Nursing Elites

1. A client has been taking a drug (Drug A) that is highly metabolized by the cytochrome P-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome P-450 system. You should monitor this client for:

• A. increased therapeutic effects of Drug A.
• B. increased adverse effects of Drug B.
• C. decreased therapeutic effects of Drug A.
• D. decreased therapeutic effects of Drug B.

Correct answer: C

Rationale: When a client is taking a drug (Drug A) metabolized by the cytochrome P-450 system and is then started on another drug (Drug B) that induces this system, the metabolism of Drug A is increased. This results in decreased therapeutic effects of Drug A as it is broken down more rapidly. Monitoring is required to address potential reduced efficacy. The therapeutic effect of Drug A is diminished, not enhanced. Inducing the cytochrome P-450 system does not directly increase the adverse effects of Drug B. Although Drug B is an inducer, its therapeutic effects are not decreased as it is not metabolized faster.

2. In Parkinson's disease, a client's difficulty in performing voluntary movements is known as:

• A. Akinesia.
• B. Dyskinesia.
• C. Chorea.
• D. Dystonia.

Correct answer: C.

Rationale: In Parkinson's disease, the client's difficulty in performing voluntary movements is termed dyskinesia. Dyskinesia refers to the impairment of the ability to execute voluntary muscle movements. Akinesia, on the other hand, refers to the absence or lack of voluntary movement. Chorea is characterized by involuntary, rapid, irregular movements. Dystonia involves sustained muscle contractions resulting in abnormal postures or twisting movements. Therefore, dyskinesia is the specific term used for the described difficulty in Parkinson's disease.

3. A nurse is caring for a client with an elevated cortisol level. The nurse can expect the client to exhibit symptoms of:

• A. urinary excess
• B. hyperpituitarism
• C. urinary deficit
• D. hyperthyroidism

Correct answer: C

Rationale: Elevated cortisol levels can lead to sodium and fluid retention and potassium deficit, resulting in urinary deficit. This imbalance in electrolytes and fluid can cause a decrease in urinary output. Choices B, hyperpituitarism, and D, hyperthyroidism, are incorrect as they do not directly relate to the symptoms expected with elevated cortisol levels. Option A, urinary excess, is also incorrect as high cortisol levels typically lead to fluid retention and urinary deficit, not excess.

4. What is the most effective strategy to assist a client in recognizing and using personal strength?

• A. Encouraging the client's self-identification of strengths.
• B. Promoting the client's active external thinking.
• C. Listening to the client and providing advice as needed.
• D. Assisting the client in maintaining an external locus of control.

Correct answer: A

Rationale: Encouraging the client to identify their own strengths is empowering and helps build self-awareness and self-confidence. This strategy promotes autonomy and self-efficacy, enabling the client to recognize and utilize their personal strengths effectively. Option B, promoting the client's active external thinking, is vague and not directly related to recognizing personal strengths. Option C, listening to the client and providing advice as needed, focuses more on the nurse's role rather than empowering the client to recognize their strengths independently. Option D, assisting the client in maintaining an external locus of control, goes against the goal of helping the client recognize and utilize their internal strengths.

5. What advice should be given to a client with stress incontinence?

• A. to consider trying Kegel exercises
• B. to undergo surgery immediately
• C. to avoid all forms of treatment
• D. to ignore the issue as it is not serious

Correct answer: A

Rationale: For stress incontinence, advising the client to consider trying Kegel exercises is appropriate. Kegel exercises involve tightening and releasing the pelvic floor muscles, which can improve stress incontinence by strengthening the muscles that control urination. Choice B suggesting immediate surgery is incorrect as surgery is usually considered after conservative treatments like Kegel exercises have been tried. Choice C advising to avoid all forms of treatment is dangerous and neglectful. Choice D recommending to ignore the issue is inappropriate as it can impact the client's quality of life and may worsen over time without intervention.

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