Nursing Elites

1. A 37-year-old woman has a 10 pack-year smoking history and has been using oral contraceptives for the past 2 years. The nurse should plan health education interventions knowing that this patient faces an increased risk of

• A. osteoporosis.
• B. dementia.
• C. myocardial infarction.
• D. deep vein thrombosis.

Correct answer: C

Rationale: The correct answer is C: myocardial infarction. Women aged 35 and older who smoke, especially with a history of 10 pack-years like in this case, face an increased risk of cardiovascular disorders, including myocardial infarction, when using oral contraceptives. Choice A, osteoporosis, is incorrect because smoking and oral contraceptives do not significantly increase the risk of osteoporosis. Choice B, dementia, is not directly associated with smoking, oral contraceptives, or their combination. Choice D, deep vein thrombosis, is a risk associated with oral contraceptives, especially in combination with smoking, but the highest increased risk in this case is for myocardial infarction.

2. When preparing to administer parenteral acyclovir (Zovirax) to an 80-year-old patient with chronic renal failure and herpes simplex, what would the nurse expect in regard to the dose?

• A. The dose is smaller due to the herpes simplex infection.
• B. The dose is smaller based on the patient's kidney function.
• C. The dose is higher in treating genital herpes.
• D. The dose is higher if the creatinine clearance is above 4.0 mg/dL.

Correct answer: B

Rationale: In patients with chronic renal failure, especially in older adults, dosages of medications excreted renally need to be adjusted based on kidney function. Acyclovir is primarily eliminated by the kidneys, so in a patient with chronic renal failure, the dose would need to be smaller to prevent drug accumulation and toxicity. Choice A is incorrect because the dose adjustment is more related to the patient's kidney function than the presence of herpes simplex. Choice C is incorrect because the type of herpes infection does not determine the dose adjustment for acyclovir. Choice D is incorrect as the creatinine clearance is a more accurate measure of kidney function compared to creatinine levels.

3. An older adult patient has just sheared the skin on her elbow while attempting to boost herself up in bed, an event that has precipitated acute inflammation in the region surrounding the wound. Which of the following events will occur during the vascular stage of the patient's inflammation?

• A. Outpouring of exudate into interstitial spaces
• B. Chemotaxis
• C. Accumulation of leukocytes along epithelium
• D. Phagocytosis of cellular debris

Correct answer: A

Rationale: During the vascular stage of inflammation, there is an outpouring of exudate into the interstitial spaces, leading to swelling and edema. Choice B, chemotaxis, occurs during the cellular stage of inflammation, where leukocytes move to the site of injury in response to chemical signals. Choice C, accumulation of leukocytes along the epithelium, is not a typical event during the vascular stage. Phagocytosis of cellular debris, as in choice D, mainly occurs during the resolution stage of inflammation.

4. A 50-year-old woman has had a relapse of her multiple sclerosis (MS) after several years of being symptom-free. Which of the following factors is most likely to have contributed to her relapse?

• A. Emotional stress
• B. Dietary indiscretion
• C. Physical overexertion
• D. Adequate rest and relaxation

Correct answer: C

Rationale: The correct answer is C: Physical overexertion. In individuals with multiple sclerosis (MS), physical overexertion can exacerbate symptoms and contribute to a relapse. It is important for individuals with MS to balance physical activity to avoid triggering symptom reoccurrence. Choices A, B, and D are less likely to have directly contributed to the relapse. Emotional stress and dietary indiscretion may play a role in exacerbating symptoms in some individuals, but physical overexertion is more commonly associated with MS relapses. Adequate rest and relaxation are important for overall well-being but are not typically linked to MS relapses.

5. A patient who is undergoing treatment for cytomegalovirus received his first dose of IV ganciclovir 3 days ago. When reviewing this patient's most recent blood work, what abnormality should the nurse most likely attribute to the use of this drug?

• A. Hemoglobin 17 g/dL (high normal)
• B. INR 3.8 (high)
• C. Platelet count 118,000/mm3 (low)
• D. Leukocytes 11,900/mm3 (high)

Correct answer: C

Rationale: The correct answer is C: Platelet count 118,000/mm3 (low). Ganciclovir, used to treat cytomegalovirus, is known to cause bone marrow suppression, leading to decreased platelet count (thrombocytopenia). This condition can increase the risk of bleeding. Choices A, B, and D are not typically associated with ganciclovir therapy. High hemoglobin levels (choice A) are not commonly seen with ganciclovir treatment. INR elevation (choice B) is associated with coagulation abnormalities, which are not a typical side effect of ganciclovir. Elevated leukocyte count (choice D) is not a common consequence of ganciclovir use.

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