Nursing Elites

1. A 65-year-old man is admitted to the intensive care unit from the operating room after a triple coronary artery bypass graft. He is intubated and on a ventilator. Lactic acid levels were normal postoperatively, but now they are rising. The increased level could be an indication of:

• A. excessive sedation
• B. bowel ischemia
• C. excessive volume infusion in the operating room
• D. mild hypothermia postoperatively

Correct answer: B

Rationale: In this scenario, the rising lactic acid levels in a 65-year-old man after a coronary artery bypass graft could indicate bowel ischemia. Bowel ischemia can lead to anaerobic metabolism, causing an increase in lactic acid levels. Excessive sedation may cause respiratory depression but would not directly lead to rising lactic acid levels. Excessive volume infusion in the operating room might cause fluid overload but would not typically result in rising lactic acid levels. Mild hypothermia postoperatively could lead to shivering and increased oxygen consumption, but it is less likely to be the primary cause of rising lactic acid levels in this context.

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. A male patient is receiving testosterone therapy for hypogonadism. What adverse effect should the nurse be most concerned about?

• A. Increased risk of breast cancer
• B. Increased risk of liver dysfunction
• C. Increased risk of cardiovascular events
• D. Increased risk of prostate cancer

Correct answer: C

Rationale: The correct answer is C: Increased risk of cardiovascular events. Cardiovascular events such as stroke and myocardial infarction are the most concerning adverse effects of testosterone therapy, especially in older patients. Choice A, increased risk of breast cancer, is not a common adverse effect of testosterone therapy in males. Choice B, increased risk of liver dysfunction, is a potential adverse effect but is not the most concerning. Choice D, increased risk of prostate cancer, is a consideration in patients with a history of prostate cancer or those with prostate carcinoma, not typically in patients receiving testosterone therapy for hypogonadism.

4. A patient is taking medroxyprogesterone acetate (Provera) for the treatment of endometriosis. What should the nurse teach the patient about this medication?

• A. Medroxyprogesterone should be taken with food to prevent nausea.
• B. Medroxyprogesterone should be taken at the same time each day to maintain consistent hormone levels.
• C. Medroxyprogesterone can be taken intermittently when symptoms worsen.
• D. Medroxyprogesterone should be stopped if side effects occur.

Correct answer: B

Rationale: The correct answer is B. Medroxyprogesterone should be taken at the same time each day to maintain consistent hormone levels and effectiveness. Choice A is incorrect because medroxyprogesterone does not necessarily need to be taken with food. Choice C is incorrect as it is typically prescribed continuously rather than intermittently. Choice D is incorrect because patients should not stop the medication if side effects occur without consulting their healthcare provider.

5. A 40-year-old man has been living with HIV for several years but experienced a significant decrease in his CD4+ levels a few months ago. The patient has just been diagnosed with Mycobacterium avium complex disease. The nurse should anticipate administering which of the following medications?

• A. Clarithromycin
• B. Pyrazinamide
• C. Rifapentine (Priftin)
• D. Azithromycin

Correct answer: A

Rationale: The correct answer is A: Clarithromycin. In the case of Mycobacterium avium complex disease, a common treatment regimen includes a macrolide antibiotic like clarithromycin or azithromycin in combination with other antimicrobials. Clarithromycin is a key component of the treatment due to its effectiveness against Mycobacterium avium complex. Choice B (Pyrazinamide) is not typically part of the standard treatment for this condition. Choice C (Rifapentine) is mainly used in tuberculosis treatment and is not a primary agent for Mycobacterium avium complex disease. Choice D (Azithromycin) is another suitable macrolide antibiotic for treating Mycobacterium avium complex disease but is not the medication typically used first-line.

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