Nursing Elites

1. When planning care for a cardiac patient, the nurse knows that in response to an increased workload, cardiac myocardial cells will:

• A. Increase in size
• B. Decrease in length
• C. Increase in excitability
• D. Increase in number

Correct answer: A

Rationale: The correct answer is A: Increase in size. Cardiac hypertrophy occurs when myocardial cells increase in size to compensate for an increased workload. This adaptation allows the heart to pump more effectively. Choice B, Decrease in length, is incorrect as cardiac cells do not decrease in length in response to increased workload. Choice C, Increase in excitability, is incorrect as increased workload does not lead to an increase in excitability of cardiac cells. Choice D, Increase in number, is incorrect as cardiac cells do not increase in number but rather increase in size to handle the increased workload.

2. What long-term risks should the nurse discuss with a patient being treated with hormone replacement therapy (HRT) for menopausal symptoms?

• A. HRT may increase the risk of cardiovascular events and breast cancer.
• B. HRT may decrease the risk of osteoporosis.
• C. HRT may improve mood and energy levels.
• D. HRT may increase the risk of venous thromboembolism.

Correct answer: A

Rationale: The correct answer is A. Long-term hormone replacement therapy (HRT) is associated with increased risks of cardiovascular events and breast cancer. These risks should be discussed with the patient to ensure they are aware of the potential adverse effects. Choice B is incorrect because HRT does not decrease the risk of osteoporosis; in fact, it has been linked to an increased risk of this condition. Choice C is incorrect as while HRT may have positive effects on mood and energy levels for some individuals, the focus here is on the long-term risks that need to be addressed. Choice D is incorrect as HRT is indeed associated with an increased risk of venous thromboembolism, but the primary focus of the question is on cardiovascular events and breast cancer.

3. The signs of thyroid crisis resulting from Graves' disease include:

• A. constipation with gastric distension.
• B. bradycardia and bradypnea.
• C. hyperthermia and tachycardia.
• D. constipation and lethargy.

Correct answer: C

Rationale: Thyroid crisis in Graves' disease typically presents with hyperthermia (high body temperature) and tachycardia (rapid heart rate). These symptoms are a result of excessive thyroid hormone production and can lead to life-threatening complications if not promptly addressed. Choices A, B, and D are incorrect because constipation with gastric distension, bradycardia and bradypnea, and constipation and lethargy are not typical signs of a thyroid crisis in Graves' disease.

4. A patient with erectile dysfunction is prescribed sildenafil (Viagra). What condition would contraindicate the use of this medication?

• A. History of hypertension
• B. Use of nitrates
• C. Recent 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 cause vasodilation, and their combined use can lead to a dangerous drop in blood pressure. Choices A, C, and D are incorrect because a history of hypertension, recent use of antihypertensive medications, or a history of peptic ulcer disease are not direct contraindications for using sildenafil.

5. A patient is taking a statin for hyperlipidemia. What important instruction should the nurse provide to the patient?

• A. Take the medication at night to avoid muscle pain.
• B. Take the medication in the morning to ensure it works throughout the day.
• C. Avoid consuming alcohol while taking this medication.
• D. Take the medication with a high-fat meal to increase absorption.

Correct answer: A

Rationale: The correct answer is to instruct the patient to take the medication at night to avoid muscle pain. Statins are known to potentially cause muscle pain or weakness; taking the medication at night can help reduce the incidence of these side effects. Option B is incorrect because the timing of statin administration is not related to its effectiveness throughout the day. Option C is a general precaution when taking medications but not the most important instruction specific to statins. Option D is incorrect as taking the medication with a high-fat meal can actually decrease its absorption.

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