Nursing Elites

1. A 25-year-old woman who works as an air traffic controller presents with facial pain and severe headache. She reports that she sometimes feels the pain in her neck or ear and that it is particularly bad during very busy times at the airport. What is the most likely diagnosis?

• A. Migraine headache
• B. Cluster headache
• C. Temporomandibular joint syndrome
• D. Sinus headache

Correct answer: C

Rationale: The most likely diagnosis for the 25-year-old woman who works as an air traffic controller and presents with facial pain and severe headache that sometimes radiates to her neck or ear, aggravated by stress, is Temporomandibular joint syndrome. This syndrome involves pain in the jaw joint and the muscles controlling jaw movement, which can radiate to the surrounding areas like the neck and ear. Stress and clenching of the jaw commonly exacerbate the symptoms. Migraine headache (choice A) typically presents with other symptoms like nausea, sensitivity to light or sound, and can be triggered by various factors, not just stress. Cluster headache (choice B) is characterized by severe, unilateral pain around the eye with associated autonomic symptoms. Sinus headache (choice D) is usually associated with sinus congestion or infection, presenting with facial pressure or pain, often worsened by bending forward.

2. What specific instructions should the nurse provide to ensure proper administration of alendronate (Fosamax) for the treatment of osteoporosis?

• A. Take the medication with a full glass of water and remain upright for at least 30 minutes.
• B. Take the medication at bedtime to ensure absorption during sleep.
• C. Take the medication with milk to enhance calcium absorption.
• D. Take the medication with food to prevent gastrointestinal upset.

Correct answer: A

Rationale: The correct answer is to take the medication with a full glass of water and remain upright for at least 30 minutes. This is important to prevent esophageal irritation and ensure proper absorption. Choice B is incorrect because alendronate should be taken in the morning on an empty stomach, at least 30 minutes before eating or drinking anything other than water. Choice C is incorrect because alendronate should not be taken with milk as it can interfere with its absorption. Choice D is incorrect because alendronate should be taken on an empty stomach, not with food.

3. A male patient with erectile dysfunction has asked for a prescription for sildenafil (Viagra). Before giving this medication, the nurse should assess for which of the following conditions?

• A. History of peptic ulcer disease
• B. Use of nitrates
• C. Recent history of a stroke
• D. History of hypertension

Correct answer: B

Rationale: The correct answer is B: Use of nitrates. Sildenafil should not be used by patients taking nitrates due to the risk of severe hypotension. Nitrates can potentiate the hypotensive effects of sildenafil, leading to a significant drop in blood pressure. Assessing for the use of nitrates is crucial to avoid this potentially dangerous interaction. Choices A, C, and D are incorrect because they are not specifically contraindications for the use of sildenafil. While a history of hypertension should be considered, it is not as critical as the use of nitrates when prescribing sildenafil.

4. Which goal is a priority for a client with a DSM-IV-TR diagnosis of delirium and the nursing diagnosis Acute confusion related to recent surgery secondary to traumatic hip fracture?

• A. The client will complete activities of daily living.
• B. The client will maintain safety.
• C. The client will remain oriented.
• D. The client will understand communication.

Correct answer: B

Rationale: The correct answer is B: 'The client will maintain safety.' For a client with delirium, especially in the context of acute confusion post-surgery, safety is the top priority. Delirium can lead to disorientation, impaired decision-making, and increased risk of falls or accidents. Ensuring the client's safety by implementing measures to prevent harm is crucial. Choices A, C, and D are important but not the priority in this scenario. Completing activities of daily living, remaining oriented, and understanding communication are relevant goals but come after ensuring the client's safety in the presence of delirium and acute confusion.

5. A client asks a nurse about the cause of Parkinson's disease. How should the nurse respond?

• A. Parkinson's disease is caused by a lack of dopamine in the brain, which affects movement.
• B. Parkinson's disease is caused by an excess of acetylcholine in the brain, leading to tremors and rigidity.
• C. Parkinson's disease is caused by an autoimmune response that attacks the nervous system.
• D. Parkinson's disease is caused by a bacterial infection that needs to be treated with antibiotics.

Correct answer: A

Rationale: The correct answer is A. Parkinson's disease is caused by a deficiency of dopamine in the brain, which results in the characteristic motor symptoms such as tremors, rigidity, and bradykinesia. Choice B is incorrect because Parkinson's disease is not caused by an excess of acetylcholine. Choice C is incorrect because Parkinson's disease is not an autoimmune disorder. Choice D is incorrect because Parkinson's disease is not caused by a bacterial infection and cannot be treated with antibiotics.

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