Nursing Elites

1. A patient is starting on alendronate (Fosamax) for the treatment of osteoporosis. What instructions should the nurse provide to ensure the effectiveness of the medication?

• A. Take the medication with a full glass of water and remain upright for at least 30 minutes.
• B. Take the medication with milk to enhance calcium absorption.
• C. Take the medication at bedtime to ensure absorption during sleep.
• D. Take the medication with food to prevent nausea.

Correct answer: A

Rationale: The correct answer is A. Alendronate should be taken with a full glass of water, and patients should remain upright for at least 30 minutes to prevent esophageal irritation and ensure proper absorption. Taking the medication with milk (choice B) is not recommended as it may interfere with alendronate absorption. Taking it at bedtime (choice C) is not necessary and may increase the risk of esophageal irritation. Taking the medication with food (choice D) can reduce its absorption and effectiveness.

2. Which of the following nursing diagnoses would provide the most plausible indication for the use of epoetin alfa (Epogen) in a patient with renal failure?

• A. Risk for infection related to decreased erythropoiesis
• B. Activity intolerance related to decreased oxygen-carrying capacity
• C. Powerlessness related to sequelae of renal failure
• D. Ineffective breathing pattern related to inadequate erythropoietin synthesis

Correct answer: B

Rationale: The correct answer is B. In a patient with renal failure, the use of epoetin alfa (Epogen) is primarily aimed at addressing the decreased oxygen-carrying capacity due to impaired erythropoiesis. Epoetin alfa is a medication that stimulates red blood cell production, thereby improving the oxygen-carrying capacity of the blood. This would directly address the activity intolerance commonly seen in patients with renal failure. Choices A, C, and D are incorrect because they do not directly relate to the primary purpose of using epoetin alfa in this context. Risk for infection, powerlessness, and ineffective breathing pattern are important considerations in the care of a patient with renal failure, but they are not the primary indications for using epoetin alfa.

3. A 30-year-old man has a history of heart transplant and is receiving long-term steroids to prevent rejection. The patient is due for routine vaccines. Attenuated vaccines are contraindicated in this patient because the antigen is:

• A. live and can cause infection.
• B. mutated and infectious.
• C. inactive but still infectious
• D. pathogenic

Correct answer: A

Rationale: The correct answer is A: live and can cause infection. Patients who are immunocompromised, like those receiving long-term steroids after an organ transplant, should not receive live vaccines because the live attenuated organisms in these vaccines can cause infections in individuals with weakened immune systems. Choice B is incorrect because attenuated vaccines are live but weakened, not mutated. Choice C is incorrect because while inactive, attenuated vaccines are not infectious. Choice D is incorrect because attenuated vaccines are not pathogenic; they are attenuated (weakened) forms of the pathogen.

4. A client with a history of rheumatic fever presents with signs of heart failure. What is the likely underlying cause?

• A. Infective endocarditis
• B. Coronary artery disease
• C. Mitral valve stenosis
• D. Aortic regurgitation

Correct answer: C

Rationale: The correct answer is C: Mitral valve stenosis. Rheumatic fever can lead to scarring and thickening of the heart valves, often affecting the mitral valve. This stenosis can impede blood flow from the left atrium to the left ventricle, eventually causing heart failure. Choice A, infective endocarditis, is an infection of the endocardium, the inner lining of the heart chambers and valves, and is not directly related to rheumatic fever. Choice B, coronary artery disease, involves the obstruction of coronary arteries supplying the heart muscle with blood, leading to ischemia and not typically associated with rheumatic fever. Choice D, aortic regurgitation, is the backflow of blood from the aorta to the left ventricle and is not a common consequence of rheumatic fever.

5. A male patient is being treated with sildenafil (Viagra) for erectile dysfunction. What condition would contraindicate the use of this medication?

• A. Peptic ulcer disease
• B. History of myocardial infarction
• C. Recent use of antihypertensive medications
• D. Use of nitrates

Correct answer: D

Rationale: The correct answer is D: Use of nitrates. Sildenafil (Viagra) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates and sildenafil both cause vasodilation, and the combination can lead to a dangerous drop in blood pressure. Choice A, peptic ulcer disease, is not a contraindication for sildenafil use. Choice B, a history of myocardial infarction, is not a contraindication unless the patient is also taking nitrates. Choice C, recent use of antihypertensive medications, is not a contraindication but requires caution as the combination can lead to additive effects lowering blood pressure.

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