Nursing Elites

1. In osteoporosis, what is the expected therapeutic action of raloxifene (Evista)?

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

Correct answer: A

Rationale: The correct answer is A. Raloxifene works by decreasing bone resorption and increasing bone density. This helps in strengthening bones, reducing the risk of fractures, and improving bone health in patients with osteoporosis. Choice B is incorrect because raloxifene does not directly stimulate the formation of new bone but rather prevents bone loss. Choice C is incorrect as raloxifene does not primarily affect calcium absorption in the intestines. Choice D is also incorrect as raloxifene does not primarily decrease the excretion of calcium through the kidneys.

2. 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.

3. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. What critical contraindication should the nurse review with the patient?

• A. Use of nitrates
• B. Use of antihypertensive medications
• C. History of hypertension
• D. History of peptic ulcer disease

Correct answer: A

Rationale: The correct answer is A: Use of nitrates. Sildenafil (Viagra) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates and sildenafil both cause vasodilation, which can lead to a dangerous drop in blood pressure. Choice B (Use of antihypertensive medications) is incorrect because antihypertensive medications are not a critical contraindication for sildenafil use. Choice C (History of hypertension) is incorrect as it is not a contraindication for sildenafil; in fact, sildenafil is sometimes used in patients with hypertension. Choice D (History of peptic ulcer disease) is also incorrect as it is not a critical contraindication for sildenafil use.

4. A patient is prescribed estradiol (Estrace) for hormone replacement therapy (HRT). What should the nurse monitor during this therapy?

• A. Blood glucose levels
• B. Liver function tests
• C. Kidney function tests
• D. Blood pressure

Correct answer: B

Rationale: During estradiol therapy, monitoring liver function tests is essential due to the potential for liver dysfunction. Estradiol can affect liver function, making it crucial to monitor enzyme levels. Choice A, blood glucose levels, is not directly impacted by estradiol therapy, making it an incorrect choice. Choice C, kidney function tests, is not typically affected by estradiol therapy, so it is not the priority for monitoring. Choice D, blood pressure, is also not the primary parameter to monitor during estradiol therapy unless there are pre-existing conditions that warrant such monitoring.

5. Joseph, a 12-year-old child, complains to the school nurse about nausea and dizziness. While assessing the child, the nurse notices a black eye that looks like an injury. This is the third time in 1 month that the child has visited the nurse. Each time, the child provides vague explanations for various injuries. Which of the following is the school nurse’s priority intervention?

• A. Contact the child’s parents and ask about the child’s injuries.
• B. Encourage the child to be honest about the injuries.
• C. Question the teacher about the child's injuries.
• D. Report suspicion of abuse to the proper authorities.

Correct answer: D

Rationale: The school nurse's priority intervention in this situation is to report suspicion of abuse to the proper authorities. Given the pattern of unexplained injuries and vague explanations provided by the child, it raises significant concerns for possible abuse. Reporting to the appropriate authorities is crucial to ensure the child's safety and well-being. Contacting the child's parents (Choice A) may not be appropriate if abuse is suspected, as it could potentially put the child at further risk. Merely encouraging the child to be honest (Choice B) does not address the immediate safety concerns. Questioning the teacher (Choice C) is not the appropriate initial action when abuse is suspected; reporting to authorities should take precedence.

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