Nursing Elites

1. After a thoracentesis on a client with a pleural effusion, which nursing intervention is most important post-procedure?

• A. Monitor for signs of infection.
• B. Assess for signs of bleeding or hematoma.
• C. Monitor vital signs and respiratory status.
• D. Instruct the client to rest and limit physical activity.

Correct answer: B

Rationale: The correct answer is to assess for signs of bleeding or hematoma. After a thoracentesis, it is crucial to monitor for any bleeding or hematoma formation at the puncture site, as this can lead to complications. Monitoring for signs of infection (Choice A) is essential but is usually a delayed concern compared to the immediate risk of bleeding post-procedure. While monitoring vital signs and respiratory status (Choice C) is important, assessing for bleeding takes precedence to address any immediate complications. Instructing the client to rest and limit physical activity (Choice D) is relevant for general post-procedure care but is not the most critical intervention in this scenario.

2. A male patient is receiving androgen therapy for hypogonadism. What laboratory tests should the nurse monitor during this therapy?

• A. Liver function tests
• B. Kidney function tests
• C. Prostate-specific antigen (PSA)
• D. Complete blood count (CBC)

Correct answer: A

Rationale: During androgen therapy for hypogonadism, it is important to monitor liver function tests. Androgens can affect the liver, potentially leading to liver dysfunction. Monitoring liver function tests helps in early detection of any liver abnormalities. Kidney function tests (Choice B) are not typically affected by androgen therapy. Prostate-specific antigen (PSA) levels (Choice C) may be monitored for conditions like prostate cancer, but it is not directly related to androgen therapy for hypogonadism. A complete blood count (CBC) (Choice D) may not show specific changes related to androgen therapy for hypogonadism.

3. A 70-year-old woman has difficulty with driving, and she has been frequently getting lost. Her husband said she has also been acting strange and seems to want to sleep a lot. He said the other night she kept saying she was seeing animals such as lions in her room. He says her memory is not too bad, but he is very concerned about her health. Physical examination reveals an alert woman with stable vital signs. Bradykinesia and limb rigidity are noted. These findings are consistent with:

• A. Alzheimer's disease.
• B. Vascular dementia.
• C. Dementia with Lewy bodies.
• D. Frontotemporal dementia.

Correct answer: C

Rationale: The symptoms described in the scenario, such as visual hallucinations, fluctuations in cognition, and parkinsonism (bradykinesia and limb rigidity), are classic features of dementia with Lewy bodies (DLB). DLB is characterized by the presence of Lewy bodies in the brain, which are abnormal protein deposits. Alzheimer's disease (Choice A) typically presents with memory loss as a predominant symptom, which is not a major concern in this case. Vascular dementia (Choice B) is associated with a history of cerebrovascular disease and is not supported by the symptoms described. Frontotemporal dementia (Choice D) usually presents with changes in behavior and personality, rather than the symptoms described in the scenario.

4. A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which process will accompany the actions of the neurotransmitter in a chemical synapse?

• A. Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses.
• B. Communication between a neuron and the single neuron it is connected with will be facilitated.
• C. The neurotransmitter will cross gap junctions more readily.
• D. More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors.

Correct answer: D

Rationale: When serotonin levels increase, more neurotransmitters will cross the synaptic cleft and bind with postsynaptic receptors, facilitating enhanced communication. Option A is incorrect because chemical synapses, unlike electrical synapses, are unidirectional. Option B is incorrect because neurotransmitters impact communication with multiple neurons, not just a single connected neuron. Option C is incorrect because neurotransmitters cross the synaptic cleft, not gap junctions.

5. A patient with a history of breast cancer is being prescribed tamoxifen (Nolvadex). What should the nurse 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. Patients should be educated about signs and symptoms of blood clots, such as swelling, pain, or redness in the legs. Choices B, C, and D are incorrect because tamoxifen is not associated with decreasing the risk of osteoporosis, causing hot flashes and menopausal symptoms, or causing weight gain and fluid retention.

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