Nokea
What hormonal medication can be used in a premenopausal patient without the concurrent use of ovarian suppression?
- A. letrozole (Femara)
- B. exemestane (Aromasin)
- C. elacestrant (Orserdu)
- D. tamoxifen (Soltamox)
Correct Answer: D
Rationale: Tamoxifen is a hormonal medication that can be used in premenopausal patients without the concurrent use of ovarian suppression. It is a selective estrogen receptor modulator (SERM) that acts by blocking estrogen receptors in breast tissue, thereby inhibiting the growth of hormone-sensitive breast cancer cells. Tamoxifen is commonly prescribed for hormone receptor-positive breast cancer in both premenopausal and postmenopausal women. Unlike aromatase inhibitors (e.g., letrozole and exemestane) which require ovarian suppression in premenopausal patients, tamoxifen can be used as monotherapy in premenopausal patients due to its different mechanism of action. Elacestrant is a selective estrogen receptor degrader (SERD) and not commonly used in clinical practice for this indication.
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Which nursing intervention is written correctly?
- A. Force fluids as necessary.
- B. Observe interaction with the infant.
- C. Encourage turning, coughing, and deep breathing. N R I G B.C M U S N T O
- D. Assist to ambulate for 10 minutes at 8 AM, 2 PM, and 6 PM.
Correct Answer: D
Rationale: The correct nursing intervention that is written correctly is option D. The intervention "Assist to ambulate for 10 minutes at 8 AM, 2 PM, and 6 PM" is clear, specific, and provides a specific time frame for the activity. It is important in nursing documentation to be precise and clearly state the details of the intervention to ensure effective communication among healthcare team members. This intervention also specifies the frequency and duration of the ambulation activity, which helps in ensuring continuity of care and proper execution of the intervention for the patient.
The clinic nurse often cares for patients who are considering an abortion. Which responsibilities does this nurse have in regard to this issue? (Select all that apply.)
- A. Informing the patient about pro-life options
- B. Informing the patient about pro-choice support groups
- C. Being informed about abortion from a legal standpoint
- D. Being informed about abortion from an ethical standpoint
Correct Answer: B
Rationale: B. Informing the patient about pro-choice support groups: It is important for the clinic nurse to provide patients with information about different support resources available, including pro-choice support groups, to ensure they have access to a variety of perspectives and guidance.
A nurse who works in the emergency department (ED) is assigned to a patient who is experiencing heavy vaginal bleeding at 12 weeks’ gestation. An ultrasound has confirmed the absence of a fetal heart rate, and the patient is scheduled for a dilation and evacuation of the pregnancy. The nurse refuses to provide any further care for this patient based on moral principles. What is the nurse manager’s initial response to the nurse?
- A. “I recall you sharing that information in your interview. I will arrange for another nurse to take report on this patient.”
- B. “Because we are shorthanded today, you have to continue to provide care. There is no one else available to provide care for this patient.”
- C. “I understand your point of view. You were hired to work here in the ED so you had to know this situation was possible.”
- D. “Abandonment is a serious issue. I have to advise you to continue to provide care for this patient.”
Correct Answer: D
Rationale: The nurse manager's initial response should prioritize patient care and safety. In this situation, the patient requires urgent medical attention due to heavy vaginal bleeding and the need for a dilation and evacuation procedure. The nurse's refusal to provide care based on personal moral principles can be considered as patient abandonment, which is a serious ethical and legal issue in healthcare. The nurse manager must advise the nurse to continue providing care for the patient to ensure that the patient's needs are met and to prevent harm resulting from abandonment. The nurse manager should also address the nurse's concerns separately through appropriate channels, such as discussing ethical considerations, providing support, and exploring options for accommodation or transfer if necessary.
Which step of the nursing process is being used when the nurse decides whether an ethical dilemma exists?
- A. Analysis
- B. Planning
- C. Evaluation
- D. Assessment
Correct Answer: A
Rationale: Analysis is the step of the nursing process being used when the nurse decides whether an ethical dilemma exists. During the analysis step, the nurse gathers and interprets data to make sense of a clinical situation. In the case of ethical dilemmas, the nurse would assess the situation, gather relevant information, and analyze it to determine if there is a conflict in values, beliefs, or principles, which would classify it as an ethical dilemma. Once the nurse identifies the existence of an ethical dilemma through analysis, they can then move on to the planning phase to decide on a course of action.
A 55-year-old postmenopausal female patient presents to the family practice clinic for her annual examination. The nurse notes that the patient has lost inch in height. Upon further investigation, the nurse discovers that the patient has a slow-healing fracture of the left radius. What screening will most likely be initiated at this time for the patient?
- A. Assessment for domestic violence
- B. Dual-energy x-ray absorptiometry scan
- C. Follicle-stimulating hormone
- D. Serum levels of calcium and vitamin D
Correct Answer: B
Rationale: In this scenario, the postmenopausal female patient who has lost height and has a slow-healing fracture of the left radius presents with concerning factors for osteoporosis. The most appropriate screening to initiate in this case would be a dual-energy x-ray absorptiometry (DEXA) scan. DEXA scan is the gold standard for diagnosing osteoporosis by measuring bone mineral density. Given the patient's age, postmenopausal status, height loss, and fracture history, assessing bone health through a DEXA scan is crucial to determine the presence of osteoporosis and guide appropriate management and treatment strategies.