Nursing Elites

1. Based on the information given, which patient would be an appropriate candidate for a closed MRI without contrast?

• A. A 20-year-old woman with unexplained joint pain and a low BMI.
• B. A 35-year-old woman with Multiple Sclerosis who is trying to conceive.
• C. A 67-year-old man who had open-heart surgery 4 years ago.
• D. A 40-year-old woman in a hypomanic state for the last 2 days.

Correct answer: A

Rationale: The correct answer is the 20-year-old woman with unexplained joint pain and a low BMI. MRI can be used to diagnose musculoskeletal disorders, and this patient has no contraindications to an MRI. Choice B is incorrect because using MRI without contrast may not be ideal for a patient trying to conceive. Choice C is incorrect as the patient's past open-heart surgery may pose risks for an MRI without contrast. Choice D is incorrect since the patient's hypomanic state does not indicate a need for an MRI without contrast for joint pain.

2. During the admission assessment of a client with chronic bilateral glaucoma, which statement by the client would the nurse anticipate due to this condition?

• A. "I have constant blurred vision."?
• B. "I can't see on my left side."?
• C. "I have to turn my head to see my room."?
• D. "I have specks floating in my eyes."?

Correct answer: C

Rationale: In chronic bilateral glaucoma, peripheral visual field loss occurs due to elevated intraocular pressure, leading to the need to turn the head to compensate for the visual field deficit. This symptom is characteristic of advanced glaucoma. Choice A is incorrect as constant blurred vision is a common symptom but not specific to peripheral vision loss in glaucoma. Choice B is incorrect because specific visual field deficits are more common than complete loss on one side. Choice D is incorrect as seeing floaters (specks floating in the eyes) is associated with other eye conditions like posterior vitreous detachment, not glaucoma.

3. What is the primary nursing concern when caring for patients being treated with splints, casts, or traction?

• A. To assess for and prevent neurovascular complications or dysfunction
• B. To ensure adequate nutrition during the healing process
• C. To provide patient education for maintenance of splints, casts, or traction in the community
• D. To treat acute pain

Correct answer: A

Rationale: The primary nursing concern when caring for patients with splints, casts, or traction is to assess for and prevent neurovascular complications or dysfunction. This is crucial to ensure adequate circulation and nerve function, preventing long-term complications such as ischemia or nerve damage. While adequate nutrition and patient education are important aspects of care, they are not the primary concern in this scenario. Acute pain management is important but is secondary to preventing neurovascular complications in patients treated with splints, casts, or traction.

4. A patient underwent fiberoptic colonoscopy 18 hours ago and presents to the emergency department with increasing abdominal pain, fever, and chills. Which of the following conditions poses the most immediate concern?

• A. Bowel perforation
• B. Viral gastroenteritis
• C. Colon cancer
• D. Diverticulitis

Correct answer: A

Rationale: The correct answer is bowel perforation. Bowel perforation is the most serious complication of fiberoptic colonoscopy, with signs such as progressive abdominal pain, fever, chills, and tachycardia indicating advancing peritonitis. Although colonoscopic perforation is rare (0.03% to 0.7% incidence), it can lead to high mortality and morbidity rates. Viral gastroenteritis (Choice B) typically presents with symptoms like diarrhea, nausea, vomiting, and abdominal cramps, but it is not the most immediate concern in this scenario. Colon cancer (Choice C) and diverticulitis (Choice D) are important conditions but are less likely to present acutely after colonoscopy compared to bowel perforation.

5. The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions?

• A. I will call the doctor if I still feel tired after a week.
• B. I will continue to do the deep breathing and coughing exercises at home.
• C. I will continue to do the deep breathing and coughing exercises at home.
• D. I'll cancel my chest x-ray appointment if Im feeling better in a couple weeks

Correct answer: C

Rationale: Patients should continue to cough and deep breathe after discharge. Fatigue is expected for several weeks. The Pneumovax and influenza vaccines can be given at the same time in different arms. Explain that a follow-up chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia.

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