Nursing Elites

1. A patient underwent fiberoptic colonoscopy 18 hours ago and presents to the emergency department with increasing abdominal pain, fever, and chills. Which of the following conditions poses the most immediate concern?

• A. Bowel perforation
• B. Viral gastroenteritis
• C. Colon cancer
• D. Diverticulitis

Correct answer: A

Rationale: The correct answer is bowel perforation. Bowel perforation is the most serious complication of fiberoptic colonoscopy, with signs such as progressive abdominal pain, fever, chills, and tachycardia indicating advancing peritonitis. Although colonoscopic perforation is rare (0.03% to 0.7% incidence), it can lead to high mortality and morbidity rates. Viral gastroenteritis (Choice B) typically presents with symptoms like diarrhea, nausea, vomiting, and abdominal cramps, but it is not the most immediate concern in this scenario. Colon cancer (Choice C) and diverticulitis (Choice D) are important conditions but are less likely to present acutely after colonoscopy compared to bowel perforation.

2. The nurse monitors a patient after chest tube placement for a hemopneumothorax. The nurse is most concerned if which assessment finding is observed?

• A. A large air leak in the water-seal chamber
• B. 400 mL of blood in the collection chamber
• C. Complaint of pain with each deep inspiration
• D. Subcutaneous emphysema at the insertion site

Correct answer: B

Rationale: The nurse should be most concerned if 400 mL of blood is observed in the collection chamber as it may indicate the patient is at risk of developing hypovolemic shock. A large air leak in the water-seal chamber is expected initially after chest tube placement for a pneumothorax. While pain with deep inspiration should be treated, it is not as urgent as the risk of continued hemorrhage. Subcutaneous emphysema is not uncommon in a patient with pneumothorax and is usually harmless. However, a large amount of blood in the collection chamber is a more critical finding that requires immediate attention to prevent potential complications.

3. Renal failure is broadly divided into specific categories. Which type is the type II diabetic patient most likely to experience secondary to diabetes?

• A. Acute renal failure (ARF)
• B. Intermittent renal failure (IRF)
• C. Chronic renal failure (CRF)
• D. Reversible renal failure (RRF)

Correct answer: C

Rationale: Diabetic nephropathy is a common complication in type II diabetic patients, leading to chronic renal failure (CRF). Chronic renal failure (CRF) and acute renal failure (ARF) are the two main categories of renal failure. CRF can result from various conditions including diabetic nephropathy, chronic glomerulonephritis, chronic pyelonephritis, polycystic kidney disease, connective tissue disorders, and amyloidosis. Unlike acute renal failure, chronic renal failure is irreversible. Timely treatment of ARF can often lead to reversibility, but CRF may require renal replacement therapy (RRT) or kidney transplant. Therefore, the correct answer is chronic renal failure (CRF). Intermittent renal failure (IRF) and reversible renal failure (RRF) are not recognized medical terms for distinct types of renal failure, making choices B and D incorrect.

4. A pregnant woman who is 36 weeks' pregnant and has hepatitis B is being informed by a nurse. Which of the following statements from the client indicates understanding of this condition?

• A. Now I know my baby will need a cesarean section.
• B. My baby will need two shots soon after birth.
• C. I will not be able to breastfeed.
• D. My baby's father does not need testing; I know I am the one with hepatitis.

Correct answer: B

Rationale: The correct answer is 'My baby will need two shots soon after birth.' A baby born to a mother with hepatitis B should receive two injections soon after birth to reduce the risk of contracting the disease. Within the first 12 hours post-birth, the baby should receive the first hepatitis B vaccine and hepatitis B immune globulin (HBIG) for additional protection. Option A is incorrect because the need for a cesarean section is not directly related to the mother's hepatitis B status. Option C is incorrect as breastfeeding can be safe if managed properly. Option D is incorrect as the baby's father should also be tested for hepatitis B to prevent transmission to the newborn.

5. An 85-year-old client is diagnosed with hypernatremia due to lack of fluid intake and dehydration. The nurse knows that symptoms of hypernatremia include:

• A. Lack of thirst
• B. Pale skin
• C. Hypertension
• D. Swollen tongue

Correct answer: D

Rationale: Hypernatremia among elderly clients can result from dehydration and insufficient fluid intake, leading to sodium levels above 145 mEq/L. Common symptoms of hypernatremia include mental status changes, a thick or swollen tongue, excessive thirst, and flushed skin. Choice A, 'Lack of thirst,' is incorrect as hypernatremia typically presents with excessive thirst. Choice B, 'Pale skin,' is not a typical symptom of hypernatremia. Choice C, 'Hypertension,' is not a direct symptom of hypernatremia and is more commonly associated with other conditions like hypertension itself.

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