Nursing Elites

1. When educating a patient about sildenafil (Viagra), which adverse effect should be a priority for the patient to report to his prescriber?

• A. Flushing
• B. Diarrhea
• C. Hearing loss
• D. Dyspepsia

Correct answer: C

Rationale: The correct answer is 'C: Hearing loss.' In rare cases, Viagra has been associated with sudden hearing loss, typically in one ear, which can be partial or complete. Any onset of hearing problems while using Viagra should be reported promptly to the prescriber. It is recommended to discontinue the medication if it is used for erectile dysfunction. 'Flushing,' 'Diarrhea,' and 'Dyspepsia' are known adverse effects of Viagra but are generally less serious compared to hearing loss.

2. A child is being assessed for Kawasaki disease. Which of the following findings should be expected?

• A. Decreased heart rate
• B. Dry, scaly skin
• C. Fever unresponsive to antipyretics
• D. Nontender cervical lymphadenopathy

Correct answer: C

Rationale: In Kawasaki disease, a child typically presents with a fever that is unresponsive to antipyretics because the disease is characterized by systemic inflammation. The persistent fever is a hallmark feature of the disease and can last for more than five days despite treatment with antipyretics.

3. A patient taking isotretinoin (Accutane) for acne vulgaris. Which statement indicates that the patient teaching has been effective?

• A. I should use a reliable form of birth control.
• B. I will stop taking the drug if my skin is dry.
• C. It is important to increase intake of vitamin A.
• D. I do not need to use sunblock while taking Accutane.

Correct answer: A

Rationale: The correct answer is A. Isotretinoin is highly teratogenic, which means it can cause birth defects. Therefore, it is crucial for patients, especially females of childbearing potential, to use effective forms of birth control to prevent pregnancy while taking this medication. This is a key component of patient teaching to ensure the safe use of isotretinoin. Choice B is incorrect because discontinuing isotretinoin abruptly can lead to a flare-up of acne. Choice C is incorrect because increasing vitamin A intake can be harmful due to the risk of hypervitaminosis A. Choice D is incorrect because isotretinoin makes the skin more sensitive to sunlight, so sunblock is essential to prevent sunburn and skin damage.

4. A patient taking sildenafil (Viagra) asks a nurse what action to take if priapism occurs. Which response should the nurse provide?

• A. Take an additional half-strength dose of sildenafil
• B. The condition usually resolves in 12 hours or less
• C. Wait until the following day and notify the doctor
• D. Seek emergency help, because permanent damage can occur

Correct answer: D

Rationale: Patients experiencing priapism from sildenafil should seek immediate medical attention. Priapism is a serious condition where an erection lasts longer than 4 hours, and if left untreated, it can lead to irreversible damage to the penile tissue, potentially causing permanent erectile dysfunction. Therefore, prompt intervention is crucial to prevent long-term complications.

5. A toddler in the emergency department has partial thickness burns on his right arm. Which of the following actions should the nurse take?

• A. Insert a nasogastric tube
• B. Initiate prophylactic antibiotic therapy
• C. Cleanse the affected area with mild soap and water
• D. Apply a topical corticosteroid to the affected area

Correct answer: C

Rationale: When a toddler has partial thickness burns, the nurse should cleanse the affected area with mild soap and water. This action helps remove any loose tissue that could lead to infection and prepares the area for appropriate wound care. Inserting a nasogastric tube (Choice A) is not indicated for a toddler with burns. Initiating prophylactic antibiotic therapy (Choice B) is not necessary for partial thickness burns unless there are signs of infection. Applying a topical corticosteroid (Choice D) is not recommended for initial management of burns as it can delay wound healing.

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