Nursing Elites

1. A patient with a history of osteoporosis is prescribed alendronate (Fosamax). What specific instructions should the nurse provide to ensure the effectiveness of the medication?

• A. Take the medication with a full glass of water and remain upright for at least 30 minutes to prevent esophageal irritation and ensure proper absorption.
• 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. This positioning helps reduce the risk of esophageal irritation and ensures adequate drug absorption. Choice B is incorrect because alendronate should be taken with water, not milk. Choice C is incorrect as there is no specific advantage to taking alendronate at bedtime. Choice D is incorrect because taking alendronate with food may interfere with its absorption.

2. A patient with a history of venous thromboembolism is being considered for hormone replacement therapy (HRT). What should the nurse discuss with the patient regarding the risks of HRT?

• A. Discuss the potential for increased bone density.
• B. Discuss the potential for an increased risk of cardiovascular events.
• C. Discuss the potential for a reduced risk of breast cancer.
• D. Discuss the potential for improved mood and energy levels.

Correct answer: B

Rationale: The correct answer is B because hormone replacement therapy (HRT) is associated with an increased risk of cardiovascular events, including venous thromboembolism. Patients with a history of venous thromboembolism are at higher risk, so discussing this potential risk is crucial. Choice A, increased bone density, is not a major risk of HRT. Choice C, reduced risk of breast cancer, is not a common discussion point regarding HRT risks. Choice D, improved mood and energy levels, is more related to the benefits of HRT rather than its risks.

3. A patient suffers from an autoimmune disorder. Which of the following represents a potential result of a viral infection in a patient with an autoimmune disorder?

• A. Lymphocytes recognize the host's tissue as foreign.
• B. Erythrocytes destroy the T cells of the host.
• C. The involution of the thymus gland increases the risk of infection.
• D. The differential decreases the sedimentation rate.

Correct answer: A

Rationale: In a patient with an autoimmune disorder, a viral infection can trigger an immune response where lymphocytes mistakenly recognize the host's tissue as foreign. This can lead to an exacerbation of the autoimmune condition. Choice B is incorrect because erythrocytes are not responsible for destroying T cells. Choice C is incorrect as thymus involution weakens the immune response, making the patient more susceptible to infections rather than increasing the infection risk. Choice D is unrelated to the potential effects of a viral infection in a patient with an autoimmune disorder.

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. The nurse is preparing to administer a vaccine to a newborn. Before administering the vaccine, the nurse should

• A. warm the vaccine to room temperature.
• B. gently cleanse the chosen injection site.
• C. check the infant's temperature.
• D. administer the full dose at a single injection site.

Correct answer: C

Rationale: Before administering a vaccine to a newborn, it is essential for the nurse to check the infant's temperature. This is important to ensure that the newborn does not have a fever, which could indicate an underlying infection or illness. Warming the vaccine to room temperature is not necessary and could be harmful. Vigorously massaging the injection site is not recommended as it can cause discomfort and tissue damage. Dividing the dose for administration to three injection sites is not standard practice for vaccine administration to a newborn.

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