Nursing Elites

1. A 24-year-old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely suspect?

• A. Diverticulosis
• B. Hypercalcemia
• C. Hypocalcemia
• D. Irritable bowel syndrome

Correct answer: B

Rationale: The correct answer is Hypercalcemia. In this case, the patient's history of myeloma, constipation, intense abdominal pain, and polyuria suggests hypercalcemia. Elevated calcium levels can lead to polyuria, severe abdominal pain, and confusion. Diverticulosis (Choice A), characterized by small pouches in the colon wall, typically does not present with confusion and polyuria. Hypocalcemia (Choice C) is unlikely given the symptoms described. Irritable bowel syndrome (Choice D) does not typically cause confusion and polyuria as seen in hypercalcemia.

2. The child with hemolytic-uremic syndrome is anuric and will undergo peritoneal dialysis. Which measure should the nurse implement?

• A. Restrict fluids as prescribed.
• B. Care for the arteriovenous fistula.
• C. Encourage foods high in potassium.
• D. Administer analgesics as prescribed.

Correct answer: A

Rationale: In hemolytic-uremic syndrome, often associated with bacterial toxins and viruses, acute kidney injury occurs in children, leading to symptoms like anemia, thrombocytopenia, renal injury, and CNS symptoms. For an anuric child with hemolytic-uremic syndrome undergoing peritoneal dialysis, fluid restriction is vital to prevent fluid overload. Pain management is not directly related to hemolytic-uremic syndrome. Foods high in potassium should be limited, not encouraged, due to impaired kidney function. Peritoneal dialysis does not involve an arteriovenous fistula, which is specific to hemodialysis.

3. A patient is admitted to the emergency department with an open stab wound to the left chest. What is the first action that the nurse should take?

• A. Position the patient so that the left chest is dependent
• B. Tape a nonporous dressing on three sides over the chest wound
• C. Cover the sucking chest wound firmly with an occlusive dressing
• D. Keep the head of the patient's bed at no more than 30 degrees elevation

Correct answer: B

Rationale: The correct initial action for a patient with an open stab wound to the chest is to tape a nonporous dressing on three sides over the chest wound. This dressing technique allows air to escape during expiration but prevents air from entering the pleural space during inspiration, helping to prevent tension pneumothorax. Placing the patient so that the left chest is dependent or covering the wound with an occlusive dressing can trap air in the pleural space, leading to tension pneumothorax. Keeping the head of the bed elevated at 30 to 45 degrees helps facilitate breathing and is not the first action to take when managing an open chest wound.

4. The nurse is writing out discharge instructions for the parents of a child diagnosed with celiac disease. The nurse should focus primarily on which aspect of care?

• A. Restricting activity
• B. Following a gluten-free diet
• C. Following a lactose-free diet
• D. Giving medication to manage the condition

Correct answer: B

Rationale: The primary nursing consideration in the care of a child with celiac disease is to instruct the child and parents about proper dietary management. The cornerstone of managing celiac disease is maintaining a strict gluten-free diet to prevent symptoms and long-term complications. While medications may be part of the treatment plan, dietary adjustments, particularly following a gluten-free diet, are crucial for managing the condition effectively. Restricting activity is not the primary focus of care for celiac disease. A lactose-free diet is not typically necessary unless the child also has lactose intolerance, which is distinct from celiac disease.

5. The healthcare provider assesses a patient suspected of having an asthma attack. Which of the following is a common clinical manifestation of this condition?

• A. Audible crackles and orthopnea
• B. An audible wheeze and use of accessory muscles
• C. Audible crackles and use of accessory muscles
• D. Audible wheeze and orthopnea

Correct answer: B

Rationale: Choice B, 'An audible wheeze and use of accessory muscles,' is the correct answer. In asthma, patients commonly present with wheezing due to airway constriction and the use of accessory muscles to aid in breathing. Audible crackles (rales) are more commonly associated with conditions like pneumonia, congestive heart failure, or pulmonary fibrosis. Orthopnea, which is difficulty breathing while lying flat, is typically seen in conditions like heart failure or chronic obstructive pulmonary disease, rather than asthma. Choice C is incorrect as crackles are not a typical finding in asthma. Choice D is incorrect as orthopnea is not a common clinical manifestation of asthma.

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