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What critical point should the nurse include in patient education regarding tamoxifen (Nolvadex) for a patient with breast cancer?
- A. Tamoxifen may increase the risk of venous thromboembolism.
- B. Tamoxifen may cause hot flashes and other menopausal symptoms.
- C. Tamoxifen may cause weight gain and fluid retention.
- D. Tamoxifen may decrease the risk of osteoporosis.
Correct Answer: A
Rationale: The correct answer is A. Tamoxifen increases the risk of venous thromboembolism. Patients should be educated about the signs and symptoms of blood clots, such as swelling, redness, and pain in the legs. Choices B, C, and D are incorrect because tamoxifen is not associated with causing hot flashes, weight gain, fluid retention, or decreasing the risk of osteoporosis.
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A patient is prescribed tadalafil (Cialis) for erectile dysfunction. What critical contraindication should the nurse discuss with the patient?
- A. Use of nitrates
- B. Use of antihypertensive medications
- C. History of hypertension
- D. History of peptic ulcer disease
Correct Answer: A
Rationale: The correct answer is A: Use of nitrates. Tadalafil (Cialis) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates potentiate the hypotensive effects of tadalafil, leading to a potentially life-threatening drop in blood pressure. Choices B, C, and D are incorrect because antihypertensive medications, history of hypertension, and history of peptic ulcer disease are not critical contraindications for tadalafil use. While caution may be needed in patients with certain conditions, the highest priority is addressing the interaction with nitrates.
A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart?
- A. Iron deficiency anemia
- B. Sideroblastic anemia
- C. Pernicious anemia
- D. Hemolytic anemia
Correct Answer: C
Rationale: The correct answer is C, Pernicious anemia. Pernicious anemia is associated with a congenital intrinsic factor deficiency, leading to the impaired absorption of vitamin B12. Iron deficiency anemia (Choice A) is not directly related to intrinsic factor deficiency. Sideroblastic anemia (Choice B) is characterized by defective iron uptake by developing erythrocytes and is not linked to intrinsic factor deficiency. Hemolytic anemia (Choice D) involves the premature destruction of red blood cells and is not specifically associated with intrinsic factor deficiency.
A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's questions is least likely to yield data that will confirm or rule out migraines as the cause of his problem?
- A. Does your son experience nausea or vomiting when he has a headache?
- B. Does your son have a history of recent head injury?
- C. Does your son become sensitive to light when he has a headache?
- D. Does anyone in your family have a history of migraines?
Correct Answer: B
Rationale: Asking about a history of recent head injury is less likely to yield data relevant to confirming or ruling out migraines. Migraines are often associated with symptoms like nausea, vomiting, sensitivity to light, and a family history of migraines. While head injuries can cause headaches, the focus of the assessment in this case should be on symptoms more specific to migraines to guide the diagnosis and management.
A patient with an 18 pack per year history presents to a family practice clinic complaining of painless hoarseness and inability to clear mucus. A biopsy of respiratory tract cells is taken and shows that these cells have been replaced by less mature squamous epithelium cells. The nurse knows this type of change is referred to as:
- A. Dysplasia
- B. Metaplasia
- C. Hyperplasia
- D. Coagulation
Correct Answer: B
Rationale: Metaplasia is the replacement of one type of cell with another, which can occur in response to chronic irritation, such as from smoking. In this case, the respiratory tract cells being replaced by less mature squamous epithelium cells indicate metaplasia. Dysplasia refers to abnormal development or growth of cells, not replacement; hyperplasia is an increase in the number of cells, not a replacement; and coagulation is a process related to blood clotting, not cell replacement.
A patient's current medical condition is suggestive of impaired erythropoiesis. Which of the following laboratory studies would be most clinically relevant in diagnosing this health problem?
- A. White blood cell count with differential
- B. RBC, hemoglobin, and hematocrit
- C. INR and aPTT
- D. d-dimer and C-reactive protein
Correct Answer: B
Rationale: In this scenario, where impaired erythropoiesis is suspected, the most clinically relevant laboratory studies would focus on red blood cell parameters. Therefore, assessing RBC count, hemoglobin levels, and hematocrit values would provide direct insights into erythropoiesis. Choices A, C, and D are not directly related to erythropoiesis assessment. White blood cell count with a differential is more indicative of immune response and infection. INR and aPTT are coagulation studies, while d-dimer and C-reactive protein levels are more associated with inflammation and thrombotic events.