Nursing Elites

1. A patient has been diagnosed with chronic renal failure. Which of the following agents will assist in raising the patient's hemoglobin levels?

• A. Epoetin alfa (Epogen, Procrit)
• B. Pentoxifylline (Pentoxil)
• C. Estazolam (ProSom)
• D. Dextromethorphan hydrobromide

Correct answer: A

Rationale: The correct answer is A: Epoetin alfa (Epogen, Procrit). Epoetin alfa is a synthetic form of erythropoietin that stimulates red blood cell production and is commonly used to treat anemia in patients with chronic renal failure. By increasing red blood cell production, epoetin alfa helps raise hemoglobin levels in these patients. Pentoxifylline (Choice B) is not indicated for raising hemoglobin levels in chronic renal failure patients; it is a peripheral vasodilator used to improve blood flow. Estazolam (Choice C) is a benzodiazepine used for treating insomnia and has no role in raising hemoglobin levels. Dextromethorphan hydrobromide (Choice D) is a cough suppressant and is not used to raise hemoglobin levels in patients with chronic renal failure.

2. A male patient is being treated with sildenafil (Viagra) for erectile dysfunction. What condition would contraindicate the use of this medication?

• A. Peptic ulcer disease
• B. History of myocardial infarction
• C. Recent use of antihypertensive medications
• D. Use of nitrates

Correct answer: D

Rationale: The correct answer is D: Use of nitrates. Sildenafil (Viagra) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates and sildenafil both cause vasodilation, and the combination can lead to a dangerous drop in blood pressure. Choice A, peptic ulcer disease, is not a contraindication for sildenafil use. Choice B, a history of myocardial infarction, is not a contraindication unless the patient is also taking nitrates. Choice C, recent use of antihypertensive medications, is not a contraindication but requires caution as the combination can lead to additive effects lowering blood pressure.

3. When a child jumps out of the tub, crying and stating her feet are 'burning,' what pathophysiologic principle is responsible for this response?

• A. Pain receptors (nociceptors) have been activated in response to a thermal stimulus.
• B. The child's skin thermal receptors have undergone adaptation.
• C. The child is exhibiting a psychogenic pain response due to anxiety.
• D. The child is experiencing a conditioned pain response based on previous experiences.

Correct answer: A

Rationale: The child's reaction is due to the activation of nociceptors, which are pain receptors that respond to thermal stimuli. This response is an immediate protective mechanism to prevent tissue damage caused by extreme temperatures. Option B is incorrect because adaptation does not explain the child's immediate and intense response. Option C is incorrect as there is a clear physical stimulus present, ruling out a psychogenic response. Option D is incorrect as the child's response is not based on previous experiences but rather on the current thermal stimulus.

4. A young man has received a diagnosis of androgen deficiency and has been prescribed testosterone. At clinic follow-up appointments, the nurse should prioritize which of the following assessments?

• A. Bladder ultrasound and urine testing for glucose and ketones
• B. Weight and measurement of blood pressure
• C. Hearing assessment and abdominal girth measurement
• D. Deep tendon reflexes and random blood glucose testing

Correct answer: B

Rationale: In a patient receiving testosterone therapy for androgen deficiency, monitoring weight and blood pressure is crucial. Testosterone therapy can lead to weight gain and hypertension, making regular assessments of these parameters important to detect and manage any adverse effects. Choices A, C, and D are not the priority assessments for a patient on testosterone therapy. Bladder ultrasound and urine testing for glucose and ketones, hearing assessment and abdominal girth measurement, and deep tendon reflexes and random blood glucose testing are not directly related to the common side effects or monitoring requirements of testosterone therapy.

5. What signs and symptoms most likely prompted this patient to initially seek care?

• A. Malaise and fatigue
• B. Severe diarrhea
• C. Intermittent fever
• D. Dizziness and confusion

Correct answer: B

Rationale: The correct answer is B: Severe diarrhea. A patient who has recently returned from a trip to Nepal with a nongovernmental organization and is seeking care for amebiasis would most likely have been prompted by the symptom of severe diarrhea. Amebiasis is an infection caused by the parasite Entamoeba histolytica, commonly transmitted through contaminated food or water sources in developing countries like Nepal. The hallmark symptom of amebiasis is dysentery, which is characterized by severe diarrhea with blood or mucus in the stool. Malaise and fatigue (choice A) are nonspecific symptoms that may accompany many illnesses and are not specific to amebiasis. Intermittent fever (choice C) is not a typical presenting symptom of amebiasis, which primarily manifests with gastrointestinal symptoms. Dizziness and confusion (choice D) are also not typical symptoms associated with amebiasis.

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