Nursing Elites

1. A patient with hypogonadism is being treated with testosterone gel. What application instructions should the nurse provide?

• A. Apply the gel to the face and neck for maximum absorption.
• B. Apply the gel to the chest or upper arms and allow it to dry completely before dressing.
• C. Apply the gel to the genitals for improved results.
• D. Apply the gel to the scalp and back.

Correct answer: B

Rationale: The correct answer is B. Testosterone gel should be applied to the chest or upper arms and allowed to dry completely before dressing to avoid transfer to others. Applying the gel to the face, neck, genitals, scalp, or back is not recommended as these areas may lead to unintentional transfer to others, inappropriate absorption, or potential side effects. Choice A is incorrect as applying the gel to the face and neck can lead to unwanted transfer. Choice C is incorrect as applying the gel to the genitals is not the recommended site for application. Choice D is incorrect as the scalp and back are not appropriate sites for applying testosterone gel.

2. A hospital client is at a high risk of developing bacterial endocarditis. Which of the following prophylactic measures is likely to be most effective?

• A. Avoiding exposure to individuals known to carry the streptococcus bacterium
• B. Daily administration of low-dose corticosteroids
• C. Prophylactic antimicrobial therapy before any invasive procedure
• D. Routine vaccinations against meningococcal and pneumococcal infections

Correct answer: C

Rationale: Prophylactic antimicrobial therapy before any invasive procedure is the most effective measure in preventing bacterial endocarditis in at-risk individuals. This measure helps to reduce the risk of bacterial infection during invasive procedures, which can lead to endocarditis. Choice A is incorrect as avoiding exposure to individuals with streptococcus does not address the primary preventive measure needed. Choice B is incorrect as corticosteroids do not prevent bacterial endocarditis, and daily administration is not the recommended prophylactic measure. Choice D is incorrect as routine vaccinations against meningococcal and pneumococcal infections are important for other conditions but not specifically for preventing bacterial endocarditis.

3. A 20-year-old college student has presented to her campus medical clinic for a scheduled Pap smear. The clinician who will interpret the smear will examine cell samples for evidence of:

• A. Changes in cell shape, size, and organization
• B. Presence of unexpected cell types
• C. Ischemic changes in cell sample
• D. Abnormally high numbers of cells

Correct answer: A

Rationale: The correct answer is changes in cell shape, size, and organization (Choice A). Pap smears are performed to detect potential precancerous or cancerous conditions by examining the cells for any abnormalities in their shape, size, or organization. This helps in identifying early signs of cervical cancer. Choices B, C, and D are incorrect because Pap smears primarily focus on detecting cellular changes associated with cancer, not unexpected cell types, ischemic changes, or abnormally high numbers of cells.

4. Which of the following conditions is associated with a positive Homan's sign?

• A. Deep vein thrombosis
• B. Peripheral artery disease
• C. Varicose veins
• D. Lymphedema

Correct answer: A

Rationale: A positive Homan's sign is indicative of deep vein thrombosis. This sign is elicited by dorsiflexing the foot of a patient with the knee slightly flexed, resulting in calf pain. Peripheral artery disease (choice B) is associated with decreased blood flow to the extremities, but it does not produce a positive Homan's sign. Varicose veins (choice C) are enlarged, twisted veins that are typically not related to Homan's sign. Lymphedema (choice D) is swelling caused by a lymphatic system blockage or dysfunction and is not linked to Homan's sign.

5. A patient with a history of breast cancer is being prescribed tamoxifen (Nolvadex). What is a critical point the nurse should 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, so patients should be educated about the signs and symptoms of blood clots. Choice B is incorrect because tamoxifen does not decrease the risk of osteoporosis. Choice C is incorrect as tamoxifen may cause hot flashes and other menopausal symptoms but this is not the critical point for patient education. Choice D is incorrect as tamoxifen may cause weight gain and fluid retention, but it is not the critical point that the nurse should focus on in patient education.

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