Nursing Elites

1. A client with a history of tuberculosis (TB) is experiencing a recurrence of symptoms. Which diagnostic test should the nurse anticipate being ordered?

• A. Sputum culture
• B. Bronchoscopy
• C. Chest x-ray
• D. CT scan of the chest

Correct answer: C

Rationale: A chest x-ray is the most appropriate diagnostic test for a client with a history of tuberculosis experiencing a recurrence of symptoms. A chest x-ray is commonly used to visualize the lungs and check for signs of active tuberculosis, such as abnormal shadows or nodules. While a sputum culture (Choice A) can confirm the presence of TB bacteria, it may not be the initial test ordered for a recurrence. Bronchoscopy (Choice B) and CT scan of the chest (Choice D) are more invasive and usually reserved for cases where the chest x-ray is inconclusive or to further assess complications, rather than as the initial diagnostic test for a recurrence of tuberculosis.

2. A patient with a history of osteoporosis is prescribed raloxifene (Evista). What is the primary therapeutic effect of this medication?

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

Correct answer: B

Rationale: The correct answer is B. Raloxifene, such as Evista, works by decreasing bone resorption and increasing bone density. This medication is beneficial in the prevention and treatment of osteoporosis by slowing down the breakdown of bone tissue, thereby reducing the risk of fractures. Choices A, C, and D are incorrect because raloxifene does not directly stimulate the formation of new bone, increase calcium absorption in the intestines, or increase the excretion of calcium through the kidneys.

3. A patient is taking raloxifene (Evista) for osteoporosis. What is the primary therapeutic effect of this medication?

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

Correct answer: B

Rationale: The correct answer is B. Raloxifene, a selective estrogen receptor modulator (SERM), primarily works by decreasing bone resorption and increasing bone density. This mechanism of action helps in the prevention and treatment of osteoporosis by maintaining or improving bone strength. Choice A is incorrect because raloxifene does not directly stimulate the formation of new bone but rather helps in preserving existing bone. Choice C is incorrect because raloxifene does not increase the excretion of calcium through the kidneys; instead, it acts on bone tissue. Choice D is incorrect as raloxifene does not directly increase calcium absorption in the intestines but rather focuses on bone health.

4. A client presents to the emergency department with lower right quadrant abdominal pain, fever, nausea, and occasional diarrhea. After palpating the abdomen, the client displays tenderness. What would the nurse anticipate the client to be experiencing?

• A. Pseudomembranous colitis
• B. Peptic ulcer disease
• C. Appendicitis
• D. Esophageal cancer

Correct answer: C

Rationale: The correct answer is C: Appendicitis. The symptoms described - lower right quadrant abdominal pain, fever, nausea, diarrhea, and tenderness upon palpation - are classic signs of appendicitis. Appendicitis is an inflammatory condition of the appendix that often presents with these symptoms and requires immediate medical attention. Choice A, Pseudomembranous colitis, typically presents with watery diarrhea and is associated with antibiotic use. Choice B, Peptic ulcer disease, commonly presents with epigastric pain related to meals and can be accompanied by nausea or vomiting, but it does not typically cause right lower quadrant pain. Choice D, Esophageal cancer, usually presents with symptoms related to swallowing difficulties, weight loss, and sometimes chest pain, but it is not associated with the symptoms described in the scenario.

5. What specific instructions should the nurse provide for a patient starting on alendronate (Fosamax) for osteoporosis to ensure proper administration?

• A. Take the medication with a full glass of water and remain upright for at least 30 minutes.
• B. Take the medication with milk to enhance calcium absorption.
• C. Take the medication at bedtime to ensure absorption during sleep.
• D. Take the medication with food to prevent nausea.

Correct answer: A

Rationale: The correct answer is A. Alendronate should be taken with a full glass of water, and patients should remain upright for at least 30 minutes to prevent esophageal irritation and ensure proper absorption. Choice B is incorrect because alendronate should not be taken with milk, as it can interfere with its absorption. Choice C is incorrect as there is no specific instruction to take alendronate at bedtime. Choice D is incorrect because alendronate should be taken on an empty stomach, not with food, to enhance absorption.

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