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A 48-year-old man presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Thyroiditis
- D. Thyroid cancer
Correct Answer: A
Rationale: The correct answer is A: Hypothyroidism. In this scenario, the patient has symptoms of hypothyroidism (fatigue, weight gain, cold intolerance) along with high TSH and low free T4 levels, indicating primary hypothyroidism. TSH is elevated as the body is trying to stimulate the thyroid to produce more thyroid hormones. Free T4 is low as the thyroid is not able to produce enough hormones. Hyperthyroidism (choice B) would present with low TSH and high free T4 levels. Thyroiditis (choice C) typically presents with symptoms of hyperthyroidism followed by hypothyroidism. Thyroid cancer (choice D) usually does not cause these specific symptoms and lab findings. Therefore, based on the symptoms and lab results, hypothyroidism is the most likely diagnosis.
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A client has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the client to describe what sign or symptom?
- A. Burning pain on swallowing
- B. Regurgitation of undigested food
- C. Symptoms mimicking a myocardial infarction
- D. Chronic parotid abscesses
Correct Answer: B
Rationale: Rationale for Correct Answer B (Regurgitation of undigested food):
1. Esophageal diverticulum is a pouch-like protrusion in the esophageal wall, causing difficulty in swallowing.
2. Due to the diverticulum, food may get trapped and regurgitated, leading to regurgitation of undigested food.
3. This symptom is characteristic of esophageal diverticulum and indicates an abnormality in the esophageal functioning.
Summary of Incorrect Choices:
A: Burning pain on swallowing - Not a typical symptom of esophageal diverticulum; more indicative of conditions like GERD.
C: Symptoms mimicking a myocardial infarction - Unrelated to esophageal diverticulum and more suggestive of cardiac issues.
D: Chronic parotid abscesses - Not associated with esophageal diverticulum, as parotid abscesses involve the salivary glands.
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.
A client with liver failure is at an increased risk of bleeding due to the inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?
- A. Alterations in glucose metabolism
- B. Retention of bile salts
- C. Inadequate production of albumin by hepatocytes
- D. Inability of the liver to use vitamin K
Correct Answer: D
Rationale: The correct answer is D: Inability of the liver to use vitamin K. Vitamin K is essential for the synthesis of clotting factors, including prothrombin. In liver failure, impaired function leads to reduced production of bile, which is necessary for the absorption of fat-soluble vitamins like vitamin K. This results in inadequate activation of clotting factors and increased risk of bleeding. Choices A, B, and C are incorrect as alterations in glucose metabolism, retention of bile salts, and inadequate albumin production do not directly impact the synthesis and activation of clotting factors like prothrombin in liver failure.
A client with portal hypertension who has developed ascites is scheduled for a paracentesis. What pre-procedure nursing intervention is essential?
- A. Encourage the client to empty the bladder
- B. Administer a laxative to clear the bowels
- C. Restrict the client's fluid intake
- D. Place the client in a supine position
Correct Answer: A
Rationale: The correct answer is A: Encourage the client to empty the bladder. Before a paracentesis, it's crucial to ensure the bladder is empty to prevent accidental puncture during the procedure. This reduces the risk of injury and complications. Options B and C are incorrect because they are not directly related to the safety of the paracentesis procedure. Option D is incorrect as placing the client in a supine position does not address the need to empty the bladder.
A 45-year-old obese man arrives at a clinic reporting daytime sleepiness, difficulty falling asleep at night, and snoring. The nurse should recognize the manifestations of what health problem?
- A. Adenoiditis
- B. Chronic tonsillitis
- C. Obstructive sleep apnea
- D. Laryngeal cancer
Correct Answer: C
Rationale: The correct answer is C: Obstructive sleep apnea. The patient's symptoms of daytime sleepiness, difficulty falling asleep, and snoring are classic signs of obstructive sleep apnea, a condition where the upper airway collapses during sleep, leading to pauses in breathing. This results in poor sleep quality and daytime fatigue. Adenoiditis (choice A) and chronic tonsillitis (choice B) typically present with symptoms like sore throat and difficulty swallowing, which are not seen in this patient. Laryngeal cancer (choice D) would present with hoarseness, persistent cough, and difficulty swallowing, which are not mentioned in the patient's symptoms. Therefore, based on the patient's presentation, the most likely diagnosis is obstructive sleep apnea.