RM, a 38-year-old woman who is attending graduate school and is very sedentary, comes to a community outpatient clinic. Her chief complaint is overwhelming fatigue that is not relieved by rest. She is so exhausted that she has difficulty walking to classes and trouble concentrating when studying. She reports a recent weight gain of 15 pounds (6.8 kg) over 2 months without clear changes in her dietary habits. Her face looks puffy, she has experienced excessive hair loss, and her skin is dry and pale. She says she has general body aches and pains with frequent muscle cramps and constipation. You note she is dressed inappropriately warmly for the weather. The physician orders lab work. The lab results are as follows:

WBC - WNL

HGB - WNL

Glucose - WNL

Amylase - WNL

Cholesterol - WNL

T4 (thyroxine) -↓

T3 (triiodothyronine) -↓

Thyroid-stimulating hormone (TSH) -↑

The physician diagnoses RM with an endocrine disorder. The assessment findings and lab work are consistent with which endocrine problem?

Addison's Disease

Cushing syndrome

Hyperthyroidism

Hypothyroidism

Answer and Explanation

The Correct Answer is D

Choice A reason: Addison's Disease is characterized by insufficient production of adrenal hormones, leading to symptoms like weight loss, hyperpigmentation, low blood pressure, and severe fatigue. The lab findings would typically show low sodium, high potassium, and low cortisol levels. RM's lab results and symptoms are not consistent with Addison's Disease, making this an unlikely diagnosis.
Choice B reason: Cushing syndrome results from excess cortisol production, often causing weight gain, particularly around the abdomen and face, thinning skin, and hypertension. RM's symptoms of fatigue, dry skin, hair loss, and weight gain without dietary changes do not align with Cushing syndrome, and her lab results do not indicate elevated cortisol levels.
Choice C reason: Hyperthyroidism is characterized by excessive thyroid hormone production, leading to symptoms like weight loss, anxiety, palpitations, and heat intolerance. RM's symptoms of weight gain, fatigue, and cold intolerance, along with her lab results showing low T4 and T3 and elevated TSH, are not consistent with hyperthyroidism.
Choice D reason: Hypothyroidism occurs due to an underactive thyroid gland producing insufficient thyroid hormones. This leads to symptoms such as fatigue, weight gain, cold intolerance, dry skin, hair loss, and constipation. RM's lab results showing low T4 and T3 levels and elevated TSH align with the diagnosis of hypothyroidism. The body's response to low thyroid hormone levels is to increase TSH production in an attempt to stimulate the thyroid gland. The clinical presentation and lab findings point towards hypothyroidism as the correct diagnosis.

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Correct Answer is D

Explanation

Choice A reason: "It must have been from sharing needles with my roommate." This statement is incorrect because hepatitis A is not typically transmitted through sharing needles. Hepatitis A is primarily spread through the fecal-oral route, which involves ingestion of contaminated food or water.
Choice B reason: "It is likely transmitted through kissing or sexual activity." This statement is also incorrect. Hepatitis A is not commonly spread through kissing or sexual activity. It is mainly transmitted through consuming contaminated food or water or close contact with an infected person.
Choice C reason: "I think I caught it because I have a family history of liver problems." This statement reflects a misunderstanding of how hepatitis A is transmitted. Hepatitis A is not linked to genetic predisposition or family history of liver problems. It is an infectious disease spread through the fecal-oral route.
Choice D reason: "I probably got it from drinking contaminated water or eating food handled by someone who didn't wash their hands properly." This statement is correct and indicates an accurate understanding of how hepatitis A is transmitted. The virus is often spread through consumption of contaminated food or water, particularly in areas with poor sanitation.

A. The patient is alert and oriented x4. B. The patient reports nausea. C. The abdomen is tender to palpation. D. The patient is 60 years old. E. The patient has dark amber urine. F. The patient's oral temperature is 102.4°F. G. The patient is voiding without difficulty.

Correct Answer is ["B","C","E","F"]

Explanation

Choice A reason: The patient is alert and oriented x4. This indicates that the patient is fully aware of their surroundings and does not require follow-up for this finding.
Choice B reason: The patient reports nausea. Nausea can be a symptom of many underlying conditions, including gastrointestinal issues or medication side effects, and requires follow-up to determine the cause and provide appropriate treatment.
Choice C reason: The abdomen is tender to palpation. Abdominal tenderness can indicate inflammation, infection, or other abdominal pathology, which requires follow-up to identify the underlying cause and provide appropriate management.
Choice D reason: The patient is 60 years old. This is a demographic detail and does not indicate a medical condition requiring follow-up.
Choice E reason: The patient has dark amber urine. Dark amber urine can be an indication of dehydration or other underlying conditions that require follow-up to identify and address the cause.
Choice F reason: The patient's oral temperature is 102.4°F. A fever indicates the presence of an infection or other health issue that needs to be investigated and managed.
Choice G reason: The patient is voiding without difficulty. This indicates that there are no issues with urinary function, so no follow-up is required for this finding.

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Naxlex Comprehensive Predictor Exams

A 23-year-old college student is diagnosed with hepatitis A after returning from an international trip. During health education, the nurse explains how hepatitis A is transmitted. Which statement by the patient indicates a correct understanding of how the virus is spread?

Correct Answer is D

Explanation

Which four patient assessment findings require follow-up by the nurse? Select all four that apply.

Correct Answer is ["B","C","E","F"]

Explanation

To prevent autonomic dysreflexia, which nursing action would the home health nurse include in the plan of care for a patient who has paraplegia at the T4 level?

Elevated serum ammonia level causes which complication of cirrhosis?

Which IV fluid is the most appropriate for treating acute Diabetes insipidus (DI)?

Which group of drugs will the nurse plan to include when teaching a patient who has a new diagnosis of peripheral artery disease (PAD)? Select all that apply:

Interpret these clinical findings and determine the nurse's next action. Clinical Findings: Complaints of dizziness and unsteady gait. BP: 98/60 mmHg. Carbidopa-Levodopa last taken 30 minutes ago.