Nursing Elites

1. A 74-year-old woman states that many of her peers underwent hormone replacement therapy (HRT) in years past. The woman asks the nurse why her primary care provider has not yet proposed this treatment for her. What fact should underlie the nurse's response to the woman?

• A. The risks of stroke and breast cancer are unacceptably high in women taking HRT.
• B. HRT was found to cause mood disturbances in many women who used it long term.
• C. HRT was found to be a significant risk factor for bone fractures and osteoporosis.
• D. The risks of chronic obstructive pulmonary disease were found to be significantly higher in women using HRT.

Correct answer: A

Rationale: The correct answer is A because the main reason HRT is not recommended for all women is due to the increased risks of stroke and breast cancer associated with its use. Hormone replacement therapy (HRT) has been linked to an elevated risk of stroke and breast cancer, which outweigh its potential benefits for many individuals. Choices B, C, and D are incorrect as they do not address the primary concerns regarding HRT use. While HRT can indeed cause mood disturbances and may affect bone health, the significant risks of stroke and breast cancer are the primary reasons why healthcare providers may choose not to recommend HRT for some women.

2. A patient is prescribed clomiphene citrate (Clomid) for the treatment of infertility. Which of the following statements should be included in the nurse's teaching?

• A. This drug induces ovulation by stimulating gonadotropins.
• B. This drug induces ovulation by inhibiting gonadotropins.
• C. This drug suppresses ovulation by inhibiting gonadotropins.
• D. This drug increases progesterone levels, which maintains pregnancy.

Correct answer: A

Rationale: The correct statement to include in the nurse's teaching is that clomiphene induces ovulation by stimulating the release of gonadotropins, which in turn stimulate the ovaries. Choice B is incorrect because clomiphene does not induce ovulation by inhibiting gonadotropins. Choice C is also incorrect as clomiphene does not suppress ovulation by inhibiting gonadotropins. Choice D is inaccurate as clomiphene does not directly increase progesterone levels to maintain pregnancy.

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

• A. Tamoxifen may increase the risk of venous thromboembolism, so patients should be educated about the signs and symptoms of blood clots.
• B. Tamoxifen may cause weight gain, so patients should monitor their diet.
• C. Tamoxifen may decrease the risk of osteoporosis, so patients should ensure adequate calcium intake.
• D. Tamoxifen may cause hot flashes and other menopausal symptoms.

Correct answer: A

Rationale: Tamoxifen increases the risk of venous thromboembolism, so patients should be educated about the signs and symptoms of blood clots and the importance of seeking immediate medical attention if they occur.

4. When a healthcare professional observes muscle stiffening occurring within 6 to 14 hours after death, the healthcare professional should document this finding as _____ present.

• A. Livor mortis
• B. Gangrene
• C. Algor mortis
• D. Rigor mortis

Correct answer: D

Rationale: The correct answer is D, Rigor mortis. Rigor mortis is the stiffening of muscles after death, typically beginning within 6 to 14 hours. Livor mortis (choice A) refers to the pooling of blood in the lowest tissues causing discoloration, gangrene (choice B) is the death of body tissue due to lack of blood flow, and algor mortis (choice C) is the cooling of the body after death.

5. In which patients would the manifestation of a headache be a sign of a serious underlying disorder?

• A. A 55-year-old man with new onset of headaches that are worse at night and reported mood swings according to his family
• B. A 30-year-old woman with a unilateral throbbing headache with photophobia and nausea
• C. A 60-year-old man with his head feeling full and throbbing and muscle aching around his neck and shoulders
• D. A 40-year-old woman who experiences food cravings, gets irritable, and then develops a pulsatile-like headache on the right side of her head

Correct answer: A

Rationale: In this scenario, the correct answer is the 55-year-old man with new onset headaches that worsen at night and reported mood swings according to his family. These symptoms, especially when combined with nighttime worsening and mood changes, could indicate a serious underlying disorder such as a brain tumor or increased intracranial pressure. Choice B is incorrect as the unilateral throbbing headache with photophobia and nausea is suggestive of migraine headaches, which are usually not associated with serious underlying disorders. Choice C describes symptoms that are more indicative of tension-type headaches rather than a serious underlying disorder. Choice D presents symptoms that are more likely related to hormonal changes and migraines rather than a serious underlying disorder.

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