Nursing Elites

1. A patient being treated for tuberculosis is determined to be drug resistant. Which of the following medications will the patient be resistant to in the treatment of tuberculosis?

• A. Isoniazid (INH) and rifampin
• B. Carbamazepine (Tegretol) and phenytoin (Dilantin)
• C. Dextroamphetamine (Dexedrine) and doxapram (Dopram)
• D. Propranolol (Inderal) and sotalol (Betapace)

Correct answer: A

Rationale: In the treatment of tuberculosis, drug resistance commonly develops against medications like Isoniazid (INH) and rifampin. These two drugs are key components of the standard anti-tuberculosis treatment regimen. Choices B, C, and D are unrelated medications that are not used in the treatment of tuberculosis. Carbamazepine and phenytoin are anticonvulsants, dextroamphetamine is a stimulant, and propranolol and sotalol are used for cardiovascular conditions.

2. A female patient has been diagnosed with tuberculosis and begun multiple-drug therapy. The woman has asked the nurse why it is necessary for her to take several different drugs instead of one single drug. How should the nurse best respond to the patient's question?

• A. “Multiple drugs are used because doctors need to combat the TB bacteria from different angles to effectively treat the infection.”
• B. “The use of multiple drugs prevents the development of drug-resistant TB.”
• C. “Multiple drugs are prescribed because the final testing results for TB can take up to 3 weeks to confirm the most effective treatment.”
• D. “Multiple drugs are used in order to speed up the course of treatment.”

Correct answer: B

Rationale: The correct answer is B. Using multiple drugs in tuberculosis treatment helps prevent the development of drug-resistant TB. This approach is crucial because if the infection is not completely eradicated, the remaining bacteria may become resistant to the single drug used, making future treatments less effective. Choice A is incorrect because the use of multiple drugs is not due to uncertainty about which drug will work, but rather to address the bacteria from different angles. Choice C is incorrect as it misleads the patient about the reason for using multiple drugs. Choice D is also incorrect because the primary purpose of using multiple drugs is not to speed up treatment but to ensure effectiveness and prevent resistance.

3. A 55-year-old man presents with a history of fatigue, weight loss, and night sweats. He reports recent onset of a productive cough and hemoptysis. Which condition should the nurse suspect?

• A. Lung cancer
• B. Pneumonia
• C. Tuberculosis
• D. Pulmonary embolism

Correct answer: C

Rationale: The correct answer is C: Tuberculosis. The symptoms described - fatigue, weight loss, night sweats, productive cough, and hemoptysis - are classic manifestations of tuberculosis. Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, commonly affecting the lungs but can also involve other organs. **Choice A: Lung cancer** typically presents with symptoms like persistent cough, chest pain, and shortness of breath, but it is less likely in this case due to the presence of hemoptysis. **Choice B: Pneumonia** can present with productive cough, fever, and chest pain, but it is less likely given the chronicity of symptoms and the presence of hemoptysis. **Choice D: Pulmonary embolism** usually presents with sudden onset shortness of breath, chest pain, and can be associated with risk factors like recent surgery or immobility.

4. When does pain in the lower extremities due to peripheral artery disease usually worsen?

• A. with rest because blood flow decreases.
• B. with elevation of the extremity because blood is diverted away.
• C. when the leg is in a dependent position because blood pools.
• D. when the leg is touched or massaged because cytokines are released.

Correct answer: B

Rationale: Pain in the lower extremities due to peripheral artery disease usually worsens with elevation of the extremity because blood is diverted away from the affected area, leading to decreased perfusion and exacerbation of symptoms. Choices A, C, and D are incorrect because resting, dependent position, and touch/massage do not typically worsen the pain associated with peripheral artery disease.

5. A client with a pneumothorax is receiving oxygen therapy. Which assessment finding would indicate that the treatment is effective?

• A. Increased respiratory rate
• B. Decreased oxygen saturation levels
• C. Improved breath sounds on the affected side
• D. Increased dyspnea and chest pain

Correct answer: C

Rationale: In a client with a pneumothorax receiving oxygen therapy, improved breath sounds on the affected side would indicate effective treatment. This finding suggests that the collapsed lung is re-expanding, allowing air to flow more freely in and out of the affected area. Choices A, B, and D are incorrect: Increased respiratory rate, decreased oxygen saturation levels, and increased dyspnea and chest pain are signs of ineffective treatment or worsening of the condition in a client with a pneumothorax.

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