Nursing Elites

1. A 60-year-old man presents with painless hematuria. Which of the following should be the next step in the evaluation?

• A. Urinalysis
• B. Renal ultrasound
• C. Cystoscopy
• D. Intravenous pyelogram

Correct answer: C

Rationale: In a 60-year-old man presenting with painless hematuria, the next step in the evaluation should be cystoscopy. Cystoscopy is recommended to assess the cause of hematuria, particularly to rule out bladder cancer, which is more common in older individuals. Urinalysis (Choice A) can provide initial information but may not definitively diagnose the underlying cause. Renal ultrasound (Choice B) and intravenous pyelogram (Choice D) are imaging studies that may be considered later in the evaluation process but are not the initial step for painless hematuria.

2. A male patient with erectile dysfunction is prescribed sildenafil (Viagra). What specific instruction should the nurse provide to ensure the safe use of this medication?

• A. Take the medication with food to prevent nausea.
• B. Avoid taking nitrates while on this medication.
• C. Take the medication at bedtime to ensure absorption during sleep.
• D. Take the medication with milk to enhance absorption.

Correct answer: B

Rationale: The correct instruction the nurse should provide is to avoid taking nitrates while on sildenafil (Viagra). Combining sildenafil with nitrates can result in severe hypotension due to additive vasodilatory effects. Choice A is incorrect because sildenafil can be taken with or without food. Choice C is incorrect as there is no specific requirement to take sildenafil at bedtime. Choice D is incorrect as taking sildenafil with milk has not been shown to enhance its absorption.

3. Which physiologic response is most likely to accompany activation of the parasympathetic nervous system?

• A. Increased heart rate
• B. Increased gastric motility
• C. Pupil dilation
• D. Sweating

Correct answer: B

Rationale: The correct answer is B: Increased gastric motility. The parasympathetic nervous system is known to promote rest and digest functions, which includes increasing gastric motility to aid in digestion. Choices A, C, and D are incorrect as they are more characteristic of the sympathetic nervous system. The sympathetic nervous system is responsible for the fight or flight response, leading to increased heart rate (Choice A), pupil dilation (Choice C), and sweating (Choice D) among other responses.

4. When a healthcare professional is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the healthcare professional calls these erythrocytes:

• A. Hyperchromic
• B. Hypochromic
• C. Macrocytic
• D. Microcytic

Correct answer: B

Rationale: Erythrocytes with an abnormally low concentration of hemoglobin are called hypochromic. Hyperchromic refers to erythrocytes with an abnormally high concentration of hemoglobin. Macrocytic indicates larger than normal red blood cells, while microcytic refers to smaller than normal red blood cells. Therefore, in this scenario, the correct term is hypochromic.

5. A 60-year-old male client with a long history of back pain has had little success with a variety of analgesic regimens that his family physician has prescribed. He has recently been diagnosed with a chronic pain disorder. Which teaching points about chronic pain would his physician most likely emphasize to the client?

• A. Chronic pain is often difficult to treat and requires a multimodal approach.
• B. Chronic pain indicates that an underlying injury has not healed properly.
• C. Chronic pain can be managed with a single long-term medication.
• D. Chronic pain is typically less severe than acute pain but lasts longer.

Correct answer: A

Rationale: The correct answer is A. Chronic pain is often complex and challenging to treat, necessitating a multimodal approach that may include medication, physical therapy, and behavioral therapy. Choice B is incorrect because chronic pain does not always indicate that an underlying injury has not healed properly; it can persist even after the initial injury has healed. Choice C is incorrect as chronic pain management usually involves a combination of treatments rather than relying solely on a single long-term medication. Choice D is incorrect because chronic pain is not necessarily less severe than acute pain; it can vary in intensity and duration depending on the individual and underlying condition.

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