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.
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A 56-year-old woman has been experiencing memory loss and confusion for the past year. The client is diagnosed with Alzheimer's disease. Which finding is most characteristic of this disease?
- A. Neurofibrillary tangles in the brain
- B. Demyelination of neurons in the brain
- C. Accumulation of beta-amyloid plaques
- D. Formation of Lewy bodies
Correct Answer: C
Rationale: The correct answer is C: Accumulation of beta-amyloid plaques. Alzheimer's disease is characterized by the accumulation of beta-amyloid plaques in the brain. These plaques are formed from the buildup of beta-amyloid protein fragments between nerve cells. Choice A, neurofibrillary tangles, are a hallmark of another neurodegenerative disease called Alzheimer's disease. Choice B, demyelination of neurons, is more characteristic of diseases like multiple sclerosis. Choice D, formation of Lewy bodies, is associated with Lewy body dementia, not Alzheimer's disease.
During a clinical assessment of a 68-year-old client who has suffered a head injury, a neurologist suspects that the client has sustained damage to her vagus nerve (CN X). Which assessment finding is most likely to lead the physician to this conclusion?
- A. The client has difficulty swallowing.
- B. The client has loss of gag reflex.
- C. The client has an inability to smell.
- D. The client has impaired eye movement.
Correct Answer: B
Rationale: The correct answer is B. Damage to the vagus nerve can result in the loss of the gag reflex, which is a key indicator for the neurologist. Difficulty swallowing (Choice A) is more associated with issues related to the glossopharyngeal nerve (CN IX) and hypoglossal nerve (CN XII). An inability to smell (Choice C) is related to the olfactory nerve (CN I), and impaired eye movement (Choice D) is typically associated with damage to the oculomotor nerve (CN III), trochlear nerve (CN IV), or abducens nerve (CN VI), not the vagus nerve.
A 25-year-old woman who works as an air traffic controller presents with facial pain and severe headache. She reports that she sometimes feels the pain in her neck or ear and that it is particularly bad during very busy times at the airport. What is the most likely diagnosis?
- A. Migraine headache
- B. Cluster headache
- C. Temporomandibular joint syndrome
- D. Sinus headache
Correct Answer: C
Rationale: The most likely diagnosis for the 25-year-old woman who works as an air traffic controller and presents with facial pain and severe headache that sometimes radiates to her neck or ear, aggravated by stress, is Temporomandibular joint syndrome. This syndrome involves pain in the jaw joint and the muscles controlling jaw movement, which can radiate to the surrounding areas like the neck and ear. Stress and clenching of the jaw commonly exacerbate the symptoms. Migraine headache (choice A) typically presents with other symptoms like nausea, sensitivity to light or sound, and can be triggered by various factors, not just stress. Cluster headache (choice B) is characterized by severe, unilateral pain around the eye with associated autonomic symptoms. Sinus headache (choice D) is usually associated with sinus congestion or infection, presenting with facial pressure or pain, often worsened by bending forward.
When educating a patient starting on oral contraceptives, what should the nurse include in the teaching plan regarding potential side effects?
- A. Weight gain, mood changes, and nausea
- B. Increased appetite, insomnia, and fatigue
- C. Breast tenderness, headaches, and dizziness
- D. Fatigue, hair loss, and joint pain
Correct Answer: A
Rationale: The correct answer is A: Weight gain, mood changes, and nausea are common side effects of oral contraceptives. Weight gain may occur due to fluid retention or changes in metabolism. Mood changes can be caused by hormonal fluctuations. Nausea is a common side effect that usually improves after a few months of use. Choices B, C, and D are incorrect because they do not reflect common side effects associated with oral contraceptives. Increased appetite, insomnia, breast tenderness, headaches, dizziness, fatigue, hair loss, and joint pain are not typically reported side effects of oral contraceptives.
A woman has been prescribed Climara, a transdermal estradiol patch. Which of the following should she be instructed by the nurse regarding the administration?
- A. Avoid prolonged sun exposure at the patch site due to increased plasma concentrations.
- B. The application of heat at the patch site will decrease effectiveness and result in pregnancy.
- C. The medication, when exposed to sunlight, can increase the risk of breast cancer.
- D. Exposure of the medication to occasional cold will increase effectiveness with application.
Correct Answer: A
Rationale: The correct answer is A. The Climara patch delivers estradiol transdermally, and patients should be instructed to avoid prolonged sun exposure at the patch site due to increased plasma concentrations. Sun exposure can accelerate the absorption of the medication, leading to higher systemic levels than intended. Choices B, C, and D are incorrect because heat at the patch site does not result in pregnancy but may alter absorption rates, there is no direct link between sunlight exposure and breast cancer risk related to this medication, and exposure to cold does not increase effectiveness of the transdermal patch.