Nursing Elites

1. As you are walking in the park, a huge black Labrador runs up to you and places his paws on your shoulders. Immediately your heart starts racing, you feel palpitations, anxiety, and your hands become a little shaky. The nurse knows that this response is primarily caused by:

• A. cerebral cortex.
• B. somatic nervous system.
• C. limbic system.
• D. autonomic nervous system.

Correct answer: D

Rationale: The autonomic nervous system controls involuntary bodily functions like heart rate, respiration, and sweating. In the given scenario, the 'fight or flight' response is activated, leading to increased heart rate, palpitations, anxiety, and shaky hands. The cerebral cortex is involved in conscious thought processes and decision-making, not the immediate physiological response observed here. The somatic nervous system regulates voluntary movements, while the limbic system is responsible for emotions and memory, but the autonomic nervous system is primarily responsible for the physiological responses seen in this situation.

2. A nurse is teaching a patient about the use of raloxifene (Evista) for the prevention of osteoporosis. What is the primary therapeutic action of this medication?

• A. It decreases the absorption of calcium from the intestines.
• B. It decreases bone resorption and increases bone density.
• C. It increases the excretion of calcium through the kidneys.
• D. It stimulates the formation of new bone.

Correct answer: B

Rationale: The correct answer is B. Raloxifene, a selective estrogen receptor modulator (SERM), works by decreasing bone resorption and increasing bone density. This action helps in preventing osteoporosis by maintaining bone strength. Choice A is incorrect as raloxifene does not affect the absorption of calcium from the intestines. Choice C is incorrect as raloxifene does not increase the excretion of calcium through the kidneys. Choice D is incorrect as raloxifene does not directly stimulate the formation of new bone; instead, it primarily works by reducing bone loss.

3. What aspect of this woman's current health status would contraindicate the use of oral contraceptives?

• A. The woman has a diagnosis of type 2 diabetes.
• B. The woman has asthma and uses inhaled corticosteroids and bronchodilators.
• C. The woman has a family history of breast cancer.
• D. The woman takes an antiplatelet medication for coronary artery disease.

Correct answer: A

Rationale: The correct answer is A. Women with type 2 diabetes are at higher risk of developing cardiovascular complications. Oral contraceptives further increase this risk due to their potential effects on blood pressure, lipid metabolism, and clotting factors. Choice B is incorrect as inhaled corticosteroids and bronchodilators do not contraindicate the use of oral contraceptives. Choice C is incorrect as a family history of breast cancer does not directly contraindicate the use of oral contraceptives. Choice D is also incorrect as taking an antiplatelet medication for coronary artery disease does not necessarily contraindicate the use of oral contraceptives.

4. A 60-year-old man presents with painless hematuria. Which of the following should be the next step in the evaluation?

• A. Urinalysis
• B. Renal ultrasound
• C. Cystoscopy
• D. Intravenous pyelogram

Correct answer: C

Rationale: In a 60-year-old man presenting with painless hematuria, the next step in the evaluation should be cystoscopy. Cystoscopy is recommended to assess the cause of hematuria, particularly to rule out bladder cancer, which is more common in older individuals. Urinalysis (Choice A) can provide initial information but may not definitively diagnose the underlying cause. Renal ultrasound (Choice B) and intravenous pyelogram (Choice D) are imaging studies that may be considered later in the evaluation process but are not the initial step for painless hematuria.

5. What is the common denominator of all forms of heart failure?

• A. Pulmonary edema
• B. Jugular venous distention
• C. Peripheral edema
• D. Reduced cardiac output

Correct answer: D

Rationale: The correct answer is D: Reduced cardiac output. All forms of heart failure share the common denominator of reduced cardiac output, which leads to inadequate tissue perfusion. Pulmonary edema (choice A) is a consequence of heart failure but not the common denominator. Jugular venous distention (choice B) and peripheral edema (choice C) are signs of heart failure but do not represent the common denominator shared by all forms.

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