A 55-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

Correct Answer: A

Rationale: The most likely diagnosis is A: Primary biliary cirrhosis. This is supported by the patient's symptoms of fatigue, pruritus, jaundice, elevated bilirubin and alkaline phosphatase levels, and dilated intrahepatic bile ducts. Primary biliary cirrhosis is an autoimmune liver disease that primarily affects middle-aged women, leading to destruction of intrahejson hepatic bile ducts. The normal common bile duct rules out obstruction from gallstones or pancreatic cancer. Primary sclerosing cholangitis typically presents with strictures in the bile ducts, which is not seen in this case. Therefore, the combination of symptoms, lab findings, and imaging results point towards primary biliary cirrhosis as the most likely diagnosis.

Correct Answer: A

Rationale: Step 1: Symptoms of fatigue, polyuria, polydipsia point to diabetes. Step 2: Hyperglycemia and ketonuria suggest uncontrolled diabetes. Step 3: Onset in a 30-year-old woman is more common in Type 1 diabetes. Step 4: Type 1 diabetes is characterized by autoimmune destruction of pancreatic beta cells leading to insulin deficiency. Step 5: Treatment for Type 1 diabetes involves insulin therapy. Summary: - Choice B (Type 2 diabetes) is less likely due to the acute presentation and ketonuria. - Choice C (Diabetes insipidus) does not involve hyperglycemia or ketonuria. - Choice D (Hyperthyroidism) does not typically present with hyperglycemia and ketonuria.

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.

Correct Answer: D

Rationale: The correct answer is D because inadequate nutrition and reduced saliva production contribute to cavities. In acute illness, the client may not be able to consume a balanced diet, leading to nutrient deficiencies that weaken teeth. Reduced saliva flow decreases the mouth's ability to naturally clean and protect teeth. Choices A, B, and C are incorrect because hormonal changes from stress do not directly lead to acidic oral environment, systemic infections do not commonly affect teeth, and lack of fluoride from intravenous hydration is not a primary factor for dental caries.

Correct Answer: C

Rationale: The correct answer is C because promoting adequate nutrition is crucial for optimal healing of mandibular fractures. Malnutrition can delay recovery and impair bone healing. The nurse should prioritize educating the client on ways to maintain a balanced diet, such as consuming foods rich in protein, vitamins, and minerals. A: Resumption of activities of daily living is important, but nutrition is more critical for healing. B: Pain control is essential, but ensuring proper nutrition is a higher priority for optimal recovery. D: Strategies for promoting adequate nutrition is redundant and less specific compared to the correct answer.