Nursing Elites

1. What therapeutic effect is expected from tamsulosin (Flomax) in a male patient with benign prostatic hyperplasia (BPH)?

• A. Relaxation of the muscles in the prostate and bladder neck, leading to improved urinary flow.
• B. Increase in urine flow and relief of urinary obstruction.
• C. Reduction in prostate size and improvement in urinary symptoms.
• D. Improvement in erectile function.

Correct answer: A

Rationale: The correct answer is A: 'Relaxation of the muscles in the prostate and bladder neck, leading to improved urinary flow.' Tamsulosin is an alpha-blocker that specifically targets alpha-1 receptors in the prostate and bladder neck, causing relaxation of smooth muscles. This relaxation results in improved urinary flow and reduced symptoms of BPH. Choice B is incorrect because while tamsulosin does improve urinary flow, it does not directly increase urine flow. Choice C is incorrect because tamsulosin does not reduce prostate size. Choice D is incorrect as tamsulosin does not have a primary effect on erectile function.

2. A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's questions is least likely to yield data that will confirm or rule out migraines as the cause of his problem?

• A. Does your son have a family history of migraines?
• B. When your son has a headache, does he ever have nausea and vomiting as well?
• C. Does your son have any food allergies that have been identified?
• D. Is your son generally pain-free during the intervals between headaches?

Correct answer: C

Rationale: The correct answer is C. In assessing a child for migraines, asking about food allergies is least likely to yield data that will confirm or rule out migraines as the cause of his headaches. Food allergies are unrelated to the typical symptoms and triggers of migraines, such as family history, associated symptoms like nausea and vomiting, and pain-free intervals between headaches. Therefore, in this scenario, focusing on food allergies is less relevant for identifying migraines as the cause of the boy's headaches.

3. A patient began antiretroviral therapy several weeks ago for the treatment of HIV, and he has now presented to the clinic for a scheduled follow-up appointment. He states to the nurse, “I've been pretty good about taking all my pills on time, though it was a bit hit and miss over the holiday weekend.” How should the nurse best respond to this patient's statement?

• A. “Remember that if you miss a dose, you need to take a double dose at the next scheduled time.”
• B. “It's acceptable to miss an occasional dose as long as your symptoms don't worsen, but it's important to strive for consistent adherence.”
• C. “Remember that your antiretroviral drugs will only be effective if you take them consistently and as prescribed.”
• D. “If you're not consistent with taking your medications, you're likely to develop more side effects.”

Correct answer: C

Rationale: The correct response is to remind the patient that antiretroviral drugs are most effective when taken consistently and as prescribed. Choice A is incorrect because taking a double dose after missing a dose is not recommended, as it can lead to medication toxicity. Choice B is incorrect as it may give the impression that missing doses is acceptable, which can reduce the effectiveness of the treatment. Choice D is incorrect because while consistency is important, the focus should be on treatment effectiveness rather than side effects.

4. What action is specific to hormonal contraceptives and should be taught to this woman?

• A. The cervical mucus is altered to prevent sperm penetration.
• B. The release of follicle-stimulating hormone is increased to block fertility.
• C. The maturation of the endometrial lining is activated by the contraceptive.
• D. The pituitary gland increases the synthesis and release of luteinizing hormone.

Correct answer: A

Rationale: The correct action specific to hormonal contraceptives that should be taught to the woman is that they alter cervical mucus to prevent sperm penetration. This mechanism helps in preventing pregnancy by reducing the chances of sperm reaching the egg. Choices B, C, and D are incorrect. Choice B is inaccurate as hormonal contraceptives work by inhibiting ovulation rather than increasing follicle-stimulating hormone release. Choice C is incorrect as hormonal contraceptives do not activate the maturation of the endometrial lining; instead, they modify it to prevent implantation. Choice D is also incorrect as hormonal contraceptives do not stimulate the pituitary gland to increase luteinizing hormone synthesis and release.

5. Which of the following imbalances is found in clients with syndrome of inappropriate antidiuretic hormone (SIADH)?

• A. Decreased insulin production
• B. Decreased antidiuretic hormone (ADH) production
• C. Increased secretion of antidiuretic hormone (ADH)
• D. Increased production of insulin

Correct answer: C

Rationale: The correct answer is C: Increased secretion of antidiuretic hormone (ADH). Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by the excessive release of ADH, which leads to water retention and dilution of blood sodium levels. Choices A, B, and D are incorrect because SIADH is not associated with decreased insulin production, decreased ADH production, or increased production of insulin.

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