Nursing Elites

1. A 48-year-old woman presents with fatigue, pruritus, and jaundice. She has a history of ulcerative colitis. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. What is the most likely diagnosis?

• A. Hepatitis B
• B. Primary biliary cirrhosis
• C. Primary sclerosing cholangitis
• D. Autoimmune hepatitis

Correct answer: C

Rationale: The combination of symptoms (fatigue, pruritus, jaundice) along with a history of ulcerative colitis and elevated bilirubin and alkaline phosphatase levels suggests primary sclerosing cholangitis. Primary sclerosing cholangitis is commonly associated with inflammatory bowel disease, such as ulcerative colitis. It is characterized by inflammation and fibrosis of the bile ducts, leading to cholestasis and elevated alkaline phosphatase and bilirubin levels.

2. A client who has just started taking levodopa-carbidopa (Sinemet) for Parkinson's disease reports experiencing nausea. What should the nurse recommend to the client?

• A. Take the medication on an empty stomach.
• B. Consume a low-protein snack with the medication.
• C. Increase your intake of dairy products.
• D. Stop taking the medication and notify your healthcare provider.

Correct answer: B

Rationale: Nausea is a common side effect of levodopa-carbidopa (Sinemet). Consuming a low-protein snack with the medication can help reduce nausea. The protein in food can compete with levodopa for absorption, so taking it with a low-protein snack may improve its effectiveness and reduce gastrointestinal side effects. Option A is incorrect as taking the medication on an empty stomach may exacerbate nausea. Option C is incorrect because increasing intake of dairy products is not recommended to alleviate nausea. Option D is incorrect because abruptly stopping the medication without healthcare provider guidance can lead to adverse effects.

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?

• A. Instruct about the increased risk of cardiovascular disease.
• B. Provide detailed information about dietary glucose control.
• C. Teach glucose self-monitoring and medication administration.
• D. Give information about the effects of exercise on glucose control.

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 40-year-old woman 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 combination of symptoms including fatigue, polyuria, polydipsia, along with laboratory findings of hyperglycemia and ketonuria strongly suggest type 1 diabetes mellitus. In type 1 diabetes mellitus, there is a deficiency of insulin leading to high blood sugar levels (hyperglycemia) and the breakdown of fats producing ketones, causing ketonuria. Type 2 diabetes mellitus typically presents differently and is more common in older individuals. Diabetes insipidus is characterized by excessive thirst and urination due to a deficiency of antidiuretic hormone, distinct from the provided clinical scenario. Hyperthyroidism may present with some overlapping symptoms like fatigue, but it does not account for the specific laboratory findings of hyperglycemia and ketonuria seen in this case.

5. A 35-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 strongly suggests Crohn's disease. These extra-intestinal manifestations are characteristic of Crohn's disease, a chronic inflammatory condition that can affect any part of the gastrointestinal tract. Ulcerative colitis primarily involves the colon, while irritable bowel syndrome is a functional disorder without the inflammatory component seen in Crohn's disease. Diverticulitis typically presents with localized left lower quadrant pain and is less likely to cause mouth ulcers and perianal fistulas.

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