Nursing Elites

1. A student nurse was asked which of the following best describes dementia. Which of the following best describes the condition?

• A. Memory loss as a natural consequence of aging
• B. Difficulty coping with physical and psychological changes
• C. Severe cognitive impairment that occurs rapidly
• D. Loss of cognitive abilities, impairing the ability to perform activities of daily living

Correct answer: D

Rationale: The correct answer is D. Dementia is characterized by a loss of cognitive abilities that impairs the individual's capacity to perform activities of daily living. Choice A is incorrect because dementia is not simply memory loss related to aging but involves broader cognitive deficits. Choice B is incorrect as it does not capture the comprehensive cognitive decline seen in dementia. Choice C is incorrect as dementia typically progresses gradually rather than rapidly, and it is not solely about severe cognitive impairment but also impacts daily functioning.

2. When teaching a young woman about the use of hormonal contraceptives, a nurse should emphasize that these drugs are most effective when taken:

• A. Immediately after sexual intercourse.
• B. At the same time each day.
• C. Before going to bed at night.
• D. On an empty stomach.

Correct answer: B

Rationale: The correct answer is B: 'At the same time each day.' Hormonal contraceptives should be taken consistently at the same time each day to maintain stable hormone levels, which is crucial for their effectiveness. Taking them at random times can increase the risk of contraceptive failure. Choices A, C, and D are incorrect because taking hormonal contraceptives immediately after sexual intercourse, before going to bed at night, or on an empty stomach does not align with the recommended usage instructions for these drugs.

3. What is the primary therapeutic action of tamsulosin (Flomax) in a male patient with benign prostatic hyperplasia (BPH)?

• A. Relaxation of the muscles in the prostate and bladder neck, leading to improved urinary flow.
• B. Reduction in prostate size and improvement in urinary symptoms.
• C. Increase in urine flow and relief of urinary obstruction.
• D. Improvement in erectile function.

Correct answer: A

Rationale: The correct answer is A: Relaxation of the muscles in the prostate and bladder neck, leading to improved urinary flow. Tamsulosin, a medication commonly prescribed for BPH, works by selectively blocking alpha-1 adrenergic receptors in the prostate, causing relaxation of smooth muscles in the prostate and bladder neck. This relaxation reduces the constriction in these areas, improving urinary flow and reducing symptoms such as hesitancy, urgency, frequency, and weak stream. Choice B is incorrect because tamsulosin does not directly reduce the size of the prostate. Choice C is incorrect as tamsulosin primarily acts by relaxing muscles rather than directly increasing urine flow. Choice D is incorrect as tamsulosin is not indicated for improving erectile function.

4. Cushing syndrome is characterized by which disorder?

• A. Hypocortisolism
• B. Exophthalmos
• C. Hypercortisolism
• D. Hyperpigmentation

Correct answer: C

Rationale: Cushing syndrome is characterized by hypercortisolism, which is an excessive amount of cortisol in the body. Choice A, 'Hypocortisolism,' is incorrect as Cushing syndrome is associated with elevated cortisol levels. Choice B, 'Exophthalmos,' refers to bulging eyes and is not a characteristic feature of Cushing syndrome. Hyperpigmentation, as mentioned in choice D, can be present in Cushing syndrome due to increased ACTH levels stimulating melanocytes, but it is not the defining characteristic of the syndrome.

5. A female patient is taking combined hormonal contraceptives to prevent pregnancy. She visits the gynecology clinic and is noted to have a blood pressure of 176/102 mm Hg. The patient is started on enalapril mesylate 10 mg. In collaboration with the primary care provider, what other patient teaching should be provided based on her current medication regimen?

• A. Instruct on a low-salt diet.
• B. Instruct to discontinue the contraceptives.
• C. Instruct on the use of relaxation techniques to decrease stress.
• D. Instruct on the rationale for increasing the contraceptive dose.

Correct answer: A

Rationale: Women on hormonal contraceptives and antihypertensives like enalapril should be counseled to adopt a low-salt diet if severe hypertension occurs. This dietary modification can help in managing blood pressure levels. Instructing to discontinue the contraceptives is crucial in cases of severe hypertension as it poses an increased risk of cardiovascular events. Instructing on relaxation techniques may have some benefits in reducing stress levels but addressing the root cause, such as discontinuing contraceptives in this scenario, is more critical. There is no rationale for increasing the contraceptive dose when hypertension is present; in fact, it should be stopped to prevent complications.

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