Nursing Elites

1. During a petit mal seizure in the clinic, what should be the highest priority?

• A. Provide a safe environment free of obstructions in the immediate area
• B. Call a code
• C. Contact the patient’s physician
• D. Prevent excessive movement of the extremities

Correct answer: Provide a safe environment free of obstructions in the immediate area

Rationale: During a petit mal seizure, the highest priority is to provide a safe environment free of obstructions in the immediate area. This action aims to prevent injuries to the patient during the seizure. While calling a code or contacting the patient’s physician may be necessary at some point, immediate safety measures take precedence. Preventing excessive movement of the extremities is relevant but ensuring a safe environment is crucial to avoid harm during the seizure.

2. In a client with asthma who develops respiratory acidosis, what should the nurse expect the client’s serum potassium level to be?

• A. normal
• B. elevated
• C. low
• D. unrelated to the pH

Correct answer: elevated

Rationale: In respiratory acidosis, the serum potassium level is expected to be elevated. This occurs because potassium shifts from cells into the bloodstream as a compensatory mechanism to maintain acid-base balance. Choices A, C, and D are incorrect. A normal potassium level is not expected in respiratory acidosis. A low potassium level is more commonly associated with alkalosis, not acidosis. The potassium level is indeed related to pH changes in respiratory acidosis, leading to the expected elevation.

3. What is pica?

• A. dependency on alcohol
• B. increased iron in the diet
• C. the sickle cell trait
• D. eating ice

Correct answer: eating ice

Rationale: Pica is a disorder characterized by the ingestion of nonfood substances, which can lead to a clinical iron deficiency. It may be the first sign of an underlying issue. Individuals with pica consume a variety of nonfood items such as ice, clay, dirt, or paste. Choice A, dependency on alcohol, is incorrect as it is not related to pica. Choice B, increased iron in the diet, is incorrect because pica involves ingesting nonfood items rather than having an increased intake of iron. Choice C, the sickle cell trait, is unrelated to pica and is therefore incorrect.

4. Which factor in a client’s health history increases their risk for cancer?

• A. Family history and environment
• B. Alcohol and smoking
• C. Alcohol consumption and smoking
• D. Proximity to an electric plant and water source

Correct answer: B

Rationale: The correct answer is 'Alcohol and smoking.' Both alcohol consumption and smoking are well-known risk factors for various types of cancer. They have a synergistic effect, meaning their combined impact raises the risk significantly. Family history and environment (Choice A) may play a role in certain cancers, but alcohol and smoking are more directly linked to increased cancer risk. Proximity to an electric plant and water source (Choice D) is not typically associated with an increased risk of cancer compared to alcohol and smoking.

5. A patient has suffered a left CVA and developed severe hemiparesis resulting in a loss of mobility. The nurse notices on assessment that an area over the patient’s left elbow appears as non-blanchable erythema, and the skin is intact. The nurse should score the patient as having which of the following?

• A. Stage I pressure ulcer
• B. Stage II pressure ulcer
• C. Stage III pressure ulcer
• D. Stage IV pressure ulcer

Correct answer: Stage I pressure ulcer

Rationale: Erythema with the skin intact is characteristic of a Stage I pressure ulcer. At this stage, the skin is not broken, but there is localized redness that does not blanch when pressed. Stage II pressure ulcers involve partial-thickness skin loss, Stage III pressure ulcers have full-thickness skin loss, and Stage IV pressure ulcers extend to deeper tissues, including muscle and bone. In this case, the non-blanchable erythema with intact skin aligns with the characteristics of a Stage I pressure ulcer.

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