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. Which pathophysiologic process causes the decreased glomerular filtration rate in a patient with acute glomerulonephritis?

• A. Decreased renal-induced constriction of the renal arteries
• B. Immune complex deposition, increased capillary permeability, and cellular proliferation
• C. Necrosis of 70% or more of the nephrons secondary to increased kidney interstitial hydrostatic pressure
• D. Scar tissue formation throughout the proximal convoluted tubule secondary to toxin-induced collagen synthesis

Correct answer: B

Rationale: The correct answer is B: Immune complex deposition, increased capillary permeability, and cellular proliferation. In acute glomerulonephritis, immune complexes deposit in the glomerulus, leading to inflammation, increased capillary permeability, and cellular proliferation. These processes collectively reduce the glomerular filtration rate. Choices A, C, and D do not accurately describe the pathophysiologic process in acute glomerulonephritis. Decreased renal-induced constriction of the renal arteries, necrosis of nephrons due to increased kidney interstitial hydrostatic pressure, and scar tissue formation in the proximal convoluted tubule are not the primary mechanisms responsible for the decreased filtration rate in this condition.

3. A 30-year-old male is being treated with testosterone enanthate for delayed puberty. What side effect should the nurse inform the patient about?

• A. Increased libido
• B. Decreased muscle mass
• C. Breast tenderness
• D. Increased aggression

Correct answer: D

Rationale: The correct side effect that the nurse should inform the patient about when receiving testosterone enanthate therapy for delayed puberty is increased aggression. Testosterone therapy can lead to mood changes, including increased aggression in some individuals. Therefore, it is essential for healthcare providers to educate patients about this potential side effect. Choices A, B, and C are incorrect because testosterone therapy is more likely to increase libido, promote muscle mass growth, and may cause breast tenderness due to hormonal imbalances.

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

• A. Take the medication at the same time each day to maintain consistent hormone levels.
• B. Medroxyprogesterone should be taken with food to reduce gastrointestinal upset.
• C. Medroxyprogesterone should be discontinued if side effects occur.
• D. Medroxyprogesterone should be taken once a week to maintain effectiveness.

Correct answer: A

Rationale: The correct instruction the nurse should provide regarding the use of medroxyprogesterone acetate (Provera) for endometriosis is to take the medication at the same time each day. This helps to maintain consistent hormone levels and ensures the effectiveness of the treatment. Choice B is incorrect because medroxyprogesterone should be taken without regard to meals. Choice C is incorrect because side effects should be reported to the healthcare provider for evaluation rather than discontinuing the medication without medical advice. Choice D is incorrect as medroxyprogesterone is usually taken daily, not weekly, for the treatment of endometriosis.

5. Which goal is a priority for a client with a DSM-IV-TR diagnosis of delirium and the nursing diagnosis Acute confusion related to recent surgery secondary to traumatic hip fracture?

• A. The client will complete activities of daily living.
• B. The client will maintain safety.
• C. The client will remain oriented.
• D. The client will understand communication.

Correct answer: B

Rationale: The correct answer is B: 'The client will maintain safety.' For a client with delirium, especially in the context of acute confusion post-surgery, safety is the top priority. Delirium can lead to disorientation, impaired decision-making, and increased risk of falls or accidents. Ensuring the client's safety by implementing measures to prevent harm is crucial. Choices A, C, and D are important but not the priority in this scenario. Completing activities of daily living, remaining oriented, and understanding communication are relevant goals but come after ensuring the client's safety in the presence of delirium and acute confusion.

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