Nursing Elites

1. A patient has been prescribed raloxifene (Evista) for the prevention of osteoporosis. What effect should the nurse include in the teaching plan regarding the action of this medication?

• A. Decreases calcium excretion by the kidneys.
• B. Increases intestinal absorption of calcium.
• C. Stimulates bone formation by increasing osteoblast activity.
• D. Selectively binds to estrogen receptors, decreasing bone resorption.

Correct answer: D

Rationale: The correct answer is D: Selectively binds to estrogen receptors, decreasing bone resorption. Raloxifene is a selective estrogen receptor modulator (SERM) that works by binding to estrogen receptors, thereby decreasing bone resorption. This action helps in the prevention and treatment of osteoporosis by preserving bone density. Choices A, B, and C are incorrect because raloxifene does not directly affect calcium excretion by the kidneys, intestinal absorption of calcium, or stimulate bone formation by increasing osteoblast activity.

2. When educating a client about to undergo a pacemaker insertion, the nurse explains the normal phases of cardiac muscle tissue. During the repolarization phase, the nurse will stress that membranes must be repolarized before they can be re-excited. Within the cell, the nurse understands that:

• A. Potassium channels open while sodium channels close, causing repolarization to the resting state.
• B. The influx of calcium is the primary stimulus for the repolarization of cardiac tissue.
• C. Only the electrical activity within the heart will determine when repolarization occurs.
• D. The cell membranes need to stay calm, resulting in muscle tissue becoming refractory.

Correct answer: A

Rationale: During the repolarization phase of cardiac muscle tissue, potassium channels open while sodium channels close. This process is crucial for the cardiac muscle to return to its resting state after depolarization. Potassium moving out of the cell and sodium staying out helps reset the membrane potential and prepare the cell for the next depolarization phase. The influx of calcium is not the primary stimulus for repolarization in cardiac tissue; it is mainly involved in the depolarization phase. While electrical activity within the heart influences repolarization, the specific ion movements described in choice A are what physiologically drive repolarization. Cell membranes need to be in an active state during repolarization, not calm, to facilitate the necessary ion movements for muscle tissue to properly function.

3. What part of the heart is responsible for starting the electrical impulse to conduct a heart rhythm and contraction of the atria and ventricles?

• A. The Purkinje fibers in the ventricles
• B. The right & left bundle branches
• C. The atrioventricular node
• D. The sinoatrial node in the atrium

Correct answer: D

Rationale: The sinoatrial node (SA node) in the atrium is indeed responsible for initiating the electrical impulse that starts the heart's rhythm. The SA node is known as the heart's natural pacemaker. Choices A, B, and C are incorrect because while the Purkinje fibers, bundle branches, and atrioventricular node play crucial roles in the conduction of the electrical impulse throughout the heart, the SA node is specifically responsible for initiating this impulse.

4. 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.

5. A 23-year-old pregnant female visits her primary care provider for her final prenatal checkup. The primary care provider determines that the fetus has developed an infection in utero. Which of the following would be increased in the fetus at birth?

• A. IgG
• B. IgA
• C. IgM
• D. IgD

Correct answer: C

Rationale: The correct answer is IgM. IgM is the first antibody produced in response to an infection and is elevated in a fetus with an in utero infection. IgG is the primary antibody responsible for providing immunity to the fetus and is transferred across the placenta during the third trimester. IgA is mainly found in mucosal areas and colostrum but not significantly elevated in fetal infections. IgD is involved in the development and maturation of B cells but not typically increased in fetal infections.

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