Nursing Elites

1. A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which process will accompany the actions of the neurotransmitter in a chemical synapse?

• A. Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses.
• B. Communication between a neuron and the single neuron it is connected with will be facilitated.
• C. The neurotransmitter will cross gap junctions more readily.
• D. More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors.

Correct answer: D

Rationale: When serotonin levels increase, more neurotransmitters will cross the synaptic cleft and bind with postsynaptic receptors, facilitating enhanced communication. Option A is incorrect because chemical synapses, unlike electrical synapses, are unidirectional. Option B is incorrect because neurotransmitters impact communication with multiple neurons, not just a single connected neuron. Option C is incorrect because neurotransmitters cross the synaptic cleft, not gap junctions.

2. An older adult patient has asked her primary care provider for a prescription that will help to resolve her “warped toenails.” The care provider has diagnosed the woman with onychomycosis. The nurse should anticipate that this patient will be treated with what drug?

• A. Micafungin (Mycamine)
• B. Terbinafine (Lamisil)
• C. Voriconazole (Vfend)
• D. Fluconazole (Diflucan)

Correct answer: B

Rationale: The correct answer is B: Terbinafine (Lamisil). Terbinafine is commonly used to treat onychomycosis, a fungal infection of the toenails or fingernails. It works by stopping the growth of the fungus. Micafungin (Mycamine) is an antifungal medication used for different types of fungal infections but is not typically used to treat onychomycosis. Voriconazole (Vfend) is another antifungal medication used for specific fungal infections, but it is not a first-line treatment for onychomycosis. Fluconazole (Diflucan) is also an antifungal medication, but it is more commonly used for yeast infections and may not be as effective for treating onychomycosis compared to terbinafine.

3. A patient is prescribed tadalafil (Cialis) for erectile dysfunction. What condition would contraindicate the use of this medication?

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

Correct answer: B

Rationale: The correct answer is B: 'Use of nitrates.' Tadalafil (Cialis) is contraindicated in patients using nitrates due to the risk of severe hypotension. Nitrates and tadalafil both cause vasodilation, leading to a synergistic effect that can result in a dangerous drop in blood pressure. Choices A, C, and D are incorrect because a history of hypertension, the use of antihypertensive medications, and a history of peptic ulcer disease are not direct contraindications for tadalafil use.

4. Interpret the following arterial blood gas results: PH = 7.30; PaCO2 = 55 mmHg; HCO3 = 24 mEq/L

• A. Respiratory acidosis
• B. Metabolic acidosis
• C. Respiratory alkalosis
• D. Metabolic alkalosis

Correct answer: A

Rationale: The correct answer is A: Respiratory acidosis. In respiratory acidosis, there is an accumulation of CO2 in the blood, leading to a decrease in pH. The elevated PaCO2 of 55 mmHg in the given results indicates hypoventilation, causing respiratory acidosis. Choices B, C, and D are incorrect because the provided data does not show metabolic acidosis, respiratory alkalosis, or metabolic alkalosis.

5. A 55-year-old man presents with a history of fatigue, weight loss, and night sweats. He reports recent onset of a productive cough and hemoptysis. Which condition should the nurse suspect?

• A. Lung cancer
• B. Pneumonia
• C. Tuberculosis
• D. Pulmonary embolism

Correct answer: C

Rationale: The correct answer is C: Tuberculosis. The symptoms described - fatigue, weight loss, night sweats, productive cough, and hemoptysis - are classic manifestations of tuberculosis. Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, commonly affecting the lungs but can also involve other organs. **Choice A: Lung cancer** typically presents with symptoms like persistent cough, chest pain, and shortness of breath, but it is less likely in this case due to the presence of hemoptysis. **Choice B: Pneumonia** can present with productive cough, fever, and chest pain, but it is less likely given the chronicity of symptoms and the presence of hemoptysis. **Choice D: Pulmonary embolism** usually presents with sudden onset shortness of breath, chest pain, and can be associated with risk factors like recent surgery or immobility.

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