Nursing Elites

1. A patient with a diagnosis of renal failure is being treated with epoetin alfa (Epogen). Frequent assessment of which of the following laboratory values should be prioritized before and during treatment?

• A. AST
• B. C-reactive protein
• C. CBC
• D. ALT

Correct answer: A

Rationale: The correct answer is AST. Epoetin alfa is a medication used to treat anemia associated with chronic renal failure. During treatment with epoetin alfa, it is crucial to monitor AST levels as this medication can potentially lead to liver toxicity. Assessing AST levels before and throughout treatment helps in early detection of any liver abnormalities. C-reactive protein is not specifically related to the use of epoetin alfa in renal failure. While CBC (Complete Blood Count) monitoring is essential during treatment with epoetin alfa to evaluate the response to therapy, prioritizing AST assessment is more critical due to the potential for liver toxicity. ALT monitoring is also important but AST is prioritized in this scenario.

2. The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which assessment question posed to the parents is likely to be most useful in the differential diagnosis?

• A. Have you ever given your child any honey or honey-containing products?
• B. Is there any family history of neuromuscular diseases?
• C. Has your baby ever been directly exposed to any chemical cleaning products?
• D. Is there any mold in your home that you know of?

Correct answer: A

Rationale: The correct answer is A. Botulism in infants is often linked to honey consumption. Asking the parents if they have ever given their child any honey or honey-containing products can provide crucial information for the differential diagnosis. This is important because infant botulism is commonly associated with the ingestion of honey contaminated with Clostridium botulinum spores. Choices B, C, and D are less relevant to botulism in infants as they do not directly relate to the typical causes of the condition. Family history of neuromuscular diseases (choice B) may be important for other conditions but not specifically for infant botulism. Direct exposure to chemical cleaning products (choice C) and the presence of mold in the home (choice D) are not typical risk factors for infant botulism.

3. A patient with endometriosis is prescribed medroxyprogesterone acetate (Provera). What should the nurse include in the patient education?

• A. Medroxyprogesterone should be taken at the same time each day to maintain consistent hormone levels.
• B. Medroxyprogesterone can 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: When educating a patient with endometriosis who is prescribed medroxyprogesterone acetate (Provera), the nurse should emphasize the importance of taking the medication at the same time each day. This helps maintain consistent hormone levels and ensures the effectiveness of the treatment. Option A is correct. Option B is incorrect because medroxyprogesterone should be taken consistently, regardless of food intake. Option C is incorrect because discontinuing the medication without consulting a healthcare provider can be harmful. Option D is incorrect because medroxyprogesterone is typically taken daily, not weekly, for the treatment of endometriosis.

4. What assessment is the nurse performing when a client is asked to stand with feet together, eyes open, and hands by the sides, and then asked to close the eyes while the nurse observes for a full minute?

• A. Romberg test
• B. Weber test
• C. Rinne test
• D. Babinski test

Correct answer: A

Rationale: The correct answer is A, Romberg test. The Romberg test is used to assess balance and proprioception. During the test, the client is asked to stand with feet together, eyes open, and hands by the sides to observe their balance. Then, the client is asked to close their eyes while the nurse continues to observe for a full minute. This test helps in detecting any issues with proprioception and balance, which may be compromised in conditions affecting the nervous system. Choices B, C, and D are incorrect because the Weber test is used to assess hearing in each ear, the Rinne test is used to compare air and bone conduction of sound, and the Babinski test is used to assess the integrity of the corticospinal tract.

5. A patient who is taking metronidazole for the past 4 days for the treatment of a parasitic infection reports to the nurse that his most recent dose made him 'flushed, sweaty, and sick in the stomach.' What assessment is most likely to address the cause of this phenomenon?

• A. “Have you experienced any allergic reactions to metronidazole before?”
• B. “Did you drink any alcoholic beverages around the time of taking the drug?”
• C. “Did you take this dose on an empty stomach?”
• D. “Are you currently using any over-the-counter antihistamines?”

Correct answer: B

Rationale: The correct answer is B. Metronidazole can cause a disulfiram-like reaction when taken with alcohol, leading to symptoms such as flushing, sweating, and gastrointestinal upset. Asking the patient about alcohol consumption can help identify if this reaction is due to alcohol interaction. Choice A is incorrect as it focuses on penicillin allergy, which is not relevant to metronidazole. Choice C is less likely to cause the reported symptoms and is not a common concern with metronidazole. Choice D is not directly related to the symptoms described by the patient.

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