Nursing Elites

1. A 30-year-old has poorly controlled asthma and is taking prednisone 10 mg by mouth once a day. He has been on this regimen for 6 weeks. Abrupt withdrawal or discontinuation of this medication can cause:

• A. adrenal crisis
• B. hypercortisolism
• C. ACTH stimulation
• D. thyroid crisis

Correct answer: A

Rationale: Abrupt withdrawal or discontinuation of prednisone, a corticosteroid, can lead to adrenal crisis. This occurs due to the suppression of the adrenal glands' natural cortisol production caused by prolonged exogenous steroid administration. Adrenal crisis presents with symptoms such as weakness, fatigue, abdominal pain, and hypotension. Hypercortisolism (Cushing syndrome) results from chronic excessive exposure to cortisol, not abrupt withdrawal. ACTH stimulation would be expected in response to low cortisol levels, not as a direct consequence of prednisone withdrawal. Thyroid crisis (thyroid storm) is associated with severe hyperthyroidism and is not directly related to corticosteroid withdrawal.

2. What is a potential implication of multiple dark bands on the nails?

• A. They are considered a normal variant.
• B. They can be associated with malignant melanoma.
• C. They are indicative of a nail fungus.
• D. They are associated with aging.

Correct answer: B

Rationale: Multiple dark bands on the nails can be a concerning sign of malignant melanoma, a type of skin cancer that can affect the nails. While some nail changes are considered normal variants, dark bands should not be dismissed lightly as they can indicate a serious condition like melanoma. Nail fungus typically presents differently, causing discoloration, thickening, or distortion of the nail without distinct dark bands. Additionally, aging can lead to various nail changes, but dark bands alone are not a common feature of normal aging.

3. A 30-year-old male is being treated with testosterone enanthate for delayed puberty. What side effect should the nurse inform the patient about?

• A. Increased libido
• B. Decreased muscle mass
• C. Breast tenderness
• D. Increased aggression

Correct answer: D

Rationale: The correct side effect that the nurse should inform the patient about when receiving testosterone enanthate therapy for delayed puberty is increased aggression. Testosterone therapy can lead to mood changes, including increased aggression in some individuals. Therefore, it is essential for healthcare providers to educate patients about this potential side effect. Choices A, B, and C are incorrect because testosterone therapy is more likely to increase libido, promote muscle mass growth, and may cause breast tenderness due to hormonal imbalances.

4. Which of the following is a cause of edema?

• A. Decreased plasma proteins
• B. Hypotension
• C. Dehydration
• D. Polyuria

Correct answer: A

Rationale: The correct answer is A: Decreased plasma proteins. Edema can be caused by decreased plasma proteins, which reduce the osmotic pressure that keeps fluid in the blood vessels. Hypotension (choice B) is low blood pressure and is not a direct cause of edema. Dehydration (choice C) involves a lack of body fluid, but it is not a direct cause of edema. Polyuria (choice D) is excessive urination and not a direct cause of edema.

5. A patient has developed a decubitus ulcer on the coccyx. What defense mechanism is most affected by this homeostatic change?

• A. The mucous membrane is affected.
• B. The respiratory tract is affected.
• C. The skin is affected.
• D. The gastrointestinal tract is affected.

Correct answer: C

Rationale: In this scenario, a decubitus ulcer on the coccyx indicates a breakdown of the skin's integrity due to prolonged pressure. The skin is the primary defense mechanism of the body against external pathogens. When the skin is compromised, it can lead to infections and other complications. The mucous membrane (Choice A) plays a role in protecting internal surfaces, not the skin. The respiratory tract (Choice B) is involved in breathing and not directly related to the skin's defense. The gastrointestinal tract (Choice D) is responsible for digestion and absorption of nutrients, not the primary defense mechanism against external threats like the skin.

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