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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
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A healthcare professional is educating a group of recent nursing graduates about their risks for contracting hepatitis B. What preventative measure should the professional promote?
- A. Immunization
- B. Chronic tonsillitis
- C. Consumption of a vitamin-rich diet
- D. Annual vitamin K injections
Correct Answer: A
Rationale: The correct answer is A: Immunization. Hepatitis B is a viral infection transmitted through exposure to infected blood or body fluids. Immunization with the hepatitis B vaccine is the most effective preventative measure, providing long-term protection against the virus. Chronic tonsillitis (B) is unrelated to hepatitis B prevention. Consumption of a vitamin-rich diet (C) and annual vitamin K injections (D) do not offer protection against hepatitis B. Immunization is the best choice due to its proven efficacy in preventing hepatitis B transmission.
A client with a history of chronic alcohol abuse is at risk for which of the following conditions?
- A. Liver cirrhosis
- B. Renal failure
- C. Chronic obstructive pulmonary disease (COPD)
- D. Peptic ulcer disease
Correct Answer: A
Rationale: The correct answer is A: Liver cirrhosis. Chronic alcohol abuse is a leading cause of liver cirrhosis due to the toxic effects of alcohol on the liver over time. Alcohol metabolism leads to liver inflammation, scarring, and ultimately cirrhosis. Renal failure (B) is not directly linked to alcohol abuse but can occur in severe cases. COPD (C) is primarily caused by smoking, not alcohol abuse. Peptic ulcer disease (D) can be exacerbated by alcohol but is not directly caused by chronic alcohol abuse. Therefore, the most significant risk for a client with a history of chronic alcohol abuse is developing liver cirrhosis.
The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors should the nurse list that can be controlled or modified?
- A. Gender, obesity, family history, and smoking
- B. Inactivity, stress, gender, and smoking
- C. Cholesterol levels, hypertension, and smoking
- D. Stress, family history, and obesity
Correct Answer: C
Rationale: The correct answer is C because cholesterol levels, hypertension, and smoking are modifiable risk factors for CAD. High cholesterol levels can be controlled through diet and medication. Hypertension can be managed through lifestyle changes and medication. Smoking is a behavior that can be modified.
A is incorrect because gender and family history are non-modifiable risk factors. Obesity can be controlled but is not listed in the correct answer.
B is incorrect because inactivity and stress are modifiable risk factors, but gender is not modifiable.
D is incorrect because stress and family history are non-modifiable risk factors, and obesity is not listed in the correct answer.
A client with a newly created ileostomy has not had ostomy output for the past 12 hours and reports worsening nausea. What is the nurse's priority action?
- A. Facilitate a referral to the wound-ostomy-continence (WOC) nurse
- B. Report signs and symptoms of obstruction to the health care provider
- C. Encourage the client to mobilize to enhance mobility
- D. Contact the health care provider to obtain a swab of the stoma for culture
Correct Answer: B
Rationale: The correct answer is B: Report signs and symptoms of obstruction to the health care provider. The priority action in this scenario is to address the possibility of an obstruction, which could be a life-threatening complication. Reporting to the healthcare provider allows for prompt assessment and intervention to prevent further complications. A: Referring to the WOC nurse may be necessary but is not the priority when obstruction is suspected. C: Encouraging mobilization is important for overall health but not the priority in this urgent situation. D: Obtaining a swab for culture is not the priority when obstruction is suspected.
A 65-year-old female client arrives in the emergency department with shortness of breath and chest pain. The nurse accidentally administers 10 mg of morphine sulfate instead of the prescribed 4 mg. Later, the client's respiratory rate is 10 breaths/minute, oxygen saturation is 98%, and she states her pain has subsided. What is the legal status of the nurse?
- A. The nurse is guilty of negligence and will be sued.
- B. The client would not be able to prove malpractice in court.
- C. The nurse is protected by the Good Samaritan Act.
- D. The healthcare provider should have given the morphine sulfate dose.
Correct Answer: B
Rationale: The correct answer is B: The client would not be able to prove malpractice in court. In this scenario, although the nurse made an error in administering a higher dose of morphine, the client's condition improved, as evidenced by stable vital signs and pain relief. Therefore, there was no harm caused to the client due to the mistake. In malpractice cases, the client needs to prove that harm or injury resulted from the healthcare provider's actions. Since the client's condition improved, it would be difficult to establish malpractice in this situation.
Choice A is incorrect because negligence requires harm or injury to occur, which is not the case here. Choice C is incorrect as the Good Samaritan Act typically applies to individuals providing emergency care in good faith at the scene of an emergency, not within a healthcare setting. Choice D is incorrect as the focus is on the nurse's error in administering the incorrect dose, not on the healthcare provider's responsibility in this context.