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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The nurse is providing education on the prevention of heart disease for adult females ages 35 to 44 years old.Which of the following would be most appropriate for this disease process? Select all that apply.
- A. Taking a brisk walking for 50 minutes three times a week
- B. Consuming a diet rich in vegetables, fruits, and whole grains
- C. Obtaining a varicella vaccine, if no evidence of immunity
- D. Recognizing the importance of smoking cessation
Correct Answer: A
Rationale: A. Selecting "A" because physical activity, such as brisk walking, is beneficial for heart health. Regular exercise helps in maintaining a healthy weight, lowering blood pressure, and improving overall cardiovascular health.
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 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.
The nurse is providing preoperative education on the laparoscope-assisted vaginal hysterectomy. Which statement by the patient verifies understanding of the procedure?
- A. I will use a mild douche solution to keep the surgical area clean.
- B. I'm relieved that I won't have any visible scars on my abdomen.
- C. I understand that there will be some light vaginal bleeding for several days.
- D. I understand that I must remain on bedrest until cleared by the surgeon.
Correct Answer: B
Rationale: The correct statement by the patient that demonstrates understanding of the laparoscope-assisted vaginal hysterectomy procedure is "I'm relieved that I won't have any visible scars on my abdomen." This is a relevant and accurate statement as the procedure involves minimal scarring due to the use of small incisions in the abdomen rather than a large incision. It shows understanding of one of the benefits of this surgical approach. The other statements are not accurate or relevant to the procedure.
A medical-surgical nurse is asked to float to a women’s health unit to care for patients who are scheduled for therapeutic abortions. The nurse refuses to accept this assignment and expresses her personal beliefs as being incongruent with this medical practice. The nursing supervisor states that the unit is short-staffed and the nurse is familiar with caring for postoperative patients. In consideration of legal and ethical practices, can the nursing supervisor enforce this assignment?
- A. The staff nurse has the reNspoRnsibIilityG of Bac.ceCptinMg any assignment that is made U S N T O while working for a health care unit, so the nursing supervisor is within his or her rights to enforce this assignment.
- B. Because the unit is short-staffed, the staff nurse should accept the assignment to provide care by benefit of her or his experience to patients who need care.
- C. The staff nurse has expressed a legitimate concern based on his or her feelings; the nursing supervisor does not have the authority to enforce this assignment.
- D. The nursing supervisor should emphasize that this assignment requires care of a surgical patient for which the staff nurse is adequately trained and should therefore enforce the assignment.
Correct Answer: C
Rationale: In this situation, the nurse's refusal to accept the assignment is based on personal beliefs that conflict with the nature of the medical practice (therapeutic abortions). According to the American Nurses Association (ANA) Code of Ethics, nurses have the right to refuse assignments that go against their personal, cultural, or religious beliefs. The nurse in this scenario has expressed a legitimate concern, and the nursing supervisor should respect the nurse's autonomy and should not enforce the assignment. It is essential to balance respecting the nurse's beliefs while also ensuring patient safety and adequate staffing levels.