Nursing Elites

1. A patient is taking raloxifene (Evista) for osteoporosis. What is the primary therapeutic effect of this medication?

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

Correct answer: B

Rationale: The correct answer is B. Raloxifene, a selective estrogen receptor modulator (SERM), primarily works by decreasing bone resorption and increasing bone density. This mechanism of action helps in the prevention and treatment of osteoporosis by maintaining or improving bone strength. Choice A is incorrect because raloxifene does not directly stimulate the formation of new bone but rather helps in preserving existing bone. Choice C is incorrect because raloxifene does not increase the excretion of calcium through the kidneys; instead, it acts on bone tissue. Choice D is incorrect as raloxifene does not directly increase calcium absorption in the intestines but rather focuses on bone health.

2. A patient is hospitalized due to nonadherence to an antitubercular drug treatment. Which of the following is most important for the nurse to do?

• A. Observe the patient taking the medications.
• B. Administer the medications parenterally.
• C. Instruct the family on the medication regimen.
• D. Count the number of tablets in the bottle daily.

Correct answer: A

Rationale: In this scenario, the most crucial action for the nurse to take is to observe the patient taking the medications. This ensures that the patient is actually consuming the prescribed antitubercular drugs, addressing the issue of nonadherence directly. Administering the medications parenterally (intravenously or intramuscularly) is not necessary unless there are specific medical reasons requiring this route of administration. Instructing the family on the medication regimen is important for support but may not directly address the patient's nonadherence. Counting the number of tablets in the bottle daily is not as effective as directly observing the patient taking the medications to ensure compliance.

3. A patient is prescribed medroxyprogesterone acetate (Provera) for the treatment of endometriosis. What should the nurse teach the patient about the use of this medication?

• A. Medroxyprogesterone should be taken with food to prevent nausea.
• B. Medroxyprogesterone can be taken intermittently when symptoms worsen.
• C. Medroxyprogesterone should be taken at the same time each day to maintain consistent hormone levels.
• D. Medroxyprogesterone should be discontinued if side effects occur.

Correct answer: C

Rationale: The correct answer is C. Medroxyprogesterone should be taken at the same time each day to maintain consistent hormone levels and effectiveness. Taking it at different times can lead to hormonal fluctuations and reduced medication efficacy. Choice A is incorrect because medroxyprogesterone does not need to be taken with food to prevent nausea. Choice B is incorrect as medroxyprogesterone is typically taken continuously rather than intermittently. Choice D is incorrect because side effects should be reported to the healthcare provider for further evaluation and management, not automatically leading to discontinuation of the medication.

4. Which type of lymphocyte recognizes and eliminates virus-infected cells and cancerous cells?

• A. Neutrophils
• B. Macrophages
• C. Natural killer cells
• D. Langerhans cells

Correct answer: C

Rationale: Natural killer cells are a type of lymphocyte that plays a crucial role in recognizing and eliminating virus-infected cells and cancerous cells. Neutrophils (Choice A) are a type of white blood cell involved in fighting infections, mainly through phagocytosis. Macrophages (Choice B) are another type of white blood cell that engulfs and digests cellular debris and pathogens. Langerhans cells (Choice D) are a type of dendritic cell found in the skin and mucosa, primarily involved in antigen presentation.

5. A 30-year-old man has a history of heart transplant and is receiving long-term steroids to prevent rejection. The patient is due for routine vaccines. Attenuated vaccines are contraindicated in this patient because the antigen is:

• A. live and can cause infection.
• B. mutated and infectious.
• C. inactive but still infectious.
• D. pathogenic.

Correct answer: A

Rationale: The correct answer is A: live and can cause infection. In patients like the one described with a history of heart transplant and receiving long-term steroids, who are immunocompromised, live attenuated vaccines are contraindicated. Live vaccines contain weakened (attenuated) forms of the virus or bacteria, which can replicate and cause mild infections in healthy individuals but can lead to serious infections in immunocompromised individuals. Choices B, C, and D are incorrect because attenuated vaccines are not mutated, not inactive, and not pathogenic in healthy individuals, respectively.

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