Nursing Elites

1. A patient taking oral contraceptives reports breakthrough bleeding. What should the nurse assess in this patient?

• A. Adherence to the medication schedule
• B. The possibility of pregnancy
• C. The need for an increased dosage
• D. The effectiveness of the current oral contraceptive

Correct answer: A

Rationale: When a patient on oral contraceptives experiences breakthrough bleeding, the nurse should assess the patient's adherence to the medication schedule. Breakthrough bleeding can be a sign of missed doses or inconsistent timing, which can decrease the effectiveness of oral contraceptives. Assessing the patient's adherence helps in ensuring proper use of the medication. Choices B, C, and D are incorrect because breakthrough bleeding is more likely related to adherence issues rather than pregnancy, the need for increased dosage, or the effectiveness of the current oral contraceptive.

2. What causes atherosclerotic plaques to form initially?

• A. Interruption of blood flow to the brain
• B. Injury to the coronary artery endothelium
• C. Administration of statin medications
• D. Poor dietary modifications

Correct answer: B

Rationale: Atherosclerotic plaques form initially due to injury to the coronary artery endothelium, which triggers a cascade of events leading to plaque buildup. Choice A is incorrect because atherosclerotic plaques do not form due to an interruption of blood flow to the brain. Choice C is incorrect as statin medications are actually used to help lower cholesterol and reduce the risk of plaque formation. Choice D is incorrect as poor dietary modifications can contribute to atherosclerosis but are not the initial cause of plaque formation.

3. A patient is prescribed medroxyprogesterone acetate (Provera) for the treatment of endometriosis. What key instruction should the nurse provide regarding the use of this medication?

• A. Take the medication at the same time each day to maintain consistent hormone levels.
• B. Medroxyprogesterone should be taken with food to reduce gastrointestinal upset.
• C. Medroxyprogesterone should be discontinued if side effects occur.
• D. Medroxyprogesterone should be taken once a week to maintain effectiveness.

Correct answer: A

Rationale: The correct instruction the nurse should provide regarding the use of medroxyprogesterone acetate (Provera) for endometriosis is to take the medication at the same time each day. This helps to maintain consistent hormone levels and ensures the effectiveness of the treatment. Choice B is incorrect because medroxyprogesterone should be taken without regard to meals. Choice C is incorrect because side effects should be reported to the healthcare provider for evaluation rather than discontinuing the medication without medical advice. Choice D is incorrect as medroxyprogesterone is usually taken daily, not weekly, for the treatment of endometriosis.

4. A nursing student is learning about the effects of bactericidal agents. How does rifampin (Rifadin) achieve a therapeutic action against both intracellular and extracellular tuberculosis organisms?

• A. It is metabolized in the liver.
• B. It binds to acetylcholine.
• C. It inhibits synthesis of RNA.
• D. It causes phagocytosis.

Correct answer: C

Rationale: Rifampin (Rifadin) achieves a therapeutic action against both intracellular and extracellular tuberculosis organisms by inhibiting the synthesis of RNA. This action interferes with bacterial RNA synthesis, leading to the suppression of protein synthesis in the bacteria, ultimately causing their death. Option A is incorrect because rifampin is primarily metabolized in the liver, but this is not how it exerts its bactericidal effects. Option B is incorrect as rifampin does not bind to acetylcholine. Option D is also incorrect as rifampin does not cause phagocytosis.

5. Abrupt withdrawal or discontinuation of prednisone can cause:

• A. adrenal crisis.
• B. hypercortisolism.
• C. ACTH stimulation.
• D. thyroid crisis.

Correct answer: A

Rationale: The correct answer is A: adrenal crisis. Abrupt discontinuation of prednisone can lead to adrenal insufficiency, resulting in adrenal crisis. Prednisone is a corticosteroid that suppresses the adrenal glands' ability to produce cortisol. Abrupt withdrawal can cause a sudden drop in cortisol levels, leading to adrenal crisis with symptoms like fatigue, weakness, abdominal pain, and potentially life-threatening low blood pressure. Choices B, C, and D are incorrect because hypercortisolism refers to excess cortisol levels, ACTH stimulation would not result from prednisone withdrawal, and thyroid crisis is not directly related to corticosteroid discontinuation.

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