Nursing Elites

1. A female patient has been diagnosed with tuberculosis and begun multiple-drug therapy. The woman has asked the nurse why it is necessary for her to take several different drugs instead of one single drug. How should the nurse best respond to the patient's question?

• A. “Multiple drugs are used because doctors need to combat the TB bacteria from different angles to effectively treat the infection.”
• B. “The use of multiple drugs prevents the development of drug-resistant TB.”
• C. “Multiple drugs are prescribed because the final testing results for TB can take up to 3 weeks to confirm the most effective treatment.”
• D. “Multiple drugs are used in order to speed up the course of treatment.”

Correct answer: B

Rationale: The correct answer is B. Using multiple drugs in tuberculosis treatment helps prevent the development of drug-resistant TB. This approach is crucial because if the infection is not completely eradicated, the remaining bacteria may become resistant to the single drug used, making future treatments less effective. Choice A is incorrect because the use of multiple drugs is not due to uncertainty about which drug will work, but rather to address the bacteria from different angles. Choice C is incorrect as it misleads the patient about the reason for using multiple drugs. Choice D is also incorrect because the primary purpose of using multiple drugs is not to speed up treatment but to ensure effectiveness and prevent resistance.

2. A patient is starting on alendronate (Fosamax) for osteoporosis. What instructions should the nurse provide to ensure the effectiveness of the medication?

• 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 alendronate with a full glass of water and remain upright for at least 30 minutes. This is essential to prevent esophageal irritation and ensure proper absorption. Choice B is incorrect because taking alendronate at bedtime can increase the risk of esophageal irritation due to lying down. Choice C is incorrect as taking alendronate with milk can reduce its absorption. Choice D is incorrect because alendronate should be taken on an empty stomach to enhance its effectiveness.

3. A patient has been prescribed an estrogen-progestin oral contraceptive. The nurse should emphasize that the risk of thrombophlebitis is most likely in patients who:

• A. Are diabetic.
• B. Smoke cigarettes.
• C. Have a history of hypertension.
• D. Are older than 40.

Correct answer: B

Rationale: The correct answer is B: Smoke cigarettes. Smoking is a significant risk factor for thrombophlebitis, especially when combined with estrogen-progestin contraceptives. Choice A, being diabetic, does not directly increase the risk of thrombophlebitis in this context. Choice C, having a history of hypertension, is not a primary risk factor for thrombophlebitis. Choice D, being older than 40, is not the most likely factor associated with an increased risk of thrombophlebitis in patients taking estrogen-progestin oral contraceptives.

4. A male patient with benign prostatic hyperplasia (BPH) is being treated with tamsulosin (Flomax). What should the nurse include in the teaching plan for this patient?

• A. Avoid lying down after taking the medication.
• B. Take the medication with meals.
• C. Report any side effects such as dizziness or fainting.
• D. Take the medication at bedtime.

Correct answer: C

Rationale: The correct answer is C: 'Report any side effects such as dizziness or fainting.' Patients taking tamsulosin should be advised to report any side effects, such as dizziness or fainting, which can occur due to orthostatic hypotension. Choices A, B, and D are incorrect because avoiding lying down after taking the medication, taking it with meals, or at bedtime are not specific teaching points related to the potential side effects of tamsulosin.

5. A woman has been prescribed Climara, a transdermal estradiol patch. Which of the following should she be instructed by the nurse regarding the administration?

• A. Avoid prolonged sun exposure at the patch site due to increased plasma concentrations.
• B. The application of heat at the patch site will decrease effectiveness and result in pregnancy.
• C. The medication, when exposed to sunlight, can increase the risk of breast cancer.
• D. Exposure of the medication to occasional cold will increase effectiveness with application.

Correct answer: A

Rationale: The correct answer is A. The Climara patch delivers estradiol transdermally, and patients should be instructed to avoid prolonged sun exposure at the patch site due to increased plasma concentrations. Sun exposure can accelerate the absorption of the medication, leading to higher systemic levels than intended. Choices B, C, and D are incorrect because heat at the patch site does not result in pregnancy but may alter absorption rates, there is no direct link between sunlight exposure and breast cancer risk related to this medication, and exposure to cold does not increase effectiveness of the transdermal patch.

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