Nursing Elites

1. A nurse is teaching a young adult patient about oral contraceptives, which the patient will soon begin taking. The patient's primary concern is the effectiveness of the medication in preventing pregnancy. The nurse should teach the patient that oral contraceptives, when taken consistently, are how effective in preventing pregnancy?

• A. Between 96% and 98%
• B. Approximately 98.5%
• C. Highly effective, but partially dependent on genetic factors
• D. Nearly 100%

Correct answer: D

Rationale: When taken correctly, estrogen–progestin contraceptive preparations are nearly 100% effective in preventing pregnancy. Choices A, B, and C are incorrect. Choice A suggests a range below the actual effectiveness, choice B provides a specific percentage that is not accurate, and choice C introduces the concept of genetic factors which is not relevant to the effectiveness of oral contraceptives.

2. A client on an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is reporting intense, diffuse pain in her abdomen. Which physiologic phenomenon is most likely contributing to her complaint?

• A. Somatic pain resulting from pressure on the parietal peritoneum
• B. Referred pain from her small bowel
• C. Visceral pain resulting from distension and ischemia
• D. Neuropathic pain resulting from autonomic dysfunction

Correct answer: C

Rationale: Visceral pain is associated with distension, ischemia, and inflammation of internal organs. In the case of a small bowel obstruction, the intense, diffuse pain reported by the client is likely due to the distension and ischemia of the small bowel. Somatic pain (Choice A) would be more localized and sharp, typically arising from the parietal peritoneum. Referred pain (Choice B) is pain perceived at a site distant from the actual pathology. Neuropathic pain (Choice D) involves dysfunction or damage to the nervous system and is not typically associated with the described physiologic phenomenon of distension and ischemia in the context of a small bowel obstruction.

3. How can a nurse determine the efficacy of a child's mebendazole treatment for roundworm after 3 weeks?

• A. Liver function tests
• B. Stool for ova and parasites
• C. Colonoscopy or sigmoidoscopy
• D. Rectal swab for culture

Correct answer: B

Rationale: The correct answer is B: Stool for ova and parasites. To assess the efficacy of treatment for roundworm, the nurse would examine the stool for ova (eggs) and parasites. This test helps determine if the infection has been cleared. Choices A, C, and D are incorrect because liver function tests are not commonly used to monitor roundworm treatment efficacy, and colonoscopy/sigmoidoscopy as well as rectal swab for culture are not routine diagnostic tests for assessing the effectiveness of mebendazole treatment for roundworm.

4. In which of the following cases is dehydration more likely to occur?

• A. A 50-year-old woman who is a bodybuilder
• B. A 50-year-old man who is morbidly obese
• C. A 10-year-old child who is thin
• D. A 30-year-old with multiple sclerosis

Correct answer: B

Rationale: The correct answer is B. Morbid obesity increases the risk of dehydration due to the larger body surface area and potential for greater insensible losses. Choices A, C, and D are less likely to experience dehydration compared to a morbidly obese individual.

5. A patient began antiretroviral therapy several weeks ago for the treatment of HIV, and he has now presented to the clinic for a scheduled follow-up appointment. He states to the nurse, “I've been pretty good about taking all my pills on time, though it was a bit hit and miss over the holiday weekend.” How should the nurse best respond to this patient's statement?

• A. “Remember that if you miss a dose, you need to take a double dose at the next scheduled time.”
• B. “It's acceptable to miss an occasional dose as long as your symptoms don't worsen, but it's important to strive for consistent adherence.”
• C. “Remember that your antiretroviral drugs will only be effective if you take them consistently and as prescribed.”
• D. “If you're not consistent with taking your medications, you're likely to develop more side effects.”

Correct answer: C

Rationale: The correct response is to remind the patient that antiretroviral drugs are most effective when taken consistently and as prescribed. Choice A is incorrect because taking a double dose after missing a dose is not recommended, as it can lead to medication toxicity. Choice B is incorrect as it may give the impression that missing doses is acceptable, which can reduce the effectiveness of the treatment. Choice D is incorrect because while consistency is important, the focus should be on treatment effectiveness rather than side effects.

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