Nursing Elites

1. What is the most frequent cause for suicide in adolescents?

• A. Progressive failure to adapt
• B. Feelings of anger or hostility
• C. Reunion wish or fantasy
• D. Feelings of alienation or isolation

Correct answer: D

Rationale: Feelings of alienation or isolation are the most frequent cause for suicide in adolescents. Adolescents may experience a gradual isolation leading to a loss of meaningful social contacts, which can be self-imposed or result from an inability to express feelings. During this developmental stage, achieving a sense of identity and peer acceptance is crucial. Choices A, B, and C are incorrect: Progressive failure to adapt, feelings of anger or hostility, and reunion wish or fantasy are not typically identified as the primary cause of suicide in adolescents.

2. A patient presents to the office with a pencil that has completely penetrated the palm of her hand. Which of the following treatments would be BEST in this situation?

• A. Assist the doctor while he sedates the patient and removes the pencil from her hand.
• B. Have the patient gently pull the pencil out of her hand and assist the physician with stitches.
• C. Wrap a gauze around the pencil, securing it as much as possible until the patient can get to a local emergency room.
• D. Tell the patient to go to the local emergency room. With a doctor's order, give the patient some aspirin for the pain.

Correct answer: C

Rationale: Penetrating wounds that leave an object behind may have damaged important blood vessels. Removing the object may lead to significant bleeding. The correct approach is to gently wrap the wound with the object in place to help control bleeding and prevent further injury. The patient should be taken promptly to the nearest emergency room where healthcare professionals can safely and appropriately remove the object and provide necessary treatment. Choice A is incorrect because removing the pencil without proper medical evaluation can worsen the injury. Choice B is incorrect because pulling out the object can cause additional damage and bleeding. Choice D is incorrect because giving aspirin without knowing the extent of the injury and causing potential drug interactions can be harmful.

3. A child is diagnosed with a Greenstick Fracture. Which of the following most accurately describes the broken bone?

• A. compound fracture of the fibula
• B. a partial break in a long bone
• C. fracture of the growth plate of the ulna near the wrist
• D. Colles fracture of the tibia

Correct answer: B

Rationale: A Greenstick Fracture is commonly found in children due to their bones being more flexible. This type of fracture occurs when a bone bends and partially breaks, resembling what happens when a green stick from a tree is bent in half. Therefore, the most accurate description of a Greenstick Fracture is 'a partial break in a long bone.' Choice A, 'compound fracture of the fibula,' is incorrect as a Greenstick Fracture is not a compound fracture. Choice C, 'fracture of the growth plate of the ulna near the wrist,' is incorrect as it describes a different type of fracture. Choice D, 'Colles fracture of the tibia,' is incorrect as it refers to a specific type of fracture in a different bone.

4. A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure?

• A. Start a peripheral IV line to administer any necessary sedative drugs.
• B. Position the patient sitting upright on the edge of the bed and leaning forward.
• C. Obtain a collection device to hold a reasonable amount of pleural fluid for extraction.
• D. Remove the water pitcher and remind the patient not to eat or drink anything for 6 hours.

Correct answer: B

Rationale: The correct action for the nurse to take in preparing a patient for a thoracentesis is to position the patient sitting upright on the edge of the bed and leaning forward. This position helps fluid accumulate at the lung bases, making it easier to locate and remove. Sedation is not usually required for a thoracentesis, so starting an IV line for sedative drugs is unnecessary. Additionally, there are no restrictions on oral intake before the procedure since the patient is not sedated or unconscious. A large collection device to hold 2 to 3 liters of pleural fluid at one time is excessive as usually only 1000 to 1200 mL of pleural fluid is removed to avoid complications like hypotension, hypoxemia, or pulmonary edema. Therefore, the correct choice is to position the patient upright for the procedure.

5. A thirty-five-year-old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect?

• A. Atherosclerosis
• B. Diabetic nephropathy
• C. Autonomic neuropathy
• D. Somatic neuropathy

Correct answer: C

Rationale: In this case, the correct answer is autonomic neuropathy. Autonomic neuropathy affects the autonomic nerves, which control various bodily functions including the bladder. In diabetes, it can lead to bladder paralysis, resulting in symptoms like urgency to urinate and difficulty initiating urination. Atherosclerosis (choice A) is a condition involving the hardening and narrowing of arteries, not directly related to the inability to urinate in this context. Diabetic nephropathy (choice B) primarily affects the kidneys, leading to kidney damage, but does not typically cause urinary retention. Somatic neuropathy (choice D) involves damage to sensory nerves, not the autonomic nerves responsible for bladder control, making it less likely to be the cause of the urinary issue described in the question.

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