Nursing Elites

1. What is the primary action of bisphosphonates when prescribed to a patient with osteoporosis?

• A. It inhibits bone resorption, which helps maintain bone density.
• B. It stimulates new bone formation by increasing osteoblast activity.
• C. It increases calcium absorption in the intestines, which helps build stronger bones.
• D. It decreases calcium excretion by the kidneys, helping to maintain bone density.

Correct answer: A

Rationale: The correct answer is A: "It inhibits bone resorption, which helps maintain bone density." Bisphosphonates work by inhibiting bone resorption carried out by osteoclasts, thereby preventing the breakdown of bones and helping to maintain or increase bone density in patients with osteoporosis. Choices B, C, and D are incorrect because bisphosphonates do not directly stimulate new bone formation, increase calcium absorption in the intestines, or decrease calcium excretion by the kidneys.

2. Which of the following women are at highest risk for the development of endometrial cancer?

• A. A 50-year-old postmenopausal woman with a history of high-risk human papillomavirus
• B. A 45-year-old woman who is obese and has menstrual irregularities with periods of amenorrhea and infrequent periods.
• C. A 40-year-old woman who is overweight and has hypertension.
• D. A 55-year-old woman who smokes.

Correct answer: B

Rationale: The correct answer is B. Obesity and irregular menstrual cycles, including periods of amenorrhea and infrequent periods, are significant risk factors for the development of endometrial cancer. Choice A is less likely as postmenopausal status reduces the risk. Choice C is not directly associated with a high risk of endometrial cancer. Choice D, smoking, is more strongly linked to other types of cancers like lung cancer rather than endometrial cancer.

3. A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was diagnosed with Hodgkin lymphoma. Which of the following abnormal cells would the nurse expect to find with this disease?

• A. Merkel cell
• B. Schwann cell
• C. Reed-Sternberg cell
• D. Kupffer cell

Correct answer: C

Rationale: Reed-Sternberg cells are characteristic of Hodgkin lymphoma. These large abnormal cells have a bi-lobed or multi-lobed nucleus and are essential for diagnosing Hodgkin lymphoma through histological examination. Merkel cells are associated with Merkel cell carcinoma, Schwann cells are related to nerve sheaths, and Kupffer cells are liver macrophages. Therefore, choices A, B, and D are incorrect for Hodgkin lymphoma.

4. A man with gout has developed large, hard nodules around his toes and elbows. The phase of gout he is in is:

• A. asymptomatic
• B. acute flare
• C. the intercritical period
• D. chronic gout

Correct answer: D

Rationale: The correct answer is 'chronic gout.' Chronic gout is characterized by the presence of tophi, which are large, hard nodules that can develop around joints like toes and elbows. These tophi are a sign of longstanding, untreated gout. Choice A, 'asymptomatic,' is incorrect as the presence of tophi indicates a symptomatic phase. Choice B, 'acute flare,' is incorrect as acute flares are characterized by sudden and severe pain, inflammation, and redness in the joints, not the development of tophi. Choice C, 'the intercritical period,' is also incorrect as this phase occurs between acute attacks and is typically asymptomatic, without the presence of tophi.

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. Patients who are immunocompromised, like those receiving long-term steroids after an organ transplant, should not receive live vaccines because the live attenuated organisms in these vaccines can cause infections in individuals with weakened immune systems. Choice B is incorrect because attenuated vaccines are live but weakened, not mutated. Choice C is incorrect because while inactive, attenuated vaccines are not infectious. Choice D is incorrect because attenuated vaccines are not pathogenic; they are attenuated (weakened) forms of the pathogen.

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