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 clinical manifestations are recognized in nephrotic syndrome?

• A. Hematuria, bacteriuria, weight gain
• B. Gross hematuria, albuminuria, fever
• C. Hypertension, weight loss, proteinuria
• D. Massive proteinuria, hypoalbuminemia, edema

Correct answer: D

Rationale: Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema. In this syndrome, there is loss of proteins, particularly albumin, in the urine leading to hypoalbuminemia, fluid retention, and subsequent edema. This results in elevated lipid levels like hypercholesterolemia, but not hypertension. Therefore, choices A, B, and C are incorrect. Hematuria, bacteriuria, fever, and weight loss are not typically associated with nephrotic syndrome, distinguishing it from other kidney disorders.

3. When developing a plan of care for a 6-year-old child diagnosed with acute glomerulonephritis, which intervention should the nurse prioritize?

• A. Encourage limited activity and provide safety measures.
• B. Catheterize the child to monitor intake and output strictly.
• C. Encourage the child to talk about feelings related to illness.
• D. Encourage classmates to visit and keep the child informed of school events.

Correct answer: A

Rationale: The priority intervention for a 6-year-old child diagnosed with acute glomerulonephritis should be to encourage limited activity and provide safety measures. In glomerulonephritis, children tend to restrict their activities voluntarily due to fatigue during the active phase of the disease. Catheterization for intake and output monitoring may predispose the child to infection and is not the primary intervention. Encouraging the child to talk about feelings related to the illness may not be developmentally appropriate for a 6-year-old; instead, children can express feelings through play. It is important to limit visitors to allow the child to rest and recover rather than encouraging classmates to visit and keep the child informed of school events.

4. A client is being assessed for risks of a pressure ulcer by a healthcare professional. What is the best description of what may be found with an early pressure ulcer in an African American client?

• A. Skin has a purple/bluish color
• B. Capillary refill is 1 second
• C. Skin appears blanched at the pressure site
• D. Tenting appears when checking skin turgor

Correct answer: A

Rationale: When assessing for signs of developing pressure ulcers in a client with dark skin, traditional signs like blanching may not be evident. In individuals with darker skin tones, the skin of an early pressure ulcer may present with a purple or bluish hue. This discoloration can be a crucial indicator of compromised circulation and tissue damage. Capillary refill, blanching, and tenting are more commonly used in the assessment of skin integrity and hydration levels but may not be as reliable in individuals with darker skin tones, making the purple/bluish color a key finding in this context.

5. A child is admitted to the hospital with a diagnosis of Wilms tumor, stage II. Which of the following statements most accurately describes this stage?

• A. The tumor is less than 3 cm in size and requires no chemotherapy.
• B. The tumor did not extend beyond the kidney and was completely resected.
• C. The tumor extended beyond the kidney but was completely resected.
• D. The tumor has spread into the abdominal cavity and cannot be resected.

Correct answer: C

Rationale: In Wilms tumor staging, stage II indicates that the tumor extends beyond the kidney but is completely resected. This means that the tumor has spread beyond the kidney but has been successfully removed. Choices A and B are incorrect because a tumor less than 3 cm in size and a tumor that did not extend beyond the kidney do not align with the characteristics of stage II Wilms tumor. Choice D is also incorrect as it describes a more advanced stage where the tumor has spread into the abdominal cavity and cannot be completely resected. Therefore, the correct answer is C, as it accurately reflects the characteristics of a stage II Wilms tumor.

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