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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.
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A 45-year-old woman presents with fatigue, weight gain, and constipation. 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 most likely diagnosis is A: Hypothyroidism. High TSH and low free T4 levels indicate primary hypothyroidism. Elevated TSH is a compensatory response by the pituitary gland to stimulate the thyroid to produce more thyroid hormones, but the thyroid gland is unable to do so effectively, resulting in low free T4 levels. Fatigue, weight gain, and constipation are classic symptoms of hypothyroidism.
- B: Hyperthyroidism is characterized by low TSH and high free T4 levels, opposite of the lab results presented.
- C: Thyroiditis may initially present with high or low thyroid hormone levels, but the combination of high TSH and low free T4 levels is more indicative of hypothyroidism.
- D: Thyroid cancer typically does not cause abnormal thyroid hormone levels; it is more commonly associated with thyroid nodules or masses.
A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn disease, rather than ulcerative colitis, as the cause of the client's signs and symptoms?
- A. A pattern of distinct exacerbations and remissions
- B. Severe diarrhea
- C. An absence of blood in stool
- D. Involvement of the rectal mucosa
Correct Answer: C
Rationale: The correct answer is C: An absence of blood in stool. This suggests Crohn's disease over ulcerative colitis because Crohn's can involve any part of the GI tract and may not always present with blood in stool, in contrast to ulcerative colitis which typically involves the rectum and almost always presents with blood in stool due to continuous inflammation in the colon. Choices A, B, and D are more commonly associated with ulcerative colitis, which typically presents with a pattern of exacerbations and remissions, severe diarrhea, and rectal mucosal involvement.
A healthcare provider is providing dietary teaching to a client with cholecystitis. Which type of diet should the healthcare provider recommend?
- A. High-fiber, low-fat diet
- B. Low-fiber, high-protein diet
- C. Low-fat, low-cholesterol diet
- D. High-protein, high-fat diet
Correct Answer: C
Rationale: The correct answer is C: Low-fat, low-cholesterol diet. For cholecystitis, which is inflammation of the gallbladder, a low-fat, low-cholesterol diet is essential to prevent exacerbation of symptoms. High-fat diets can trigger gallbladder attacks, while low-fat and low-cholesterol diets help reduce the workload on the gallbladder. High-fiber (choice A) may be too harsh on the digestive system. Low-fiber, high-protein (choice B) and high-protein, high-fat (choice D) diets can exacerbate symptoms due to the high-fat content.
A 40-year-old man presents with abdominal pain, diarrhea, and weight loss. He has a history of Crohn's disease. Laboratory tests reveal low hemoglobin and elevated ESR. What is the most likely diagnosis?
- A. Ulcerative colitis
- B. Irritable bowel syndrome
- C. Celiac disease
- D. Crohn's disease flare
Correct Answer: D
Rationale: The correct answer is D: Crohn's disease flare. Given the patient's history of Crohn's disease, symptoms of abdominal pain, diarrhea, weight loss, and abnormal lab findings (low hemoglobin, elevated ESR) are indicative of a flare-up of Crohn's disease. This is supported by the clinical presentation and the lab results. Ulcerative colitis (A) presents differently with rectal bleeding and mucous diarrhea. Irritable bowel syndrome (B) does not typically cause weight loss or abnormal lab findings. Celiac disease (C) would present with malabsorption symptoms and specific antibodies, not consistent with this patient's presentation. Crohn's disease flare (D) is the most likely diagnosis based on the information provided.
A client admitted with acute diverticulitis has experienced a sudden increase in temperature and reports a sudden onset of exquisite abdominal tenderness. The nurse's rapid assessment reveals that the client's abdomen is uncharacteristically rigid on palpation. What is the nurse's best response?
- A. Administer a Fleet enema as prescribed and remain with the client
- B. Contact the primary care provider promptly and report these signs of perforation
- C. Position the client supine and insert an NG tube
- D. Page the primary provider and report that the client may be obstructed
Correct Answer: B
Rationale: The correct answer is B: Contact the primary care provider promptly and report these signs of perforation.
Rationale:
1. Sudden increase in temperature, sudden onset of exquisite abdominal tenderness, and uncharacteristically rigid abdomen are signs of perforation in diverticulitis.
2. Promptly contacting the primary care provider allows for immediate evaluation and intervention.
3. Perforation is a serious complication that requires urgent medical attention to prevent further complications like sepsis.
Summary of other choices:
A: Administering a Fleet enema is not appropriate and can worsen the condition of a perforated diverticulum.
C: Inserting an NG tube is not indicated for a perforated diverticulum and may exacerbate the situation.
D: Reporting the client may be obstructed is not accurate based on the signs presented and does not address the urgency of perforation.