Nursing Elites

1. 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.

2. 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.

3. If the client's dorsal columns are not functioning, the nurse will observe which response during neuro testing, where the nurse asks the client to close his eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points?

• A. The client will not be able to distinguish between the two points.
• B. The client will feel only one point of contact.
• C. The client will accurately identify both points.
• D. The client will report no sensation in the touched areas.

Correct answer: A

Rationale: If the client's dorsal columns are not functioning, the ability to distinguish between two closely spaced points is impaired. This results in the client not being able to differentiate between the two points when touched simultaneously. Choice B is incorrect because the client feeling only one point suggests an intact dorsal column function. Choice C is incorrect as accurately identifying both points indicates normal discrimination ability. Choice D is incorrect as reporting no sensation does not correspond to the specific impairment related to dorsal column dysfunction.

4. A client is admitted with a suspected aortic dissection. What is the priority nursing intervention?

• A. Administer antihypertensive medications as prescribed.
• B. Prepare the client for emergency surgery.
• C. Administer intravenous fluids to maintain blood pressure.
• D. Monitor the client's urine output closely.

Correct answer: B

Rationale: The correct answer is B: Prepare the client for emergency surgery. Aortic dissection is a life-threatening emergency that often necessitates immediate surgical intervention to prevent rupture and further complications. Administering antihypertensive medications (choice A) may be necessary but is not the priority over surgical intervention. While maintaining blood pressure with intravenous fluids (choice C) is important, the urgent need for surgery takes precedence. Monitoring urine output (choice D) is essential for assessing renal function but is not the priority in this critical situation.

5. A patient receiving isoniazid (INH) and rifampin (Rifadin) has a decreased urinary output and decreased sensation in his great toes. Which laboratory values should be assessed?

• A. Hematocrit and hemoglobin
• B. ALT and AST
• C. Urine culture and sensitivity
• D. Erythrocyte count and differential

Correct answer: C

Rationale: In a patient receiving isoniazid (INH) and rifampin (Rifadin) with symptoms of decreased urinary output and decreased sensation in great toes, assessing urine culture and sensitivity is crucial. These symptoms could indicate peripheral neuropathy, a known side effect of isoniazid, and rifampin can cause renal toxicity. Checking for any urinary tract infection or drug-induced nephrotoxicity is important. Choices A, B, and D are incorrect as they do not directly address the symptoms presented by the patient or the potential side effects of the medications mentioned.

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