Nursing Elites

1. 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.

2. Following a knee injury, a football player is taking ibuprofen, a nonsteroidal anti-inflammatory drug, for the control of pain. Which drug action is most likely to result in diminished sensation of pain for the player?

• A. Inhibition of cyclooxygenase (COX) enzymes
• B. Activation of opioid receptors
• C. Blocking of NMDA receptors
• D. Stimulation of serotonin receptors

Correct answer: A

Rationale: The correct answer is A: Inhibition of cyclooxygenase (COX) enzymes. Ibuprofen works by inhibiting these enzymes, which are involved in the production of prostaglandins that mediate pain and inflammation. This inhibition leads to decreased prostaglandin production, resulting in a decrease in pain and inflammation. Choices B, C, and D are incorrect because ibuprofen does not act on opioid receptors, NMDA receptors, or serotonin receptors to control pain. It primarily exerts its analgesic and anti-inflammatory effects through COX enzyme inhibition.

3. Which physiologic response is most likely to accompany activation of the parasympathetic nervous system?

• A. Increased heart rate
• B. Increased gastric motility
• C. Pupil dilation
• D. Sweating

Correct answer: B

Rationale: The correct answer is B: Increased gastric motility. The parasympathetic nervous system is known to promote rest and digest functions, which includes increasing gastric motility to aid in digestion. Choices A, C, and D are incorrect as they are more characteristic of the sympathetic nervous system. The sympathetic nervous system is responsible for the fight or flight response, leading to increased heart rate (Choice A), pupil dilation (Choice C), and sweating (Choice D) among other responses.

4. A family member expresses concern to a nurse about behavioral changes in an elderly aunt. Which would cause the nurse to suspect a cognitive impairment disorder?

• A. Decreased interest in activities that she once enjoyed
• B. Fear of being alone at night
• C. Increased complaints of physical ailments
• D. Problems with preparing a meal or balancing her checkbook

Correct answer: D

Rationale: The correct answer is D. Problems with tasks like meal preparation and balancing a checkbook can indicate cognitive impairment, as these activities involve cognitive functions such as memory, attention, and executive function. Choices A, B, and C are less indicative of cognitive impairment. Decreased interest in activities and increased complaints of physical ailments may be related to other factors like depression, while fear of being alone at night could be due to anxiety or other psychological issues.

5. A child is experiencing difficulty with chewing and swallowing. The nurse knows that which cells may be innervating specialized gut-related receptors that provide taste and smell?

• A. Special somatic afferent fibers
• B. General somatic afferents
• C. Special visceral afferent cells
• D. General visceral afferent neurons

Correct answer: C

Rationale: The correct answer is C: Special visceral afferent cells. These cells are responsible for innervating taste and smell receptors related to the gut. Special somatic afferent fibers (choice A) are involved in sensations like touch and proprioception, not taste and smell. General somatic afferents (choice B) carry sensory information from the skin and musculoskeletal system, not taste and smell. General visceral afferent neurons (choice D) transmit sensory information from internal organs, but not specifically related to taste and smell sensations.

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