Nokea
A 32-year-old Caucasian woman experiences chest pain with exertion. She reports having similar episodes in the past. It is determined that she is experiencing stable angina. She is given nitroglycerin to relax her vascular smooth musculature. Which best describes a step on nitroglycerin's mechanism of action?
- A. Activation of adenylate cyclase
- B. Activation of guanylate cyclase
- C. Inhibition of calcium channels
- D. Inhibition of cGMP phosphodiesterase
Correct Answer: B
Rationale: Nitroglycerin releases NO, activating guanylate cyclase, increasing cGMP, and relaxing vascular smooth muscle.
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Side effect of cyclosporine A is:
- A. Diarrhea
- B. Headache
- C. GI disturbance
- D. Immunosuppression
Correct Answer: C
Rationale: The correct answer is C: GI disturbance. Cyclosporine A is known to cause gastrointestinal (GI) disturbances as a common side effect, including nausea, vomiting, abdominal pain, and diarrhea. This is due to its impact on the digestive system. Choice A (Diarrhea) is too specific and not the most common side effect. Choice B (Headache) is not a typical side effect of cyclosporine A. Choice D (Immunosuppression) is the intended therapeutic effect of cyclosporine A, not a side effect. Therefore, C is the correct choice based on the common side effects associated with cyclosporine A.
Indicate the inhaled anesthetic,which reduces arterial pressure and heart rate:
- A. Isoflurane
- B. Halothane
- C. Desflurane
- D. Nitrous oxide
Correct Answer: A
Rationale: The correct answer is A: Isoflurane. Isoflurane is known to reduce arterial pressure and heart rate. It achieves this through its vasodilatory effects, leading to decreased systemic vascular resistance and cardiac depression. Halothane can cause arrhythmias and increased heart rate. Desflurane can increase heart rate and arterial pressure due to sympathetic activation. Nitrous oxide typically has minimal effects on heart rate and arterial pressure. Therefore, the correct choice is isoflurane due to its specific physiological effects that result in reduced arterial pressure and heart rate.
Which of the following mediators is found mainly in long descending pathways from the midbrain to the dorsal horn?
- A. Prostaglandin E
- B. Dynorphin
- C. Enkephalin
- D. Glutamate
Correct Answer: B
Rationale: The correct answer is B: Dynorphin. Dynorphin is mainly found in long descending pathways from the midbrain to the dorsal horn. It acts as an endogenous opioid peptide that modulates pain perception. Prostaglandin E, Enkephalin, and Glutamate are not primarily found in these pathways. Prostaglandin E is involved in inflammation and fever, Enkephalin acts as an endogenous opioid peptide in pain modulation, and Glutamate is a major excitatory neurotransmitter in the central nervous system. Thus, B is the correct choice based on its specific localization in the described pathways.
A patient who has received lithium for 3 weeks to control acute mania has the following symptoms: coarse hand tremor, diarrhea, vomiting, lethargy, and mild confusion. The priority nursing action should be to:
- A. Administer prn Cogentin to relieve the symptoms.
- B. Provide reassurance that the symptoms are transient.
- C. Obtain a stat lithium level; hold lithium pending results.
- D. Assist the patient to decrease the sodium in their daily diet.
Correct Answer: C
Rationale: Correct Answer: C
Rationale:
1. The patient is showing signs of lithium toxicity, indicated by symptoms like tremors, diarrhea, vomiting, lethargy, and confusion.
2. Obtaining a stat lithium level is crucial to confirm toxicity levels.
3. Holding lithium pending results prevents further toxicity and guides appropriate treatment adjustments.
4. Administering Cogentin (A) may mask symptoms but does not address the underlying issue of lithium toxicity.
5. Providing reassurance (B) is important but not the priority when the patient is experiencing potential toxicity.
6. Assisting the patient to decrease sodium intake (D) is not the priority as it does not address the immediate need to manage lithium toxicity.
A nurse observes a patient diagnosed with schizophrenia tapping both feet, smacking both lips, and making contorted faces while speaking to another patient. These behaviors prompt the nurse to suspect the patient is experiencing:
- A. neuroleptic malignant syndrome.
- B. Parkinson syndrome.
- C. tardive dyskinesia.
- D. torticollis.
Correct Answer: C
Rationale: The correct answer is C: tardive dyskinesia. Tardive dyskinesia is a movement disorder characterized by repetitive, involuntary, purposeless movements such as lip smacking, facial grimacing, and tapping feet. These symptoms are often seen in patients on long-term antipsychotic medications, like those used to treat schizophrenia. Neuroleptic malignant syndrome (choice A) presents with fever, muscle rigidity, and altered mental status. Parkinson syndrome (choice B) is characterized by tremors, bradykinesia, and rigidity. Torticollis (choice D) is a condition where the neck muscles contract involuntarily, causing the head to twist or turn to one side.