Nursing Elites

1. A female client with bone metastases secondary to lung cancer is admitted for palliative radiation treatment and pain control. The client is currently experiencing pain that she rates at 9 out of 10. Which of the following nonpharmacologic treatments is most likely to be a useful and appropriate supplement to pharmacologic analgesia at this point?

• A. Teaching the client guided imagery and meditation
• B. Initiating neurostimulation
• C. Heat therapy
• D. Relaxation and distraction

Correct answer: D

Rationale: In the scenario described, the client is experiencing high pain levels, rated at 9 out of 10. Relaxation and distraction techniques are effective nonpharmacologic interventions for managing pain. Teaching the client guided imagery and meditation (Choice A) can also be beneficial; however, in this acute situation of severe pain, relaxation and distraction techniques are more likely to provide immediate relief. Initiating neurostimulation (Choice B) and heat therapy (Choice C) may not be suitable for immediate pain relief in this scenario and are not as commonly used for managing high pain levels in palliative care settings.

2. How does influenza immunization produce immunity?

• A. The virus from the vaccine remains in the body until the end of the season
• B. An attenuated virus causes immune system suppression and triggers immunity
• C. The body identifies the virus and develops antibodies against the virus
• D. The vaccine remains in the injection site and produces immune cells

Correct answer: C

Rationale: The correct answer is C. Influenza immunization works by introducing a weakened or inactivated form of the virus into the body, allowing the immune system to recognize it as foreign. This recognition triggers the production of antibodies specific to the virus. Choice A is incorrect as the virus in the vaccine does not remain in the body until the end of the season. Choice B is incorrect as an attenuated virus does not cause immune system suppression but rather stimulates an immune response. Choice D is incorrect because the vaccine does not stay at the injection site but rather prompts a systemic immune response throughout the body.

3. Which of the following is a characteristic of disseminated intravascular coagulation (DIC)?

• A. Simultaneous stroke and heart attack
• B. Simultaneous clotting and bleeding
• C. Simultaneous clotting and insulin release
• D. Simultaneous bleeding and vomiting

Correct answer: B

Rationale: Disseminated intravascular coagulation (DIC) is characterized by simultaneous clotting and bleeding throughout the body. This imbalance in the body's clotting system leads to the formation of blood clots in small blood vessels, which can consume clotting factors and platelets, ultimately leading to excessive bleeding. Choices A, C, and D are incorrect because they do not describe the characteristic feature of DIC, which involves both clotting and bleeding.

4. What causes the appearance of a barrel chest in clients with emphysema?

• A. Peripheral edema
• B. Bacterial infections in the lungs
• C. Air trapping in the alveoli
• D. Muscle atrophy of the diaphragm

Correct answer: C

Rationale: The correct answer is C: Air trapping in the alveoli. A barrel chest in emphysema results from the hyperinflation of the lungs due to air trapping in the alveoli. This leads to increased anteroposterior diameter of the chest. Choices A, B, and D are incorrect. Peripheral edema is swelling caused by fluid retention in tissues, not associated with a barrel chest in emphysema. Bacterial infections in the lungs can lead to conditions like pneumonia but do not directly cause a barrel chest. Muscle atrophy of the diaphragm could affect breathing mechanics but is not specifically linked to the development of a barrel chest in emphysema.

5. A patient is being treated with raloxifene (Evista) for osteoporosis. What should the nurse teach the patient about this medication?

• A. It is used as a selective estrogen receptor modulator to prevent bone loss.
• B. It works by decreasing bone formation and increasing bone resorption.
• C. It should be taken with food to reduce gastrointestinal side effects.
• D. It may cause weight gain and fluid retention.

Correct answer: C

Rationale: The correct answer is C. Raloxifene is a selective estrogen receptor modulator (SERM) used to prevent bone loss. It should be taken with food to reduce gastrointestinal side effects, not on an empty stomach. Choices A and B are incorrect because raloxifene is indeed a SERM that prevents bone loss, but it does not directly work by increasing bone formation or decreasing bone resorption. Choice D is incorrect as weight gain and fluid retention are not common side effects of raloxifene.

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