Nursing Elites

1. What is the treatment for patients with hemophilia A?

• A. Chemotherapy
• B. Factor VIII replacement
• C. Heparin administration
• D. Bone marrow transplant

Correct answer: B

Rationale: The correct treatment for patients with hemophilia A is Factor VIII replacement. Hemophilia A is a genetic disorder where there is a deficiency in clotting factor VIII. Therefore, replacing this factor is crucial in managing and preventing bleeding episodes. Choice A, chemotherapy, is not the correct treatment for hemophilia A. Choice C, heparin administration, is not recommended as it can further increase the risk of bleeding in patients with hemophilia. Choice D, bone marrow transplant, is not a standard treatment for hemophilia A.

2. What is the etiology and most likely treatment for myasthenia gravis in a 22-year-old female college student?

• A. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids.
• B. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins.
• C. Cerebellar lesions; surgical and immunosuppressive treatment.
• D. Excess acetylcholinesterase production; treatment with thymectomy.

Correct answer: B

Rationale: Myasthenia gravis is characterized by a decline in functioning acetylcholine receptors rather than autoimmune destruction of skeletal muscle cells (Choice A), cerebellar lesions (Choice C), or excess acetylcholinesterase production (Choice D). The most likely treatment for myasthenia gravis involves corticosteroids to reduce inflammation and intravenous immunoglobulins to block the antibodies attacking acetylcholine receptors. Intensive physical therapy and anabolic steroids are not primary treatments for myasthenia gravis.

3. A patient is starting on a statin medication for hyperlipidemia. What critical instruction should the nurse provide?

• A. Take the medication at night to reduce the risk of muscle pain and other side effects.
• B. Take the medication in the morning with breakfast to improve absorption.
• C. Avoid alcohol consumption while taking this medication to reduce the risk of liver damage.
• D. Take the medication with a high-fat meal to increase its effectiveness.

Correct answer: A

Rationale: The correct answer is A. Statins like atorvastatin should be taken at night to reduce the risk of muscle pain and other side effects. Taking the medication with a high-fat meal (choice D) is not recommended as it can decrease the effectiveness of the medication. Alcohol consumption (choice C) should be moderated but does not need to be completely avoided unless contraindicated. Taking the medication with breakfast (choice B) may not be as effective as taking it at night due to the circadian rhythm of cholesterol synthesis.

4. A nursing student is learning about the effects of bactericidal agents. How does rifampin (Rifadin) achieve a therapeutic action against both intracellular and extracellular tuberculosis organisms?

• A. It is metabolized in the liver.
• B. It binds to acetylcholine.
• C. It inhibits synthesis of RNA.
• D. It causes phagocytosis.

Correct answer: C

Rationale: Rifampin (Rifadin) achieves a therapeutic action against both intracellular and extracellular tuberculosis organisms by inhibiting the synthesis of RNA. This action interferes with bacterial RNA synthesis, leading to the suppression of protein synthesis in the bacteria, ultimately causing their death. Option A is incorrect because rifampin is primarily metabolized in the liver, but this is not how it exerts its bactericidal effects. Option B is incorrect as rifampin does not bind to acetylcholine. Option D is also incorrect as rifampin does not cause phagocytosis.

5. A patient with an 18 pack per year history presents to a family practice clinic complaining of painless hoarseness and inability to clear mucus. A biopsy of respiratory tract cells is taken and shows that these cells have been replaced by less mature squamous epithelium cells. The nurse knows this type of change is referred to as:

• A. Dysplasia
• B. Metaplasia
• C. Hyperplasia
• D. Coagulation

Correct answer: B

Rationale: Metaplasia is the replacement of one type of cell with another, which can occur in response to chronic irritation, such as from smoking. In this case, the respiratory tract cells being replaced by less mature squamous epithelium cells indicate metaplasia. Dysplasia refers to abnormal development or growth of cells, not replacement; hyperplasia is an increase in the number of cells, not a replacement; and coagulation is a process related to blood clotting, not cell replacement.

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