Nursing Elites

1. When discussing the risks associated with hormone replacement therapy (HRT) with a patient who has a history of coronary artery disease, what should the nurse emphasize?

• A. HRT may increase the risk of cardiovascular events such as heart attack and stroke.
• B. HRT may increase the risk of osteoporosis.
• C. HRT may decrease the risk of venous thromboembolism.
• D. HRT may increase the risk of breast cancer.

Correct answer: A

Rationale: The correct answer is A. Hormone replacement therapy (HRT) is associated with an increased risk of cardiovascular events, such as heart attack and stroke, especially in patients with a history of coronary artery disease. Choice B is incorrect because HRT is actually known to decrease the risk of osteoporosis. Choice C is incorrect as HRT is associated with an increased risk of venous thromboembolism. Choice D is also incorrect as HRT may slightly increase the risk of breast cancer.

2. A 30-year-old has poorly controlled asthma and is taking prednisone 10 mg by mouth once a day. He has been on this regimen for 6 weeks. Abrupt withdrawal or discontinuation of this medication can cause:

• A. adrenal crisis
• B. hypercortisolism
• C. ACTH stimulation
• D. thyroid crisis

Correct answer: A

Rationale: Abrupt withdrawal or discontinuation of prednisone, a corticosteroid, can lead to adrenal crisis. This occurs due to the suppression of the adrenal glands' natural cortisol production caused by prolonged exogenous steroid administration. Adrenal crisis presents with symptoms such as weakness, fatigue, abdominal pain, and hypotension. Hypercortisolism (Cushing syndrome) results from chronic excessive exposure to cortisol, not abrupt withdrawal. ACTH stimulation would be expected in response to low cortisol levels, not as a direct consequence of prednisone withdrawal. Thyroid crisis (thyroid storm) is associated with severe hyperthyroidism and is not directly related to corticosteroid withdrawal.

3. A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which process will accompany the actions of the neurotransmitter in a chemical synapse?

• A. Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses.
• B. Communication between a neuron and the single neuron it is connected with will be facilitated.
• C. The neurotransmitter will cross gap junctions more readily.
• D. More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors.

Correct answer: D

Rationale: When serotonin levels increase, more neurotransmitters will cross the synaptic cleft and bind with postsynaptic receptors, facilitating enhanced communication. Option A is incorrect because chemical synapses, unlike electrical synapses, are unidirectional. Option B is incorrect because neurotransmitters impact communication with multiple neurons, not just a single connected neuron. Option C is incorrect because neurotransmitters cross the synaptic cleft, not gap junctions.

4. A patient is prescribed levothyroxine (Synthroid) for hypothyroidism. What is a key point the nurse should include in the patient education?

• A. Take the medication on an empty stomach with a full glass of water to ensure proper absorption.
• B. Do not take this medication with calcium supplements.
• C. Avoid taking this medication with grapefruit juice.
• D. Take the medication with food to enhance absorption.

Correct answer: A

Rationale: The correct answer is A. Levothyroxine should be taken on an empty stomach with a full glass of water, typically 30 minutes to an hour before breakfast, to ensure proper absorption. Taking it with food, calcium supplements, or grapefruit juice can interfere with its absorption. Choice B is incorrect because taking levothyroxine with calcium supplements can reduce its effectiveness. Choice C is incorrect because grapefruit juice can also interfere with levothyroxine absorption. Choice D is incorrect because taking levothyroxine with food can decrease its absorption.

5. Which of the following correctly identifies the plasma protein inflammatory mediator systems?

• A. Phagocytic, interferon, and complement systems.
• B. Complement, fibrinolytic, and clotting systems.
• C. Complement, clotting, and kinin systems.
• D. Complement, clotting, and acute phase reactant systems.

Correct answer: C

Rationale: The correct answer is C: Complement, clotting, and kinin systems. These are the three main plasma protein inflammatory mediator systems. The complement system helps in inflammation and immune responses, the clotting system is involved in blood coagulation, and the kinin system regulates inflammation and blood pressure. Choice A is incorrect because interferon is not part of the plasma protein inflammatory mediator systems. Choice B is incorrect because the fibrinolytic system is not a primary inflammatory mediator system. Choice D is incorrect because acute phase reactants are not part of the plasma protein inflammatory mediator systems.

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