Nursing Elites

1. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. What important contraindication should the nurse emphasize during patient education?

• A. Use of nitrates
• B. History of hypertension
• C. History of peptic ulcer disease
• D. Use of antihypertensive medications

Correct answer: A

Rationale: The correct answer is A: 'Use of nitrates.' Sildenafil (Viagra) is contraindicated in patients using nitrates due to the risk of severe hypotension. Nitrates and sildenafil both cause vasodilation, leading to a synergistic effect that can result in a dangerous drop in blood pressure. Choices B, C, and D are incorrect because they are not direct contraindications for sildenafil use. While a history of hypertension or peptic ulcer disease may require caution, they are not absolute contraindications like the concomitant use of nitrates.

2. A male patient is receiving androgen therapy for hypogonadism. What laboratory tests should the nurse monitor during this therapy?

• A. Liver function tests
• B. Kidney function tests
• C. Prostate-specific antigen (PSA)
• D. Complete blood count (CBC)

Correct answer: A

Rationale: During androgen therapy for hypogonadism, it is important to monitor liver function tests. Androgens can affect the liver, potentially leading to liver dysfunction. Monitoring liver function tests helps in early detection of any liver abnormalities. Kidney function tests (Choice B) are not typically affected by androgen therapy. Prostate-specific antigen (PSA) levels (Choice C) may be monitored for conditions like prostate cancer, but it is not directly related to androgen therapy for hypogonadism. A complete blood count (CBC) (Choice D) may not show specific changes related to androgen therapy for hypogonadism.

3. A 70-year-old woman has difficulty with driving, and she has been frequently getting lost. Her husband said she has also been acting strange and seems to want to sleep a lot. He said the other night she kept saying she was seeing animals such as lions in her room. He says her memory is not too bad, but he is very concerned about her health. Physical examination reveals an alert woman with stable vital signs. Bradykinesia and limb rigidity are noted. These findings are consistent with:

• A. Alzheimer's disease.
• B. Vascular dementia.
• C. Dementia with Lewy bodies.
• D. Frontotemporal dementia.

Correct answer: C

Rationale: The symptoms described in the scenario, such as visual hallucinations, fluctuations in cognition, and parkinsonism (bradykinesia and limb rigidity), are classic features of dementia with Lewy bodies (DLB). DLB is characterized by the presence of Lewy bodies in the brain, which are abnormal protein deposits. Alzheimer's disease (Choice A) typically presents with memory loss as a predominant symptom, which is not a major concern in this case. Vascular dementia (Choice B) is associated with a history of cerebrovascular disease and is not supported by the symptoms described. Frontotemporal dementia (Choice D) usually presents with changes in behavior and personality, rather than the symptoms described in the scenario.

4. Which of the following is a characteristic of osteosarcoma?

• A. Slow-growing tumor that begins in the bone marrow
• B. Solitary tumor that most often affects the metaphyseal region of the femur or tibia
• C. An aggressive tumor most often found in the bone marrow of long bones
• D. A tumor that infiltrates the trabeculae in spongy bone and implants in surrounding tissue

Correct answer: C

Rationale: Osteosarcoma is an aggressive bone tumor that most commonly arises in the bone marrow of long bones, such as the femur or tibia. Choice A is incorrect as osteosarcoma is not a slow-growing tumor but rather a fast-growing one. Choice B is incorrect as osteosarcoma is not typically solitary but can involve multiple lesions. Choice D is incorrect as osteosarcoma primarily affects the medullary (marrow) cavity of bones, rather than infiltrating the trabeculae in spongy bone and surrounding tissue.

5. A patient has been prescribed sildenafil (Viagra) for erectile dysfunction. What important information should the healthcare provider provide?

• A. This medication can cause sudden hearing loss.
• B. This medication should not be taken more than once a day.
• C. You should avoid taking this medication with high-fat meals.
• D. Avoid taking nitrates while on this medication.

Correct answer: D

Rationale: The correct answer is D. Sildenafil (Viagra) should not be taken with nitrates due to the risk of severe hypotension. Nitrates can potentiate the hypotensive effects of sildenafil, leading to a dangerous drop in blood pressure. Choice A is incorrect because sudden hearing loss is a rare but serious side effect associated with sildenafil, not a common side effect. Choice B is not the most important information related to sildenafil use. While it is generally recommended not to exceed one dose per day, the interaction with nitrates is more critical. Choice C is also important to consider as high-fat meals can delay the onset of action of sildenafil, but it is not as crucial as avoiding nitrates.

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