Nokea
A 60-year-old man presents with fatigue, weight gain, and constipation. Laboratory tests reveal low TSH and high free T4 levels. What is the most likely diagnosis?
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Thyroiditis
- D. Thyroid cancer
Correct Answer: B
Rationale: The correct answer is B: Hyperthyroidism. In this case, the low TSH and high free T4 levels indicate an overactive thyroid gland, leading to symptoms like fatigue, weight gain, and constipation. The low TSH is due to negative feedback as the high free T4 suppresses TSH production. Hyperthyroidism fits this clinical picture, as opposed to hypothyroidism (choice A) which would have high TSH and low free T4 levels. Thyroiditis (choice C) typically presents with symptoms of both hyperthyroidism and hypothyroidism and is usually transient. Thyroid cancer (choice D) is less likely given the presentation of symptoms and specific lab results.
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A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?
- A. Proton-pump inhibitors and H2-blockers are equally effective in prophylaxis against NSAID-related GI toxicity.
- B. Misoprostol is superior to an H2-blocker in prophylaxis against NSAID-related GI toxicity.
- C. Sucralfate is not the drug of choice for prophylaxis in this patient.
- D. H. pylori infection can alter the risk for an NSAID-induced ulcer.
Correct Answer: B
Rationale: Step 1: Misoprostol is a prostaglandin analog that helps protect the gastric mucosa by increasing mucus production. This mechanism of action makes it effective in preventing NSAID-related GI toxicity.
Step 2: H2-blockers (Choice A) and PPIs are not as effective as misoprostol in preventing NSAID-related GI toxicity.
Step 3: Sucralfate (Choice C) is not as effective as misoprostol in preventing NSAID-related GI toxicity due to its different mechanism of action.
Step 4: H. pylori infection (Choice D) can increase the risk of NSAID-induced ulcers but is not directly related to the prophylactic treatment with misoprostol.
Which of the following statements about Helicobacter pylori (H. pylori) is false?
- A. H. pylori does not invade the gastric or duodenal epithelium
- B. H. pylori stimulates gastric acid secretion
- C. Eradication of H. pylori prevents adenocarcinoma of the stomach
- D. H. pylori produces a urease that splits urea into ammonia and CO2
Correct Answer: C
Rationale: Rationale:
C is false because eradication of H. pylori does not completely prevent adenocarcinoma of the stomach, although it reduces the risk. A is true as H. pylori can invade epithelium. B is true as it can stimulate acid secretion. D is true as H. pylori produces urease. Thus, C is the only false statement.
A client with a history of myocardial infarction (MI) is prescribed nitroglycerin (Nitrostat) for chest pain. Which instruction should the nurse provide?
- A. Take the medication with food.
- B. Swallow the tablet whole.
- C. Take the medication at bedtime.
- D. Place the tablet under your tongue.
Correct Answer: D
Rationale: The correct answer is D: Place the tablet under your tongue. Nitroglycerin is a vasodilator used to relieve chest pain in patients with MI. Placing the tablet under the tongue allows for rapid absorption through the oral mucosa, providing quick relief. Taking it with food (A) may delay absorption. Swallowing the tablet whole (B) would result in slower absorption through the GI tract. Taking it at bedtime (C) is not necessary for immediate relief of chest pain.
A 60-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?
- A. Hepatitis C
- B. Primary biliary cirrhosis
- C. Hemochromatosis
- D. Wilson's disease
Correct Answer: B
Rationale: The most likely diagnosis is B: Primary biliary cirrhosis. This condition commonly presents with fatigue, pruritus, jaundice, elevated bilirubin, and alkaline phosphatase levels in older women. Primary biliary cirrhosis is an autoimmune liver disease that leads to destruction of bile ducts. The other choices are less likely because Hepatitis C typically presents with acute symptoms, Hemochromatosis presents with iron overload symptoms, and Wilson's disease presents with copper accumulation symptoms, which do not match the patient's clinical presentation.
An 82-year-old woman with no past medical history presents to your clinic complaining of arthritic symptoms. She is not taking any medications but needs something for her arthritis. You want to start her on a nonsteroidal anti-inflammatory drug (NSAID) but are concerned about her age and the risk of peptic ulcers. As she has to pay for her medications out-of-pocket and requests the most cost-effective option, what is the most appropriate treatment plan?
- A. Prescribe an inexpensive NSAID alone
- B. Prescribe an inexpensive NSAID and misoprostol
- C. Prescribe celecoxib
- D. Prescribe an inexpensive NSAID and sucralfate
Correct Answer: A
Rationale: The correct answer is A: Prescribe an inexpensive NSAID alone. This option is the most appropriate because it balances the need for cost-effectiveness with the concern for peptic ulcers in an elderly patient. Starting with a simple NSAID reduces the risk of adverse effects and minimizes the financial burden on the patient. Option B adds misoprostol, which may help protect the stomach but increases the cost. Option C, prescribing celecoxib, is more expensive and carries a higher cardiovascular risk. Option D, adding sucralfate, does not have strong evidence for preventing NSAID-induced ulcers and adds unnecessary cost. Therefore, option A is the most suitable choice for this scenario.