Nursing Elites

1. A patient is being treated for a severe fungal infection with amphotericin B. What is the expected length of treatment for this patient?

• A. 1 to 2 weeks
• B. 3 to 6 weeks
• C. 4 to 12 weeks
• D. 15 to 18 weeks

Correct answer: C

Rationale: The correct answer is C: '4 to 12 weeks.' Amphotericin B treatment duration for severe fungal infections typically ranges from 4 to 12 weeks. This extended period is necessary to ensure complete eradication of the fungal infection and prevent relapse. Choices A, B, and D provide durations that are either too short or too long for treating severe fungal infections effectively, making them incorrect.

2. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. What is a key contraindication that the nurse should review with the patient?

• A. History of hypertension
• B. Use of nitrates
• C. Use of antihypertensive medications
• D. History of peptic ulcer disease

Correct answer: B

Rationale: The correct answer is B: 'Use of nitrates.' Sildenafil (Viagra) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates and sildenafil both act as vasodilators, and their combined use can lead to a dangerous drop in blood pressure. Choices A, C, and D are incorrect because having a history of hypertension, using antihypertensive medications, or having a history of peptic ulcer disease are not key contraindications for sildenafil use.

3. A client arrives with symptoms of stroke. What should the nurse assess first?

• A. Level of consciousness
• B. Blood pressure
• C. Pupil reaction
• D. Heart rate

Correct answer: A

Rationale: Assessing the level of consciousness is a critical first step in evaluating a potential stroke. Changes in the level of consciousness can indicate the severity and location of brain damage, helping to guide immediate interventions. Assessing blood pressure, pupil reaction, and heart rate are also important aspects of the assessment in a suspected stroke patient. However, the priority is to quickly determine the client's level of consciousness to assess their neurological status.

4. A patient presents with a sudden onset of severe chest pain radiating to his back. His blood pressure is significantly higher in the right arm than in the left arm. Which of the following conditions is most likely?

• A. Acute myocardial infarction
• B. Pulmonary embolism
• C. Aortic dissection
• D. Pericarditis

Correct answer: C

Rationale: The correct answer is C, aortic dissection. Aortic dissection is characterized by sudden, severe chest pain that can radiate to the back. The discrepancy in blood pressure between the arms (higher in the right arm) is known as a 'pulse deficit' and is a classic finding in aortic dissection. This condition involves a tear in the inner layer of the aorta, leading to the abnormal flow of blood within the aortic wall. Acute myocardial infarction (choice A) presents with chest pain but typically does not cause discrepancies in blood pressure between arms. Pulmonary embolism (choice B) usually presents with chest pain and difficulty breathing but does not cause unequal blood pressures in the arms. Pericarditis (choice D) can cause chest pain exacerbated by breathing or lying down, but it does not typically lead to differences in blood pressure between arms.

5. Multiple sclerosis manifests as asymmetrical and in different parts of the body because:

• A. Autoreactive lymphocytes are causing diffuse patchy damage to the myelin sheath in the central nervous system.
• B. Acetylcholine receptors are destroyed by immunoglobulin G.
• C. Autoreactive T lymphocytes cause progressive loss of neurons in the substantia nigra.
• D. Cortical motor cells degenerate.

Correct answer: A

Rationale: The correct answer is A. Multiple sclerosis is characterized by the immune system attacking the myelin sheath in the central nervous system. This attack leads to patchy damage on the myelin sheath, resulting in asymmetrical neurological symptoms. Choices B, C, and D are incorrect because they do not accurately describe the pathophysiology of multiple sclerosis. In multiple sclerosis, it is the autoreactive lymphocytes that target and damage the myelin sheath, not acetylcholine receptors, T lymphocytes, or cortical motor cells.

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