Nursing Elites

1. A patient is taking medroxyprogesterone acetate (Provera) for the treatment of endometriosis. What should the nurse include in the patient teaching?

• A. Take the medication with food to prevent gastrointestinal upset.
• B. Avoid prolonged sun exposure while taking this medication.
• C. Take the medication at the same time each day to maintain consistent hormone levels.
• D. Discontinue the medication if side effects occur.

Correct answer: C

Rationale: The correct answer is to take the medication at the same time each day to maintain consistent hormone levels. This is important for the effectiveness of medroxyprogesterone acetate. Choice A is incorrect because medroxyprogesterone acetate does not need to be taken with food. Choice B is irrelevant as sun exposure is not a concern with this medication. Choice D is incorrect as discontinuing the medication without consulting a healthcare provider can lead to adverse effects.

2. What condition is a result of Polycythemia Vera, which involves excess red blood cells?

• A. Tissue ischemia & necrosis
• B. Chronic pancreatitis
• C. Low blood pressure & heart rate
• D. Increased numbers of infections

Correct answer: A

Rationale: Polycythemia Vera, characterized by excess red blood cells, can cause tissue ischemia and necrosis due to the increased blood viscosity. This condition restricts blood flow, leading to inadequate oxygen delivery to tissues and subsequent tissue damage. Choices B, C, and D are incorrect because they are not directly associated with the pathophysiology of Polycythemia Vera.

3. A 65-year-old man is admitted to the intensive care unit from the operating room after a triple coronary artery bypass graft. He is intubated and on a ventilator. Lactic acid levels were normal postoperatively, but now they are rising. The increased level could be an indication of:

• A. excessive sedation
• B. bowel ischemia
• C. excessive volume infusion in the operating room
• D. mild hypothermia postoperatively

Correct answer: B

Rationale: In this scenario, the rising lactic acid levels in a 65-year-old man after a coronary artery bypass graft could indicate bowel ischemia. Bowel ischemia can lead to anaerobic metabolism, causing an increase in lactic acid levels. Excessive sedation may cause respiratory depression but would not directly lead to rising lactic acid levels. Excessive volume infusion in the operating room might cause fluid overload but would not typically result in rising lactic acid levels. Mild hypothermia postoperatively could lead to shivering and increased oxygen consumption, but it is less likely to be the primary cause of rising lactic acid levels in this context.

4. A nurse is caring for a client with a newly inserted pacemaker. What is the most important nursing action post-procedure?

• A. Monitor the insertion site for signs of infection.
• B. Educate the client about activity restrictions.
• C. Monitor the client's heart rate and rhythm.
• D. Assess the client's lung sounds for signs of fluid overload.

Correct answer: A

Rationale: Post-procedure, monitoring the insertion site for signs of infection is crucial because it helps in early detection of any potential complications such as infection. While educating the client about activity restrictions, monitoring the client's heart rate and rhythm, and assessing lung sounds for signs of fluid overload are important aspects of care, the immediate priority post-procedure is to prevent infection at the insertion site, which could lead to serious complications.

5. The neurotransmitter GABA mainly functions to trigger inhibitory postsynaptic potentials (IPSPs). Therefore, when explaining this to a group of nursing students, the nurse will state:

• A. It takes at least three chemical substances (amino acids, neuropeptides, and monoamines) to stimulate any activity between the cells.
• B. There is a symbiotic relationship; therefore, the end result will be depolarization of the postsynaptic membrane.
• C. The combination of GABA with a receptor site is inhibitory since it causes the local nerve membrane to become hyperpolarized and less excitable.
• D. The neurotransmitters will interact with cholinergic receptors to bind to acetylcholine in order to produce hypopolarization within the cell.

Correct answer: C

Rationale: When GABA binds with a receptor site, it causes hyperpolarization of the local nerve membrane, making it less excitable. This hyperpolarization leads to inhibition of nerve cell activity. Choice A is incorrect because GABA is a neurotransmitter itself and does not require three chemical substances to stimulate activity between cells. Choice B is incorrect as GABA triggers inhibitory postsynaptic potentials (IPSPs), leading to hyperpolarization, not depolarization, of the postsynaptic membrane. Choice D is also incorrect as it describes a process involving cholinergic receptors and acetylcholine, which is unrelated to GABA's mechanism of action.

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