Nursing Elites

1. A client with a history of rheumatic fever presents with signs of heart failure. What is the likely underlying cause?

• A. Infective endocarditis
• B. Coronary artery disease
• C. Mitral valve stenosis
• D. Aortic regurgitation

Correct answer: C

Rationale: The correct answer is C: Mitral valve stenosis. Rheumatic fever can lead to scarring and thickening of the heart valves, often affecting the mitral valve. This stenosis can impede blood flow from the left atrium to the left ventricle, eventually causing heart failure. Choice A, infective endocarditis, is an infection of the endocardium, the inner lining of the heart chambers and valves, and is not directly related to rheumatic fever. Choice B, coronary artery disease, involves the obstruction of coronary arteries supplying the heart muscle with blood, leading to ischemia and not typically associated with rheumatic fever. Choice D, aortic regurgitation, is the backflow of blood from the aorta to the left ventricle and is not a common consequence of rheumatic fever.

2. A female patient is prescribed medroxyprogesterone acetate (Provera) for dysfunctional uterine bleeding. What should the nurse include in the patient education?

• A. This medication may cause breakthrough bleeding or spotting.
• B. This medication may cause weight gain.
• C. This medication may increase your risk of developing diabetes.
• D. This medication may increase your risk of breast cancer.

Correct answer: A

Rationale: The correct answer is A. Medroxyprogesterone acetate (Provera) can cause breakthrough bleeding or spotting, which is a common side effect of this medication. Choices B, C, and D are incorrect because weight gain, increased risk of diabetes, and increased risk of breast cancer are not commonly associated side effects of medroxyprogesterone acetate. Therefore, the nurse should focus on educating the patient about the potential for breakthrough bleeding or spotting.

3. 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.

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. A male patient is receiving androgen therapy for hypogonadism. What adverse effect should the nurse monitor for during this therapy?

• A. Increased risk of bone fractures
• B. Increased risk of cardiovascular events
• C. Increased risk of liver dysfunction
• D. Increased risk of prostate cancer

Correct answer: B

Rationale: The correct answer is B: Increased risk of cardiovascular events. Androgen therapy can lead to an increased risk of cardiovascular events like heart attacks and strokes, especially in older patients. Monitoring for signs and symptoms of cardiovascular issues is essential during this therapy. Choices A, C, and D are incorrect because androgen therapy is not typically associated with an increased risk of bone fractures, liver dysfunction, or prostate cancer.

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