Nursing Elites

1. A patient is prescribed medroxyprogesterone acetate (Provera) for the treatment of endometriosis. What key instruction should the nurse provide regarding the administration of this medication?

• A. Take the medication at the same time each day to maintain consistent hormone levels.
• B. Discontinue the medication if side effects occur.
• C. Take the medication with food to prevent gastrointestinal upset.
• D. Apply the medication once a week.

Correct answer: A

Rationale: The correct instruction for medroxyprogesterone acetate (Provera) is to take the medication at the same time each day to maintain consistent hormone levels and ensure its effectiveness. Choice B is incorrect because discontinuing the medication abruptly without consulting healthcare providers can be harmful. Choice C is incorrect as taking the medication with food is not necessary for this specific drug. Choice D is incorrect as medroxyprogesterone is typically taken orally, not applied topically.

2. A 30-year-old male has been brought to the emergency department by his wife because of a severe headache, nausea, vomiting, and fever. A lumbar puncture is performed, and cerebrospinal fluid (CSF) analysis reveals a high protein count, low glucose, and numerous polymorphonuclear leukocytes (PMNs). Which organism is the most likely cause of these findings?

• A. Streptococcus pneumoniae
• B. Neisseria meningitidis
• C. Escherichia coli
• D. Listeria monocytogenes

Correct answer: A

Rationale: The cerebrospinal fluid (CSF) analysis findings of high protein count, low glucose, and numerous polymorphonuclear leukocytes (PMNs) are classic for bacterial meningitis. Among the choices, Streptococcus pneumoniae is the most likely cause in this case. Streptococcus pneumoniae is a common cause of bacterial meningitis in adults, especially presenting with symptoms such as severe headache, nausea, vomiting, and fever. Neisseria meningitidis is another common cause of bacterial meningitis but is more frequently associated with a different CSF profile. Escherichia coli is a common cause of neonatal meningitis, not typically seen in a 30-year-old male. Listeria monocytogenes is more commonly associated with meningitis in immunocompromised individuals and neonates, and typically presents differently in CSF analysis.

3. Which of the following are normal arterial blood gas values?

• A. PH 7.25, PaCO2 52 mm Hg, PaO2 75 mm Hg, HCO3 18 mEq/L
• B. PH 7.50, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 28 mEq/L
• C. PH 7.40, PaCO2 40 mm Hg, PaO2 90 mm Hg, HCO3 24 mEq/L
• D. PH 7.15, PaCO2 30 mm Hg, PaO2 50 mm Hg, HCO3 24 mEq/L

Correct answer: C

Rationale: The correct answer is C: PH 7.40, PaCO2 40 mm Hg, PaO2 90 mm Hg, HCO3 24 mEq/L. These values represent a balanced state for arterial blood gas. Choice A has lower than normal PH and HCO3 levels and higher PaCO2 and lower PaO2 levels. Choice B has higher than normal PH and HCO3 levels, lower PaCO2, and a normal PaO2 level. Choice D has a significantly lower PH and PaO2 level, normal HCO3 level, and low PaCO2 level, indicating an acidic state with impaired oxygenation.

4. What is the most appropriate nursing diagnosis for the client's son based on the information provided?

• A. Risk for other-directed violence
• B. Disturbed sleep pattern
• C. Caregiver role strain
• D. Social isolation

Correct answer: C

Rationale: The correct answer is 'Caregiver role strain.' In the scenario presented, the son expresses that his father's constant confusion, incontinence, and tendency to wander are intolerable. These challenges indicate that the son is experiencing strain in his role as a caregiver. 'Risk for other-directed violence' is not appropriate because there is no indication of violent behavior. 'Disturbed sleep pattern' is not the most relevant nursing diagnosis given the information provided. 'Social isolation' is not the most appropriate choice as the son's concerns are related to the challenges of caregiving, not isolation.

5. A school nurse is meeting with a high school student who mentions that she is frustrated with her repeated outbreaks of cold sores. The student states that she tried an over-the-counter topical cream but that it failed to produce an appreciable improvement. The nurse should recognize that this student used what medication?

• A. Ganciclovir
• B. Valacyclovir (Valtrex)
• C. Famciclovir (Famvir)
• D. Docosanol (Abreva)

Correct answer: D

Rationale: The correct answer is D: Docosanol (Abreva). Docosanol is an over-the-counter topical cream commonly used to treat cold sores caused by the herpes simplex virus. It works by inhibiting viral fusion to host cell membranes, reducing the spread of the virus. Ganciclovir (Choice A) is an antiviral medication used for the treatment of cytomegalovirus infections. Valacyclovir (Choice B) and Famciclovir (Choice C) are prescription antiviral medications used to treat herpes simplex virus infections but are not typically available over-the-counter like Docosanol.

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