Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
The nurse is caring for a client who reports periods of exacerbations and remissions of bloody diarrhea and abdominal pain. A recent X-ray indicated a continuous pattern of lesions in the large bowel. What underlying condition does the nurse suspect?
A. Colorectal cancer
Colorectal cancer may cause bleeding or pain but typically presents with mass lesions or obstruction, not a continuous pattern of mucosal lesions on X-ray. Its symptoms are less likely to remit and exacerbate cyclically, unlike inflammatory bowel diseases, making it less likely than ulcerative colitis.
B. Crohn’s disease
Crohn’s disease causes patchy, transmural bowel lesions, not continuous large bowel involvement. Its skip lesions and potential for small bowel involvement distinguish it from the continuous mucosal inflammation seen in ulcerative colitis, making this an inaccurate diagnosis for the described X-ray findings.
C. Diverticulitis
Diverticulitis involves inflamed diverticula, typically causing localized pain and fever, not continuous large bowel lesions or bloody diarrhea with remissions. X-ray may show diverticula, but not diffuse mucosal involvement. This condition is less likely than ulcerative colitis given the described symptom pattern.
D. Ulcerative colitis
Ulcerative colitis causes continuous mucosal inflammation in the large bowel, leading to bloody diarrhea, abdominal pain, and periods of exacerbation and remission. X-ray showing continuous lesions aligns with its diffuse colitis pattern, making this the most accurate diagnosis for the client’s symptoms and findings.
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Full Explanation
Choice A reason: Colorectal cancer may cause bleeding or pain but typically presents with mass lesions or obstruction, not a continuous pattern of mucosal lesions on X-ray. Its symptoms are less likely to remit and exacerbate cyclically, unlike inflammatory bowel diseases, making it less likely than ulcerative colitis.
Choice B reason: Crohn’s disease causes patchy, transmural bowel lesions, not continuous large bowel involvement. Its skip lesions and potential for small bowel involvement distinguish it from the continuous mucosal inflammation seen in ulcerative colitis, making this an inaccurate diagnosis for the described X-ray findings.
Choice C reason: Diverticulitis involves inflamed diverticula, typically causing localized pain and fever, not continuous large bowel lesions or bloody diarrhea with remissions. X-ray may show diverticula, but not diffuse mucosal involvement. This condition is less likely than ulcerative colitis given the described symptom pattern.
Choice D reason: Ulcerative colitis causes continuous mucosal inflammation in the large bowel, leading to bloody diarrhea, abdominal pain, and periods of exacerbation and remission. X-ray showing continuous lesions aligns with its diffuse colitis pattern, making this the most accurate diagnosis for the client’s symptoms and findings.
Similar Questions
The client states they are experiencing constipation. What tool would not be included in the assessment of this condition?
A. Presence of kidney disease
Kidney disease does not directly cause constipation. While it may cause fluid imbalances or medication side effects, it is not a primary factor in assessing constipation. Bowel function is more influenced by diet, activity, and medications, making kidney disease irrelevant as a routine assessment tool for this condition.
B. Description of dietary intake
Dietary intake, particularly low fiber or inadequate hydration, is a primary cause of constipation. Assessing fiber, fluid, and food types helps identify contributing factors, as low-fiber diets slow intestinal transit. This tool is essential in evaluating constipation, as diet directly impacts stool consistency and frequency.
C. Description of activities routinely performed
Routine physical activity affects bowel motility, as sedentary lifestyles slow peristalsis, contributing to constipation. Assessing activity levels identifies whether lack of movement is a factor. This tool is critical, as exercise promotes intestinal transit, making it a key component in constipation assessment.
D. Medication history
Medication history is vital, as drugs like opioids, anticholinergics, or calcium supplements can cause constipation by slowing gut motility or altering fluid balance. Assessing medications identifies potential causes, making this tool essential for a comprehensive constipation evaluation to guide appropriate interventions.
Full Explanation
Choice A reason: Kidney disease does not directly cause constipation. While it may cause fluid imbalances or medication side effects, it is not a primary factor in assessing constipation. Bowel function is more influenced by diet, activity, and medications, making kidney disease irrelevant as a routine assessment tool for this condition.
Choice B reason: Dietary intake, particularly low fiber or inadequate hydration, is a primary cause of constipation. Assessing fiber, fluid, and food types helps identify contributing factors, as low-fiber diets slow intestinal transit. This tool is essential in evaluating constipation, as diet directly impacts stool consistency and frequency.
Choice C reason: Routine physical activity affects bowel motility, as sedentary lifestyles slow peristalsis, contributing to constipation. Assessing activity levels identifies whether lack of movement is a factor. This tool is critical, as exercise promotes intestinal transit, making it a key component in constipation assessment.
Choice D reason: Medication history is vital, as drugs like opioids, anticholinergics, or calcium supplements can cause constipation by slowing gut motility or altering fluid balance. Assessing medications identifies potential causes, making this tool essential for a comprehensive constipation evaluation to guide appropriate interventions.
