Nursing Elites

1. A patient is receiving epoetin alfa (Epogen) for anemia. Which of the following adjunctive therapies is imperative with epoetin alfa?

• A. Potassium supplements
• B. Sodium restriction
• C. Iron supplement
• D. Renal dialysis

Correct answer: C

Rationale: The correct answer is C: Iron supplement. When a patient is receiving epoetin alfa for anemia, it is imperative to provide iron supplementation as epoetin alfa works by stimulating the production of red blood cells, which require iron for hemoglobin synthesis. Therefore, iron supplementation is crucial to support the increased erythropoiesis. Choices A, B, and D are incorrect because potassium supplements, sodium restriction, and renal dialysis are not typically indicated as adjunctive therapies with epoetin alfa for anemia.

2. In chronic obstructive pulmonary disease, the inflammatory response predominantly involves:

• A. eosinophils
• B. neutrophils
• C. monocytes
• D. cells

Correct answer: B

Rationale: In chronic obstructive pulmonary disease, the inflammatory response predominantly involves neutrophils. Neutrophils play a key role in COPD due to their involvement in initiating and sustaining the inflammatory process. Eosinophils are more commonly associated with asthma rather than COPD. Monocytes are less involved in the inflammatory response in COPD compared to neutrophils. The choice 'cells' is too broad and vague to be a specific answer in this context.

3. A patient with a history of osteoporosis is prescribed raloxifene (Evista). What is the primary therapeutic action of this medication?

• A. It stimulates the formation of new bone.
• B. It decreases bone resorption and increases bone density.
• C. It increases calcium absorption in the intestines.
• D. It increases the excretion of calcium through the kidneys.

Correct answer: B

Rationale: The correct answer is B: 'It decreases bone resorption and increases bone density.' Raloxifene, as a selective estrogen receptor modulator (SERM), works by reducing bone resorption (breakdown) and maintaining or increasing bone density. This mechanism helps in preventing further bone loss and can even increase bone mass. Choices A, C, and D are incorrect. Raloxifene does not stimulate the formation of new bone (choice A), increase calcium absorption in the intestines (choice C), or increase the excretion of calcium through the kidneys (choice D).

4. A patient with hypogonadism is being treated with testosterone gel. What application instructions should the nurse provide?

• A. Apply the gel to the face and neck for maximum absorption.
• B. Apply the gel to the chest or upper arms and allow it to dry completely before dressing.
• C. Apply the gel to the genitals for improved results.
• D. Apply the gel to the scalp and back.

Correct answer: B

Rationale: The correct answer is B. Testosterone gel should be applied to the chest or upper arms and allowed to dry completely before dressing to avoid transfer to others. Applying the gel to the face, neck, genitals, scalp, or back is not recommended as these areas may lead to unintentional transfer to others, inappropriate absorption, or potential side effects. Choice A is incorrect as applying the gel to the face and neck can lead to unwanted transfer. Choice C is incorrect as applying the gel to the genitals is not the recommended site for application. Choice D is incorrect as the scalp and back are not appropriate sites for applying testosterone gel.

5. Which of the following statements characterizes irritable bowel syndrome?

• A. Typically does not cause anemia
• B. Not generally associated with intestinal E. coli
• C. Can be associated with anxiety and/or depression
• D. Not often associated with bloody diarrhea

Correct answer: C

Rationale: Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by abdominal pain, bloating, and changes in bowel habits. While IBS can lead to symptoms like diarrhea or constipation, it typically does not cause anemia (choice A), is not generally associated with intestinal E. coli (choice B), and is not often associated with bloody diarrhea (choice D). However, IBS can indeed be associated with anxiety and/or depression (choice C) due to the gut-brain axis, a bidirectional communication system between the gut and the brain. This association is well-documented in IBS patients, highlighting the importance of considering psychological factors in managing the condition.

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