Nursing Elites

1. A 55-year-old man presents with a history of fatigue, weight loss, and night sweats. He reports recent onset of a productive cough and hemoptysis. Which condition should the nurse suspect?

• A. Lung cancer
• B. Pneumonia
• C. Tuberculosis
• D. Pulmonary embolism

Correct answer: C

Rationale: The correct answer is C: Tuberculosis. The symptoms described - fatigue, weight loss, night sweats, productive cough, and hemoptysis - are classic manifestations of tuberculosis. Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, commonly affecting the lungs but can also involve other organs. **Choice A: Lung cancer** typically presents with symptoms like persistent cough, chest pain, and shortness of breath, but it is less likely in this case due to the presence of hemoptysis. **Choice B: Pneumonia** can present with productive cough, fever, and chest pain, but it is less likely given the chronicity of symptoms and the presence of hemoptysis. **Choice D: Pulmonary embolism** usually presents with sudden onset shortness of breath, chest pain, and can be associated with risk factors like recent surgery or immobility.

2. Although stress exposure initiates integrated responses by multiple systems, which system first activates the most important changes?

• A. Pulmonary
• B. Gastrointestinal
• C. Neuroendocrine
• D. Cardiovascular

Correct answer: C

Rationale: The correct answer is C, the Neuroendocrine system. When the body is exposed to stress, the neuroendocrine system plays a crucial role in initiating the body's response. This system, particularly through the hypothalamic-pituitary-adrenal axis, triggers a cascade of physiological responses to stress. Choices A, B, and D are incorrect because while other systems like the cardiovascular and gastrointestinal systems also respond to stress, the neuroendocrine system is primarily responsible for the initial and significant changes in the body's stress response.

3. A patient with a history of venous thromboembolism is prescribed hormone replacement therapy (HRT). What should the nurse emphasize about the risks associated with this therapy?

• A. HRT is associated with an increased risk of venous thromboembolism, so patients should be educated about the signs and symptoms of blood clots.
• B. HRT may improve mood and energy levels, but it also increases the risk of osteoporosis.
• C. HRT can decrease the risk of fractures, but it also increases the risk of developing diabetes.
• D. HRT may increase the risk of breast cancer, so regular mammograms are essential.

Correct answer: A

Rationale: HRT is associated with an increased risk of venous thromboembolism, so patients should be educated about the signs and symptoms of blood clots and advised to seek immediate medical attention if they occur.

4. A 25-year-old just had a colonoscopy and was diagnosed with Crohn disease. Which of the following symptoms is consistent with this diagnosis?

• A. Right lower quadrant cramping
• B. Severe bloody diarrhea
• C. Nausea and vomiting
• D. Mostly affects the rectum

Correct answer: A

Rationale: The correct answer is A: Right lower quadrant cramping. Crohn's disease commonly presents with abdominal pain, particularly in the right lower quadrant. Choice B, severe bloody diarrhea, is more characteristic of ulcerative colitis, another type of inflammatory bowel disease. Choice C, nausea and vomiting, are not typical symptoms of Crohn's disease. Choice D is incorrect as Crohn's disease can affect any part of the gastrointestinal tract, not just the rectum.

5. If the client's dorsal columns are not functioning, the nurse will observe which response during neuro testing, where the nurse asks the client to close his eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points?

• A. The client will not be able to distinguish between the two points.
• B. The client will feel only one point of contact.
• C. The client will accurately identify both points.
• D. The client will report no sensation in the touched areas.

Correct answer: A

Rationale: If the client's dorsal columns are not functioning, the ability to distinguish between two closely spaced points is impaired. This results in the client not being able to differentiate between the two points when touched simultaneously. Choice B is incorrect because the client feeling only one point suggests an intact dorsal column function. Choice C is incorrect as accurately identifying both points indicates normal discrimination ability. Choice D is incorrect as reporting no sensation does not correspond to the specific impairment related to dorsal column dysfunction.

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