Nursing Elites

1. Which of the following disorders is more likely associated with blood in stool?

• A. Gastroesophageal reflux
• B. Crohn's disease
• C. Irritable bowel syndrome
• D. Colon cancer

Correct answer: D

Rationale: Colon cancer is more likely associated with blood in stool due to the presence of bleeding from the tumor in the colon. Gastroesophageal reflux (Choice A) typically presents with heartburn and regurgitation but not blood in stool. Crohn's disease (Choice B) can cause gastrointestinal symptoms, but bloody stools are more commonly associated with ulcerative colitis. Irritable bowel syndrome (Choice C) is characterized by abdominal pain, bloating, and changes in bowel habits, but it does not typically cause blood in stool. Therefore, the correct answer is D, Colon cancer.

2. A patient who is being administered isoniazid (INH) for tuberculosis has a yellow color in the sclera of her eye. What other finding would lead you to believe that hepatotoxicity has developed?

• A. Diarrhea
• B. Numbness
• C. Diminished vision
• D. Light-colored stools

Correct answer: A

Rationale: The correct answer is A: Diarrhea. Hepatotoxicity caused by isoniazid can present with various symptoms, including yellow discoloration of the sclera of the eyes, which indicates jaundice. Another common sign of hepatotoxicity is gastrointestinal symptoms such as nausea, vomiting, and diarrhea, which can occur due to liver dysfunction affecting bile production and digestion. Numbness (choice B) is more commonly associated with peripheral neuropathy caused by isoniazid, while diminished vision (choice C) and light-colored stools (choice D) are not typical manifestations of hepatotoxicity.

3. A patient with a history of venous thromboembolism is prescribed hormone replacement therapy (HRT). What should the nurse discuss with the patient regarding the risks of HRT?

• A. HRT is associated with an increased risk of venous thromboembolism, so the patient should be aware of the signs and symptoms of blood clots.
• B. HRT can decrease the risk of osteoporosis, but the patient should also be aware of the increased risk of venous thromboembolism.
• C. HRT may increase the risk of breast cancer, so the patient should undergo regular breast exams.
• D. HRT can improve mood and energy levels, but it also carries a risk of cardiovascular events.

Correct answer: A

Rationale: The correct answer is A. Hormone replacement therapy (HRT) is indeed associated with an increased risk of venous thromboembolism. Therefore, patients should be educated about the signs and symptoms of blood clots and advised to seek immediate medical attention if they occur. Choice B is incorrect because although HRT may decrease the risk of osteoporosis, the focus of concern in this case is the increased risk of venous thromboembolism. Choice C is incorrect as it mentions the risk of breast cancer, which is not the primary concern when discussing HRT with a patient with a history of venous thromboembolism. Choice D is also incorrect as it mentions cardiovascular events, which are not the main focus of risk associated with HRT in this scenario.

4. During admission, 82-year-old Mr. Robeson is brought to the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client’s daughter best supports the diagnosis?

• A. “Maybe it’s just caused by aging. This usually happens by age 82.”
• B. “The changes in his behavior came on so quickly! I wasn’t sure what was happening.”
• C. “Dad just didn’t seem to know what he was doing. He would forget what he had for breakfast.”
• D. “Dad has always been so independent. He’s lived alone for years since mom died.”

Correct answer: B

Rationale: The correct answer is B because sudden onset of behavioral changes is a typical symptom of delirium. Delirium is characterized by an acute and fluctuating disturbance in attention, awareness, and cognition. Choice A is incorrect because delirium is not a normal part of aging. Choice C describes memory issues, which can be seen in delirium but are less specific than sudden behavioral changes. Choice D, while it mentions the patient's independence, does not directly support the diagnosis of delirium.

5. When starting on oral contraceptives, what should the nurse include in the education regarding the timing of the medication?

• A. Oral contraceptives should be taken at the same time each day to maintain stable hormone levels and prevent pregnancy.
• B. Oral contraceptives can be taken at any time of day, as long as the schedule is consistent.
• C. Oral contraceptives should be taken in the morning to avoid nighttime side effects.
• D. Oral contraceptives are effective immediately upon starting, regardless of timing.

Correct answer: A

Rationale: When educating a patient starting on oral contraceptives, it is essential to stress the importance of taking the medication at the same time each day. This ensures stable hormone levels, improving the effectiveness of the contraceptives in preventing pregnancy. Choice B is incorrect because consistency in timing is crucial for maintaining hormone levels. Choice C is incorrect as there is no specific requirement to take oral contraceptives in the morning to avoid side effects. Choice D is incorrect as oral contraceptives may take some time to become fully effective, and consistent timing is important for their efficacy.

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