Nursing Elites

1. A 65-year-old man is prescribed Flomax (Tamsulosin) for Benign Prostatic Hyperplasia. The patient lives in an upstairs apartment. The nurse is most concerned about which side effect of Flomax?

• A. Hypotension
• B. Tachycardia
• C. Back Pain
• D. Difficulty Urinating

Correct answer: A

Rationale: The correct answer is 'Hypotension.' Flomax (Tamsulosin) is known to cause orthostatic hypotension, especially in the elderly, leading to a sudden drop in blood pressure when standing up. This side effect can result in dizziness, falls, and injury, especially concerning for a patient living in an upstairs apartment. Tachycardia (increased heart rate) and back pain are less commonly associated with Flomax use, while difficulty urinating is a symptom that Flomax is intended to improve in patients with Benign Prostatic Hyperplasia.

2. A patient is deciding whether they should take the live influenza vaccine (nasal spray) or the inactivated influenza vaccine (shot). The nurse reviews the client's history. Which condition would NOT contraindicate the nasal (live vaccine) route of administration?

• A. The patient takes long-term corticosteroids
• B. The patient is not feeling well today
• C. The patient is 55 years old
• D. The patient has young children

Correct answer: D

Rationale: The correct answer is that the patient has young children. Having young children is not a contraindication for the live influenza vaccine unless the children are immunocompromised, which is not mentioned. Choice A, the patient taking long-term corticosteroids, is a contraindication for the live vaccine due to potential immunosuppression. Choice B, the patient not feeling well today, is a general precaution for vaccination and not a contraindication specific to the live influenza vaccine. Choice C, the patient being 55 years old, is not a contraindication for the live vaccine unless there are other specific medical conditions present.

3. Which of the following patients is at the greatest risk for a stroke?

• A. A 60-year-old male who weighs 270 pounds, has atrial fibrillation, and has had a TIA in the past
• B. A 75-year-old male who has frequent migraines, drinks a glass of wine every day, and is Hispanic
• C. A 40-year-old female who has high cholesterol and uses oral contraceptives
• D. A 65-year-old female who is African American, has sickle cell disease, and smokes cigarettes

Correct answer: A

Rationale: The correct answer is the 60-year-old male who has a combination of significant risk factors for stroke, including atrial fibrillation, a history of a transient ischemic attack (TIA), and obesity. These factors greatly increase his risk of stroke. While other choices may have some individual risk factors, they do not collectively pose as high a risk as the patient described in option A. Option B includes migraines and alcohol consumption but lacks other major risk factors seen in option A. Option C mentions high cholesterol and oral contraceptives, which are risk factors but not as significant as atrial fibrillation and a prior TIA. Option D includes smoking and sickle cell disease but lacks the crucial risk factors present in option A.

4. When assessing the respiratory system of an older patient, which finding indicates that the nurse should take immediate action?

• A. Weak cough effort
• B. Barrel-shaped chest
• C. Dry mucous membranes
• D. Bilateral crackles at lung bases

Correct answer: D

Rationale: Bilateral crackles at lung bases indicate a potential acute issue like heart failure. Immediate action is necessary in this situation. The nurse should conduct further assessments such as oxygen saturation and inform the healthcare provider promptly. A barrel-shaped chest and hyperresonance to percussion are typical signs of aging and do not require immediate action. A weak cough effort is common in older patients due to age-related changes, and dry mucous membranes are also expected in older individuals. While these findings may warrant further evaluation, they do not demand immediate action like bilateral crackles at lung bases.

5. Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy?

• A. Ask the patient to extend both arms forward.
• B. Request that the patient walk with eyes closed.
• C. Ask the patient to perform the Valsalva maneuver.
• D. Observe the patient's breathing pattern.

Correct answer: B

Rationale: To evaluate treatment effectiveness for a patient with hepatic encephalopathy, requesting the patient to walk with eyes closed is crucial. This test assesses the patient's balance, gait, and coordination, which can be impaired in hepatic encephalopathy due to altered mental status and brain function. Walking with eyes closed challenges the patient's sensory input and proprioception, providing valuable information on improvement or deterioration in neurological function. Asking the patient to extend both arms forward is used to check for asterixis, a sign often seen in hepatic encephalopathy, but it is not specific for evaluating treatment effectiveness. Performing the Valsalva maneuver is unrelated to assessing hepatic encephalopathy and is more commonly used in cardiac evaluations. Observing the patient's breathing pattern may be important in other conditions but is not directly relevant to evaluating treatment effectiveness for hepatic encephalopathy.

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