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 patient with a history of breast cancer is being prescribed tamoxifen (Nolvadex). What is a critical point the nurse should 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, so patients should be educated about the signs and symptoms of blood clots. Choice B is incorrect because tamoxifen does not decrease the risk of osteoporosis. Choice C is incorrect as tamoxifen may cause hot flashes and other menopausal symptoms but this is not the critical point for patient education. Choice D is incorrect as tamoxifen may cause weight gain and fluid retention, but it is not the critical point that the nurse should focus on in patient education.

3. What are the major mechanisms of spinal cord injuries?

• A. Hypoextension, expansion, hyperflexion
• B. Hyperflexion, expansion, hypometabolism
• C. Hypermetabolism, compression, hyperextension
• D. Hyperextension, hyperflexion, compression

Correct answer: D

Rationale: The correct answer is D. Spinal cord injuries commonly occur due to hyperextension, hyperflexion, and compression. Hyperextension and hyperflexion refer to the excessive bending or stretching of the spinal cord, while compression is the exertion of pressure on the spinal cord. These mechanisms can lead to damage such as contusions, lacerations, and compression of the spinal cord. Choices A, B, and C are incorrect as they do not accurately represent the major mechanisms of spinal cord injuries.

4. In a patient with chronic kidney disease and a hemoglobin level of 9 g/dL, which of the following treatments is most appropriate?

• A. Iron supplementation
• B. Erythropoiesis-stimulating agents
• C. Blood transfusion
• D. Vitamin B12 supplementation

Correct answer: B

Rationale: In chronic kidney disease, anemia commonly occurs due to decreased erythropoietin production. Erythropoiesis-stimulating agents, such as erythropoietin or darbepoetin, are the mainstay of treatment to stimulate red blood cell production. Iron supplementation is more appropriate for iron-deficiency anemia, not the anemia of chronic kidney disease. Blood transfusion is reserved for severe cases or acute blood loss. Vitamin B12 supplementation is indicated for megaloblastic anemia caused by vitamin B12 deficiency, not specifically in chronic kidney disease-related anemia.

5. A male patient with benign prostatic hyperplasia (BPH) is prescribed finasteride (Proscar). What is the expected therapeutic effect of this medication?

• A. Decreased urinary frequency and urgency
• B. Decreased blood pressure
• C. Increased urinary output
• D. Increased hair growth

Correct answer: A

Rationale: The correct answer is A: Decreased urinary frequency and urgency. Finasteride is used to reduce the size of the prostate gland in patients with BPH, which helps alleviate symptoms such as urinary frequency and urgency. Choice B, decreased blood pressure, is incorrect because finasteride is not indicated for lowering blood pressure. Choice C, increased urinary output, is incorrect as finasteride does not typically increase urine production. Choice D, increased hair growth, is incorrect as the primary use of finasteride is not for promoting hair growth but rather for treating BPH.

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