Nursing Elites

1. The sister of a patient diagnosed with BRCA gene-related breast cancer asks the nurse, 'Do you think I should be tested for the gene?' Which response by the nurse is most appropriate?

• A. In most cases, breast cancer is not caused by the BRCA gene.
• B. It depends on how you will feel if the test is positive for the BRCA gene.
• C. There are many things to consider before deciding to have genetic testing.
• D. You should decide first whether you are willing to have a bilateral mastectomy.

Correct answer: C

Rationale: The most appropriate response by the nurse is C: 'There are many things to consider before deciding to have genetic testing.' Genetic testing for BRCA gene mutations is a complex decision that involves various factors such as emotional readiness, potential impact on insurance and employability, and the implications of test results. Option A is incorrect because although most breast cancers are not related to BRCA gene mutations, individuals with these mutations have a significantly higher risk. Option B is not ideal as it oversimplifies the decision-making process by focusing solely on emotional aspects. Option D is incorrect as it implies a predetermined course of action (mastectomy) before even undergoing genetic testing, which is not appropriate.

2. A 28-year-old woman presents with abdominal pain, diarrhea, and rectal bleeding. She has a history of similar episodes in the past. What is the most likely diagnosis?

• A. Ulcerative colitis
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Diverticulitis

Correct answer: A

Rationale: The constellation of symptoms including abdominal pain, diarrhea, and rectal bleeding in a young woman with a history of similar episodes is highly suggestive of ulcerative colitis. This chronic inflammatory condition primarily affects the colon and rectum, leading to symptoms such as bloody diarrhea, abdominal pain, and urgency. The recurrent nature of her symptoms and the presence of rectal bleeding further support this diagnosis over other conditions listed, such as irritable bowel syndrome, celiac disease, or diverticulitis, which typically do not present with the same combination of symptoms and history.

3. The client is receiving intravenous (IV) morphine for pain control. Which assessment finding requires the most immediate intervention?

• A. Drowsiness.
• B. Itching.
• C. Nausea.
• D. Respiratory rate of 8 breaths per minute.

Correct answer: D

Rationale: A respiratory rate of 8 breaths per minute indicates severe respiratory depression, a life-threatening side effect of opioid therapy. Immediate intervention is crucial to prevent respiratory failure. Monitoring and managing respiratory status are critical in clients receiving opioids to prevent adverse events. Drowsiness, itching, and nausea are common side effects of morphine but are not as immediately life-threatening as severe respiratory depression.

4. A patient with systemic lupus erythematosus (SLE) is prescribed hydroxychloroquine. What is the most important instruction the nurse should give?

• A. Report any vision changes immediately.
• B. Take the medication with milk.
• C. Avoid high-fat foods.
• D. Increase intake of green leafy vegetables.

Correct answer: A

Rationale: The correct instruction for a patient prescribed hydroxychloroquine, especially in the context of systemic lupus erythematosus (SLE), is to report any vision changes immediately. Hydroxychloroquine can potentially cause retinal damage, so prompt reporting and ophthalmologic evaluation are essential in preventing irreversible eye complications. Choices B, C, and D are incorrect because they do not address the significant adverse effect of hydroxychloroquine on vision. Taking the medication with milk, avoiding high-fat foods, or increasing intake of green leafy vegetables are not relevant to the primary concern of monitoring for visual changes.

5. A client is undergoing chemotherapy and is at risk for developing thrombocytopenia. What precaution should the nurse teach the client to minimize the risk of bleeding?

• A. Use a soft-bristled toothbrush.
• B. Engage in daily aerobic exercise.
• C. Take aspirin for headaches.
• D. Use an electric razor for shaving.

Correct answer: A

Rationale: Using a soft-bristled toothbrush is essential for clients at risk of thrombocytopenia to prevent gum bleeding, as their platelet counts may be low. Vigorous brushing with a hard-bristled toothbrush can injure the gums, leading to bleeding, which can be exacerbated in clients with low platelets. Therefore, advising the client to use a soft-bristled toothbrush is a crucial precaution to minimize the risk of bleeding.

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