Nokea
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 most likely diagnosis is Crohn's disease (Choice C). This is supported by the symptoms of abdominal pain, diarrhea, weight loss, mouth ulcers, and perianal fistula, which are characteristic of Crohn's disease. These symptoms are not typically seen in irritable bowel syndrome (Choice B) or diverticulitis (Choice D). While ulcerative colitis (Choice A) may also present with similar symptoms, the presence of perianal fistula and mouth ulcers is more indicative of Crohn's disease. Crohn's disease is a chronic inflammatory condition that can affect any part of the gastrointestinal tract, leading to the diverse range of symptoms seen in this patient.
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When assessing a client with a chest tube connected to suction, which observation indicates that the chest tube is functioning properly?
- A. Continuous bubbling in the water seal chamber.
- B. Intermittent bubbling in the suction control chamber.
- C. No fluctuation in the water seal chamber.
- D. Steady bubbling in the suction control chamber.
Correct Answer: D
Rationale: The correct answer is D: Steady bubbling in the suction control chamber. This indicates proper functioning as it shows that the suction is maintaining a consistent pressure, which is essential for effective drainage and lung re-expansion. Continuous bubbling in the water seal chamber (choice A) indicates an air leak. Intermittent bubbling in the suction control chamber (choice B) could suggest fluctuating pressure. No fluctuation in the water seal chamber (choice C) indicates either a blockage or disconnection. Steady bubbling in the suction control chamber (choice D) indicates the suction is working consistently, ensuring proper drainage and lung re-expansion.
What is the best therapy for a 65-year-old man with symptoms of regurgitation, chest pain, dysphagia, weight loss, dilated esophagus, and an absent gastric air bubble on CXR?
- A. Proton-pump inhibitor
- B. Endoscopic balloon dilatation
- C. Sucralfate
- D. Esophageal resection
Correct Answer: B
Rationale: The correct answer is B: Endoscopic balloon dilatation. This is the best therapy for a 65-year-old man with symptoms of regurgitation, chest pain, dysphagia, weight loss, dilated esophagus, and an absent gastric air bubble on CXR because these symptoms suggest achalasia, a motility disorder of the esophagus. Endoscopic balloon dilatation helps to disrupt the lower esophageal sphincter muscle, relieving symptoms and improving esophageal emptying. Proton-pump inhibitors (A) are used for acid-related conditions, not for achalasia. Sucralfate (C) is a mucosal protective agent and not indicated for achalasia. Esophageal resection (D) is a more invasive option and usually reserved for severe cases or when other treatments have failed.
A 70-year-old woman presents with fatigue, anorexia, and weight loss. She has noticed darkening of her skin, particularly in sun-exposed areas. Laboratory tests reveal hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?
- A. Cushing's syndrome
- B. Addison's disease
- C. Hypothyroidism
- D. Pheochromocytoma
Correct Answer: B
Rationale: The most likely diagnosis for the 70-year-old woman is Addison's disease. The symptoms of fatigue, anorexia, weight loss, darkened skin, along with hyponatremia, hyperkalemia, and low cortisol levels indicate adrenal insufficiency. Addison's disease is characterized by inadequate production of cortisol and aldosterone by the adrenal glands. The darkening of the skin, known as hyperpigmentation, is a classic sign of Addison's due to increased ACTH levels stimulating melanin production. In contrast, Cushing's syndrome presents with weight gain, hypertension, and high cortisol levels. Hypothyroidism typically presents with weight gain, cold intolerance, and constipation. Pheochromocytoma presents with hypertension, palpitations, and headaches due to excess catecholamine production. Therefore, the correct diagnosis in this case is Addison's disease.
A 68-year-old man with a history of diabetes, hypertension, and coronary artery disease (s/p coronary artery bypass graft two years ago) presents to the emergency room with fevers and left-sided abdominal pain. His physical examination reveals a temperature of 101.5°F, pulse 96, and blood pressure of 135/80. His abdomen is soft with moderate left lower quadrant tenderness. There is no rebound or guarding. Bowel sounds are present. A CT scan is done which reveals inflammation around an area of the left colon. The next step in his workup/management should be
- A. Antibiotic therapy with ciprofloxacin and metronidazole
- B. Referral for urgent colonoscopy
- C. Referral to a surgeon for immediate hemicolectomy
- D. Barium enema
Correct Answer: A
Rationale: The correct answer is A: Antibiotic therapy with ciprofloxacin and metronidazole. This patient likely has diverticulitis given his age, comorbidities, symptoms, and imaging findings. Antibiotic therapy is the initial management for uncomplicated diverticulitis to cover for common pathogens. Surgical intervention is not indicated in the absence of complications like perforation or abscess. Urgent colonoscopy or barium enema are contraindicated during an acute episode of diverticulitis due to the risk of perforation. Antibiotic therapy aims to resolve the infection and prevent complications.
A client is receiving chemotherapy and is at risk for neutropenia. Which precaution should the nurse implement?
- A. Encourage regular visitors to boost morale.
- B. Ensure the client receives live vaccines.
- C. Place the client in a private room.
- D. Provide a diet high in fresh fruits and vegetables.
Correct Answer: C
Rationale: The correct answer is C: Place the client in a private room. This is important to reduce the risk of infection for the client with neutropenia, as being in a private room minimizes exposure to pathogens from other individuals. Neutropenia is a condition where there is a low level of neutrophils, a type of white blood cell that helps fight infections. By placing the client in a private room, the nurse can control the environment and limit the client's exposure to potential sources of infection.
Choice A is incorrect because regular visitors may introduce pathogens that could increase the client's risk of infection. Choice B is incorrect as live vaccines are contraindicated in clients receiving chemotherapy due to their weakened immune system. Choice D is incorrect because while fresh fruits and vegetables are important for overall health, in this case, the risk of infection outweighs the benefits of a diet high in these foods.