Nursing Elites

1. A man with gout has developed large, hard nodules around his toes and elbows. The phase of gout he is in is:

• A. asymptomatic
• B. acute flare
• C. the intercritical period
• D. chronic gout

Correct answer: D

Rationale: The correct answer is 'chronic gout.' Chronic gout is characterized by the presence of tophi, which are large, hard nodules that can develop around joints like toes and elbows. These tophi are a sign of longstanding, untreated gout. Choice A, 'asymptomatic,' is incorrect as the presence of tophi indicates a symptomatic phase. Choice B, 'acute flare,' is incorrect as acute flares are characterized by sudden and severe pain, inflammation, and redness in the joints, not the development of tophi. Choice C, 'the intercritical period,' is also incorrect as this phase occurs between acute attacks and is typically asymptomatic, without the presence of tophi.

2. How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia?

• A. Administer radioactive cobalamin and measure its excretion time
• B. Measure antigen-antibody immune complexes
• C. Measure serum ferritin and total iron-binding capacity
• D. Administer folate and evaluate folate content in a blood serum sample

Correct answer: A

Rationale: The correct answer is A. To prepare a patient for a Schilling test for pernicious anemia, the nurse should administer radioactive cobalamin and measure its excretion time. This test is specifically designed to assess the absorption of vitamin B12. Choices B, C, and D are incorrect because they do not align with the preparation and procedure of a Schilling test. Measuring antigen-antibody immune complexes, serum ferritin, or total iron-binding capacity, as well as administering folate and evaluating folate content, are not part of the Schilling test protocol.

3. Which of the following cell types would be the first to aid in killing bacteria to prevent infection in his hand?

• A. Eosinophils
• B. Neutrophils
• C. Leukotrienes
• D. Monocytes

Correct answer: B

Rationale: Neutrophils are the first responders to a bacterial infection. They are phagocytes that engulf and destroy bacteria, playing a crucial role in the early stages of the immune response. Eosinophils are primarily involved in combating parasitic infections and allergic reactions, not bacterial infections. Leukotrienes are signaling molecules that contribute to inflammation and immune responses, but they are not cells. Monocytes are another type of white blood cell that differentiates into macrophages and dendritic cells, playing a role in immune response but not as immediate as neutrophils.

4. A client with multiple sclerosis (MS) is experiencing a relapse. Which of the following factors is most likely contributing to the relapse?

• A. Taking an over-the-counter multivitamin
• B. Experiencing high levels of emotional stress
• C. Getting a flu shot
• D. Engaging in strenuous physical activity

Correct answer: B

Rationale: Emotional stress can trigger a relapse in multiple sclerosis by exacerbating symptoms. While taking an over-the-counter multivitamin and getting a flu shot are generally safe, they are not typically known to trigger MS relapses. Engaging in strenuous physical activity, if done carefully, can actually have benefits for individuals with MS by improving strength and mobility, so it is less likely to be the cause of a relapse.

5. A male patient is receiving testosterone therapy for hypogonadism. What serious adverse effect should the nurse monitor for during this therapy?

• A. Increased risk of liver dysfunction
• B. Increased risk of prostate cancer
• C. Increased risk of bone fractures
• D. Increased risk of breast cancer

Correct answer: A

Rationale: The correct answer is A: Increased risk of liver dysfunction. Testosterone therapy can lead to liver dysfunction, including cholestatic jaundice and hepatitis. This adverse effect necessitates monitoring of liver function tests during testosterone therapy. Choice B, increased risk of prostate cancer, is incorrect because testosterone therapy does not cause prostate cancer but is contraindicated in patients with known or suspected prostate cancer. Choice C, increased risk of bone fractures, is incorrect as testosterone therapy is actually associated with an increase in bone mineral density, reducing the risk of fractures. Choice D, increased risk of breast cancer, is incorrect because testosterone therapy in males does not increase the risk of breast cancer.

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