stool
• D. Involvement of the rectal mucosa

Correct answer: C

Rationale: In the context of inflammatory bowel disease, the absence of blood in stool is more indicative of Crohn disease. Crohn disease typically presents with non-bloody stools, while ulcerative colitis often involves bloody stools due to continuous mucosal inflammation confined to the colon and rectum.

4. Which assessment finding indicates a client's readiness to leave the nursing unit for a bronchoscopy?

• A. Client denies allergies to contrast media.
• B. Skin prep to insertion site completed.
• C. On-call sedation administered.
• D. Oxygen at 2 L/minute via nasal cannula.

Correct answer: C

Rationale: Administering on-call sedation is crucial before a bronchoscopy to ensure the client is comfortable and adequately prepared for the procedure. Sedation helps reduce anxiety, discomfort, and ensures the client remains still during the bronchoscopy, enabling the healthcare provider to perform the procedure effectively.

5. The client was recently diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease?

• A. Perform 15 minutes of physical activity at least three times per week.
• B. Avoid taking aspirin to treat pain or fever.
• C. Take multivitamins as prescribed and eat organic foods whenever possible.
• D. Maintain a healthy body weight.

Correct answer: B

Rationale: The correct answer is B. Avoiding aspirin is crucial in managing chronic gastritis as it can further irritate the stomach lining, leading to exacerbations of the condition. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can increase stomach acid production, potentially worsening gastritis symptoms. Therefore, the nurse should educate the client on using alternative pain or fever relief methods that are less likely to aggravate gastritis, such as acetaminophen.

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