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 60-year-old woman presents with pruritus, jaundice, and xanthomas. Laboratory tests reveal elevated cholesterol and alkaline phosphatase levels. What is the most likely diagnosis?

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

Correct answer: A

Rationale: The combination of pruritus, jaundice, and xanthomas, along with elevated cholesterol and alkaline phosphatase levels, is classic for primary biliary cirrhosis. Pruritus is often the initial symptom, followed by jaundice due to cholestasis. Xanthomas, elevated cholesterol, and alkaline phosphatase levels are also common findings in primary biliary cirrhosis. Primary sclerosing cholangitis and pancreatic cancer may present with similar symptoms but are less likely in this clinical context.

3. A patient with deep vein thrombosis (DVT) is prescribed warfarin. Which dietary instruction should the nurse provide?

• A. Avoid foods high in vitamin K.
• B. Increase intake of dairy products.
• C. Limit intake of citrus fruits.
• D. Avoid high-sodium foods.

Correct answer: A

Rationale: Patients on warfarin should avoid foods high in vitamin K because vitamin K can interfere with the anticoagulant effect of the medication. Warfarin works by inhibiting vitamin K-dependent clotting factors, so consuming large amounts of vitamin K-rich foods may decrease the effectiveness of the medication. Choices B, C, and D are incorrect. Increasing intake of dairy products, limiting citrus fruits, or avoiding high-sodium foods are not directly related to the mechanism of action of warfarin or its dietary considerations.

4. During an admission physical assessment, the nurse is examining a newborn who is small for gestational age (SGA). Which finding should the nurse report immediately to the pediatric healthcare provider?

• A. Heel stick glucose of 65 mg/dL.
• B. Head circumference of 35 cm (14 inches).
• C. Widened, tense, bulging fontanel.
• D. High-pitched shrill cry.

Correct answer: C

Rationale: A widened, tense, bulging fontanel is a critical finding in a newborn as it can indicate increased intracranial pressure. This condition requires immediate attention and intervention to prevent further complications. Monitoring fontanel status is crucial in assessing the newborn's neurological well-being and ensuring early detection of potential issues.

5. A healthcare professional is preparing to administer digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tablets. How many tablets should the healthcare professional administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

• A. 1
• B. 2
• C. 3
• D. 4

Correct answer: B

Rationale: To achieve the prescribed dose of 0.25 mg, the healthcare professional should administer 2 tablets of 0.125 mg each, totaling 0.25 mg.

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