Nursing Elites

1. Your patient has shown the following signs and symptoms: Feeling very thirsty, large amount of water intake, dryness of the mouth, and urinary frequency. What physical disorder does this patient most likely have?

• A. Diabetes
• B. Angina
• C. Hypertension
• D. Hypotension

Correct answer: A

Rationale: The patient is exhibiting classic signs of diabetes, such as polydipsia (feeling very thirsty), polyuria (large amount of water intake and urinary frequency), and xerostomia (dryness of the mouth). These symptoms are indicative of high blood glucose levels, which are characteristic of diabetes. Other common signs of diabetes include poor vision, unexplained weight loss, peripheral neuropathy (tingling in the feet and hands), and fatigue. Angina is chest pain due to reduced blood flow to the heart, not associated with the symptoms described in the patient. Hypertension is high blood pressure, which typically does not present with these specific symptoms related to diabetes. Hypotension is low blood pressure and is not consistent with the signs and symptoms presented by the patient, pointing more towards diabetes as the likely diagnosis.

2. A child is suspected of suffering from intussusception. The nurse should be alert to which clinical manifestation of this condition?

• A. Tender, distended abdomen
• B. Presence of fecal incontinence
• C. Incomplete development of the anus
• D. Infrequent and difficult passage of dry stools

Correct answer: A

Rationale: Intussusception is an invagination of a section of the intestine into the distal bowel, and it is the most common cause of bowel obstruction in children aged 3 months to 6 years. A tender, distended abdomen is a typical clinical manifestation of intussusception. The presence of fecal incontinence is not a characteristic presentation of intussusception; it describes encopresis, which generally affects preschool and school-aged children but is not specific to intussusception. Incomplete development of the anus describes imperforate anus, a disorder diagnosed in the neonatal period, not intussusception. The infrequent and difficult passage of dry stools is characteristic of constipation, a common issue in children that can occur at any age, although it often peaks at 2 to 3 years old.

3. A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem?

• A. Diarrhea
• B. Metabolic acidosis
• C. Metabolic alkalosis
• D. Hyperactive bowel sounds

Correct answer: C

Rationale: In the scenario of persistent vomiting, the child is at risk of developing metabolic alkalosis due to the loss of hydrochloric acid. Vomiting leads to the loss of gastric acid, resulting in an imbalance that causes metabolic alkalosis. Metabolic acidosis is incorrect as it would occur in a child with diarrhea due to the loss of bicarbonate. While diarrhea can sometimes be associated with vomiting, in this case, the primary focus is on the effects of vomiting. Hyperactive bowel sounds are not typically associated with vomiting, making this choice less relevant to the situation described.

4. A patient has taken an overdose of aspirin. Which of the following should a nurse closely monitor during acute management of this patient?

• A. Onset of pulmonary edema
• B. Metabolic alkalosis
• C. Respiratory alkalosis
• D. Parkinson's disease type symptoms

Correct answer: A

Rationale: The correct answer is to monitor the onset of pulmonary edema. In cases of aspirin overdose, metabolic acidosis is a common consequence that can lead to the development of pulmonary edema. Early signs of aspirin poisoning include symptoms like tinnitus, hyperventilation, vomiting, dehydration, and fever. Late signs may manifest as drowsiness, bizarre behavior, unsteady walking, and coma. Aspirin poisoning can cause abnormal breathing that is typically rapid and deep. Pulmonary edema may occur due to increased capillary permeability in the lungs, leading to the leakage of proteins and fluid transudation in renal and pulmonary tissues. Changes in renal tubule permeability can also affect colloid osmotic pressure, potentially contributing to pulmonary edema. Monitoring pulmonary edema is crucial in managing aspirin overdose cases to prevent further complications. Choices B, C, and D are incorrect because metabolic alkalosis, respiratory alkalosis, and Parkinson's disease type symptoms are not typically associated with aspirin overdose and are not primary concerns in its acute management.

5. A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The mother reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question to elicit data specific to this condition?

• A. Are the stools ribbon-like, and is the infant eating poorly?
• B. Does the infant suddenly become pale, begin to cry, and draw the legs up to the chest?
• C. Does the vomit contain sour, undigested food without bile, and is the infant constipated?
• D. Does the infant cry loudly and continuously during the evening hours but nurses or takes formula well?

Correct answer: C

Rationale: Vomiting undigested food that is not bile stained and constipation are classic symptoms of pyloric stenosis. Stools that are ribbon-like and a child who is eating poorly are signs of congenital megacolon (Hirschsprung's disease). An infant who suddenly becomes pale, cries out, and draws the legs up to the chest is demonstrating physical signs of intussusception. Crying during the evening hours, appearing to be in pain, eating well, and gaining weight are clinical manifestations of colic.

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