Nursing Elites

1. Which of the following is a characteristic of disseminated intravascular coagulation (DIC)?

• A. Simultaneous stroke and heart attack
• B. Simultaneous clotting and bleeding
• C. Simultaneous clotting and insulin release
• D. Simultaneous bleeding and vomiting

Correct answer: B

Rationale: Disseminated intravascular coagulation (DIC) is characterized by simultaneous clotting and bleeding throughout the body. This imbalance in the body's clotting system leads to the formation of blood clots in small blood vessels, which can consume clotting factors and platelets, ultimately leading to excessive bleeding. Choices A, C, and D are incorrect because they do not describe the characteristic feature of DIC, which involves both clotting and bleeding.

2. Joseph, a 12-year-old child, complains to the school nurse about nausea and dizziness. While assessing the child, the nurse notices a black eye that looks like an injury. This is the third time in 1 month that the child has visited the nurse. Each time, the child provides vague explanations for various injuries. Which of the following is the school nurse’s priority intervention?

• A. Contact the child’s parents and ask about the child’s injuries.
• B. Encourage the child to be honest about the injuries.
• C. Question the teacher about the child's injuries.
• D. Report suspicion of abuse to the proper authorities.

Correct answer: D

Rationale: The school nurse's priority intervention in this situation is to report suspicion of abuse to the proper authorities. Given the pattern of unexplained injuries and vague explanations provided by the child, it raises significant concerns for possible abuse. Reporting to the appropriate authorities is crucial to ensure the child's safety and well-being. Contacting the child's parents (Choice A) may not be appropriate if abuse is suspected, as it could potentially put the child at further risk. Merely encouraging the child to be honest (Choice B) does not address the immediate safety concerns. Questioning the teacher (Choice C) is not the appropriate initial action when abuse is suspected; reporting to authorities should take precedence.

3. A patient is prescribed tadalafil (Cialis) for erectile dysfunction. What condition would contraindicate the use of this medication?

• A. History of hypertension
• B. Use of nitrates
• C. Use of antihypertensive medications
• D. History of peptic ulcer disease

Correct answer: B

Rationale: The correct answer is B: 'Use of nitrates.' Tadalafil (Cialis) is contraindicated in patients using nitrates due to the risk of severe hypotension. Nitrates and tadalafil both cause vasodilation, leading to a synergistic effect that can result in a dangerous drop in blood pressure. Choices A, C, and D are incorrect because a history of hypertension, the use of antihypertensive medications, and a history of peptic ulcer disease are not direct contraindications for tadalafil use.

4. What long-term risks should the nurse discuss with a patient starting on hormone replacement therapy (HRT)?

• A. HRT is associated with increased risks of cardiovascular events and breast cancer, so these risks should be discussed with the patient.
• B. HRT can improve mood and energy levels, but it also increases the risk of osteoporosis.
• C. HRT can increase the risk of venous thromboembolism, so patients should undergo regular screening.
• D. HRT decreases the risk of fractures, but it also increases the risk of developing diabetes.

Correct answer: A

Rationale: The correct answer is A. When starting on hormone replacement therapy (HRT), the nurse should discuss the increased risks of cardiovascular events and breast cancer with the patient. These risks are important to consider to make an informed decision. Choice B is incorrect as HRT does not increase the risk of osteoporosis; in fact, it may help prevent it. Choice C is incorrect as while HRT can increase the risk of venous thromboembolism, regular screening is not the primary focus for discussion. Choice D is incorrect as HRT does not decrease the risk of fractures and is not primarily associated with an increased risk of developing diabetes.

5. When a Tae Kwon Do (TKD) master applies downward pressure just above the elbow joint on an attacker who immediately collapses to the ground, which reflex is applicable to this example?

• A. Golgi tendon reflex
• B. Myotatic reflex
• C. Withdrawal reflex
• D. Crossed-extensor reflex

Correct answer: A

Rationale: The Golgi tendon reflex is the correct answer. This reflex protects the muscle and tendons from excessive force by causing the muscle to relax. In this scenario, the downward pressure applied just above the elbow joint triggers the Golgi tendon reflex, resulting in the attacker's collapse. The other options are incorrect: - The myotatic reflex (also known as the stretch reflex) is responsible for contracting a muscle in response to its stretch, not relaxing it. - The withdrawal reflex is a spinal reflex that moves a body part away from a painful stimulus, not directly related to the scenario described. - The crossed-extensor reflex is a reflex that occurs on the opposite side of the body in response to a withdrawal reflex, which is not the case in this situation.

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