Nursing Elites

1. Which individual is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult:

• A. client who developed rhabdomyolysis and ischemic injury after a tourniquet application.
• B. who suffered a bone-depth laceration to the shoulder during a knife attack.
• C. who had his forearm partially crushed by gears during an industrial accident.
• D. client who had nerves transected during surgery to remove a tumor from the mandible.

Correct answer: C

Rationale: The correct answer is C. Crushing-type injuries to the peripheral nervous system generally have a better prognosis compared to nerve transections or lacerations. In the scenario provided, the individual who had his forearm partially crushed by gears during an industrial accident is likely to have a better chance of recovery compared to nerve transection (choice D) or laceration (choice B). Rhabdomyolysis and ischemic injury after tourniquet application (choice A) are not directly related to peripheral nerve injury and do not indicate a better prognosis for recovery.

2. A patient is being educated about the use of raloxifene (Evista) for osteoporosis. What is the primary therapeutic action of this medication?

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

Correct answer: B

Rationale: The correct answer is B: 'It decreases bone resorption and increases bone density.' Raloxifene, a selective estrogen receptor modulator (SERM), works by decreasing bone resorption, which is the breakdown of bone, and increasing bone density. This action helps in preventing bone loss and maintaining bone strength. Choice A is incorrect because raloxifene does not stimulate the formation of new bone but rather prevents its breakdown. Choice C is incorrect as raloxifene does not increase the excretion of calcium but rather helps in maintaining calcium levels in the bones. Choice D is also incorrect as raloxifene does not directly increase calcium absorption in the intestines.

3. What important information should the nurse provide about the risks associated with tamoxifen (Nolvadex) for a patient with a history of breast cancer?

• 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 may increase the risk of venous thromboembolism. Patients on tamoxifen should be educated about the signs and symptoms of blood clots. Choices B, C, and D are incorrect. Tamoxifen does not decrease the risk of osteoporosis; it may cause hot flashes and other menopausal symptoms, and it may cause weight gain and fluid retention.

4. What is the best way to prevent transmission of infectious agents?

• A. Take antibiotics daily
• B. Call the practitioner for herbal supplements
• C. Wash hands
• D. Avoid public areas as much as possible

Correct answer: C

Rationale: The correct answer is C: Wash hands. Washing hands is the most effective way to prevent the transmission of infectious agents. Antibiotics are not effective in preventing infections, and their overuse can lead to antibiotic resistance. Calling a practitioner for herbal supplements is not a primary method for preventing the transmission of infectious agents. Avoiding public areas entirely is impractical and not as effective as proper hand hygiene.

5. What specific instructions should the nurse provide to ensure proper administration of alendronate (Fosamax) for the treatment of osteoporosis?

• 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 gastrointestinal upset.

Correct answer: A

Rationale: The correct answer is to take the medication with a full glass of water and remain upright for at least 30 minutes. This is important to prevent esophageal irritation and ensure proper absorption. Choice B is incorrect because alendronate should be taken in the morning on an empty stomach, at least 30 minutes before eating or drinking anything other than water. Choice C is incorrect because alendronate should not be taken with milk as it can interfere with its absorption. Choice D is incorrect because alendronate should be taken on an empty stomach, not with food.

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