Nursing Elites

1. During shift change, a healthcare professional is reviewing a patient's medication. Which of the following medications would be contraindicated if the patient were pregnant?

• A. Warfarin (Coumadin)
• B. Celecoxib (Celebrex)
• C. Clonidine (Catapres)
• D. Transdermal nicotine (Habitrol)

Correct answer: A

Rationale: Warfarin (Coumadin) is contraindicated in pregnancy due to its pregnancy category X classification. It is associated with central nervous system defects, spontaneous abortion, stillbirth, prematurity, hemorrhage, and ocular defects when administered at any time during pregnancy. Fetal warfarin syndrome can occur when given during the first trimester. Celecoxib (Celebrex) is a pregnancy category C medication, which means there may be risks but benefits may outweigh them. Clonidine (Catapres) is also a pregnancy category C drug, and while animal studies have shown adverse effects on the fetus, there are limited human studies. Transdermal nicotine (Habitrol) is classified as a pregnancy category D drug, indicating positive evidence of fetal risk, but benefits may still warrant its use in pregnant women with serious conditions.

2. The patient with chronic pancreatitis will be taught to take the prescribed pancrelipase (Viokase)

• A. at bedtime.
• B. in the morning.
• C. with each meal.
• D. for abdominal pain.

Correct answer: C

Rationale: The correct answer is to take pancrelipase (Viokase) with each meal. Pancrelipase is a pancreatic enzyme replacement medication that helps with the digestion of nutrients. Patients with chronic pancreatitis often have difficulty digesting food properly due to insufficient pancreatic enzyme production. Taking pancrelipase with each meal assists in the breakdown of fats, proteins, and carbohydrates consumed during the meal. Option A ('at bedtime') is incorrect because enzymes should be taken with meals to aid in digestion. Option B ('in the morning') is not ideal as it does not ensure optimal enzyme activity during meals. Option D ('for abdominal pain') is incorrect as pancrelipase is not meant to be taken solely for pain relief but rather to aid in digestion.

3. Which of the following is the most common type of malignant brain tumor in the United States?

• A. Meningioma
• B. Glioblastoma multiforme
• C. Acoustic neuroma
• D. Pituitary adenoma

Correct answer: B

Rationale: Glioblastoma multiforme is the most common malignant brain tumor in the United States, accounting for a significant portion of cases. It is known for its aggressive nature and poor prognosis. Surgical resection, followed by radiation and chemotherapy, is the standard treatment approach for glioblastoma multiforme. Meningioma, acoustic neuroma, and pituitary adenoma are also types of brain tumors but are not as common as glioblastoma multiforme in the United States.

4. The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies?

• A. Observe for distended neck veins.
• B. Auscultate for crackles in the lungs.
• C. Palpate for heaves or thrills over the heart.
• D. Review hemoglobin and hematocrit values.

Correct answer: A

Rationale: To evaluate the effectiveness of therapies for cor pulmonale and right-sided heart failure, observing for distended neck veins would be the most appropriate assessment. Cor pulmonale is characterized by right ventricular failure due to pulmonary hypertension, leading to clinical manifestations such as peripheral edema, jugular venous distention, and right upper-quadrant abdominal tenderness. These signs indicate increased central venous pressure and right heart strain, which can be assessed by observing for distended neck veins. Auscultating for crackles in the lungs is more indicative of left-sided heart failure rather than right-sided heart failure. Heaves or thrills over the heart are not typically associated with cor pulmonale. Reviewing hemoglobin and hematocrit values may show elevations due to chronic hypoxemia and polycythemia in cor pulmonale, but these values alone do not directly evaluate the immediate effectiveness of the prescribed therapies on the patient's condition.

5. Following a diagnosis of acute glomerulonephritis (AGN) in their 6-year-old child, the parent's remark: "We just don't know how he caught the disease!"? The nurse's response is based on an understanding that:

• A. AGN is a streptococcal infection that involves the kidney tubules.
• B. The disease is easily transmissible in schools and camps.
• C. The illness is usually associated with chronic respiratory infections.
• D. It is not "caught"? but is a response to a previous B-hemolytic strep infection.

Correct answer: D

Rationale: The correct answer is that acute glomerulonephritis (AGN) is not 'caught' but is a response to a previous B-hemolytic strep infection. AGN is generally accepted as an immune-complex disease triggered by an antecedent streptococcal infection occurring 4 to 6 weeks prior. It is considered a noninfectious renal disease. Choice A is incorrect because AGN is not a streptococcal infection that involves the kidney tubules but rather a noninfectious renal disease. Choice B is incorrect as AGN is not easily transmissible in schools and camps but is a result of a previous streptococcal infection. Choice C is incorrect as AGN is not usually associated with chronic respiratory infections, but with a previous streptococcal infection.

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