Nursing Elites

1. A nurse caring for a patient with a diagnosis of lung cancer is aware that the primary risk factor for developing lung cancer is:

• A. Alcohol consumption
• B. Smoking
• C. Poor diet
• D. Environmental exposure

Correct answer: B

Rationale: The correct answer is B: Smoking. Smoking is the primary risk factor for developing lung cancer. Tobacco smoke contains numerous carcinogens that can damage the cells in the lungs, leading to the development of cancer. Alcohol consumption (Choice A), poor diet (Choice C), and environmental exposure (Choice D) can contribute to overall health risks, but they are not the primary risk factors specifically associated with the development of lung cancer.

2. While assessing a critically ill client in the emergency department, the nurse notes on the cardiac monitor an R-on-T premature ventricular beat that develops into ventricular tachycardia (VT). Immediately, the client became unresponsive. The nurse knows that based on pathophysiologic principles, the most likely cause of the unresponsiveness is:

• A. metabolic acidosis that occurs spontaneously following any dysrhythmias.
• B. interruption of the blood/oxygen supply to the brain.
• C. massive cerebrovascular accident (CVA) resulting from increased perfusion.
• D. a blood clot coming from the heart and occluding the carotid arteries.

Correct answer: B

Rationale: The correct answer is B. Ventricular tachycardia (VT) can disrupt the normal heart function, leading to a decreased cardiac output. This decreased output can interrupt the blood supply to the brain, causing the client to become unresponsive. Metabolic acidosis (Choice A) is not the most likely cause of unresponsiveness in this scenario. A massive cerebrovascular accident (CVA) (Choice C) would not result from increased perfusion. A blood clot occluding the carotid arteries (Choice D) may lead to a stroke but is not the most likely cause of sudden unresponsiveness in this situation.

3. What is the primary therapeutic action of tamsulosin (Flomax) in a male patient with benign prostatic hyperplasia (BPH)?

• A. Relaxation of the muscles in the prostate and bladder neck, leading to improved urinary flow.
• B. Reduction in prostate size and improvement in urinary symptoms.
• C. Increase in urine flow and relief of urinary obstruction.
• D. Improvement in erectile function.

Correct answer: A

Rationale: The correct answer is A: Relaxation of the muscles in the prostate and bladder neck, leading to improved urinary flow. Tamsulosin, a medication commonly prescribed for BPH, works by selectively blocking alpha-1 adrenergic receptors in the prostate, causing relaxation of smooth muscles in the prostate and bladder neck. This relaxation reduces the constriction in these areas, improving urinary flow and reducing symptoms such as hesitancy, urgency, frequency, and weak stream. Choice B is incorrect because tamsulosin does not directly reduce the size of the prostate. Choice C is incorrect as tamsulosin primarily acts by relaxing muscles rather than directly increasing urine flow. Choice D is incorrect as tamsulosin is not indicated for improving erectile function.

4. After a generalized seizure, a 27-year-old woman with epilepsy feels tired and falls asleep. This is:

• A. an ominous sign.
• B. normal and termed the postictal period.
• C. a reflection of an underlying brain tumor.
• D. only worrisome if there are focal neurologic deficits after.

Correct answer: B

Rationale: Choice B is the correct answer. The postictal period is the phase following a seizure, characterized by symptoms like fatigue, confusion, and sleepiness. It is a normal part of the seizure process and does not necessarily indicate a serious underlying issue. Choice A is incorrect because feeling tired and falling asleep after a seizure is expected and not an ominous sign. Choice C is incorrect as there is no indication in the scenario provided to suggest an underlying brain tumor. Choice D is incorrect because the presence of focal neurologic deficits would indeed be concerning, but the postictal state itself is a common and expected occurrence post-seizure.

5. A nurse on a postsurgical unit is providing care for a 76-year-old female client who is two days post-hemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which guideline should the nurse use for short-term and long-term treatment of the client's pain?

• A. Pain is what the client says it is, even if she is not exhibiting outward signs.
• B. Pain should be treated only when it is associated with observable symptoms.
• C. Long-term opioid use is generally safe for elderly clients in a hospital setting.
• D. The client's pain should be reassessed after every dose of pain medication.

Correct answer: A

Rationale: Pain is a subjective experience, and the client's report of pain should be taken seriously even if there are no outward signs. Choice B is incorrect because pain can be present without observable symptoms, and waiting for observable signs may delay appropriate pain management. Choice C is incorrect because the safety of long-term opioid use in elderly clients is a complex issue and should be carefully evaluated due to the risk of adverse effects. Choice D is incorrect because while pain reassessment is important, it should not be limited to just after medication administration but should occur regularly to ensure adequate pain control.

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