Nokea
An 89-year-old male client complains to the nurse that people are whispering behind his back and mumbling when they talk to him. What age-related condition is likely to be occurring with this client?
- A. Delirium
- B. Presbyopia
- C. Presbycusis
- D. Cerebral dysfunction
Correct Answer: C
Rationale: The correct answer is C: Presbycusis. This age-related condition refers to gradual hearing loss typically seen in older adults. In this case, the client's complaint of people whispering and mumbling suggests difficulty hearing clearly, which aligns with symptoms of presbycusis. Delirium (choice A) is characterized by acute confusion and disorientation, not specifically related to hearing loss. Presbyopia (choice B) is a condition of aging that affects near vision, not hearing. Cerebral dysfunction (choice D) refers to broader cognitive impairment, not specifically related to hearing loss as in presbycusis. Therefore, choice C is the most likely age-related condition in this scenario.
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A client diagnosed with dementia is disoriented, wandering, has a decreased appetite, and is having trouble sleeping. What is the priority nursing problem for this client?
- A. Disturbed thought processes.
- B. Altered sleep pattern.
- C. Imbalanced nutrition: less than.
- D. Risk for injury.
Correct Answer: D
Rationale: The correct answer is D: Risk for injury. The client's symptoms of disorientation, wandering, decreased appetite, and difficulty sleeping indicate an increased risk for falls, accidents, or getting lost. Ensuring the client's safety and preventing any potential harm is the priority.
A: Disturbed thought processes may contribute to the client's disorientation but do not pose an immediate threat to their safety.
B: Altered sleep pattern is concerning but is secondary to the risk of injury in this scenario.
C: Imbalanced nutrition: less than is important, but the immediate priority is addressing the client's safety due to the risk of injury.
In summary, the priority nursing problem for this client is the risk for injury due to their disorientation and wandering behavior, which could lead to accidents or harm.
A client with chronic kidney disease (CKD) is scheduled for hemodialysis. Which pre-dialysis assessment finding should the nurse report to the healthcare provider?
- A. Serum potassium of 5.5 mEq/L.
- B. Blood pressure of 180/90 mm Hg.
- C. Heart rate of 80 beats per minute.
- D. Serum sodium of 140 mEq/L.
Correct Answer: B
Rationale: The correct answer is B: Blood pressure of 180/90 mm Hg. High blood pressure can worsen kidney function and increase the risk of cardiovascular complications during hemodialysis. The nurse should report this finding to the healthcare provider for prompt management.
A: Serum potassium of 5.5 mEq/L is slightly elevated but not an immediate concern before hemodialysis.
C: Heart rate of 80 beats per minute is within normal range and not a priority assessment for pre-dialysis.
D: Serum sodium of 140 mEq/L is within normal limits and does not require immediate attention before hemodialysis.
The patient described in the preceding questions has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?
- A. She is at high risk for reinfection with H. pylori.
- B. A positive serum IgG indicates that eradication of H. pylori was unsuccessful.
- C. The urease breath test is an ideal test to document failure of eradication.
- D. Dyspepsia usually improves with H. pylori eradication.
Correct Answer: C
Rationale: Step 1: The patient has a positive H. pylori antibody blood test, indicating exposure to the bacteria.
Step 2: Compliance with medical regimen suggests treatment for H. pylori infection.
Step 3: Persistence of symptoms after treatment indicates possible treatment failure.
Step 4: The urease breath test is ideal for detecting treatment failure as it directly measures the presence of H. pylori.
Step 5: Therefore, choice C is correct as it identifies the appropriate test for confirming eradication failure.
Summary:
- Choice A is incorrect as reinfection risk is not the immediate concern.
- Choice B is incorrect as a positive serum IgG doesn't definitively indicate eradication failure.
- Choice D is incorrect as not all dyspepsia cases improve with H. pylori eradication.
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.
A 65-year-old man presents with weight loss, jaundice, and a palpable mass in the right upper quadrant. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?
- A. Gallstones
- B. Hepatitis
- C. Pancreatic cancer
- D. Primary biliary cirrhosis
Correct Answer: C
Rationale: The most likely diagnosis for a 65-year-old man with weight loss, jaundice, palpable mass in the right upper quadrant, elevated bilirubin, and alkaline phosphatase levels is pancreatic cancer. This is because the symptoms and findings are classic for pancreatic cancer, which commonly presents with obstructive jaundice due to compression of the common bile duct by the tumor. Weight loss is also a common symptom of pancreatic cancer. Gallstones typically present with acute episodes of biliary colic, not a palpable mass. Hepatitis typically presents with elevated liver enzymes, but not a palpable mass. Primary biliary cirrhosis presents with chronic cholestasis and autoimmune features, not a palpable mass.