Nursing Elites

1. A male patient with erectile dysfunction has asked for a prescription for sildenafil (Viagra). Before giving this medication, the nurse should assess for which of the following conditions?

• A. History of peptic ulcer disease
• B. Use of nitrates
• C. Recent history of a stroke
• D. History of hypertension

Correct answer: B

Rationale: The correct answer is B: Use of nitrates. Sildenafil should not be used by patients taking nitrates due to the risk of severe hypotension. Nitrates can potentiate the hypotensive effects of sildenafil, leading to a significant drop in blood pressure. Assessing for the use of nitrates is crucial to avoid this potentially dangerous interaction. Choices A, C, and D are incorrect because they are not specifically contraindications for the use of sildenafil. While a history of hypertension should be considered, it is not as critical as the use of nitrates when prescribing sildenafil.

2. When planning care for a cardiac patient, the nurse knows that in response to an increased workload, cardiac myocardial cells will:

• A. Increase in size
• B. Decrease in length
• C. Increase in excitability
• D. Increase in number

Correct answer: A

Rationale: The correct answer is A: Increase in size. Cardiac hypertrophy occurs when myocardial cells increase in size to compensate for an increased workload. This adaptation allows the heart to pump more effectively. Choice B, Decrease in length, is incorrect as cardiac cells do not decrease in length in response to increased workload. Choice C, Increase in excitability, is incorrect as increased workload does not lead to an increase in excitability of cardiac cells. Choice D, Increase in number, is incorrect as cardiac cells do not increase in number but rather increase in size to handle the increased workload.

3. A patient with breast cancer is prescribed tamoxifen (Nolvadex). What key point should the nurse include in the patient education?

• A. Tamoxifen may increase the risk of venous thromboembolism.
• B. Tamoxifen may cause hot flashes and other menopausal symptoms.
• C. Tamoxifen may cause weight gain and fluid retention.
• D. Tamoxifen may decrease the risk of osteoporosis.

Correct answer: A

Rationale: The correct answer is A: "Tamoxifen may increase the risk of venous thromboembolism." It is crucial for patients to be aware of the signs and symptoms of blood clots while taking tamoxifen. Choice B is incorrect because hot flashes and menopausal symptoms are common side effects of tamoxifen, but they are not the key point to emphasize. Choice C is incorrect as weight gain and fluid retention are potential side effects of tamoxifen but not the key point for patient education. Choice D is incorrect as tamoxifen does not decrease the risk of osteoporosis; in fact, it may increase the risk of bone loss.

4. Which goal is a priority for a client with a DSM-IV-TR diagnosis of delirium and the nursing diagnosis Acute confusion related to recent surgery secondary to traumatic hip fracture?

• A. The client will complete activities of daily living.
• B. The client will maintain safety.
• C. The client will remain oriented.
• D. The client will understand communication.

Correct answer: B

Rationale: The correct answer is B: 'The client will maintain safety.' For a client with delirium, especially in the context of acute confusion post-surgery, safety is the top priority. Delirium can lead to disorientation, impaired decision-making, and increased risk of falls or accidents. Ensuring the client's safety by implementing measures to prevent harm is crucial. Choices A, C, and D are important but not the priority in this scenario. Completing activities of daily living, remaining oriented, and understanding communication are relevant goals but come after ensuring the client's safety in the presence of delirium and acute confusion.

5. Muscular dystrophy is a result of an abnormality of the muscle protein:

• A. glycoprotein
• B. dystrophin
• C. troponin
• D. actinomyosin

Correct answer: B

Rationale: Muscular dystrophy is primarily caused by mutations in the gene that provides instructions for making the protein dystrophin. Dystrophin plays a crucial role in maintaining the structure of muscle fibers. Glycoprotein is a general term for proteins with sugar molecules attached, not specifically related to muscular dystrophy. Troponin is a protein involved in muscle contraction regulation, and actinomyosin is not a specific muscle protein but a complex formed during muscle contraction. Therefore, the correct answer is dystrophin.

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