Nursing Elites

1. In a patient with chronic kidney disease and a hemoglobin level of 9 g/dL, which of the following treatments is most appropriate?

• A. Iron supplementation
• B. Erythropoiesis-stimulating agents
• C. Blood transfusion
• D. Vitamin B12 supplementation

Correct answer: B

Rationale: In chronic kidney disease, anemia commonly occurs due to decreased erythropoietin production. Erythropoiesis-stimulating agents, such as erythropoietin or darbepoetin, are the mainstay of treatment to stimulate red blood cell production. Iron supplementation is more appropriate for iron-deficiency anemia, not the anemia of chronic kidney disease. Blood transfusion is reserved for severe cases or acute blood loss. Vitamin B12 supplementation is indicated for megaloblastic anemia caused by vitamin B12 deficiency, not specifically in chronic kidney disease-related anemia.

2. 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 A biopsy of respiratory tract cells is taken and shows that these cells have been replaced by less mature squamous epithelium cells.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.

3. A female client with bone metastases secondary to lung cancer is admitted for palliative radiation treatment and pain control. The client is currently experiencing pain that she rates at 9 out of 10. Which of the following nonpharmacologic treatments is most likely to be a useful and appropriate supplement to pharmacologic analgesia at this point?

• A. Teaching the client guided imagery and meditation
• B. Initiating neurostimulation
• C. Heat therapy
• D. Relaxation and distraction

Correct answer: D

Rationale: In the scenario described, the client is experiencing high pain levels, rated at 9 out of 10. Relaxation and distraction techniques are effective nonpharmacologic interventions for managing pain. Teaching the client guided imagery and meditation (Choice A) can also be beneficial; however, in this acute situation of severe pain, relaxation and distraction techniques are more likely to provide immediate relief. Initiating neurostimulation (Choice B) and heat therapy (Choice C) may not be suitable for immediate pain relief in this scenario and are not as commonly used for managing high pain levels in palliative care settings.

4. A healthcare provider is explaining to a patient the difference between primary and secondary immunodeficiency disorders and explains that secondary immunodeficiencies (select ONE that does not apply):

• A. May develop after viral infections
• B. Develop before birth
• C. May develop following immunosuppressive therapies
• D. Are caused by superimposed conditions

Correct answer: B

Rationale: The correct statements about secondary immunodeficiencies are that they may develop after viral infections, following immunosuppressive therapies, and are caused by superimposed conditions. Choice B ('Develop before birth') is incorrect because secondary immunodeficiencies do not develop before birth. They are acquired later in life. Therefore, the correct answers are A, C, and D.

5. What causes type I diabetes?

• A. Overproduction of insulin from the beta cells of the pancreas
• B. Destruction of the beta cells within the pancreas, resulting in an inability to produce insulin
• C. Loss of insulin receptors on the target cells, resulting in insulin resistance
• D. A pituitary tumor in the brain, resulting in increased antidiuretic hormone production

Correct answer: B

Rationale: Type I diabetes is caused by the destruction of the beta cells in the pancreas, leading to an inability to produce insulin. This results in a lack of insulin, leading to hyperglycemia. Choice A is incorrect as type I diabetes is characterized by a deficiency of insulin production, not overproduction. Choice C describes the pathophysiology of type 2 diabetes, where insulin receptors become less responsive to insulin. Choice D is unrelated to type I diabetes as it describes a pituitary tumor causing increased antidiuretic hormone production.

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