Nursing Elites

1. A patient with a diagnosis of renal failure is being treated with epoetin alfa (Epogen). Frequent assessment of which of the following laboratory values should be prioritized before and during treatment?

• A. AST
• B. C-reactive protein
• C. CBC
• D. ALT

Correct answer: A

Rationale: The correct answer is AST. Epoetin alfa is a medication used to treat anemia associated with chronic renal failure. During treatment with epoetin alfa, it is crucial to monitor AST levels as this medication can potentially lead to liver toxicity. Assessing AST levels before and throughout treatment helps in early detection of any liver abnormalities. C-reactive protein is not specifically related to the use of epoetin alfa in renal failure. While CBC (Complete Blood Count) monitoring is essential during treatment with epoetin alfa to evaluate the response to therapy, prioritizing AST assessment is more critical due to the potential for liver toxicity. ALT monitoring is also important but AST is prioritized in this scenario.

2. 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.

3. An older adult patient has just sheared the skin on her elbow while attempting to boost herself up in bed, an event that has precipitated acute inflammation in the region surrounding the wound. Which of the following events will occur during the vascular stage of the patient's inflammation?

• A. Outpouring of exudate into interstitial spaces
• B. Chemotaxis
• C. Accumulation of leukocytes along epithelium
• D. Phagocytosis of cellular debris

Correct answer: A

Rationale: During the vascular stage of inflammation, there is an outpouring of exudate into the interstitial spaces, leading to swelling and edema. Choice B, chemotaxis, occurs during the cellular stage of inflammation, where leukocytes move to the site of injury in response to chemical signals. Choice C, accumulation of leukocytes along the epithelium, is not a typical event during the vascular stage. Phagocytosis of cellular debris, as in choice D, mainly occurs during the resolution stage of inflammation.

4. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. What condition would contraindicate the use of this medication?

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

Correct answer: B

Rationale: The correct answer is B: Use of nitrates. Sildenafil (Viagra) is contraindicated in patients taking nitrates due to the risk of severe hypotension. Nitrates combined with sildenafil can lead to a dangerous drop in blood pressure. Choices A, C, and D are incorrect because a history of peptic ulcer disease, use of antihypertensive medications, or a history of hypertension are not direct contraindications for sildenafil use.

5. A 5-month-old child is admitted to the hospital with recurring respiratory infections. A possible cause of this condition is:

• A. Hypergammaglobulinemia
• B. Increased maternal IgG
• C. Immune insufficiency
• D. Decreased maternal antibody breakdown, resulting in hyposensitivity

Correct answer: C

Rationale: Immune insufficiency is a possible cause of recurring respiratory infections in a 5-month-old child. In this scenario, the child's immune system may not be functioning optimally, leading to a susceptibility to infections. Choices A, B, and D are incorrect. Hypergammaglobulinemia refers to high levels of gamma globulins in the blood and is not typically associated with recurring respiratory infections in this context. Increased maternal IgG would provide passive immunity to the child, offering some protection against infections. Decreased maternal antibody breakdown leading to hyposensitivity is not a common cause of recurring respiratory infections in a 5-month-old child.

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