Nursing Elites

1. A child presents to the emergency department with colicky abdominal pain in the lower right quadrant. What disorder is suspected based on these symptoms?

• A. Peritonitis
• B. Appendicitis
• C. Intussusception
• D. Hirschsprung's disease

Correct answer: B

Rationale: The child's presentation of colicky abdominal pain in the lower right quadrant is classic for appendicitis. Appendicitis typically presents with localized pain that starts near the umbilicus and then shifts to the right lower quadrant. Peritonitis, on the other hand, is characterized by diffuse abdominal pain, tenderness, and guarding, usually resulting from organ perforation or intestinal obstruction. Intussusception is associated with acute, severe abdominal pain and currant jelly-like stools due to intestinal telescoping. Hirschsprung's disease, which lacks ganglion cells in the colon, manifests with symptoms like constipation, abdominal distension, and foul-smelling, ribbon-like stools.

2. Which assessment finding is of most concern for a 46-year-old woman with acute pancreatitis?

• A. Absent bowel sounds
• B. Abdominal tenderness
• C. Left upper quadrant pain
• D. Palpable abdominal mass

Correct answer: D

Rationale: The correct answer is a palpable abdominal mass. In a 46-year-old woman with acute pancreatitis, a palpable abdominal mass may indicate the presence of a pancreatic abscess, which requires rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common symptoms in acute pancreatitis but do not necessarily indicate an immediate need for surgical intervention. Therefore, the presence of a palpable abdominal mass is the most concerning finding in this scenario.

3. A child is seen in the emergency department for scarlet fever. Which of the following descriptions of scarlet fever is not correct?

• A. Scarlet fever is caused by infection with group A Streptococcus bacteria.
• B. "Strawberry tongue"? is a characteristic sign.
• C. Petechiae occur on the soft palate.
• D. The pharynx is red and swollen.

Correct answer: C

Rationale: Petechiae on the soft palate are not a typical finding in scarlet fever. Scarlet fever is caused by group A Streptococcus bacteria, often presenting with a strawberry tongue, red and swollen pharynx, and a sandpaper-like rash. The presence of petechiae on the soft palate is more commonly associated with conditions like rubella rather than scarlet fever. Therefore, this description is not correct in the context of scarlet fever.

4. Claudication is a well-known effect of peripheral vascular disease. Which of the following facts about claudication is correct? Select the one that doesn't apply:

• A. It results when oxygen demand is greater than oxygen supply.
• B. It is characterized by pain that often occurs during rest.
• C. It is a result of tissue hypoxia.
• D. It is characterized by cramping and weakness.

Correct answer: D

Rationale: Claudication is a symptom of peripheral vascular disease where there is an inadequate supply of oxygen to the muscles due to reduced blood flow. This mismatch between oxygen demand and supply leads to tissue hypoxia, resulting in cramping, weakness, and discomfort. Option D correctly states that claudication is characterized by cramping and weakness, making it the correct answer. Options A, B, and C are incorrect. Claudication occurs when oxygen demand exceeds supply, not the other way around as stated in Option A. Pain in claudication typically occurs with activity, not at rest as mentioned in Option B. While tissue hypoxia is a consequence of claudication, it is not the primary cause, making Option C incorrect.

5. 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.

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