Nursing Elites

1. An adolescent client has bloodshot eyes, a voracious appetite, and dry mouth. Which drug abuse would the nurse most likely suspect?

• A. Marijuana
• B. Amphetamines
• C. Barbiturates
• D. Anxiolytics

Correct answer: A

Rationale: The symptoms described, including bloodshot eyes, a voracious appetite, and dry mouth, are consistent with marijuana use. Bloodshot eyes are a common side effect of marijuana due to its effect on blood vessels in the eyes. Marijuana also often causes an increase in appetite (known as 'the munchies') and can result in dry mouth. Amphetamines typically cause symptoms like increased alertness, energy, and decreased appetite. Barbiturates and anxiolytics would not typically cause bloodshot eyes, a voracious appetite, and dry mouth as described in the scenario. Therefore, the most likely drug abuse the nurse would suspect in this case is marijuana.

2. The nurse interprets the statement “Bow down before me! I am the holy mother of Christ! I am the blessed Virgin Mary!” as important in documenting in which of the following areas of mental status examination?

• A. Thought content
• B. Mood
• C. Affect
• D. Attitude

Correct answer: C

Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.

3. A client receiving total parenteral nutrition (TPN is awaiting the next container. What fluid should the nurse infuse in the interim?

• A. Dextrose 5% in water
• B. 0.9% sodium chloride
• C. Dextrose 10% in water
• D. Lactated Ringer's solution

Correct answer: B

Rationale: The correct answer is 0.9% sodium chloride. When a client receiving TPN is awaiting the next container, infusing 0.9% sodium chloride is the appropriate choice to maintain fluid and electrolyte balance. Dextrose solutions are not recommended as they do not provide sufficient nutrition. Lactated Ringer's solution contains electrolytes but lacks essential nutrients found in TPN, making it an inadequate choice during the delay in TPN delivery.

4. What is the approximate energy value of alcohol?

• A. 3 kcal/g
• B. 7 kcal/g
• C. 10 kcal/g
• D. 25 kcal/g

Correct answer: B

Rationale: The correct answer is B: 7 kcal/g. Alcohol provides approximately 7 kilocalories per gram, making it a significant source of energy or 'empty calories' in the diet that do not contain any nutrients. 'Empty calories' refer to the calorie content without the presence of essential nutrients. Choices A, C, and D are incorrect. The energy values of 3 kcal/g, 10 kcal/g, and 25 kcal/g are not accurate for alcohol; instead, they may pertain to other nutrients such as carbohydrates (approximately 4 kcal/g), fats (approximately 9 kcal/g), and oils (approximately 9 kcal/g).

5. Which of the following is NOT a part of a process recording?

• A. Non-verbal narrative account
• B. Analysis and interpretation
• C. Audio-visual recording
• D. Verbal narrative account

Correct answer: C

Rationale: A process recording typically includes a non-verbal narrative account (Choice A), an analysis and interpretation (Choice B), and a verbal narrative account (Choice D). These components help in providing a comprehensive assessment of a patient's condition and ensuring that interventions are appropriately targeted for optimized outcomes. An audio-visual recording (Choice C), while it can be a part of some data collection processes, is not typically included in a process recording, making it the correct answer.

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