Nursing Elites

1. A nurse at an outpatient clinic is returning phone calls that have been made to the clinic. Which of the following calls should have the highest priority for medical intervention?

• A. A home health patient reports, "I am starting to have a breakdown of my heels."?
• B. A patient that received an upper extremity cast yesterday reports, "I can't feel my fingers in my right hand today."?
• C. A young female reports, 'I think I sprained my ankle about 2 weeks ago.'
• D. A middle-aged patient reports, 'My knee is still hurting from the TKR.'

Correct answer: B

Rationale: The correct answer is the patient who received an upper extremity cast yesterday and reports not being able to feel their fingers in the right hand. This situation indicates a potential neurovascular issue that requires immediate attention to prevent complications. The other options are of lesser priority: A - Breakdown of the heels, while concerning, is not an acute issue that necessitates immediate intervention. C - An ankle sprain that occurred two weeks ago is now subacute and unlikely to be an urgent medical concern. D - Pain in the knee following a total knee replacement (TKR) is common in the early postoperative period and is not unexpected.

2. In the Emergency Department (ED), which client should the nurse see first?

• A. COPD client with a non-productive cough
• B. Diabetic client who has an infected sore on the foot
• C. Client with adrenal insufficiency who feels weak
• D. Client with a fracture of the forearm in an air splint

Correct answer: C

Rationale: In the Emergency Department, the priority is to assess and manage clients based on the urgency of their conditions. A client with adrenal insufficiency presenting with weakness should be seen first as this could indicate a state of shock, which requires immediate attention to stabilize the client's condition. Weakness in adrenal insufficiency can progress rapidly to a life-threatening adrenal crisis. Choice A, a COPD client with a non-productive cough, may need treatment but is not immediately life-threatening. Choice B, a diabetic client with an infected sore on the foot, requires timely care to prevent complications but can generally wait for evaluation compared to the potential urgency of adrenal insufficiency. Choice D, a client with a fracture of the forearm in an air splint, is important but not as time-sensitive as a client potentially in shock.

3. Which of the following procedures describes an opening between the colon and abdominal wall?

• A. ileostomy
• B. jejunostomy
• C. colostomy
• D. cecostomy

Correct answer: C

Rationale: A colostomy is an opening between the colon and abdominal wall. An ileostomy is an opening between the ileum and abdominal wall, not the colon. Jejunostomy is an opening between the jejunum and abdominal wall, and cecostomy is an opening into the cecum. The term 'colostomy' specifically refers to the surgical procedure where a part of the colon is brought through the abdominal wall to create a stoma, allowing feces to leave the body. Therefore, the correct answer is colostomy as it accurately describes the opening between the colon and the abdominal wall, distinct from the other options.

4. The anemias most often associated with pregnancy are:

• A. folic acid and iron deficiency.
• B. folic acid deficiency and thalassemia.
• C. iron deficiency and thalassemia.
• D. thalassemia and B12 deficiency.

Correct answer: B

Rationale: Folic acid and iron deficiency anemia are the most common types of anemia associated with pregnancy. Approximately 50% of pregnant women experience this type of anemia. Iron deficiency anemia during pregnancy typically results from the increased plasma volume, rather than a decrease in iron levels. Moreover, if a woman has iron deficiency anemia before pregnancy, it often worsens during pregnancy. Folic acid deficiency is also prevalent during pregnancy due to the increased demand for this nutrient to support fetal development. Thalassemia and B12 deficiency, while types of anemia, are not as commonly associated with pregnancy compared to folic acid and iron deficiency anemia, making them incorrect choices in this context.

5. The charge nurse on a cardiac unit tells you a patient is exhibiting signs of right-sided heart failure. Which of the following would not indicate right-sided heart failure?

• A. Muscle tetany
• B. Syncope
• C. Numbness
• D. Anxiety

Correct answer: D

Rationale: The correct answer is 'Anxiety.' Anxiety is not a typical sign of right-sided heart failure. Right-sided heart failure usually presents with symptoms such as muscle tetany, syncope, and numbness. Muscle tetany can occur due to electrolyte imbalances seen in heart failure. Syncope can result from decreased cardiac output, leading to decreased perfusion to the brain. Numbness can occur due to poor circulation. While anxiety can be present in patients with various medical conditions, it is more commonly associated with respiratory acidosis or other psychological factors rather than right-sided heart failure.

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