Nursing Elites

1. What is a cause of the crystallization within the synovial fluid of the joint affected by gouty arthritis?

• A. Destruction of proteoglycans
• B. Underexcretion of uric acid
• C. Overexcretion of uric acid
• D. Increased absorption of uric acid

Correct answer: B

Rationale: The correct answer is B: Underexcretion of uric acid. In gouty arthritis, the crystallization within the synovial fluid of the affected joint is caused by the underexcretion of uric acid, leading to the accumulation and subsequent crystallization of urate crystals. Choice A, destruction of proteoglycans, is incorrect as it is not directly related to the crystallization process in gouty arthritis. Choice C, overexcretion of uric acid, is incorrect because gout is primarily associated with underexcretion or decreased excretion of uric acid rather than overexcretion. Choice D, increased absorption of uric acid, is also incorrect as the primary issue in gouty arthritis is the body's inability to properly eliminate uric acid.

2. Which of the following is not included in the care plan of a client with moderate cognitive impairment involving dementia of the Alzheimer’s type?

• A. Daily structured schedule
• B. Positive reinforcement for performing activities of daily living
• C. Stimulating environment
• D. Use of validation techniques

Correct answer: C

Rationale: In the care plan for a client with moderate cognitive impairment involving Alzheimer's type dementia, a stimulating environment is not included as it can potentially increase confusion. Therefore, it is important to provide a familiar, structured, and predictable environment to reduce stress and disorientation. Daily structured schedules help in maintaining routine and familiarity, positive reinforcement encourages engagement in activities, and validation techniques help in communicating effectively with the client by acknowledging their feelings and reality orientation.

3. When teaching a patient starting on oral contraceptives, what should the nurse include regarding the medication's effectiveness?

• A. Oral contraceptives are 100% effective when taken correctly.
• B. Oral contraceptives are effective immediately after starting.
• C. Oral contraceptives are less effective if taken with certain antibiotics.
• D. Oral contraceptives are less effective if taken with food.

Correct answer: C

Rationale: The correct answer is C. Oral contraceptives can be less effective when taken with certain antibiotics as they may interfere with the effectiveness of the contraceptive. It is important for patients to be aware of this interaction to consider additional contraceptive methods during antibiotic therapy. Choices A and B are incorrect as no contraceptive method is 100% effective, and oral contraceptives typically require a period of time to reach full effectiveness. Choice D is incorrect as taking oral contraceptives with food does not significantly impact their effectiveness.

4. A patient who is being administered isoniazid (INH) for tuberculosis has a yellow color in the sclera of her eye. What other finding would lead you to believe that hepatotoxicity has developed?

• A. Diarrhea
• B. Numbness
• C. Diminished vision
• D. Light-colored stools

Correct answer: A

Rationale: The correct answer is A: Diarrhea. Hepatotoxicity caused by isoniazid can present with various symptoms, including yellow discoloration of the sclera of the eyes, which indicates jaundice. Another common sign of hepatotoxicity is gastrointestinal symptoms such as nausea, vomiting, and diarrhea, which can occur due to liver dysfunction affecting bile production and digestion. Numbness (choice B) is more commonly associated with peripheral neuropathy caused by isoniazid, while diminished vision (choice C) and light-colored stools (choice D) are not typical manifestations of hepatotoxicity.

5. A male patient with benign prostatic hyperplasia (BPH) is prescribed finasteride (Proscar). What should the nurse include in the patient education?

• A. The medication is expected to reduce the size of the prostate, which should improve urinary symptoms over time.
• B. The medication will improve symptoms within a few days.
• C. The medication will cure BPH after treatment is complete.
• D. The medication may cause erectile dysfunction as a side effect.

Correct answer: A

Rationale: Finasteride is expected to reduce the size of the prostate, which should improve urinary symptoms over time, although the effects may take several weeks or months to become noticeable.

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