Nursing Elites

1. A 62-year-old female is being seen on a home visit by a nurse. The patient reports she has been taking Premarin for years. Which of the following would indicate an overdose?

• A. Lower extremity edema
• B. Sensory changes in the upper extremities
• C. Increased occurrence of fractures
• D. Decreased peripheral blood flow

Correct answer: A

Rationale: Lower extremity edema can indicate an overdose of Premarin. Premarin, an estrogen hormone replacement therapy, can cause fluid retention leading to edema in the lower extremities. Sensory changes in the upper extremities, increased occurrence of fractures, and decreased peripheral blood flow are not typically associated with an overdose of Premarin.

2. Which of the following should not be included in the teaching for clients who take oral iron preparations?

• A. Mix the liquid iron preparation with antacids to reduce GI distress.
• B. Take the iron with meals if GI distress occurs.
• C. Liquid forms should be taken with a straw to avoid discoloration of tooth enamel.
• D. Oral forms should be taken with juice, not milk.

Correct answer: A

Rationale: The correct answer is to mix the liquid iron preparation with antacids to reduce GI distress. This statement is incorrect because iron should not be mixed with antacids as it can significantly reduce the absorption of iron. Choice B is a good recommendation as taking iron with meals can help reduce gastrointestinal distress. Choice C is also correct as liquid forms of iron should be taken with a straw to prevent the discoloration of tooth enamel. Choice D is incorrect as iron preparations can be taken with juice or water, but not with milk, as calcium in milk can inhibit iron absorption.

3. The client develops a tension pneumothorax. Assessment is expected to reveal?

• A. Sudden hypertension and bradycardia
• B. Productive cough with yellow mucus
• C. Tracheal deviation and dyspnea
• D. Sudden development of profuse hemoptysis and weakness

Correct answer: C

Rationale: In a tension pneumothorax, the trachea deviates to the unaffected side due to increased pressure in the affected pleural space, causing respiratory distress. Dyspnea is a hallmark symptom as the lung on the affected side collapses, leading to difficulty in breathing. Sudden hypertension and bradycardia (Choice A) are not typical findings of tension pneumothorax. Productive cough with yellow mucus (Choice B) is more suggestive of respiratory infections rather than a tension pneumothorax. Sudden development of profuse hemoptysis and weakness (Choice D) is not characteristic of tension pneumothorax presentation.

4. What type of cells create exocrine secretions?

• A. alpha cells
• B. beta cells
• C. acinar cells
• D. plasma cells

Correct answer: C

Rationale: Acinar cells are responsible for creating exocrine secretions, such as enzymes and digestive juices. Alpha cells are found in the pancreas and are responsible for producing glucagon, beta cells produce insulin, and plasma cells are a type of white blood cell involved in immune responses. Therefore, the correct answer is acinar cells, as they specifically produce exocrine secretions.

5. The factor that most determines drug distribution is:

• A. vascular perfusion of the tissue or organ.
• B. salt form.
• C. drug interactions.
• D. steady state.

Correct answer: A

Rationale: The correct answer is 'vascular perfusion of the tissue or organ.' Drug distribution is primarily determined by how well the circulatory system delivers the drug to various tissues and organs. Adequate perfusion ensures proper distribution of the drug throughout the body. While the salt form (choice B), drug interactions (choice C), and steady state (choice D) can influence drug efficacy and metabolism, they are not as crucial as vascular perfusion for the initial distribution of a drug.

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