Nursing Elites

1. Macular degeneration occurs as a result of:

• A. loss of lens accommodation
• B. detachment of the retina
• C. increased intraocular pressure
• D. impaired blood supply leading to cellular waste accumulation and ischemia

Correct answer: D

Rationale: Macular degeneration is a condition that affects the macula, a part of the retina responsible for central vision. It is primarily caused by impaired blood supply to the macula, leading to cellular waste accumulation and ischemia. This results in the death of photoreceptor cells and ultimately vision loss. Choices A, B, and C are incorrect because macular degeneration is not related to the loss of lens accommodation, detachment of the retina, or increased intraocular pressure. The correct answer directly addresses the underlying pathophysiology of macular degeneration.

2. A patient is prescribed testosterone gel for hypogonadism. What important instruction should the nurse provide regarding the application of this medication?

• A. Apply the gel to the chest or upper arms.
• B. Apply the gel to the face and neck.
• C. Apply the gel to the genitals for maximum absorption.
• D. Apply the gel to the scalp and back.

Correct answer: A

Rationale: The correct answer is to apply the testosterone gel to the chest or upper arms. This is recommended to minimize the risk of unintentional transfer of the medication to others, especially women and children, through skin contact. Applying the gel to the face, neck, or genitals is not advised as it can lead to unintended exposure to others. Additionally, applying the gel to the scalp or back is not appropriate as these areas are not indicated for absorption of testosterone.

3. A patient who is undergoing treatment for cytomegalovirus received his first dose of IV ganciclovir 3 days ago. When reviewing this patient's most recent blood work, what abnormality should the nurse most likely attribute to the use of this drug?

• A. Hemoglobin 17 g/dL (high normal)
• B. INR 3.8 (high)
• C. Platelet count 118,000/mm3 (low)
• D. Leukocytes 11,900/mm3 (high)

Correct answer: C

Rationale: The correct answer is C: Platelet count 118,000/mm3 (low). Ganciclovir, used to treat cytomegalovirus, is known to cause bone marrow suppression, leading to decreased platelet count (thrombocytopenia). This condition can increase the risk of bleeding. Choices A, B, and D are not typically associated with ganciclovir therapy. High hemoglobin levels (choice A) are not commonly seen with ganciclovir treatment. INR elevation (choice B) is associated with coagulation abnormalities, which are not a typical side effect of ganciclovir. Elevated leukocyte count (choice D) is not a common consequence of ganciclovir use.

4. What are the signs of thyroid crisis resulting from Graves' disease?

• A. Constipation with gastric distension.
• B. Bradycardia and bradypnea.
• C. Hyperthermia and tachycardia.
• D. Constipation and lethargy.

Correct answer: C

Rationale: In a thyroid crisis resulting from Graves' disease, the patient typically experiences symptoms such as hyperthermia (elevated body temperature) and tachycardia (rapid heart rate). These symptoms are indicative of the hypermetabolic state seen in thyroid storm. Choices A and D are incorrect as constipation and lethargy are not typical signs of a thyroid crisis; instead, patients with hyperthyroidism often experience diarrhea and agitation. Choice B is incorrect because bradycardia (slow heart rate) and bradypnea (slow breathing rate) are more commonly associated with hypothyroidism rather than a thyroid crisis in Graves' disease.

5. A patient is prescribed raloxifene (Evista) for osteoporosis. What is the primary therapeutic action 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 works by decreasing bone resorption and increasing bone density, which helps in the prevention and treatment of osteoporosis. Choice A is incorrect as raloxifene does not directly stimulate the formation of new bone. Choice C is incorrect because raloxifene does not primarily affect calcium absorption in the intestines. Choice D is incorrect as raloxifene does not increase the excretion of calcium through the kidneys.

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