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. Which of these clients is likely to receive sublingual morphine?

• A. A 75-year-old woman in a hospice program
• B. A 40-year-old man who just had throat surgery
• C. A 20-year-old woman with trigeminal neuralgia
• D. A 60-year-old man who has a painful incision

Correct answer: A

Rationale: The correct answer is a 75-year-old woman in a hospice program. Sublingual morphine is commonly used in hospice care because patients may have difficulty swallowing, and intravenous access can be uncomfortable and not ideal for palliative care. Choice B, a 40-year-old man who just had throat surgery, is less likely to receive sublingual morphine as he may be able to swallow, and other pain management options may be more suitable. Choice C, a 20-year-old woman with trigeminal neuralgia, would typically require specific medications targeting neuropathic pain rather than sublingual morphine. Choice D, a 60-year-old man with a painful incision, may benefit from localized pain relief or other systemic pain management options, but sublingual morphine is not usually the first choice for this type of pain.

3. A client is found unresponsive in his room by a nurse. The client is not breathing and does not have a pulse. After calling for help, what is the next action the nurse should take?

• A. Administer 2 ventilations
• B. Perform a head-tilt, chin lift to open the airway
• C. Begin chest compressions
• D. Perform a jaw thrust to open the airway

Correct answer: C

Rationale: After finding an unresponsive client who is not breathing and has no pulse, the nurse's immediate action should be to call for help and start chest compressions. Chest compressions should be initiated at a rate of at least 100 per minute and a depth of at least 2 inches. Choice A, administering ventilations, is not the initial step as compressions take priority. Choice B, performing a head-tilt, chin lift, is also not the first step; chest compressions are crucial before airway management. Choice D, performing a jaw thrust, is typically used in cases of suspected cervical spine injury and is not the immediate action in this scenario.

4. When auscultating the patient's lungs during a shift assessment on a patient admitted in the early phase of heart failure, which finding would the nurse most likely hear?

• A. Continuous rumbling, snoring, or rattling sounds mainly on expiration
• B. Continuous high-pitched musical sounds on inspiration and expiration
• C. Discontinuous, high-pitched sounds of short duration heard on inspiration
• D. A series of long-duration, discontinuous, low-pitched sounds during inspiration

Correct answer: C

Rationale: In the early phase of heart failure, fine crackles are likely to be heard upon auscultation of the lungs. Fine crackles are characterized as discontinuous, high-pitched sounds of short duration heard on inspiration. Rhonchi are continuous rumbling, snoring, or rattling sounds mainly on expiration, which are often associated with airway secretions. Coarse crackles are a series of long-duration, discontinuous, low-pitched sounds during inspiration, typically indicating fluid in the alveoli. Wheezes are continuous high-pitched musical sounds on inspiration and expiration, commonly heard in conditions like asthma or chronic obstructive pulmonary disease (COPD). Therefore, the correct choice is C, as it describes the expected lung sounds in a patient with early heart failure.

5. While caring for the client during the first hour after delivery, the nurse determines that the uterus is boggy and there is vaginal bleeding. What should be the nurse's first action?

• A. Check vital signs
• B. Massage the fundus
• C. Offer a bedpan
• D. Check for perineal lacerations

Correct answer: B

Rationale: Massage the fundus. The nurse's first action should be to massage the fundus until it is firm as uterine atony is the primary cause of bleeding in the first hour after delivery. Checking vital signs, offering a bedpan, or checking for perineal lacerations are important assessments but addressing the boggy uterus and vaginal bleeding due to uterine atony takes precedence in this situation.

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