Nursing Elites

1. A nurse is providing education to a patient starting hormone replacement therapy (HRT) for menopausal symptoms. What should the nurse emphasize regarding the long-term risks associated with HRT?

• A. HRT may increase the risk of cardiovascular events, including heart attack and stroke.
• B. HRT may decrease the risk of osteoporosis.
• C. HRT may improve mood and energy levels.
• D. HRT may decrease the risk of breast cancer.

Correct answer: A

Rationale: HRT is associated with an increased risk of cardiovascular events, including heart attack and stroke, particularly with long-term use.

2. A nurse is teaching a patient about the use of raloxifene (Evista) for the prevention of osteoporosis. What is the primary therapeutic action of this medication?

• A. It decreases the absorption of calcium from the intestines.
• B. It decreases bone resorption and increases bone density.
• C. It increases the excretion of calcium through the kidneys.
• D. It stimulates the formation of new bone.

Correct answer: B

Rationale: The correct answer is B. Raloxifene, a selective estrogen receptor modulator (SERM), works by decreasing bone resorption and increasing bone density. This action helps in preventing osteoporosis by maintaining bone strength. Choice A is incorrect as raloxifene does not affect the absorption of calcium from the intestines. Choice C is incorrect as raloxifene does not increase the excretion of calcium through the kidneys. Choice D is incorrect as raloxifene does not directly stimulate the formation of new bone; instead, it primarily works by reducing bone loss.

3. A female patient is taking combined hormonal contraceptives to prevent pregnancy. She visits the gynecology clinic and is noted to have a blood pressure of 176/102 mm Hg. The patient is started on enalapril mesylate 10 mg. In collaboration with the primary care provider, what other patient teaching should be provided based on her current medication regimen?

• A. Instruct on a low-salt diet.
• B. Instruct to discontinue the contraceptives.
• C. Instruct on the use of relaxation techniques to decrease stress.
• D. Instruct on the rationale for increasing the contraceptive dose.

Correct answer: A

Rationale: Women on hormonal contraceptives and antihypertensives like enalapril should be counseled to adopt a low-salt diet if severe hypertension occurs. This dietary modification can help in managing blood pressure levels. Instructing to discontinue the contraceptives is crucial in cases of severe hypertension as it poses an increased risk of cardiovascular events. Instructing on relaxation techniques may have some benefits in reducing stress levels but addressing the root cause, such as discontinuing contraceptives in this scenario, is more critical. There is no rationale for increasing the contraceptive dose when hypertension is present; in fact, it should be stopped to prevent complications.

4. Which of the following is a complication of compartment syndrome?

• A. Hemorrhage
• B. Pain and tissue damage
• C. Increased limb function
• D. Chronic kidney disease

Correct answer: B

Rationale: The correct answer is B: Pain and tissue damage. Compartment syndrome occurs due to increased pressure within the muscle compartments, leading to pain and tissue damage. Hemorrhage (choice A) is not a typical complication of compartment syndrome. Increased limb function (choice C) is not a complication but rather a potential improvement if the condition is managed appropriately. Chronic kidney disease (choice D) is unrelated to compartment syndrome.

5. Which of the following wounds is most likely to heal by secondary intention?

• A. A finger laceration received while cutting onions
• B. A stage IV pressure ulcer that developed in a nursing home
• C. A needlestick injury received while administering parenteral medication
• D. An incision from an open appendectomy

Correct answer: B

Rationale: A stage IV pressure ulcer is a deep wound involving tissue loss that typically heals by secondary intention. This process involves the wound healing from the bottom up with granulation tissue and often results in significant scarring. Choice A, a finger laceration, would generally heal by primary intention due to its clean edges and minimal tissue loss. Choice C, a needlestick injury, is likely to be sutured and heal by primary intention since it is a small, clean wound. Choice D, an incision from an open appendectomy, is usually closed with sutures and heals by primary intention as well.

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