Nursing Elites

1. What is the major effect of filgrastim (Neupogen) in a patient with chronic renal failure?

• A. Decreases neutropenia related to chemotherapy
• B. Decreases white blood cells related to infection
• C. Decreases growth of blood vessels due to ischemia
• D. Decreases platelet count related to bleeding

Correct answer: A

Rationale: The major effect of filgrastim (Neupogen) is to stimulate the production of neutrophils, thereby decreasing neutropenia in patients undergoing chemotherapy. This medication helps the bone marrow produce more white blood cells, specifically neutrophils, to reduce the risk of infections associated with low neutrophil counts. Choices B, C, and D are incorrect because filgrastim does not decrease white blood cells related to infection, growth of blood vessels, or platelet count related to bleeding.

2. Women who have breast cancer due to a BRCA1 gene mutation are usually:

• A. positive for human epidermal growth factor receptor 1 and 2.
• B. negative for estrogen receptor.
• C. positive for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2.
• D. negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2.

Correct answer: D

Rationale: Women with breast cancer due to a BRCA1 gene mutation commonly have a triple-negative breast cancer subtype, which means they are negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2). This subtype tends to be more aggressive and harder to treat. Choice A is incorrect as they are typically negative for HER2. Choice B is incorrect because they are usually negative for estrogen receptor. Choice C is incorrect as they are usually negative for progesterone receptor and HER2.

3. A 52-year-old has made an appointment with his primary care provider and has reluctantly admitted that his primary health concern is erectile dysfunction (ED). He describes the problem as increasing in severity and consequent distress. Which of the nurse's assessment questions is most likely to address a common cause of ED?

• A. “How would you describe your overall health status?”
• B. “Are you taking any medications for high blood pressure?”
• C. “How has this issue been impacting your relationship?”
• D. “Have you experienced any recent injuries?”

Correct answer: B

Rationale: In the context of erectile dysfunction (ED), medication use is a crucial factor to consider. Many medications, including those used for high blood pressure, can contribute to ED as a side effect. Asking about medication use, particularly for conditions like high blood pressure, can help identify a common cause of ED. Choices A, C, and D do not directly address potential causes related to medication use, making them less likely to reveal a common underlying issue for ED in this case.

4. A male patient is being treated with testosterone gel for hypogonadism. What important instruction should the nurse provide?

• A. Apply the gel to the face and neck for maximum absorption.
• B. Apply the gel to the chest or upper arms and allow it to dry completely before dressing.
• C. Apply the gel to the scalp and back.
• D. Apply the gel to the genitals for improved results.

Correct answer: B

Rationale: The correct instruction for applying testosterone gel is to apply it to the chest or upper arms and allow it to dry completely before dressing. This is important to prevent the transfer of the medication to others. Applying it to the face and neck (Choice A) is incorrect as these areas are not recommended. Similarly, applying it to the scalp and back (Choice C) or the genitals (Choice D) is also incorrect and can lead to inappropriate absorption or undesirable effects.

5. Which disorder is caused by a Staphylococcus aureus organism producing a toxin leading to exfoliation and large blister formation?

• A. Herpes simplex I virus
• B. Bullous impetigo
• C. Necrotizing fasciitis
• D. Cellulitis

Correct answer: B

Rationale: Bullous impetigo is the correct answer because it is caused by a Staphylococcus aureus toxin that leads to exfoliation and the formation of large blisters. Herpes simplex I virus (Choice A) causes cold sores and is not associated with exfoliation and blister formation. Necrotizing fasciitis (Choice C) is a severe skin infection involving the deeper layers of skin and subcutaneous tissues, typically caused by bacteria such as Streptococcus or Clostridium species, not Staphylococcus aureus. Cellulitis (Choice D) is a common bacterial skin infection, but it does not involve exfoliation and blister formation as seen in bullous impetigo.

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