Nursing Elites

1. During your evaluation of a 14-year-old girl with a BMI of 18, she reports inability to eat, induced vomiting, and severe constipation. Which of the following would you most likely suspect?

• A. Multiple sclerosis
• B. Anorexia nervosa
• C. Bulimia nervosa
• D. Systemic sclerosis

Correct answer: B

Rationale: The clinical presentation described in the question is highly suggestive of anorexia nervosa. Anorexia nervosa is characterized by self-imposed starvation due to a distorted body image and an intense fear of gaining weight, even when the individual is underweight. The patient's symptoms of inability to eat, induced vomiting, and severe constipation align with the behavior seen in anorexia nervosa, including restrictive eating patterns and purging behaviors. Multiple sclerosis (Choice A) is a neurological disorder, not associated with the described symptoms. Bulimia nervosa (Choice C) typically involves binge eating followed by purging behaviors, which is different from the described primary restriction seen in anorexia nervosa. Systemic sclerosis (Choice D) is a connective tissue disorder and is not related to the symptoms of self-induced vomiting and severe constipation reported in this case.

2. The patient in the emergency room has a history of alprazolam (Xanax) abuse and abruptly stopped taking Xanax about 24 hours ago. He presents with visible tremors, pacing, fear, impaired concentration, and memory. Which intervention takes priority?

• A. Have the patient lie down on a stretcher with bed rails raised
• B. Offer the patient a cup of water and a small amount of food
• C. Reassure the patient about his well-being
• D. Inform the physician about the patient's Xanax withdrawal

Correct answer: A

Rationale: The 1-4 day period after Xanax withdrawal is critical as it poses the highest risk of life-threatening seizures. Alprazolam is a benzodiazepine, and sudden cessation can lead to severe withdrawal symptoms. The patient's visible tremors, fear, pacing, and cognitive impairment indicate a state of heightened distress and potential seizure risk. Placing the patient on a stretcher with raised bed rails is essential for seizure precautions, ensuring safety and preventing injury during a potential seizure. Offering water and food, reassuring the patient, or informing the physician about Xanax withdrawal are not immediate priorities compared to managing the risk of seizures in this high-risk situation.

3. 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.

4. A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse recognizes that this condition most frequently follows which type of infection?

• A. Trichomoniasis
• B. Chlamydia
• C. Staphylococcus
• D. Streptococcus

Correct answer: B

Rationale: Chlamydial infections are one of the most common causes of salpingitis or pelvic inflammatory disease. Chlamydia can ascend from the vagina or cervix to the reproductive organs, leading to inflammation and infection. Trichomoniasis, caused by a parasite, typically presents with different symptoms than pelvic inflammatory disease and is not the primary cause. Staphylococcus and Streptococcus are bacteria that can cause other types of infections but are not the primary culprits in most cases of pelvic inflammatory disease.

5. A 1-year-old child is diagnosed with intussusception, and the mother of the child asks the student nurse to describe the disorder. Which statement by the student nurse indicates correct understanding of this disorder?

• A. It is an acute bowel obstruction.
• B. It is a condition that causes an acute inflammatory process in the bowel.
• C. It is a condition in which a distal segment of the bowel prolapses into a proximal segment of the bowel.
• D. It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel.

Correct answer: D

Rationale: Intussusception is a condition in which a proximal segment of the bowel telescopes or prolapses into a distal segment of the bowel. This leads to bowel obstruction and potential ischemia. It is not an acute bowel obstruction, as the obstruction is caused by the telescoping of bowel segments rather than a blockage in the bowel lumen. Intussusception is not primarily an inflammatory process; instead, it is a mechanical issue involving bowel invagination. Choice A is incorrect as it does not accurately describe the pathophysiology of intussusception. Choice C is incorrect because it presents the opposite scenario of what happens in intussusception.

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