Nursing Elites

1. When assessing a patient experiencing breakthrough bleeding while taking oral contraceptives, what should the nurse consider?

• A. The possibility of pregnancy
• B. The patient's adherence to the medication schedule
• C. The need for an increased dosage
• D. The effectiveness of the current oral contraceptive

Correct answer: B

Rationale: When a patient on oral contraceptives experiences breakthrough bleeding, it is crucial for the nurse to consider the patient's adherence to the medication schedule. Breakthrough bleeding is often a sign of missed doses or inconsistent use, which can decrease the effectiveness of the oral contraceptive. Considering the possibility of pregnancy (Choice A) is important but secondary to assessing adherence. The need for an increased dosage (Choice C) is not typically the first consideration for breakthrough bleeding. Evaluating the effectiveness of the current oral contraceptive (Choice D) is relevant but should come after assessing adherence to the medication schedule.

2. When the maternal immune system becomes sensitized against antigens expressed by the fetus, what type of immune reaction occurs?

• A. Autoimmune
• B. Anaphylaxis
• C. Alloimmune
• D. Allergic

Correct answer: C

Rationale: When the maternal immune system becomes sensitized against antigens expressed by the fetus, an alloimmune reaction occurs. In this situation, the mother's immune system recognizes the fetus as foreign due to differences in antigens, leading to an immune response against the fetus. Choice A, 'Autoimmune,' is incorrect because it refers to the immune system mistakenly attacking the body's own cells and tissues. Choice B, 'Anaphylaxis,' is not the correct answer as it is a severe allergic reaction that can be life-threatening. Choice D, 'Allergic,' is also incorrect as it refers to an immune response triggered by allergens, not antigens expressed by the fetus.

3. A 34-year-old woman has presented to the clinic for the first time, and the nurse learns that she has been taking Depo Provera for the past 13 years. This aspect of the woman's medical history should prompt what assessment?

• A. Cardiac stress testing
• B. Renal ultrasound
• C. Bone density testing
• D. Evaluation of triglyceride levels

Correct answer: C

Rationale: The correct answer is bone density testing (Choice C). Long-term use of Depo Provera, a hormonal contraceptive, is associated with decreased bone mineral density. Assessing bone density is crucial to monitor for potential osteoporosis. Cardiac stress testing (Choice A) is not indicated based on the medication history provided. Renal ultrasound (Choice B) and evaluation of triglyceride levels (Choice D) are not directly related to the use of Depo Provera.

4. A 5-year-old female takes a hike through the woods during a school field trip. Upon returning home, she hugs her father, and he later develops poison ivy. Which of the following immune reactions is he experiencing?

• A. IgE-mediated
• B. Tissue-specific
• C. Immune complex
• D. Cell-mediated

Correct answer: D

Rationale: The father's immune reaction to poison ivy is an example of cell-mediated immunity, specifically a type IV hypersensitivity reaction. In this type of reaction, sensitized T cells react to antigens, leading to inflammation and tissue damage. IgE-mediated reactions involve antibodies of the IgE class, commonly seen in allergic responses like anaphylaxis. Tissue-specific reactions target specific organs or tissues. Immune complex reactions involve immune complexes formed by antigens and antibodies that can deposit in tissues, leading to inflammation.

5. During the cellular stage of acute inflammation, which type of cells arrive first and in great numbers?

• A. Basophils
• B. Lymphocytes
• C. Neutrophils
• D. Platelets

Correct answer: C

Rationale: During the cellular stage of acute inflammation, neutrophils are the first responders. Neutrophils arrive at the site of injury in large numbers to combat pathogens and remove debris. Basophils and lymphocytes are also involved in the inflammatory response, but they are not the first to arrive. Platelets play a role in hemostasis and blood clotting, rather than being the primary cells involved in the initial inflammatory response.

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