Nursing Elites

1. In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening hours is called:

• A. Aphasia.
• B. Agnosia.
• C. Sundowning.
• D. Confabulation.

Correct answer: C

Rationale: The correct answer is C: Sundowning. Sundowning is a phenomenon where individuals with cognitive impairment experience increased confusion and agitation in the late afternoon or early evening. This often occurs in conditions like dementia. Choice A, Aphasia, refers to a language disorder affecting a person's ability to communicate. Choice B, Agnosia, is the inability to recognize objects. Choice D, Confabulation, is the production of false memories without the intention to deceive, often seen in conditions like Korsakoff's syndrome.

2. A patient with breast cancer is prescribed tamoxifen (Nolvadex). What should the nurse emphasize during patient education?

• A. Tamoxifen may increase the risk of venous thromboembolism, so patients should be aware of the signs and symptoms of blood clots.
• B. Tamoxifen may cause weight gain, so patients should monitor their diet.
• C. Tamoxifen may cause hot flashes and other menopausal symptoms.
• D. Tamoxifen may decrease the risk of osteoporosis, so patients should ensure adequate calcium intake.

Correct answer: A

Rationale: The correct answer is A. Tamoxifen increases the risk of venous thromboembolism, a serious side effect. Therefore, patients should be educated about the signs and symptoms of blood clots, such as swelling, pain, and redness in the legs, and advised to seek immediate medical attention if they occur. Choice B is incorrect because weight gain is not a significant side effect of tamoxifen. Choice C is incorrect because hot flashes and menopausal symptoms are common side effects of tamoxifen but are not as critical to address as venous thromboembolism. Choice D is incorrect because tamoxifen does not decrease the risk of osteoporosis; in fact, it may increase the risk of bone loss in premenopausal women.

3. A patient is taking alendronate (Fosamax) for osteoporosis. What 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.
• B. Take the medication at bedtime to ensure absorption during sleep.
• C. Take the medication with milk to enhance calcium absorption.
• 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. Taking the medication at bedtime (choice B) is not recommended as it can lead to esophageal irritation when lying down. Taking the medication with milk (choice C) is incorrect as it may interfere with the absorption of alendronate. Taking the medication with food (choice D) is not recommended as it may reduce the effectiveness of the medication.

4. What is the purpose of the inflammatory response?

• A. Prevents blood from entering the injured tissue
• B. Elevates body temperature to prevent spread of infection
• C. Prevents formation of abscess
• D. Minimizes injury and promotes healing

Correct answer: D

Rationale: The inflammatory response is a protective mechanism triggered by tissue damage or infection. It aims to minimize injury by removing harmful stimuli and initiating the healing process. Choice A is incorrect because blood flow to the injured tissue is actually increased to deliver immune cells and nutrients. Choice B is incorrect because while fever is a response to infection, it is not the primary purpose of the inflammatory response. Choice C is incorrect because abscess formation can occur as part of the inflammatory response in an attempt to contain an infection.

5. A child is experiencing difficulty with chewing and swallowing. The nurse knows that which cells may be innervating specialized gut-related receptors that provide taste and smell?

• A. Special somatic afferent fibers
• B. General somatic afferents
• C. Special visceral afferent cells
• D. General visceral afferent neurons

Correct answer: C

Rationale: The correct answer is C: Special visceral afferent cells. These cells are responsible for innervating taste and smell receptors related to the gut. Special somatic afferent fibers (choice A) are involved in sensations like touch and proprioception, not taste and smell. General somatic afferents (choice B) carry sensory information from the skin and musculoskeletal system, not taste and smell. General visceral afferent neurons (choice D) transmit sensory information from internal organs, but not specifically related to taste and smell sensations.

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