Nursing Elites

1. Why is it important to genotype HCV before initiating drug therapy?

• A. Side effects of nucleotide analogs
• B. Measures for improving the appetite
• C. Ways to increase activity and exercise
• D. Administering alpha-interferon (Intron A)

Correct answer: B

Rationale: Genotyping of HCV plays a crucial role in managing treatment as it helps determine the most effective therapy for the specific viral strain. It allows healthcare providers to personalize treatment regimens and predict response rates. The statement about acute HCV infection converting to chronic state is accurate, highlighting the need for appropriate management. Immune globulin and vaccines are not available for HCV, and Ribavirin is commonly used for chronic HCV infection. Improving appetite is essential in liver health as adequate nutritional intake supports hepatocyte regeneration. Choices A, C, and D are incorrect as they do not address the specific importance of genotyping in HCV treatment or the significance of appetite improvement in liver function.

2. Which of the following can cause coup-contrecoup injuries?

• A. Rotational forces
• B. Deformation forces
• C. Deceleration forces
• D. Acceleration forces

Correct answer: C

Rationale: Deceleration forces occur when the head is moving and abruptly comes to a stop, such as in a car crash. This sudden deceleration can cause the brain to hit against the skull, resulting in coup-contrecoup injuries. In a coup-contrecoup injury, the brain is damaged on opposite sides due to the initial impact and the rebound effect inside the skull. Rotational forces usually result in diffuse axonal injuries rather than coup-contrecoup injuries. Deformation forces can cause focal brain injuries but not coup-contrecoup injuries. Acceleration forces typically lead to diffuse brain injuries, not coup-contrecoup injuries. Therefore, the correct answer is deceleration forces.

3. To prevent a Valsalva maneuver in a client recovering from an acute myocardial infarction, the nurse would:

• A. Assist the client in using the bedside commode
• B. Administer stool softeners daily as prescribed
• C. Administer antidysrhythmics PRN as prescribed
• D. Maintain the client on strict bed rest

Correct answer: B

Rationale: Administering stool softeners daily as prescribed is essential to prevent straining during defecation, which can lead to a Valsalva maneuver. Straining can increase intra-abdominal pressure, hinder venous return, and elevate blood pressure, risking cardiac complications in a client recovering from a heart attack. Using a bedside commode might be useful to minimize exertion during toileting but does not directly address the risk of a Valsalva maneuver. Administering antidysrhythmics PRN is not the primary intervention for preventing a Valsalva maneuver; these medications are used to manage dysrhythmias if they occur. Keeping the client on strict bed rest is not the best option as early mobilization is encouraged in post-myocardial infarction recovery to prevent complications such as deep vein thrombosis and muscle weakness.

4. After hydrostatic reduction for intussusception, what client response should the nurse expect to observe?

• A. Abdominal distension
• B. Currant jelly-like stools
• C. Severe, colicky-type pain with vomiting
• D. Passage of barium or water-soluble contrast with stools

Correct answer: D

Rationale: After hydrostatic reduction for intussusception, the nurse should observe the passage of barium or water-soluble contrast with stools. This indicates a successful reduction of the telescoped bowel segment. Abdominal distension and currant jelly-like stools are clinical manifestations of intussusception, not expected outcomes following hydrostatic reduction. Severe, colicky-type pain with vomiting suggests an unresolved gastrointestinal issue, not a successful reduction of intussusception.

5. A 34-year-old patient with chronic hepatitis C infection has several medications prescribed. Which medication requires further discussion with the healthcare provider before administration?

• A. Ribavirin (Rebetol, Copegus) 600 mg PO bid
• B. Pegylated α-interferon (PEG-Intron, Pegasys) SQ weekly
• C. Diphenhydramine (Benadryl) 25 mg PO every 4 hours PRN itching
• D. Dimenhydrinate (Dramamine) 50 mg PO every 6 hours PRN nausea

Correct answer: B

Rationale: The correct answer is B: Pegylated α-interferon (PEG-Intron, Pegasys) SQ weekly. Pegylated α-interferon is typically administered once weekly, not daily. Therefore, this medication requires further discussion with the healthcare provider before administration to ensure the correct dosing frequency. Ribavirin, choice A, is appropriate for chronic hepatitis C treatment. Choices C and D, Diphenhydramine and Dimenhydrinate, are commonly used for symptomatic relief in patients with hepatitis C and do not require further discussion with the healthcare provider in this context.

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