Nursing Elites

1. What is the etiology and most likely treatment for myasthenia gravis in a 22-year-old female college student?

• A. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids.
• B. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins.
• C. Cerebellar lesions; surgical and immunosuppressive treatment.
• D. Excess acetylcholinesterase production; treatment with thymectomy.

Correct answer: B

Rationale: Myasthenia gravis is characterized by a decline in functioning acetylcholine receptors rather than autoimmune destruction of skeletal muscle cells (Choice A), cerebellar lesions (Choice C), or excess acetylcholinesterase production (Choice D). The most likely treatment for myasthenia gravis involves corticosteroids to reduce inflammation and intravenous immunoglobulins to block the antibodies attacking acetylcholine receptors. Intensive physical therapy and anabolic steroids are not primary treatments for myasthenia gravis.

2. If a patient complains of dizziness, which term below best describes this feeling?

• A. Contraindication
• B. Sign
• C. Objective data
• D. Symptom

Correct answer: D

Rationale: The correct answer is D: 'Symptom.' Dizziness is a symptom because it is a subjective experience reported by the patient. A 'contraindication' refers to a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful. A 'sign' is an objective finding that can be observed or measured. 'Objective data' refers to measurable and observable information about a patient's condition, which is usually obtained through physical examination or diagnostic tests. Therefore, in this case, 'Symptom' is the best term to describe the patient's feeling of dizziness.

3. A male patient is receiving testosterone therapy for hypogonadism. What adverse effect should the nurse monitor during this therapy?

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

Correct answer: A

Rationale: The correct answer is A: Increased risk of cardiovascular events. Testosterone therapy can lead to an increased risk of cardiovascular events like heart attacks and strokes, especially in older patients. Choice B, increased risk of liver dysfunction, is not a common adverse effect of testosterone therapy. Choice C, increased risk of prostate cancer, is a concern when using testosterone therapy in patients with existing prostate cancer, but not a general adverse effect. Choice D, increased risk of bone fractures, is not typically associated with testosterone therapy.

4. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. What condition would contraindicate the use of this medication?

• A. History of peptic ulcer disease
• B. Use of nitrates
• C. Use of antihypertensive medications
• D. History of hypertension

Correct answer: B

Rationale: The correct answer is B: Use of nitrates. Sildenafil (Viagra) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates combined with sildenafil can lead to a dangerous drop in blood pressure. Choices A, C, and D are incorrect because a history of peptic ulcer disease, use of antihypertensive medications, or a history of hypertension are not direct contraindications for sildenafil use.

5. In a patient with HIV infected with Mycobacterium avium complex from an indoor pool, which of the following medications is the recommended treatment for MAC?

• A. Clarithromycin
• B. Isoniazid (INH)
• C. Rifabutin
• D. Azithromycin

Correct answer: A

Rationale: The correct answer is Clarithromycin. Clarithromycin is one of the recommended medications for treating Mycobacterium avium complex (MAC) infections in patients with HIV. It is a macrolide antibiotic that is effective against MAC. Isoniazid (INH) is used to treat tuberculosis, not MAC. Rifabutin is another medication used in the treatment of MAC infections, but clarithromycin is preferred as a first-line agent. Azithromycin is also used in the treatment of MAC infections; however, clarithromycin is more commonly recommended due to its efficacy and safety profile.

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