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. What important information should the nurse provide about the risks associated with tamoxifen (Nolvadex) for a patient with a history of breast cancer?

• 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 may increase the risk of venous thromboembolism. Patients on tamoxifen should be educated about the signs and symptoms of blood clots. Choices B, C, and D are incorrect. Tamoxifen does not decrease the risk of osteoporosis; it may cause hot flashes and other menopausal symptoms, and it may cause weight gain and fluid retention.

3. A client with chronic obstructive pulmonary disease (COPD) is admitted to the hospital for pneumonia. Which intervention should the nurse prioritize?

• A. Administer bronchodilators as prescribed.
• B. Monitor oxygen saturation levels continuously.
• C. Administer intravenous antibiotics as prescribed.
• D. Provide respiratory therapy treatments as needed.

Correct answer: C

Rationale: Administering IV antibiotics is crucial for treating pneumonia in a client with COPD. Pneumonia is an infection of the lungs that requires prompt antibiotic therapy to prevent complications and improve outcomes. While bronchodilators may help with COPD symptoms, in the case of pneumonia, addressing the infection is the priority. Continuous monitoring of oxygen saturation is important, but administering antibiotics to treat the underlying infection takes precedence. Respiratory therapy treatments can be beneficial, but they are not the initial priority when managing pneumonia in a client with COPD.

4. A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's questions is least likely to yield data that will confirm or rule out migraines as the cause of his problem?

• A. Does your son have a family history of migraines?
• B. When your son has a headache, does he ever have nausea and vomiting as well?
• C. Does your son have any food allergies that have been identified?
• D. Is your son generally pain-free during the intervals between headaches?

Correct answer: C

Rationale: The correct answer is C. In assessing a child for migraines, asking about food allergies is least likely to yield data that will confirm or rule out migraines as the cause of his headaches. Food allergies are unrelated to the typical symptoms and triggers of migraines, such as family history, associated symptoms like nausea and vomiting, and pain-free intervals between headaches. Therefore, in this scenario, focusing on food allergies is less relevant for identifying migraines as the cause of the boy's headaches.

5. 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.

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