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A 30-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: Step 1: Symptoms of fatigue, polyuria, polydipsia point to diabetes.
Step 2: Hyperglycemia and ketonuria suggest uncontrolled diabetes.
Step 3: Onset in a 30-year-old woman is more common in Type 1 diabetes.
Step 4: Type 1 diabetes is characterized by autoimmune destruction of pancreatic beta cells leading to insulin deficiency.
Step 5: Treatment for Type 1 diabetes involves insulin therapy.
Summary:
- Choice B (Type 2 diabetes) is less likely due to the acute presentation and ketonuria.
- Choice C (Diabetes insipidus) does not involve hyperglycemia or ketonuria.
- Choice D (Hyperthyroidism) does not typically present with hyperglycemia and ketonuria.
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A client's healthcare provider has ordered a 'liver panel' in response to the client's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select one that doesn't apply.
- A. Alanine aminotransferase (ALT)
- B. C-reactive protein (CRP)
- C. Gamma-glutamyl transferase (GGT)
- D. Aspartate aminotransferase (AST)
Correct Answer: B
Rationale: The correct answer is B: C-reactive protein (CRP). A liver panel typically includes tests such as ALT, GGT, and AST to assess liver function, but CRP is not part of a standard liver panel. CRP is a marker of inflammation and infection, not specific to liver function. Therefore, when reviewing the results of a liver panel for a client with jaundice, the nurse should not expect to see CRP among the blood tests.
A client with hepatic encephalopathy is being treated with lactulose. What is an expected outcome of this treatment?
- A. Reduction in blood ammonia levels
- B. Improvement in liver enzyme levels
- C. Decrease in bilirubin levels
- D. Increase in urine output
Correct Answer: A
Rationale: Step-by-step rationale:
1. Lactulose works by reducing blood ammonia levels through promoting its excretion in the stool.
2. Hepatic encephalopathy is caused by elevated blood ammonia levels affecting brain function.
3. Therefore, the expected outcome of lactulose treatment is a reduction in blood ammonia levels, improving the client's condition.
Summary:
- Reduction in blood ammonia levels is the correct outcome as lactulose targets this mechanism.
- Improvement in liver enzyme levels and decrease in bilirubin levels are not direct effects of lactulose.
- Increase in urine output is not a typical outcome of lactulose treatment for hepatic encephalopathy.
When creating a care plan for a 70-year-old obese client admitted to the postsurgical unit following a colon resection, the client's age and increased body mass index put them at increased risk for which complication in the postoperative period?
- A. Hyperglycemia
- B. Azotemia
- C. Falls
- D. Infection
Correct Answer: D
Rationale: The correct answer is D: Infection. Postoperative obese patients are at higher risk for surgical site infections due to impaired wound healing, decreased tissue oxygenation, and increased tissue pressure. Obesity also compromises the immune system, further increasing susceptibility to infections. Age is a risk factor for infection as well, as older adults may have weakened immune responses. Hyperglycemia (choice A) is a common issue in obese patients but not specifically related to postoperative complications. Azotemia (choice B) refers to elevated levels of nitrogen-containing compounds in the blood and is not directly related to obesity or age. Falls (choice C) are more related to mobility issues and environmental factors, not specifically to age and obesity in the postoperative period.
A client with diabetes has a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that should be prepared in the insulin syringe?
- A. 42 units
- B. 14 units
- C. 28 units
- D. 32 units
Correct Answer: A
Rationale: The correct answer is A: 42 units. To calculate the total number of units of insulin to be prepared in the syringe, you need to add the units of regular insulin (14 units) and NPH insulin (28 units). Therefore, 14 units + 28 units = 42 units. This is the total amount of insulin that should be drawn up and administered subcutaneously.
Summary of other choices:
B: 14 units - This is only the amount of regular insulin and doesn't include the NPH insulin.
C: 28 units - This is only the amount of NPH insulin and doesn't include the regular insulin.
D: 32 units - This is the sum of 14 units of regular insulin and 18 units of NPH insulin, which is incorrect as the NPH insulin prescribed is 28 units, not 18 units.
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: The most likely diagnosis for the 45-year-old woman with fatigue, pruritus, jaundice, elevated bilirubin and alkaline phosphatase levels, and dilated intrahepatic bile ducts is Primary Biliary Cirrhosis (PBC). PBC is an autoimmune liver disease that primarily affects middle-aged women, leading to bile duct destruction and liver damage. The elevated alkaline phosphatase levels and presence of pruritus are typical in PBC due to impaired bile flow. Imaging showing dilated intrahepatic bile ducts supports the diagnosis of PBC as it indicates bile duct damage.
Summary of other choices:
B: Primary sclerosing cholangitis typically presents with strictures and beading of bile ducts on imaging.
C: Gallstones would typically present with a common bile duct obstruction and not dilated intrahepatic bile ducts.
D: Pancreatic cancer would typically present with different imaging findings and symptoms such as