Nursing Elites

1. Which of the following nursing diagnoses would provide the most plausible indication for the use of epoetin alfa (Epogen) in a patient with renal failure?

• A. Risk for infection related to decreased erythropoiesis
• B. Activity intolerance related to decreased oxygen-carrying capacity
• C. Powerlessness related to sequelae of renal failure
• D. Ineffective breathing pattern related to inadequate erythropoietin synthesis

Correct answer: B

Rationale: The correct answer is B. In a patient with renal failure, the use of epoetin alfa (Epogen) is primarily aimed at addressing the decreased oxygen-carrying capacity due to impaired erythropoiesis. Epoetin alfa is a medication that stimulates red blood cell production, thereby improving the oxygen-carrying capacity of the blood. This would directly address the activity intolerance commonly seen in patients with renal failure. Choices A, C, and D are incorrect because they do not directly relate to the primary purpose of using epoetin alfa in this context. Risk for infection, powerlessness, and ineffective breathing pattern are important considerations in the care of a patient with renal failure, but they are not the primary indications for using epoetin alfa.

2. Following the administration of her annual influenza vaccination, a health care worker remains at the clinic for observation due to pain at the injection site. What should the nurse recommend?

• A. ASA
• B. Acetaminophen
• C. Meperidine (Demerol)
• D. Heat application

Correct answer: B

Rationale: The correct recommendation for pain at the injection site after an influenza vaccination is Acetaminophen. Acetaminophen is a suitable choice for managing mild to moderate pain and fever commonly associated with vaccinations. Choice A, ASA (aspirin), is not recommended due to the risk of Reye's syndrome in children and teenagers following viral illnesses. Choice C, Meperidine (Demerol), is a potent opioid analgesic and is not typically indicated for mild pain relief. Choice D, heat application, is not the standard recommendation for pain at an injection site and may not provide adequate relief.

3. Which immunoglobulin presents the first challenge to the antigen?

• A. IgA
• B. IgG
• C. IgM
• D. IgE

Correct answer: C

Rationale: IgM is the first immunoglobulin to challenge the antigen during an immune response. IgM is the primary antibody produced during the initial or primary immune response. It is efficient in agglutination and complement activation, making it crucial in the early stages of defense. IgA is mainly found in mucosal areas and secretions. IgG is the most abundant antibody in circulation and is involved in secondary immune responses. IgE is primarily associated with allergic reactions and parasitic infections. Therefore, IgM is the correct choice as it acts first during the immune response, while the other immunoglobulins have different roles and functions.

4. A patient is being educated about sildenafil (Viagra). Which of the following statements by the patient indicates that further teaching is necessary?

• A. I can take this medication with nitroglycerin.
• B. This medication can cause an erection lasting more than 4 hours.
• C. I should not take this medication if I am taking medications containing nitrates.
• D. This medication is safe to take with any over-the-counter medication.

Correct answer: A

Rationale: The correct answer is A because sildenafil should not be taken with medications containing nitrates, such as nitroglycerin, due to the risk of severe hypotension. Choice B is incorrect because priapism (prolonged erection) is a serious side effect but does not require immediate intervention like severe hypotension. Choice C is incorrect as it correctly identifies a contraindication for sildenafil use. Choice D is incorrect because not all over-the-counter medications are safe to take with sildenafil, and interactions can occur.

5. Which of the following wounds is most likely to heal by secondary intention?

• A. A finger laceration received while cutting onions
• B. A stage IV pressure ulcer that developed in a nursing home
• C. A needlestick injury received while administering parenteral medication
• D. An incision from an open appendectomy

Correct answer: B

Rationale: A stage IV pressure ulcer is a deep wound involving tissue loss that typically heals by secondary intention. This process involves the wound healing from the bottom up with granulation tissue and often results in significant scarring. Choice A, a finger laceration, would generally heal by primary intention due to its clean edges and minimal tissue loss. Choice C, a needlestick injury, is likely to be sutured and heal by primary intention since it is a small, clean wound. Choice D, an incision from an open appendectomy, is usually closed with sutures and heals by primary intention as well.

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