Nursing Elites

1. An older adult patient comes to the clinic complaining of not being able to do what he used to be able to. You know that normal changes associated with aging include:

• A. Improved blood flow
• B. Slowed metabolic rate
• C. Increased brain weight
• D. Improved nerve fiber conduction

Correct answer: B

Rationale: Normal changes associated with aging include a slowed metabolic rate and decreased brain weight. Option A, 'Improved blood flow,' is incorrect as aging is generally associated with reduced vascular health rather than improved blood flow. Option D, 'Improved nerve fiber conduction,' is incorrect as aging typically leads to a decline in nerve function rather than improvement.

2. What part of the heart is responsible for starting the electrical impulse to conduct a heart rhythm and contraction of the atria and ventricles?

• A. The Purkinje fibers in the ventricles
• B. The right & left bundle branches
• C. The atrioventricular node
• D. The sinoatrial node in the atrium

Correct answer: D

Rationale: The sinoatrial node (SA node) in the atrium is indeed responsible for initiating the electrical impulse that starts the heart's rhythm. The SA node is known as the heart's natural pacemaker. Choices A, B, and C are incorrect because while the Purkinje fibers, bundle branches, and atrioventricular node play crucial roles in the conduction of the electrical impulse throughout the heart, the SA node is specifically responsible for initiating this impulse.

3. In which patient is alpha-1 antitrypsin deficiency the likely cause of chronic obstructive pulmonary disease?

• A. A 30-year-old who has smoked for 3 years
• B. A 65-year-old man who drove a taxi most of his life
• C. A 70-year-old woman who smoked for 40 years
• D. A 50-year-old with exposure to secondhand smoke

Correct answer: A

Rationale: Alpha-1 antitrypsin deficiency is a genetic cause of chronic obstructive pulmonary disease (COPD). It is more common in younger patients with a history of smoking at a younger age, like the 30-year-old who has smoked for 3 years. Choices B, C, and D are less likely to be associated with alpha-1 antitrypsin deficiency as COPD in these cases is more likely due to smoking and environmental exposures.

4. A client arrives with symptoms of stroke. What should the nurse assess first?

• A. Level of consciousness
• B. Blood pressure
• C. Pupil reaction
• D. Heart rate

Correct answer: A

Rationale: Assessing the level of consciousness is a critical first step in evaluating a potential stroke. Changes in the level of consciousness can indicate the severity and location of brain damage, helping to guide immediate interventions. Assessing blood pressure, pupil reaction, and heart rate are also important aspects of the assessment in a suspected stroke patient. However, the priority is to quickly determine the client's level of consciousness to assess their neurological status.

5. A patient with breast cancer is prescribed tamoxifen (Nolvadex). What key point should the nurse include in the patient education?

• A. Tamoxifen may increase the risk of venous thromboembolism.
• B. Tamoxifen may cause hot flashes and other menopausal symptoms.
• C. Tamoxifen may cause weight gain and fluid retention.
• D. Tamoxifen may decrease the risk of osteoporosis.

Correct answer: A

Rationale: The correct answer is A: "Tamoxifen may increase the risk of venous thromboembolism." It is crucial for patients to be aware of the signs and symptoms of blood clots while taking tamoxifen. Choice B is incorrect because hot flashes and menopausal symptoms are common side effects of tamoxifen, but they are not the key point to emphasize. Choice C is incorrect as weight gain and fluid retention are potential side effects of tamoxifen but not the key point for patient education. Choice D is incorrect as tamoxifen does not decrease the risk of osteoporosis; in fact, it may increase the risk of bone loss.

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