Nursing Elites

1. A 74-year-old woman states that many of her peers underwent hormone replacement therapy (HRT) in years past. The woman asks the nurse why her primary care provider has not yet proposed this treatment for her. What fact should underlie the nurse's response to the woman?

• A. The risks of stroke and breast cancer are unacceptably high in women taking HRT.
• B. HRT was found to cause mood disturbances in many women who used it long term.
• C. HRT was found to be a significant risk factor for bone fractures and osteoporosis.
• D. The risks of chronic obstructive pulmonary disease were found to be significantly higher in women using HRT.

Correct answer: A

Rationale: The correct answer is A because the main reason HRT is not recommended for all women is due to the increased risks of stroke and breast cancer associated with its use. Hormone replacement therapy (HRT) has been linked to an elevated risk of stroke and breast cancer, which outweigh its potential benefits for many individuals. Choices B, C, and D are incorrect as they do not address the primary concerns regarding HRT use. While HRT can indeed cause mood disturbances and may affect bone health, the significant risks of stroke and breast cancer are the primary reasons why healthcare providers may choose not to recommend HRT for some women.

2. What assessment is the nurse performing when a client is asked to stand with feet together, eyes open, and hands by the sides, and then asked to close the eyes while the nurse observes for a full minute?

• A. Romberg test
• B. Weber test
• C. Rinne test
• D. Babinski test

Correct answer: A

Rationale: The correct answer is A, Romberg test. The Romberg test is used to assess balance and proprioception. During the test, the client is asked to stand with feet together, eyes open, and hands by the sides to observe their balance. Then, the client is asked to close their eyes while the nurse continues to observe for a full minute. This test helps in detecting any issues with proprioception and balance, which may be compromised in conditions affecting the nervous system. Choices B, C, and D are incorrect because the Weber test is used to assess hearing in each ear, the Rinne test is used to compare air and bone conduction of sound, and the Babinski test is used to assess the integrity of the corticospinal tract.

3. What is the best method to identify which type of stroke the client has?

• A. Obtain a 12-lead electrocardiogram STAT
• B. Obtain a blood specimen for electrolytes and blood cultures
• C. Ask the client about current allergies
• D. Obtain a cranial computerized tomogram (CT) STAT

Correct answer: D

Rationale: The correct answer is to obtain a cranial computerized tomogram (CT) STAT. A cranial CT scan is the best method to quickly identify the type of stroke a client is experiencing. Options A, B, and C are not appropriate for identifying the type of stroke as they are not specific to assessing stroke types.

4. A family member expresses concern to a nurse about behavioral changes in an elderly aunt. Which would cause the nurse to suspect a cognitive impairment disorder?

• A. Decreased interest in activities that she once enjoyed
• B. Fear of being alone at night
• C. Increased complaints of physical ailments
• D. Problems with preparing a meal or balancing her checkbook

Correct answer: D

Rationale: The correct answer is D. Problems with tasks like meal preparation and balancing a checkbook can indicate cognitive impairment, as these activities involve cognitive functions such as memory, attention, and executive function. Choices A, B, and C are less indicative of cognitive impairment. Decreased interest in activities and increased complaints of physical ailments may be related to other factors like depression, while fear of being alone at night could be due to anxiety or other psychological issues.

5. A nurse is teaching a patient about the use of raloxifene (Evista) for the prevention of osteoporosis. What is the primary therapeutic action of this medication?

• A. It decreases the absorption of calcium from the intestines.
• B. It decreases bone resorption and increases bone density.
• C. It increases the excretion of calcium through the kidneys.
• D. It stimulates the formation of new bone.

Correct answer: B

Rationale: The correct answer is B. Raloxifene, a selective estrogen receptor modulator (SERM), works by decreasing bone resorption and increasing bone density. This action helps in preventing osteoporosis by maintaining bone strength. Choice A is incorrect as raloxifene does not affect the absorption of calcium from the intestines. Choice C is incorrect as raloxifene does not increase the excretion of calcium through the kidneys. Choice D is incorrect as raloxifene does not directly stimulate the formation of new bone; instead, it primarily works by reducing bone loss.

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