Nursing Elites

1. A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). How should the nurse respond when the patient asks what causes pernicious anemia? A decrease in ______ is the most likely cause.

• A. Ferritin
• B. Gastric enzymes
• C. Intrinsic factor
• D. Erythropoietin

Correct answer: C

Rationale: Pernicious anemia is primarily caused by a decrease in intrinsic factor. Intrinsic factor is a protein produced by the stomach that is necessary for the absorption of vitamin B12 in the intestines. Without intrinsic factor, vitamin B12 cannot be absorbed properly, leading to anemia. Ferritin is a protein that stores iron in the body and is not directly related to pernicious anemia. Gastric enzymes play a role in digestion but are not the primary cause of pernicious anemia. Erythropoietin is a hormone produced by the kidneys to stimulate red blood cell production and is not linked to pernicious anemia.

2. What should the nurse discuss with a patient with a history of cardiovascular disease regarding the risks of hormone replacement therapy (HRT)?

• A. HRT may increase the risk of cardiovascular events, including heart attack and stroke.
• B. HRT may decrease the risk of osteoporosis.
• C. HRT may improve mood and energy levels.
• D. HRT may decrease the risk of breast cancer.

Correct answer: A

Rationale: The correct answer is A. Hormone replacement therapy (HRT) is associated with an increased risk of cardiovascular events, including heart attack and stroke, especially in patients with a history of cardiovascular disease. Choice B is incorrect because HRT is not typically used to decrease the risk of osteoporosis. Choice C is incorrect as mood and energy level improvements are not the primary risks associated with HRT. Choice D is incorrect because HRT may actually increase the risk of breast cancer in some individuals.

3. What is the primary action of bisphosphonates when prescribed to a patient with osteoporosis?

• A. It inhibits bone resorption, which helps maintain bone density.
• B. It stimulates new bone formation by increasing osteoblast activity.
• C. It increases calcium absorption in the intestines, which helps build stronger bones.
• D. It decreases calcium excretion by the kidneys, helping to maintain bone density.

Correct answer: A

Rationale: The correct answer is A: "It inhibits bone resorption, which helps maintain bone density." Bisphosphonates work by inhibiting bone resorption carried out by osteoclasts, thereby preventing the breakdown of bones and helping to maintain or increase bone density in patients with osteoporosis. Choices B, C, and D are incorrect because bisphosphonates do not directly stimulate new bone formation, increase calcium absorption in the intestines, or decrease calcium excretion by the kidneys.

4. A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has?

• A. Sideroblastic anemia
• B. Hemolytic anemia
• C. Pernicious anemia
• D. Iron deficiency anemia

Correct answer: B

Rationale: The correct answer is B, Hemolytic anemia. Normocytic-normochromic anemia is a type of anemia characterized by normal-sized and normal-colored red blood cells. Hemolytic anemia is a condition where red blood cells are destroyed prematurely, leading to normocytic-normochromic anemia. Sideroblastic anemia (Choice A) is characterized by ringed sideroblasts in the bone marrow. Pernicious anemia (Choice C) is due to vitamin B12 deficiency. Iron deficiency anemia (Choice D) is characterized by microcytic-hypochromic red blood cells.

5. A child's thymus gland is fully formed and proportionately larger than an adult's. Which of the following processes that contribute to immunity takes place in the thymus gland?

• A. Differentiation of B cells
• B. Production of natural killer (NK) cells
• C. Proliferation of T cells
• D. Filtration of antigens from the blood

Correct answer: C

Rationale: The correct answer is C: Proliferation of T cells. The thymus gland is responsible for the maturation and proliferation of T cells, which play a crucial role in adaptive immunity. Option A, differentiation of B cells, is incorrect because B cell maturation primarily occurs in the bone marrow. Option B, production of natural killer (NK) cells, is incorrect as NK cells are mainly produced in the bone marrow and lymph nodes. Option D, filtration of antigens from the blood, is incorrect as antigen filtration is not a primary function of the thymus gland.

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