Nursing Elites

1. A 60-year-old man 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 presentation of a 60-year-old man with fatigue, polyuria, polydipsia, hyperglycemia, and ketonuria strongly suggests type 1 diabetes mellitus. Type 1 diabetes typically presents with acute symptoms due to absolute insulin deficiency, leading to hyperglycemia and ketonuria. Conversely, type 2 diabetes often presents more insidiously and is associated with relative insulin deficiency and insulin resistance. Diabetes insipidus, a condition characterized by excessive thirst and excretion of large amounts of dilute urine, is due to problems with antidiuretic hormone (ADH) and is not associated with hyperglycemia or ketonuria. Hyperthyroidism, while also presenting with symptoms like fatigue, does not typically manifest with hyperglycemia or ketonuria. Therefore, based on the clinical presentation and laboratory findings, the most likely diagnosis in this case is type 1 diabetes mellitus.

2. A 50-year-old man presents with severe epigastric pain radiating to his back, nausea, and vomiting. He has a history of heavy alcohol use. Laboratory tests reveal elevated serum amylase and lipase. What is the most likely diagnosis?

• A. Acute cholecystitis
• B. Peptic ulcer disease
• C. Acute pancreatitis
• D. Gastroesophageal reflux disease

Correct answer: C

Rationale: The patient's history of heavy alcohol use, severe epigastric pain radiating to the back, nausea, vomiting, and elevated serum amylase and lipase levels are classic signs of acute pancreatitis. Alcohol consumption is a common predisposing factor for pancreatitis, leading to inflammation of the pancreas. The clinical presentation, along with the laboratory findings, strongly support the diagnosis of acute pancreatitis in this patient.

3. A client with chronic renal failure is scheduled to receive epoetin alfa (Epogen). Which laboratory result should the nurse review before administering the medication?

• A. Blood urea nitrogen (BUN)
• B. Creatinine clearance
• C. Hemoglobin level
• D. Serum potassium

Correct answer: C

Rationale: The correct answer is to review the hemoglobin level before administering epoetin alfa (Epogen) to assess its effectiveness in stimulating red blood cell production. Hemoglobin level is a crucial indicator to monitor in clients with chronic renal failure receiving this medication. Choice A (Blood urea nitrogen) and Choice B (Creatinine clearance) are commonly monitored in renal failure but are not specifically relevant to assessing the effectiveness of epoetin alfa. Choice D (Serum potassium) is important to monitor due to potential imbalances in renal failure, but it is not directly related to evaluating the effectiveness of epoetin alfa.

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 patient with diabetes insipidus is prescribed desmopressin. What is the primary purpose of this medication?

• A. Increase urine output
• B. Reduce blood sugar levels
• C. Decrease urine output
• D. Lower blood pressure

Correct answer: C

Rationale: Desmopressin is prescribed to decrease urine output in patients with diabetes insipidus. It works by increasing water reabsorption in the kidneys, helping to control fluid balance in the body.

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