Nursing Elites

1. A female patient is taking combined hormonal contraceptives to prevent pregnancy. She visits the gynecology clinic and is noted to have a blood pressure of 176/102 mm Hg. The patient is started on enalapril mesylate 10 mg. In collaboration with the primary care provider, what other patient teaching should be provided based on her current medication regimen?

• A. Instruct on a low-salt diet.
• B. Instruct to discontinue the contraceptives.
• C. Instruct on the use of relaxation techniques to decrease stress.
• D. Instruct on the rationale for increasing the contraceptive dose.

Correct answer: A

Rationale: Women on hormonal contraceptives and antihypertensives like enalapril should be counseled to adopt a low-salt diet if severe hypertension occurs. This dietary modification can help in managing blood pressure levels. Instructing to discontinue the contraceptives is crucial in cases of severe hypertension as it poses an increased risk of cardiovascular events. Instructing on relaxation techniques may have some benefits in reducing stress levels but addressing the root cause, such as discontinuing contraceptives in this scenario, is more critical. There is no rationale for increasing the contraceptive dose when hypertension is present; in fact, it should be stopped to prevent complications.

2. A 60-year-old male patient is receiving androgen therapy for the treatment of hypogonadism. Which of the following adverse effects should the nurse monitor for?

• A. Hepatotoxicity
• B. Nephrotoxicity
• C. Cardiotoxicity
• D. Pulmonary toxicity

Correct answer: A

Rationale: The correct answer is A: Hepatotoxicity. Androgen therapy, such as testosterone, can lead to hepatotoxicity, which is toxic to the liver. Therefore, the nurse should monitor the patient's liver function. Choices B, C, and D are incorrect because androgen therapy is not typically associated with nephrotoxicity, cardiotoxicity, or pulmonary toxicity.

3. A nursing student is learning about the effects of bactericidal agents. How does rifampin (Rifadin) achieve a therapeutic action against both intracellular and extracellular tuberculosis organisms?

• A. It is metabolized in the liver.
• B. It binds to acetylcholine.
• C. It inhibits synthesis of RNA.
• D. It causes phagocytosis.

Correct answer: C

Rationale: Rifampin (Rifadin) achieves a therapeutic action against both intracellular and extracellular tuberculosis organisms by inhibiting the synthesis of RNA. This action interferes with bacterial RNA synthesis, leading to the suppression of protein synthesis in the bacteria, ultimately causing their death. Option A is incorrect because rifampin is primarily metabolized in the liver, but this is not how it exerts its bactericidal effects. Option B is incorrect as rifampin does not bind to acetylcholine. Option D is also incorrect as rifampin does not cause phagocytosis.

4. 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.

5. A male patient is receiving testosterone therapy for hypogonadism. What serious adverse effect should the nurse monitor for during this therapy?

• A. Increased risk of liver dysfunction
• B. Increased risk of prostate cancer
• C. Increased risk of bone fractures
• D. Increased risk of breast cancer

Correct answer: A

Rationale: The correct answer is A: Increased risk of liver dysfunction. Testosterone therapy can lead to liver dysfunction, including cholestatic jaundice and hepatitis. This adverse effect necessitates monitoring of liver function tests during testosterone therapy. Choice B, increased risk of prostate cancer, is incorrect because testosterone therapy does not cause prostate cancer but is contraindicated in patients with known or suspected prostate cancer. Choice C, increased risk of bone fractures, is incorrect as testosterone therapy is actually associated with an increase in bone mineral density, reducing the risk of fractures. Choice D, increased risk of breast cancer, is incorrect because testosterone therapy in males does not increase the risk of breast cancer.

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