Nursing Elites

1. A client with amyotrophic lateral sclerosis (ALS) is admitted to the hospital. Which intervention should the nurse include in the plan of care?

• A. Administer muscle relaxants as prescribed.
• B. Assist the client with activities of daily living (ADLs).
• C. Provide nutritional support to prevent aspiration.
• D. Encourage the client to participate in physical therapy.

Correct answer: C

Rationale: The correct intervention for a client with ALS is to provide nutritional support to prevent aspiration. ALS causes muscle weakness, including the muscles used for swallowing, increasing the risk of aspiration. Providing proper nutrition and support can help prevent this complication. Administering muscle relaxants (Choice A) may not be suitable for ALS as it can further weaken muscles. While assisting with ADLs (Choice B) and encouraging physical therapy (Choice D) are important aspects of care, the priority for a client with ALS is to prevent complications related to swallowing and nutrition.

2. A patient with a history of breast cancer is being prescribed tamoxifen (Nolvadex). What should the nurse include in the patient education?

• A. Tamoxifen may increase the risk of venous thromboembolism.
• B. Tamoxifen may decrease the risk of osteoporosis.
• C. Tamoxifen may cause hot flashes and other menopausal symptoms.
• D. Tamoxifen may cause weight gain and fluid retention.

Correct answer: A

Rationale: The correct answer is A. Tamoxifen increases the risk of venous thromboembolism. Patients should be educated about signs and symptoms of blood clots, such as swelling, pain, or redness in the legs. Choices B, C, and D are incorrect because tamoxifen is not associated with decreasing the risk of osteoporosis, causing hot flashes and menopausal symptoms, or causing weight gain and fluid retention.

3. An oncology nurse is providing care for an adult patient who is currently immunocompromised. The nurse is aware of the physiology involved in hematopoiesis and immune function, including the salient role of cytokines. What is the primary role of cytokines in maintaining homeostasis?

• A. Cytokines perform phagocytosis in response to bacterial and protozoal infections.
• B. Cytokines perform a regulatory role in the development of diverse blood cells.
• C. Cytokines play a significant role in the formation of all blood cells.
• D. Cytokines are produced in response to the presence of antibodies.

Correct answer: B

Rationale: The primary role of cytokines in maintaining homeostasis is to perform a regulatory function in the development of diverse blood cells. Cytokines act as signaling molecules that regulate the immune response and hematopoiesis. Choice A is incorrect because cytokines do not perform phagocytosis; they regulate immune responses. Choice C is incorrect because while cytokines are involved in the formation of some blood cells, they are not considered the basic 'building blocks' of all blood cells. Choice D is incorrect because cytokines are not formed in response to antibodies, but rather play a role in the immune response to various stimuli.

4. Which patient is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)?

• A. A patient who has experienced a spinal cord injury and reports severe, burning pain in his legs.
• B. A patient who reports severe pain in her hand following a surgery for carpal tunnel syndrome.
• C. A patient who develops pain in his foot following a fracture and immobilization with a cast.
• D. A patient who experiences chronic pain and swelling in his arm following a brachial plexus injury.

Correct answer: D

Rationale: Complex regional pain syndrome II (CRPS II) typically occurs after an injury to a peripheral nerve. In this case, a brachial plexus injury involves damage to the nerves that control muscles in the arm and hand, leading to chronic pain and swelling. Choices A, B, and C describe pain related to other conditions such as spinal cord injury, carpal tunnel surgery, and fracture immobilization, which are not typically associated with CRPS II.

5. A male patient with hypogonadism is receiving testosterone therapy. What is the most serious adverse effect the nurse should monitor for?

• A. Increased risk of breast cancer
• B. Increased risk of cardiovascular events
• C. Increased risk of liver dysfunction
• D. Increased risk of prostate cancer

Correct answer: B

Rationale: The correct answer is B: Increased risk of cardiovascular events. Testosterone therapy can lead to an increased risk of cardiovascular events such as heart attacks and strokes, especially in older patients. Monitoring for signs and symptoms of cardiovascular issues is crucial when administering testosterone therapy. Choices A, C, and D are incorrect because testosterone therapy does not typically lead to an increased risk of breast cancer, liver dysfunction, or prostate cancer.

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