Nursing Elites

1. What is the major effect of filgrastim (Neupogen) in a patient with chronic renal failure?

• A. Decreases neutropenia related to chemotherapy
• B. Decreases white blood cells related to infection
• C. Decreases growth of blood vessels due to ischemia
• D. Decreases platelet count related to bleeding

Correct answer: A

Rationale: The major effect of filgrastim (Neupogen) is to stimulate the production of neutrophils, thereby decreasing neutropenia in patients undergoing chemotherapy. This medication helps the bone marrow produce more white blood cells, specifically neutrophils, to reduce the risk of infections associated with low neutrophil counts. Choices B, C, and D are incorrect because filgrastim does not decrease white blood cells related to infection, growth of blood vessels, or platelet count related to bleeding.

2. A patient is taking alendronate (Fosamax) for the treatment of osteoporosis. What instructions should the nurse provide to ensure the effectiveness of the medication?

• A. Take the medication with food to avoid gastrointestinal upset.
• B. Take the medication in the morning with a full glass of water and remain upright for at least 30 minutes.
• C. Take the medication before bed to ensure absorption during sleep.
• D. Take the medication with milk to enhance calcium absorption.

Correct answer: B

Rationale: The correct answer is B. Alendronate should be taken in the morning with a full glass of water and the patient should remain upright for at least 30 minutes. This is important to prevent esophageal irritation and ensure proper absorption of the medication. Choice A is incorrect because alendronate should not be taken with food as it can decrease its absorption. Choice C is incorrect as taking the medication before bed increases the risk of esophageal irritation and reduces absorption due to lying down. Choice D is also incorrect because taking alendronate with milk or other calcium-rich foods can decrease its absorption.

3. A 75-year-old male presents with chest pain on exertion. The chest pain is most likely due to hypoxic injury secondary to:

• A. Malnutrition
• B. Free radicals
• C. Ischemia
• D. Chemical toxicity

Correct answer: C

Rationale: The correct answer is C: Ischemia. In this scenario, the 75-year-old male experiences chest pain on exertion, which is indicative of angina. Angina is primarily caused by reduced blood flow to the heart muscle, leading to hypoxic injury. This condition is known as ischemia. Options A, B, and D are incorrect. Malnutrition does not typically cause chest pain related to exertion. Free radicals and chemical toxicity are not common causes of chest pain in the context described. Therefore, the most likely cause of chest pain in this case is ischemia due to reduced blood flow.

4. Which of the following describes passive immunity?

• A. Vaccination against the disease
• B. Transfer of antibodies from mother to baby
• C. Cuts or wounds that are infected and heal
• D. Having the disease in question

Correct answer: B

Rationale: Passive immunity is the transfer of pre-formed antibodies from one individual to another, providing immediate but temporary protection. In this case, the correct answer is the transfer of antibodies from the mother to the baby, as it describes the concept of passive immunity. Choice A, vaccination against the disease, refers to active immunity where the individual's immune system is stimulated to produce antibodies. Choice C, cuts or wounds that are infected and heal, is unrelated to immunity. Choice D, having the disease in question, does not describe passive immunity but rather acquiring active immunity through exposure to the pathogen.

5. What aspect of hormonal contraceptives places a woman at the greatest risk for the development of blood clots?

• A. Hormonal contraceptives increase serum triglyceride and cholesterol levels.
• B. Hormonal contraceptives increase platelet levels.
• C. Hormonal contraceptives increase blood levels of clotting factors.
• D. Hormonal contraceptives cause injury to blood vessel linings.

Correct answer: C

Rationale: The correct answer is C. Hormonal contraceptives increase blood levels of clotting factors, particularly factors II, VII, IX, and X. This elevation in clotting factors can predispose individuals to thromboembolic events, including blood clots. Choices A, B, and D are incorrect because hormonal contraceptives do not have a significant effect on serum triglycerides and cholesterol, platelet levels, or causing direct injury to blood vessel linings as the primary mechanism for clot formation.

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