Nursing Elites

1. A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. Her thyroid function tests reveal low T3 and T4 levels and elevated TSH levels. Which of the following is the most likely diagnosis?

• A. Hyperthyroidism
• B. Hypothyroidism
• C. Euthyroid sick syndrome
• D. Subclinical hyperthyroidism

Correct answer: B

Rationale: The scenario describes a 45-year-old woman with fatigue, weight gain, cold intolerance, low T3 and T4 levels, and elevated TSH levels, which are indicative of hypothyroidism. In hypothyroidism, there is decreased production of thyroid hormones (T3 and T4) leading to elevated TSH levels as the pituitary gland tries to stimulate the thyroid gland to produce more hormones. Therefore, the correct answer is hypothyroidism (Choice B). Choice A, Hyperthyroidism, is incorrect as the patient's symptoms and thyroid function tests point towards decreased thyroid hormone levels, which is characteristic of hypothyroidism, not hyperthyroidism. Choice C, Euthyroid sick syndrome, is incorrect because this condition typically presents with normal to low T3 and T4 levels in the setting of non-thyroid illness, unlike the elevated TSH levels observed in this case. Choice D, Subclinical hyperthyroidism, is also incorrect as the patient has low T3 and T4 levels, which is not consistent with hyperthyroidism, whether clinical or subclinical.

2. What important point should the nurse emphasize about taking oral contraceptives consistently?

• A. Oral contraceptives must be taken at the same time each day to maintain consistent hormone levels and ensure effectiveness in preventing pregnancy.
• B. Oral contraceptives should be taken in the morning to avoid side effects at night.
• C. Oral contraceptives should be taken with food to enhance absorption.
• D. Oral contraceptives can be skipped occasionally without significant consequences.

Correct answer: A

Rationale: The correct answer is A. It is crucial for patients taking oral contraceptives to take them at the same time each day to maintain consistent hormone levels, which is essential for their effectiveness in preventing pregnancy. Choice B is incorrect as the timing of the medication is more about consistency than avoiding side effects at night. Choice C is incorrect as oral contraceptives do not necessarily need to be taken with food for absorption. Choice D is incorrect because skipping oral contraceptives occasionally can significantly reduce their effectiveness in preventing pregnancy.

3. What are direct effects of antibodies? (Select ONE that does not apply):

• A. Neutralization
• B. Agglutination
• C. Precipitation
• D. Phagocytosis

Correct answer: D

Rationale: The direct effects of antibodies include neutralization, agglutination, and precipitation. Antibodies neutralize pathogens by binding to them and preventing their harmful effects. Agglutination involves the clumping together of pathogens, making it easier for phagocytes to engulf them. Precipitation refers to the process where antibodies bind to soluble antigens, forming large complexes that are easily removed from the body. Phagocytosis, on the other hand, is an indirect effect of antibodies where phagocytes engulf and destroy pathogens opsonized by antibodies, not a direct effect.

4. When taking medroxyprogesterone acetate (Provera) for the treatment of endometriosis, what important instruction should the nurse provide about taking this medication?

• A. Take the medication at the same time each day to maintain consistent hormone levels.
• B. Medroxyprogesterone should be taken without regard to meals.
• C. Discontinuing medroxyprogesterone should only be done under the guidance of a healthcare provider.
• D. Medroxyprogesterone is typically taken daily rather than weekly for the treatment of endometriosis.

Correct answer: A

Rationale: When taking medroxyprogesterone acetate for endometriosis, it is essential to maintain consistent hormone levels by taking the medication at the same time each day. This consistency helps optimize the effectiveness of the treatment. Choice B is incorrect because medroxyprogesterone should be taken without regard to meals, not necessarily with food. Choice C is incorrect because discontinuing the medication without consulting a healthcare provider can be harmful and may not address side effects appropriately. Choice D is incorrect as medroxyprogesterone is typically taken daily to manage endometriosis symptoms, not weekly, to ensure continuous therapy and symptom control.

5. Which of the following women is at highest risk for the development of endometrial cancer?

• A. A 50-year-old postmenopausal woman with a history of high-risk human papillomavirus
• B. A 45-year-old woman who is obese and has a menstrual pattern consisting of periods of amenorrhea and infrequent periods
• C. A 40-year-old woman who is overweight and has hypertension
• D. A 55-year-old woman who smokes

Correct answer: B

Rationale: The correct answer is a 45-year-old woman who is obese and has a menstrual pattern consisting of periods of amenorrhea and infrequent periods. Obesity and prolonged exposure to estrogen unopposed by progesterone due to infrequent ovulation are significant risk factors for endometrial cancer. Choices A, C, and D do not directly correlate with the increased risk of endometrial cancer. Postmenopausal status alone (Choice A), overweight with hypertension (Choice C), and smoking (Choice D) are not the primary risk factors for endometrial cancer.

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