A patient presents with a thyroid nodule and signs of hyperthyroidism. Fine-needle aspiration biopsy reveals granulomatous inflammation and multinucleated giant cells. Which endocrine disorder is most likely responsible for these symptoms?

Correct Answer: C

Rationale: Subacute thyroiditis is an inflammatory disorder of the thyroid gland that causes gland destruction and release of pre-formed thyroid hormone leading to hyperthyroidism. The fine-needle aspiration biopsy findings of granulomatous inflammation and multinucleated giant cells are characteristic of subacute thyroiditis. This condition typically presents with a painful, tender thyroid gland and may be preceded by a viral illness. Unlike Graves' disease, which is an autoimmune disorder resulting in hyperthyroidism with diffuse goiter and positive thyroid stimulating immunoglobulins, subacute thyroiditis is typically self-limited and resolves spontaneously without the need for long-term treatment.

Correct Answer: C

Rationale: Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia characterized by wide QRS complexes and absence of P waves on electrocardiogram (ECG). Patients with VT may present with symptoms such as chest pain, dyspnea, and syncope due to reduced cardiac output and ineffective pumping of the heart. VT is a serious condition that requires prompt treatment to prevent hemodynamic compromise and potential cardiac arrest. Stable angina typically presents with chest pain that is provoked by exertion and relieved by rest or nitroglycerin. Atrial fibrillation is characterized by an irregularly irregular rhythm with absent P waves on ECG. Supraventricular tachycardia typically presents with a narrow QRS complex on ECG.

Correct Answer: C

Rationale: In this situation, the most appropriate response for the palliative nurse is to validate the patient's feelings of guilt and offer support to address their concerns. It is important to acknowledge the patient's emotions and help them navigate through their guilt in a compassionate and understanding manner. By validating their feelings, the nurse can create a safe space for the patient to express their concerns and work towards finding solutions to alleviate their guilt. This approach fosters trust and a therapeutic relationship between the patient and the nurse, ultimately promoting emotional well-being and facilitating open communication.

Correct Answer: C

Rationale: The most appropriate intervention for a patient with end-stage dementia experiencing agitation and restlessness is to create a calm and soothing environment to promote relaxation. Patients with dementia often respond positively to a familiar and tranquil setting, which can help reduce their symptoms of agitation and restlessness. This approach is preferred over administering antipsychotic medications or recommending physical exercise, as these may not be feasible or beneficial for patients in the advanced stages of dementia. Referring the patient to a psychiatrist may not address the immediate need for symptom management and can be considered if other interventions are ineffective. Creating a calm environment, such as dim lighting, soft music, and familiar objects, can help provide comfort and reduce distress for the patient.

Correct Answer: A

Rationale: The most appropriate intervention for managing hepatic encephalopathy in this patient receiving palliative care for end-stage liver disease is to administer lactulose or other ammonia-lowering agents to reduce ammonia levels. Hepatic encephalopathy is believed to be primarily caused by the accumulation of ammonia in the bloodstream due to compromised liver function. Lactulose works by acidifying the gut lumen, which facilitates the excretion of ammonia in the form of ammonium ions. By reducing ammonia levels, hepatic encephalopathy symptoms, such as confusion and altered mental status, can be improved. Initiating other supportive measures like managing precipitating factors, maintaining hydration, and addressing nutritional issues should also be part of the holistic approach in managing hepatic encephalopathy in palliative care. However, addressing the underlying cause by reducing ammonia levels with lactulose is the priority intervention in this scenario.