Nursing Elites

1. A 54-year-old man presents with a temperature of 38.8°C (101.8°F), a racing heart, fatigue, and an upset stomach after spending an afternoon building a deck on a very hot, humid day. The physician assessing the man is performing a differential diagnosis as part of her assessment. Which finding would suggest fever rather than hyperthermia as a cause of the elevation in the man's temperature?

• A. Absence of sweating
• B. Shivering
• C. Lack of thirst
• D. Increased heart rate

Correct answer: B

Rationale: Shivering is a physiological response to fever, as the body attempts to generate heat to increase the internal temperature. Hyperthermia, on the other hand, does not involve shivering. Absence of sweating (choice A) is more indicative of hyperthermia, as the body struggles to cool down without sweating. Lack of thirst (choice C) can be seen in both fever and hyperthermia. Increased heart rate (choice D) can occur in both fever and hyperthermia due to the body's attempt to regulate temperature.

2. The nurse is closely following a patient who began treatment with testosterone several months earlier. When assessing the patient for potential adverse effects of treatment, the nurse should prioritize which of the following assessments?

• A. Skin inspection for developing lesions
• B. Lung function testing
• C. Assessment of serum calcium levels
• D. Assessment of arterial blood gases

Correct answer: C

Rationale: In patients receiving testosterone therapy, the nurse should prioritize assessing serum calcium levels. Testosterone therapy can lead to hypercalcemia, making the evaluation of serum calcium levels crucial. Skin inspection for developing lesions, lung function testing, and arterial blood gas assessment are not the priority assessments for potential adverse effects of testosterone therapy. Skin inspection may be relevant for dermatological side effects, lung function testing and arterial blood gas assessment are not directly related to the common side effects of testosterone therapy.

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. What is the primary action of bisphosphonates when prescribed to a patient with osteoporosis?

• A. It inhibits bone resorption, which helps maintain bone density.
• B. It stimulates new bone formation by increasing osteoblast activity.
• C. It increases calcium absorption in the intestines, which helps build stronger bones.
• D. It decreases calcium excretion by the kidneys, helping to maintain bone density.

Correct answer: A

Rationale: The correct answer is A: "It inhibits bone resorption, which helps maintain bone density." Bisphosphonates work by inhibiting bone resorption carried out by osteoclasts, thereby preventing the breakdown of bones and helping to maintain or increase bone density in patients with osteoporosis. Choices B, C, and D are incorrect because bisphosphonates do not directly stimulate new bone formation, increase calcium absorption in the intestines, or decrease calcium excretion by the kidneys.

5. Which of the following is a factor that leads to increased risk for dehydration in the elderly?

• A. More insensible losses
• B. Increase in muscle mass
• C. Decline in kidney function
• D. Decrease in fat

Correct answer: C

Rationale: The correct answer is C: Decline in kidney function. As people age, their kidneys may not work as effectively in conserving water and concentrating urine, leading to a higher risk of dehydration. Choice A is incorrect because more insensible losses do not directly relate to an increased risk of dehydration in the elderly. Choice B, an increase in muscle mass, is not a factor that leads to dehydration. Choice D, a decrease in fat, is also not a direct factor contributing to dehydration in the elderly.

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