Nursing Elites

1. What is the etiology and most likely treatment for myasthenia gravis in a 22-year-old female college student?

• A. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids.
• B. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins.
• C. Cerebellar lesions; surgical and immunosuppressive treatment.
• D. Excess acetylcholinesterase production; treatment with thymectomy.

Correct answer: B

Rationale: Myasthenia gravis is characterized by a decline in functioning acetylcholine receptors rather than autoimmune destruction of skeletal muscle cells (Choice A), cerebellar lesions (Choice C), or excess acetylcholinesterase production (Choice D). The most likely treatment for myasthenia gravis involves corticosteroids to reduce inflammation and intravenous immunoglobulins to block the antibodies attacking acetylcholine receptors. Intensive physical therapy and anabolic steroids are not primary treatments for myasthenia gravis.

2. Why is it important for a patient to take a new oral contraceptive at the same time each day?

• A. Taking the medication at the same time each day helps maintain stable hormone levels, which is critical for preventing pregnancy.
• B. Taking the medication at the same time each day reduces the risk of breakthrough bleeding.
• C. Taking the medication at the same time each day ensures consistent absorption and effectiveness.
• D. Taking the medication at the same time each day is important, but missing a dose occasionally is not a concern.

Correct answer: A

Rationale: The correct answer is A. Taking oral contraceptives at the same time each day is crucial for maintaining stable hormone levels, which is essential for the contraceptive's effectiveness in preventing pregnancy. Choice B is incorrect because the primary reason for taking the medication consistently is hormone level stability, not specifically to reduce breakthrough bleeding. Choice C is incorrect as it focuses on absorption and effectiveness, which are important but do not address the main reason for consistent timing. Choice D is incorrect because missing doses can impact contraceptive efficacy, making consistent timing essential for optimal protection.

3. A patient is administered isoniazid (INH) for tuberculosis. Which of the following adverse effects will result in discontinuation of the medication?

• A. Weight gain
• B. Jaundice
• C. Fever
• D. Arthralgia

Correct answer: B

Rationale: The correct answer is B: Jaundice. Isoniazid (INH) is known to cause hepatotoxicity, which can manifest as jaundice. Jaundice is a serious adverse effect that warrants immediate discontinuation of the medication to prevent further liver damage. Weight gain, fever, and arthralgia are not typically associated with isoniazid use and would not necessitate discontinuation of the medication.

4. A client with atrial fibrillation is at risk for which of the following complications?

• A. Deep vein thrombosis (DVT)
• B. Pulmonary embolism
• C. Hypertensive crisis
• D. Myocardial infarction

Correct answer: B

Rationale: Corrected Rationale: A client with atrial fibrillation is at increased risk of thromboembolism due to blood stasis in the atria. This can lead to the formation of blood clots, which may travel to the lungs and cause a pulmonary embolism. Pulmonary embolism is a serious complication of atrial fibrillation. Choices A, C, and D are incorrect because while atrial fibrillation can lead to complications such as stroke or heart failure, it is specifically associated with an increased risk of pulmonary embolism due to the clot formation associated with the condition.

5. A patient is prescribed tadalafil (Cialis) for erectile dysfunction. What critical contraindication should the nurse discuss 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. Tadalafil (Cialis) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates potentiate the hypotensive effects of tadalafil, leading to a potentially life-threatening drop in blood pressure. Choices B, C, and D are incorrect because antihypertensive medications, history of hypertension, and history of peptic ulcer disease are not critical contraindications for tadalafil use. While caution may be needed in patients with certain conditions, the highest priority is addressing the interaction with nitrates.

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