Nursing Elites

1. A client on an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is reporting intense, diffuse pain in her abdomen. Which physiologic phenomenon is most likely contributing to her complaint?

• A. Somatic pain resulting from pressure on the parietal peritoneum
• B. Referred pain from her small bowel
• C. Visceral pain resulting from distension and ischemia
• D. Neuropathic pain resulting from autonomic dysfunction

Correct answer: C

Rationale: Visceral pain is associated with distension, ischemia, and inflammation of internal organs. In the case of a small bowel obstruction, the intense, diffuse pain reported by the client is likely due to the distension and ischemia of the small bowel. Somatic pain (Choice A) would be more localized and sharp, typically arising from the parietal peritoneum. Referred pain (Choice B) is pain perceived at a site distant from the actual pathology. Neuropathic pain (Choice D) involves dysfunction or damage to the nervous system and is not typically associated with the described physiologic phenomenon of distension and ischemia in the context of a small bowel obstruction.

2. A female patient is concerned about the side effects of hormone replacement therapy (HRT). What common side effect should the nurse explain?

• A. Weight gain
• B. Hair loss
• C. Increased libido
• D. Decreased energy levels

Correct answer: A

Rationale: The correct answer is A: Weight gain. Weight gain is a common side effect of hormone replacement therapy (HRT) due to hormonal changes. Patients should be informed about this possibility as part of their treatment plan. Hair loss (Choice B) is not a common side effect of HRT. Increased libido (Choice C) and decreased energy levels (Choice D) are not typically associated with HRT side effects. Therefore, the nurse should focus on discussing weight gain with the patient.

3. Women who have breast cancer due to a BRCA1 gene mutation are usually:

• A. positive for human epidermal growth factor receptor 1 and 2.
• B. negative for estrogen receptor.
• C. positive for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2.
• D. negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2.

Correct answer: D

Rationale: Women with breast cancer due to a BRCA1 gene mutation commonly have a triple-negative breast cancer subtype, which means they are negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2). This subtype tends to be more aggressive and harder to treat. Choice A is incorrect as they are typically negative for HER2. Choice B is incorrect because they are usually negative for estrogen receptor. Choice C is incorrect as they are usually negative for progesterone receptor and HER2.

4. What condition can be caused by an excessive amount of growth hormone released by the pituitary gland in childhood?

• A. Acromegaly
• B. Gigantism
• C. Syndrome of inappropriate antidiuretic hormone
• D. Dwarfism

Correct answer: B

Rationale: Gigantism is the correct answer. It is a condition caused by excessive growth hormone release before the epiphyseal plates close, leading to abnormal growth. Acromegaly (choice A) is caused by excess growth hormone after the epiphyseal plates close, resulting in enlargement of bones and tissues. Syndrome of inappropriate antidiuretic hormone (choice C) is characterized by the excessive release of antidiuretic hormone, leading to water retention and dilutional hyponatremia. Dwarfism (choice D) is a condition characterized by significantly below-average height.

5. A patient is hospitalized due to nonadherence to an antitubercular drug treatment. Which of the following is most important for the nurse to do?

• A. Observe the patient taking the medications.
• B. Administer the medications parenterally.
• C. Instruct the family on the medication regimen.
• D. Count the number of tablets in the bottle daily.

Correct answer: A

Rationale: In this scenario, the most crucial action for the nurse to take is to observe the patient taking the medications. This ensures that the patient is actually consuming the prescribed antitubercular drugs, addressing the issue of nonadherence directly. Administering the medications parenterally (intravenously or intramuscularly) is not necessary unless there are specific medical reasons requiring this route of administration. Instructing the family on the medication regimen is important for support but may not directly address the patient's nonadherence. Counting the number of tablets in the bottle daily is not as effective as directly observing the patient taking the medications to ensure compliance.

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