Nursing Elites

1. Which of the following are manifestations of Cushing syndrome?

• A. Truncal obesity with thin extremities.
• B. Enlargement of face, hands, and feet.
• C. Cachexia.
• D. Thick scalp hair.

Correct answer: A

Rationale: Truncal obesity with thin extremities is a classic manifestation of Cushing syndrome due to the redistribution of fat. Enlargement of face, hands, and feet is seen in conditions like acromegaly, not Cushing syndrome. Cachexia is a state of severe weight loss and muscle wasting, typically seen in conditions like cancer or advanced infections. Thick scalp hair is not typically associated with Cushing syndrome.

2. A patient with breast cancer is prescribed tamoxifen (Nolvadex). What should the nurse emphasize during patient education?

• A. Tamoxifen may increase the risk of venous thromboembolism, so patients should be aware of the signs and symptoms of blood clots.
• B. Tamoxifen may cause weight gain, so patients should monitor their diet.
• C. Tamoxifen may cause hot flashes and other menopausal symptoms.
• D. Tamoxifen may decrease the risk of osteoporosis, so patients should ensure adequate calcium intake.

Correct answer: A

Rationale: The correct answer is A. Tamoxifen increases the risk of venous thromboembolism, a serious side effect. Therefore, patients should be educated about the signs and symptoms of blood clots, such as swelling, pain, and redness in the legs, and advised to seek immediate medical attention if they occur. Choice B is incorrect because weight gain is not a significant side effect of tamoxifen. Choice C is incorrect because hot flashes and menopausal symptoms are common side effects of tamoxifen but are not as critical to address as venous thromboembolism. Choice D is incorrect because tamoxifen does not decrease the risk of osteoporosis; in fact, it may increase the risk of bone loss in premenopausal women.

3. A patient is diagnosed with type 2 diabetes mellitus. Which of the following is a common initial treatment strategy?

• A. Insulin therapy
• B. Lifestyle modification and metformin
• C. Sulfonylureas
• D. Thiazolidinediones

Correct answer: B

Rationale: The correct answer is B: Lifestyle modification and metformin. When managing type 2 diabetes mellitus, initial treatment often involves lifestyle changes such as adopting a healthy diet and increasing physical activity, along with the oral medication metformin. Insulin therapy (choice A) is usually reserved for cases where lifestyle changes and oral medications are not sufficient to control blood sugar levels. Sulfonylureas (choice C) and thiazolidinediones (choice D) are also oral medications used in diabetes management, but they are not typically recommended as first-line treatments due to various side effects and considerations in type 2 diabetes management.

4. A 17-year-old woman has come to the clinic requesting emergency contraception after having unprotected sex 24 hours ago. What medication is the clinician most likely to prescribe?

• A. Levonorgestrel (Plan B)
• B. Mifepristone (RU-486)
• C. Ulipristal acetate (ella)
• D. Estradiol (Estrace)

Correct answer: A

Rationale: The correct answer is A: Levonorgestrel (Plan B). Levonorgestrel is the most commonly prescribed medication for emergency contraception within 72 hours of unprotected intercourse. It is effective when taken within 72 hours after intercourse, with better efficacy the sooner it is taken. Choice B, Mifepristone (RU-486), is not indicated for emergency contraception but is used for medical abortion. Choice C, Ulipristal acetate (ella), is another option for emergency contraception that is effective up to 120 hours after unprotected intercourse. Choice D, Estradiol (Estrace), is not used for emergency contraception.

5. While planning care for an elderly patient, the nurse remembers that increased age is associated with:

• A. Increased T cell function
• B. Increased immune function
• C. Increased production of antibodies
• D. Increased levels of circulating autoantibodies

Correct answer: D

Rationale: As individuals age, their immune function tends to decrease, making them more susceptible to infections and diseases. Additionally, increased age is associated with higher levels of circulating autoantibodies, which can lead to autoimmune conditions. Choice A is incorrect as aging is not typically associated with increased T cell function. Choice C is also incorrect as aging does not necessarily result in increased production of antibodies. Therefore, the correct answers are B (Decreased immune function) and D (Increased levels of circulating autoantibodies).

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