Nursing Elites

1. A 60-year-old male patient presents with severe and persistent pain in his left leg and hip that worsens with activity. After further evaluation, the patient is diagnosed with osteosarcoma. Which of the following is true about osteosarcoma?

• A. It is more common in children and young adults.
• B. Early diagnosis improves the prognosis.
• C. It is frequently located in the leg bones.
• D. All of the above are true.

Correct answer: D

Rationale: Osteosarcoma is a type of bone cancer that can be found in any bone but is most commonly located in the long bones of the legs. While it is more prevalent in children and young adults, it can also occur in older individuals like the 60-year-old male patient in this case. Early diagnosis is crucial for a better prognosis in osteosarcoma cases. Therefore, all the statements provided are true regarding osteosarcoma, making option D the correct answer. Option A is accurate as osteosarcoma is more common in children and young adults. Option B is correct as early diagnosis improves the prognosis. Option C is accurate as osteosarcoma is frequently located in the leg bones.

2. A patient with a history of breast cancer is prescribed tamoxifen (Nolvadex). What critical information should the nurse include in the patient education?

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

Correct answer: A

Rationale: Tamoxifen increases the risk of venous thromboembolism, so patients should be educated about the signs and symptoms of blood clots and the importance of seeking immediate medical attention if they occur.

3. A group of prison inmates developed tuberculosis following exposure to an infected inmate. On examination, tissues were soft and granular (like clumped cheese). Which of the following is the most likely cause?

• A. Coagulative necrosis
• B. Liquefactive necrosis
• C. Caseous necrosis
• D. Autonecrosis

Correct answer: C

Rationale: The correct answer is C. Caseous necrosis is characteristic of tuberculosis, where the tissue has a soft, cheese-like appearance. Coagulative necrosis involves protein denaturation, liquefactive necrosis is seen in brain infarcts and abscesses, and autonecrosis is not a recognized term in pathology, making them incorrect choices in this scenario.

4. The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which assessment question posed to the parents is likely to be most useful in the differential diagnosis?

• A. Have you ever given your child any honey or honey-containing products?
• B. Is there any family history of neuromuscular diseases?
• C. Has your baby ever been directly exposed to any chemical cleaning products?
• D. Is there any mold in your home that you know of?

Correct answer: A

Rationale: The correct answer is A. Botulism in infants is often linked to honey consumption. Asking the parents if they have ever given their child any honey or honey-containing products can provide crucial information for the differential diagnosis. This is important because infant botulism is commonly associated with the ingestion of honey contaminated with Clostridium botulinum spores. Choices B, C, and D are less relevant to botulism in infants as they do not directly relate to the typical causes of the condition. Family history of neuromuscular diseases (choice B) may be important for other conditions but not specifically for infant botulism. Direct exposure to chemical cleaning products (choice C) and the presence of mold in the home (choice D) are not typical risk factors for infant botulism.

5. A nurse on a postsurgical unit is providing care for a 76-year-old female client who is two days post-hemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which guideline should the nurse use for short-term and long-term treatment of the client's pain?

• A. Pain is what the client says it is, even if she is not exhibiting outward signs.
• B. Pain should be treated only when it is associated with observable symptoms.
• C. Long-term opioid use is generally safe for elderly clients in a hospital setting.
• D. The client's pain should be reassessed after every dose of pain medication.

Correct answer: A

Rationale: Pain is a subjective experience, and the client's report of pain should be taken seriously even if there are no outward signs. Choice B is incorrect because pain can be present without observable symptoms, and waiting for observable signs may delay appropriate pain management. Choice C is incorrect because the safety of long-term opioid use in elderly clients is a complex issue and should be carefully evaluated due to the risk of adverse effects. Choice D is incorrect because while pain reassessment is important, it should not be limited to just after medication administration but should occur regularly to ensure adequate pain control.

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