During a home visit, the nurse should evaluate the adequacy of a client's COPD treatment by assessing for which primary symptom?

Correct Answer: A

Rationale: The correct answer is A: Dyspnea. Dyspnea is a primary symptom of COPD due to impaired airflow. Assessing dyspnea helps determine the effectiveness of COPD treatment. Tachycardia (B) may occur but is not a primary symptom. Unilateral diminished breath sounds (C) suggest other conditions, not COPD. Edema of the ankles (D) is more indicative of heart failure.

Correct Answer: A

Rationale: The most likely diagnosis is A: Hypothyroidism. High TSH and low free T4 levels indicate primary hypothyroidism. Elevated TSH is a compensatory response by the pituitary gland to stimulate the thyroid to produce more thyroid hormones, but the thyroid gland is unable to do so effectively, resulting in low free T4 levels. Fatigue, weight gain, and constipation are classic symptoms of hypothyroidism. - B: Hyperthyroidism is characterized by low TSH and high free T4 levels, opposite of the lab results presented. - C: Thyroiditis may initially present with high or low thyroid hormone levels, but the combination of high TSH and low free T4 levels is more indicative of hypothyroidism. - D: Thyroid cancer typically does not cause abnormal thyroid hormone levels; it is more commonly associated with thyroid nodules or masses.

Correct Answer: C

Rationale: The most likely diagnosis in this case is pancreatic cancer (Choice C) based on the constellation of symptoms including weight loss, jaundice, palpable mass in the right upper quadrant, and elevated bilirubin and alkaline phosphatase levels. These findings are indicative of a pancreatic head mass causing obstruction of the common bile duct, leading to jaundice and elevated liver enzymes. Gallstones (Choice A) typically present with colicky pain, not a palpable mass. Hepatitis (Choice B) would present with different liver enzyme patterns and usually lacks a palpable mass. Primary biliary cirrhosis (Choice D) typically presents with pruritus and fatigue, not a palpable mass and jaundice.

Correct Answer: A

Rationale: The correct answer is A: Hypothyroidism. The patient's symptoms of fatigue, weight gain, and cold intolerance are classic signs of hypothyroidism. Elevated TSH and low free T4 levels indicate primary hypothyroidism. TSH is high due to the pituitary gland trying to stimulate the thyroid gland to produce more thyroid hormones, but the thyroid gland is unable to do so. Hyperthyroidism (choice B) would present with opposite symptoms and lab values. Thyroiditis (choice C) typically presents with transient hyperthyroidism followed by hypothyroidism. Thyroid cancer (choice D) is less common and typically does not present with these typical hypothyroid symptoms and lab findings.

Correct Answer: D

Rationale: The correct answer is D: Crohn's disease flare. Given the patient's history of Crohn's disease, symptoms of abdominal pain, diarrhea, weight loss, and abnormal lab findings (low hemoglobin, elevated ESR) are indicative of a flare-up of Crohn's disease. This is supported by the clinical presentation and the lab results. Ulcerative colitis (A) presents differently with rectal bleeding and mucous diarrhea. Irritable bowel syndrome (B) does not typically cause weight loss or abnormal lab findings. Celiac disease (C) would present with malabsorption symptoms and specific antibodies, not consistent with this patient's presentation. Crohn's disease flare (D) is the most likely diagnosis based on the information provided.