Nursing Elites

1. In which of the following cases is dehydration more likely to occur?

• A. A 50-year-old woman who is a bodybuilder
• B. A 50-year-old man who is morbidly obese
• C. A 10-year-old child who is thin
• D. A 30-year-old with multiple sclerosis

Correct answer: B

Rationale: Dehydration is more likely to occur in a 50-year-old man who is morbidly obese due to the increased risk of conditions like diabetes and heart disease that can lead to fluid imbalances. Being morbidly obese can also strain the body's systems, increasing the need for water. The other choices are less likely to experience dehydration as a primary concern. While being a bodybuilder may require strict hydration practices, dehydration is more prevalent in individuals with conditions like obesity.

2. A patient with a history of breast cancer is being prescribed tamoxifen (Nolvadex). What should the nurse include in the patient education about the use of this medication?

• A. Tamoxifen may increase the risk of venous thromboembolism, so the patient should be aware of the signs and symptoms of blood clots.
• B. Tamoxifen may cause hot flashes, so the patient should be prepared for this side effect.
• C. Tamoxifen may decrease the risk of osteoporosis, so the patient should ensure adequate calcium intake.
• D. Tamoxifen may cause weight gain, so the patient should monitor their diet and exercise regularly.

Correct answer: A

Rationale: The correct answer is A. Tamoxifen is known to increase the risk of venous thromboembolism, a serious side effect. Patients should be educated about the signs and symptoms of blood clots, such as swelling, pain, or redness in the affected limb, and the importance of seeking immediate medical attention if they occur. Choice B is incorrect because hot flashes are a common side effect of tamoxifen but not a critical concern like venous thromboembolism. Choice C is incorrect as tamoxifen is not associated with a decreased risk of osteoporosis. Choice D is incorrect because while weight gain can occur with tamoxifen, it is not as crucial to educate the patient about as the risk of venous thromboembolism.

3. In chronic obstructive pulmonary disease, the inflammatory response predominantly involves:

• A. eosinophils
• B. neutrophils
• C. monocytes
• D. cells

Correct answer: B

Rationale: In chronic obstructive pulmonary disease, the inflammatory response predominantly involves neutrophils. Neutrophils play a key role in COPD due to their involvement in initiating and sustaining the inflammatory process. Eosinophils are more commonly associated with asthma rather than COPD. Monocytes are less involved in the inflammatory response in COPD compared to neutrophils. The choice 'cells' is too broad and vague to be a specific answer in this context.

4. What is a potential implication of multiple dark bands on the nails?

• A. They are considered a normal variant.
• B. They can be associated with malignant melanoma.
• C. They are indicative of a nail fungus.
• D. They are associated with aging.

Correct answer: B

Rationale: Multiple dark bands on the nails can be a concerning sign of malignant melanoma, a type of skin cancer that can affect the nails. While some nail changes are considered normal variants, dark bands should not be dismissed lightly as they can indicate a serious condition like melanoma. Nail fungus typically presents differently, causing discoloration, thickening, or distortion of the nail without distinct dark bands. Additionally, aging can lead to various nail changes, but dark bands alone are not a common feature of normal aging.

5. A patient with a history of breast cancer is being prescribed tamoxifen (Nolvadex). What should the nurse include in the patient education?

• 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 increases the risk of venous thromboembolism. Patients should be educated about signs and symptoms of blood clots, such as swelling, pain, or redness in the legs. Choices B, C, and D are incorrect because tamoxifen is not associated with decreasing the risk of osteoporosis, causing hot flashes and menopausal symptoms, or causing weight gain and fluid retention.

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