Nursing Elites

1. An adult patient has begun treatment with fluconazole. The nurse should recognize the need to likely discontinue the drug if the patient develops which of the following signs or symptoms?

• A. Jaundice
• B. Weight gain
• C. Iron deficiency anemia
• D. Hematuria

Correct answer: A

Rationale: The correct answer is A: Jaundice. Fluconazole, an antifungal medication, can rarely cause hepatotoxicity, which may manifest as jaundice. Monitoring for signs of liver dysfunction, such as jaundice, is crucial during fluconazole therapy. Weight gain, iron deficiency anemia, and hematuria are not commonly associated with fluconazole use and are not indications for discontinuing the drug.

2. What can multiple dark bands on the nails indicate?

• A. They are considered a normal variant.
• B. They can be associated with malignant melanoma.
• C. They are indicative of a nail fungus.
• D. They are associated with aging.

Correct answer: B

Rationale: Multiple dark bands on the nails can be associated with malignant melanoma, a serious type of skin cancer. While dark bands on the nails can sometimes be a normal variant, they should not be ignored as they could also be a sign of a serious condition like melanoma. Nail fungus typically presents with different symptoms such as thickened, discolored, or brittle nails. Dark bands on the nails are not directly associated with aging.

3. Which of the following characterizes ductal carcinoma in situ?

• A. It is less common than lobular carcinoma in situ.
• B. Malignant cells have not invaded the stroma.
• C. It is considered a cancer precursor.
• D. Malignant cells have not invaded the stroma; it is considered a cancer precursor and has a higher risk for invasive cancer compared to lobular carcinoma in situ.

Correct answer: D

Rationale: The correct answer is that ductal carcinoma in situ is characterized by malignant cells that have not invaded the stroma, making it a cancer precursor with a higher risk for invasive cancer compared to lobular carcinoma in situ. Choice A is incorrect because ductal carcinoma in situ is more common than lobular carcinoma in situ. Choice B is incorrect as it only partially describes ductal carcinoma in situ without mentioning its potential for progression to invasive cancer. Choice C is incorrect because it does not capture the complete characteristics of ductal carcinoma in situ, which include the risk for invasive cancer.

4. 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.

5. When a patient asks the nurse what hypersensitivity is, how should the nurse respond? Hypersensitivity is best defined as:

• A. A reduced immune response found in most pathologic states
• B. A normal immune response to an infectious agent
• C. An excessive or inappropriate response of the immune system to a sensitizing antigen
• D. Antigenic desensitization

Correct answer: C

Rationale: Hypersensitivity is correctly defined as an excessive or inappropriate response of the immune system to a sensitizing antigen. This response leads to tissue damage or other clinical manifestations. Choice A is incorrect as hypersensitivity involves an exaggerated, not a reduced, immune response. Choice B is incorrect because hypersensitivity is not a normal immune response to an infectious agent but rather an exaggerated one. Choice D is incorrect as it refers to desensitization, which is the opposite of hypersensitivity.

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