Which lab result would be consistent with a diagnosis of rheumatoid arthritis?
A. Elevated rheumatoid factor
Elevated rheumatoid factor (RF), an autoantibody, is present in 70-80% of rheumatoid arthritis (RA) patients. It contributes to immune complex formation, driving synovial inflammation and joint damage. This lab result is a key diagnostic marker, making it consistent with RA and critical for confirming the diagnosis.
B. Decreased C-reactive protein
Decreased C-reactive protein (CRP) is inconsistent with RA, which typically shows elevated CRP due to systemic inflammation. CRP reflects acute-phase response in active RA, and low levels suggest inactive disease or another condition, making this result inaccurate for supporting an RA diagnosis.
C. Normal erythrocyte sedimentation rate
Normal erythrocyte sedimentation rate (ESR) is not typical in active RA, where ESR is elevated due to inflammation-driven increases in plasma proteins. Normal ESR may occur in remission but does not support an active RA diagnosis, making this result inconsistent with the condition.
D. Low antinuclear antibody levels
Low antinuclear antibody (ANA) levels are not specific to RA and are more associated with systemic lupus erythematosus. While some RA patients may have low ANA, it is not a diagnostic marker for RA, making this result irrelevant and inconsistent with confirming rheumatoid arthritis.
Full Explanation
Choice A reason: Elevated rheumatoid factor (RF), an autoantibody, is present in 70-80% of rheumatoid arthritis (RA) patients. It contributes to immune complex formation, driving synovial inflammation and joint damage. This lab result is a key diagnostic marker, making it consistent with RA and critical for confirming the diagnosis.
Choice B reason: Decreased C-reactive protein (CRP) is inconsistent with RA, which typically shows elevated CRP due to systemic inflammation. CRP reflects acute-phase response in active RA, and low levels suggest inactive disease or another condition, making this result inaccurate for supporting an RA diagnosis.
Choice C reason: Normal erythrocyte sedimentation rate (ESR) is not typical in active RA, where ESR is elevated due to inflammation-driven increases in plasma proteins. Normal ESR may occur in remission but does not support an active RA diagnosis, making this result inconsistent with the condition.
Choice D reason: Low antinuclear antibody (ANA) levels are not specific to RA and are more associated with systemic lupus erythematosus. While some RA patients may have low ANA, it is not a diagnostic marker for RA, making this result irrelevant and inconsistent with confirming rheumatoid arthritis.
The client has been diagnosed with type 1 diabetes mellitus and has been prescribed Humulin R insulin. The patient will take the dose at 0900. When should the client be sure to have a snack or meal?
A. 0900-0930
Humulin R (regular insulin) has an onset of 30-60 minutes and peaks at 2-3 hours. Taking a snack at 0900-0930, immediately after injection, is too early, as insulin action is minimal, and glucose from the meal may cause hyperglycemia before insulin peaks, making this timing inappropriate.
B. 1100-1130
Humulin R peaks at 2-3 hours (1100-1200 for a 0900 dose), when hypoglycemia risk is highest due to maximum glucose uptake. A snack or meal at 1100-1130 provides glucose to counter insulin’s peak effect, preventing low blood sugar, making this the most appropriate timing.
C. 1400-1430
By 1400-1430, Humulin R’s effect (duration 5-8 hours) is waning, reducing hypoglycemia risk. A snack at this time is less critical, as insulin’s glucose-lowering action is declining. This timing is less effective for preventing hypoglycemia compared to the peak action period at 1100-1130.
D. 1700-1730
At 1700-1730, Humulin R’s effect is nearly gone (duration 5-8 hours), making hypoglycemia unlikely from the 0900 dose. A snack this late is irrelevant to the insulin’s action, as glucose levels are stabilized, making this timing inappropriate for preventing hypoglycemia.
Full Explanation
Choice A reason: Humulin R (regular insulin) has an onset of 30-60 minutes and peaks at 2-3 hours. Taking a snack at 0900-0930, immediately after injection, is too early, as insulin action is minimal, and glucose from the meal may cause hyperglycemia before insulin peaks, making this timing inappropriate.
Choice B reason: Humulin R peaks at 2-3 hours (1100-1200 for a 0900 dose), when hypoglycemia risk is highest due to maximum glucose uptake. A snack or meal at 1100-1130 provides glucose to counter insulin’s peak effect, preventing low blood sugar, making this the most appropriate timing.
Choice C reason: By 1400-1430, Humulin R’s effect (duration 5-8 hours) is waning, reducing hypoglycemia risk. A snack at this time is less critical, as insulin’s glucose-lowering action is declining. This timing is less effective for preventing hypoglycemia compared to the peak action period at 1100-1130.
Choice D reason: At 1700-1730, Humulin R’s effect is nearly gone (duration 5-8 hours), making hypoglycemia unlikely from the 0900 dose. A snack this late is irrelevant to the insulin’s action, as glucose levels are stabilized, making this timing inappropriate for preventing hypoglycemia.