Nursing Elites

1. 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).

2. When arterial blood pressure declines, the kidneys secrete a hormone to increase blood pressure and peripheral resistance. What is this hormone called?

• A. Renin
• B. Antidiuretic hormone
• C. Atrial natriuretic
• D. Insulin

Correct answer: A

Rationale: Renin is the correct answer. When arterial blood pressure decreases, the kidneys release renin, which triggers a series of reactions ultimately leading to an increase in blood pressure and peripheral resistance. Antidiuretic hormone (choice B) is involved in water retention, atrial natriuretic hormone (choice C) promotes sodium excretion and lowers blood pressure, and insulin (choice D) regulates glucose metabolism, not blood pressure.

3. A 57-year-old male presents to his primary care provider with a red face, hands, feet, ears, headache, and drowsiness. A blood smear reveals an increased number of erythrocytes, indicating:

• A. Leukemia
• B. Sideroblastic anemia
• C. Hemosiderosis
• D. Polycythemia vera

Correct answer: D

Rationale: In this case, the symptoms of a red face, hands, feet, ears, headache, and drowsiness along with an increased number of erythrocytes in the blood smear are indicative of polycythemia vera. This condition is characterized by the overproduction of red blood cells, leading to symptoms related to increased blood volume and viscosity. Leukemia (Choice A) is a cancer of the blood and bone marrow, but the presentation described here is more suggestive of polycythemia vera. Sideroblastic anemia (Choice B) is characterized by abnormal iron deposits in erythroblasts, not an increased number of erythrocytes. Hemosiderosis (Choice C) refers to abnormal accumulation of iron in the body, not an increase in red blood cells as seen in polycythemia vera.

4. What is the primary function of the kidneys in acid-base balance?

• A. The kidneys remove hydrogen ions and retain bicarbonate ions.
• B. The kidneys convert ammonia into urea, which is excreted in the urine.
• C. The kidneys produce aldosterone to regulate sodium levels.
• D. The kidneys secrete renin to regulate blood pressure.

Correct answer: A

Rationale: The correct answer is A. The kidneys are crucial in maintaining acid-base balance by removing hydrogen ions to decrease acidity and retaining bicarbonate ions to increase alkalinity. Choice B is incorrect because the conversion of ammonia into urea is related to nitrogen waste excretion, not acid-base balance. Choice C is incorrect as aldosterone regulates sodium levels, not acid-base balance. Choice D is also incorrect as renin is involved in regulating blood pressure, not acid-base balance.

5. Which electrolyte imbalance does the nurse suspect in a patient with hyperaldosteronism?

• A. Hyponatremia
• B. Hypernatremia
• C. Hyperkalemia
• D. Hypercalcemia

Correct answer: C

Rationale: In a patient with hyperaldosteronism, the nurse would suspect hyperkalemia. Hyperaldosteronism leads to increased potassium excretion, resulting in low potassium levels in the blood. Therefore, choices A (Hyponatremia), B (Hypernatremia), and D (Hypercalcemia) are incorrect. Hyponatremia refers to low sodium levels, Hypernatremia refers to high sodium levels, and Hypercalcemia refers to high calcium levels, none of which are typically associated with hyperaldosteronism.

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