Nursing Elites

1. An older adult man has moved to a long-term care facility, and the nurse is performing medication reconciliation. The resident's current medication regimen includes alfuzosin (Uroxatral). After considering the most likely indication for this drug, what potential problem should the nurse include in the resident's interdisciplinary plan of care?

• A. Impaired urinary elimination
• B. Ineffective sexual pattern
• C. Sexual dysfunction
• D. Functional urinary incontinence

Correct answer: C

Rationale: The correct answer is C, 'Sexual dysfunction.' Alfuzosin is commonly prescribed for benign prostatic hyperplasia (BPH), a condition that can lead to sexual dysfunction in older men. It is important to include this potential problem in the interdisciplinary plan of care to address the impact of the medication on the resident's sexual health. Choices A, B, and D are incorrect because while alfuzosin can affect urinary function, the primary concern related to this medication in this scenario is sexual dysfunction due to its indication for BPH.

2. A patient with a history of osteoporosis is prescribed raloxifene (Evista). What is the primary therapeutic effect of this medication?

• A. It stimulates the formation of new bone.
• B. It decreases bone resorption and increases bone density.
• C. It increases calcium absorption in the intestines.
• D. It increases the excretion of calcium through the kidneys.

Correct answer: B

Rationale: The correct answer is B. Raloxifene, such as Evista, works by decreasing bone resorption and increasing bone density. This medication is beneficial in the prevention and treatment of osteoporosis by slowing down the breakdown of bone tissue, thereby reducing the risk of fractures. Choices A, C, and D are incorrect because raloxifene does not directly stimulate the formation of new bone, increase calcium absorption in the intestines, or increase the excretion of calcium through the kidneys.

3. Which manifestation of stress reflects the non-specific fight or flight response?

• A. Decreased pupillary light response
• B. Increased GI motility
• C. Decreased short-term memory
• D. Increased cardiopulmonary rates

Correct answer: D

Rationale: The correct answer is D, 'Increased cardiopulmonary rates.' The fight or flight response, activated by stress, is a non-specific physiological reaction that prepares the body to deal with perceived threats. In this response, the heart rate and breathing rate increase to supply more oxygen to muscles and vital organs, enabling a rapid response in dangerous situations. Choices A, B, and C are incorrect because decreased pupillary light response, increased GI motility, and decreased short-term memory are not typical manifestations of the fight or flight response.

4. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. What critical contraindication should the nurse review with the patient?

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

Correct answer: A

Rationale: The correct answer is A: Use of nitrates. Sildenafil (Viagra) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates and sildenafil both cause vasodilation, which can lead to a dangerous drop in blood pressure. Choice B (Use of antihypertensive medications) is incorrect because antihypertensive medications are not a critical contraindication for sildenafil use. Choice C (History of hypertension) is incorrect as it is not a contraindication for sildenafil; in fact, sildenafil is sometimes used in patients with hypertension. Choice D (History of peptic ulcer disease) is also incorrect as it is not a critical contraindication for sildenafil use.

5. The early stages of atheroma development are characterized by:

• A. macrophages full of oxidized low-density lipoprotein (LDL; i.e., foam cells) in the intima
• B. accumulation of lipids in the intima (i.e., fatty streak)
• C. accumulation of proteins such as collagen and elastin (i.e., fibrous cap)
• D. development of calcium and a necrotic lipid core

Correct answer: A

Rationale: The correct answer is A. In the early stages of atheroma development, macrophages accumulate oxidized low-density lipoprotein (LDL) and transform into foam cells, leading to the formation of fatty streaks in the intima of blood vessels. This process is a hallmark of the initial stages of atherosclerosis. Choice B is incorrect as it describes the accumulation of lipids in the intima, which is a later event following foam cell formation. Choice C is also incorrect as it refers to the accumulation of proteins forming the fibrous cap, which occurs at a later stage to stabilize the atheroma. Choice D is incorrect as it describes the development of calcium and a necrotic lipid core, typically seen in advanced atherosclerosis rather than the early stages.

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