A patient presents with central obesity, moon face, buffalo hump, and purple striae. Laboratory tests reveal elevated cortisol levels. Which endocrine disorder is most likely responsible for these symptoms?

Correct Answer: D

Rationale: The patient's presentation of central obesity, moon face, buffalo hump, purple striae, and elevated cortisol levels strongly suggest Cushing's syndrome. Cushing's syndrome is a disorder characterized by excessive levels of cortisol, either due to an endogenous (e.g., adrenal tumor) or exogenous (e.g., prolonged steroid use) source. The classic physical features of Cushing's syndrome include central obesity with thin extremities (truncal obesity), moon face (rounding and reddening of the face), buffalo hump (accumulation of fat between the shoulders), and purple striae (stretch marks that are wide and purple in color). In the context of the elevated cortisol levels, these clinical signs are highly indicative of Cushing's syndrome. Hyperthyroidism, hypothyroidism, and diabetes mellitus would not typically present with the specific combination of symptoms described.

Correct Answer: C

Rationale: The patient's presentation of thyroid nodule with compression symptoms like difficulty swallowing and breathing, along with fine-needle aspiration biopsy showing a follicular pattern and colloid-filled spaces, is highly suggestive of a follicular adenoma. Follicular adenomas are benign thyroid tumors that can cause compression symptoms due to their growth and size, leading to pressure on surrounding structures in the neck area. The presence of colloid-filled spaces in the biopsy is characteristic of follicular adenomas.

Correct Answer: B

Rationale: The patient's presenting symptoms of chest pain worsened by inspiration and relieved by sitting forward, with associated DVT in the lower extremity, suggest a high likelihood of pulmonary embolism. Chest pain that worsens with inspiration due to pleuritic involvement is a classic symptom of pulmonary embolism. Additionally, the presence of DVT in the lower extremity represents a risk factor for the development of pulmonary embolism, as clots originating in the deep veins can travel to the pulmonary circulation to cause an obstruction. Patients with pulmonary embolism may also exhibit signs of right heart strain, such as tachycardia, tachypnea, and sometimes hemoptysis.

Correct Answer: C

Rationale: Chest pain, dyspnea, hypotension, and ST-segment elevation on an ECG in the inferior leads are classic signs of an acute myocardial infarction (MI). An acute MI occurs when there is a sudden blockage of blood flow to a part of the heart muscle, leading to tissue damage. This causes symptoms such as chest pain due to ischemia, dyspnea due to heart failure, and hypotension due to poor cardiac output. The ST-segment elevation seen on the ECG is indicative of significant myocardial injury. Prompt diagnosis and management are crucial in acute MI to prevent further complications and to minimize damage to the heart muscle. It is important to differentiate an acute MI from stable or unstable angina or other cardiovascular disorders, as the management and prognosis vary significantly.

Correct Answer: B

Rationale: When a patient receiving palliative care for end-stage cancer experiences severe nausea and vomiting despite current antiemetic therapy, the palliative nurse should consider switching to a different antiemetic medication with a different mechanism of action. This approach is based on the concept of individual variability in response to medications, as well as the potential development of tolerance to a particular drug. Switching to a different antiemetic with a new mechanism of action can provide the patient with a fresh chance at better symptom control by targeting different receptors or pathways involved in nausea and vomiting. It is important to consult the healthcare team and consider the patient's overall condition and medication history before making any changes in the treatment plan.