Nursing Elites

1. During surgery, the anesthesia personnel notice the client is having a steady rise in end-tidal carbon dioxide level. At this time, the nurse anesthetist begins to assess the client for malignant hyperthermia. The initial (priority) assessment for this disorder may include:

• A. measuring serum potassium levels.
• B. monitoring for muscle rigidity.
• C. evaluating renal function.
• D. checking arterial blood gases.

Correct answer: B

Rationale: The correct answer is B: monitoring for muscle rigidity. Muscle rigidity is a hallmark sign of malignant hyperthermia, a life-threatening condition triggered by certain anesthetics. Monitoring for this sign is critical in the early identification of the condition. Choices A, C, and D are not the initial priority assessments for malignant hyperthermia. Measuring serum potassium levels, evaluating renal function, and checking arterial blood gases are not specific initial assessments for malignant hyperthermia and would not aid in its early identification.

2. A 52-year-old has made an appointment with his primary care provider and has reluctantly admitted that his primary health concern is erectile dysfunction (ED). He describes the problem as increasing in severity and consequent distress. Which of the nurse's assessment questions is most likely to address a common cause of ED?

• A. “How would you describe your overall health status?”
• B. “Are you taking any medications for high blood pressure?”
• C. “How has this issue been impacting your relationship?”
• D. “Have you experienced any recent injuries?”

Correct answer: B

Rationale: In the context of erectile dysfunction (ED), medication use is a crucial factor to consider. Many medications, including those used for high blood pressure, can contribute to ED as a side effect. Asking about medication use, particularly for conditions like high blood pressure, can help identify a common cause of ED. Choices A, C, and D do not directly address potential causes related to medication use, making them less likely to reveal a common underlying issue for ED in this case.

3. During the cellular stage of acute inflammation, which type of cells arrive first and in great numbers?

• A. Basophils
• B. Lymphocytes
• C. Neutrophils
• D. Platelets

Correct answer: C

Rationale: During the cellular stage of acute inflammation, neutrophils are the first responders. Neutrophils arrive at the site of injury in large numbers to combat pathogens and remove debris. Basophils and lymphocytes are also involved in the inflammatory response, but they are not the first to arrive. Platelets play a role in hemostasis and blood clotting, rather than being the primary cells involved in the initial inflammatory response.

4. A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's questions is least likely to yield data that will confirm or rule out migraines as the cause of his problem?

• A. Does your son experience nausea or vomiting when he has a headache?
• B. Does your son have a history of recent head injury?
• C. Does your son become sensitive to light when he has a headache?
• D. Does anyone in your family have a history of migraines?

Correct answer: B

Rationale: Asking about a history of recent head injury is less likely to yield data relevant to confirming or ruling out migraines. Migraines are often associated with symptoms like nausea, vomiting, sensitivity to light, and a family history of migraines. While head injuries can cause headaches, the focus of the assessment in this case should be on symptoms more specific to migraines to guide the diagnosis and management.

5. The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which assessment question posed to the parents is likely to be most useful in the differential diagnosis?

• A. Has your child received all recommended vaccinations?
• B. Has your child been feeding poorly or showing signs of constipation?
• C. Has your child been exposed to any sick individuals?
• D. Has your child been displaying signs of respiratory distress?

Correct answer: B

Rationale: The correct answer is B. Poor feeding and constipation are common early symptoms of infant botulism, which is caused by a neurotoxin that impairs muscle function. Option A is unrelated to the presentation of botulism. Option C does not directly relate to the symptoms of botulism. Option D is more indicative of respiratory issues rather than the constellation of symptoms seen in botulism.

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