Nursing Elites

1. Which of the following characterizes ductal carcinoma in situ?

• A. It is less common than lobular carcinoma in situ.
• B. Malignant cells have not invaded the stroma.
• C. It is considered a cancer precursor.
• D. Malignant cells have not invaded the stroma; it is considered a cancer precursor and has a higher risk for invasive cancer compared to lobular carcinoma in situ.

Correct answer: D

Rationale: The correct answer is that ductal carcinoma in situ is characterized by malignant cells that have not invaded the stroma, making it a cancer precursor with a higher risk for invasive cancer compared to lobular carcinoma in situ. Choice A is incorrect because ductal carcinoma in situ is more common than lobular carcinoma in situ. Choice B is incorrect as it only partially describes ductal carcinoma in situ without mentioning its potential for progression to invasive cancer. Choice C is incorrect because it does not capture the complete characteristics of ductal carcinoma in situ, which include the risk for invasive cancer.

2. A female client with bone metastases secondary to lung cancer is admitted for palliative radiation treatment and pain control. The client is currently experiencing pain that she rates at 9 out of 10. Which of the following nonpharmacologic treatments is most likely to be a useful and appropriate supplement to pharmacologic analgesia at this point?

• A. Teaching the client guided imagery and meditation
• B. Initiating neurostimulation
• C. Heat therapy
• D. Relaxation and distraction

Correct answer: D

Rationale: In the scenario described, the client is experiencing high pain levels, rated at 9 out of 10. Relaxation and distraction techniques are effective nonpharmacologic interventions for managing pain. Teaching the client guided imagery and meditation (Choice A) can also be beneficial; however, in this acute situation of severe pain, relaxation and distraction techniques are more likely to provide immediate relief. Initiating neurostimulation (Choice B) and heat therapy (Choice C) may not be suitable for immediate pain relief in this scenario and are not as commonly used for managing high pain levels in palliative care settings.

3. A nurse is caring for a patient who is being treated with clomiphene citrate (Clomid) for infertility. What side effect should the nurse warn the patient about?

• A. Headaches and visual disturbances
• B. Nausea and vomiting
• C. Hot flashes and abdominal discomfort
• D. Fatigue and depression

Correct answer: C

Rationale: The correct answer is C: 'Hot flashes and abdominal discomfort.' Clomiphene citrate, commonly known as Clomid, can lead to hot flashes and abdominal discomfort as side effects. It is important for the nurse to warn the patient about these potential effects. Choices A, B, and D are incorrect because headaches and visual disturbances, nausea and vomiting, as well as fatigue and depression are not commonly associated with clomiphene citrate use.

4. A patient is prescribed testosterone gel for hypogonadism. What important instruction should the nurse provide regarding the application of this medication?

• A. Apply the gel to the chest or upper arms.
• B. Apply the gel to the face and neck.
• C. Apply the gel to the genitals for maximum absorption.
• D. Apply the gel to the scalp and back.

Correct answer: A

Rationale: The correct answer is to apply the testosterone gel to the chest or upper arms. This is recommended to minimize the risk of unintentional transfer of the medication to others, especially women and children, through skin contact. Applying the gel to the face, neck, or genitals is not advised as it can lead to unintended exposure to others. Additionally, applying the gel to the scalp or back is not appropriate as these areas are not indicated for absorption of testosterone.

5. A client with heart failure is experiencing pulmonary edema. Which intervention should be prioritized?

• A. Administer diuretics to reduce fluid overload.
• B. Position the client in high-Fowler's position.
• C. Administer oxygen therapy to improve oxygenation.
• D. Restrict fluid intake to prevent further fluid overload.

Correct answer: C

Rationale: In a client experiencing pulmonary edema due to heart failure, the priority intervention is to administer oxygen therapy to improve oxygenation. This helps in increasing the oxygen levels in the blood, thereby improving tissue perfusion and reducing the workload on the heart. Positioning the client in high-Fowler's position can also aid in improving oxygenation, but administering oxygen therapy directly addresses the immediate need for increased oxygen levels. Administering diuretics to reduce fluid overload and restricting fluid intake are important interventions in heart failure management, but in the acute situation of pulmonary edema, oxygen therapy takes precedence to ensure adequate oxygen supply to vital organs.

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