Nursing Elites

1. A patient with benign prostatic hyperplasia (BPH) is prescribed finasteride (Proscar). What outcome should the nurse expect if the medication is effective?

• A. Decreased urinary frequency and urgency
• B. Increased prostate size
• C. Increased blood pressure
• D. Decreased blood pressure

Correct answer: A

Rationale: The correct answer is A: Decreased urinary frequency and urgency. Finasteride is used to reduce the size of the prostate gland in patients with BPH. As a result, when the medication is effective, the patient should experience a decrease in urinary frequency and urgency. Choices B, C, and D are incorrect. Choice B is inaccurate because finasteride aims to reduce prostate size, not increase it. Choices C and D are unrelated to the action of finasteride in treating BPH.

2. What symptoms would the nurse expect to see in a client with chronic obstructive pulmonary disease (COPD)?

• A. Dyspnea on exertion
• B. Normal lung sounds
• C. Normal arterial blood gases
• D. Onset of the disease during young adulthood

Correct answer: A

Rationale: The correct answer is A: Dyspnea on exertion. COPD typically manifests with symptoms like dyspnea on exertion due to impaired lung function. This symptom is a result of the airways being obstructed and the lungs not being able to expel air effectively. Choices B and C are incorrect because in COPD, abnormal lung sounds such as wheezing, crackles, or diminished breath sounds are often heard upon auscultation, and arterial blood gases are usually abnormal, showing low oxygen levels and high carbon dioxide levels. Choice D is incorrect as COPD is more commonly diagnosed in individuals over 40 who have a history of smoking or exposure to lung irritants.

3. A client with diabetes mellitus has just undergone a right, below-the-knee amputation following gangrene infection. A few days after the amputation, the client confides in the nurse that he still feels his right foot. Knowing the pathophysiologic principles behind this, the nurse can:

• A. administer a psychotropic medication to help the client cope with the sensation of his amputated leg.
• B. explain that many amputees have this sensation and that one theory surmises the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site.
• C. call the physician and request an order for a psychological consult.
• D. educate the client that this area has an unusually abnormal increase in sensitivity to sensation but that it will go away with time.

Correct answer: B

Rationale: The correct answer is B. The sensation of feeling the amputated limb is known as phantom limb pain, which is common after amputation. One theory suggests that it occurs because the end of a regenerating nerve becomes trapped in the scar tissue at the amputation site. Administering psychotropic medication (choice A) is not the first-line treatment for phantom limb pain. Requesting a psychological consult (choice C) is premature without first addressing the known pathophysiological basis of phantom limb pain. Educating the client that the sensitivity will go away with time (choice D) is not entirely accurate as phantom limb pain can persist long-term.

4. A 55-year-old man presents with a history of fatigue, weight loss, and night sweats. He reports recent onset of a productive cough and hemoptysis. Which condition should the nurse suspect?

• A. Lung cancer
• B. Pneumonia
• C. Tuberculosis
• D. Pulmonary embolism

Correct answer: C

Rationale: The correct answer is C: Tuberculosis. The symptoms described - fatigue, weight loss, night sweats, productive cough, and hemoptysis - are classic manifestations of tuberculosis. Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, commonly affecting the lungs but can also involve other organs. **Choice A: Lung cancer** typically presents with symptoms like persistent cough, chest pain, and shortness of breath, but it is less likely in this case due to the presence of hemoptysis. **Choice B: Pneumonia** can present with productive cough, fever, and chest pain, but it is less likely given the chronicity of symptoms and the presence of hemoptysis. **Choice D: Pulmonary embolism** usually presents with sudden onset shortness of breath, chest pain, and can be associated with risk factors like recent surgery or immobility.

5. Which of the following nonpharmacologic treatments is most likely to be a useful and appropriate supplement to pharmacologic analgesia at this point?

• A. Cognitive-behavioral therapy
• B. Cold and heat application
• C. Therapeutic ultrasound
• D. Biofeedback

Correct answer: B

Rationale: The correct answer is B: Cold and heat application. Cold and heat application are commonly used nonpharmacologic methods for managing pain and can complement pharmacologic treatments. Cold packs can help reduce inflammation and numb localized areas, while heat application can increase blood flow and relax muscles. Cognitive-behavioral therapy (A) focuses on changing negative thought patterns and behaviors to manage pain but may not directly supplement pharmacologic analgesia. Therapeutic ultrasound (C) uses sound waves to generate heat within body tissues, which can be therapeutic, but it may not be as directly complementary to pharmacologic analgesia as cold and heat application. Biofeedback (D) involves using electronic devices to help individuals control physiological processes, but its direct role as a supplement to pharmacologic analgesia may be less pronounced compared to cold and heat application.

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