Nursing Elites

1. The patient should be taught that an improvement in symptoms will likely be noticed within

• A. 48 hours.
• B. a week to 10 days.
• C. 2 to 3 weeks.
• D. 4 to 6 weeks.

Correct answer: C

Rationale: When taking isoniazid and rifampin for active tuberculosis, patients should be taught that an improvement in symptoms will likely be noticed within 2 to 3 weeks. Choice A (48 hours) is too soon to expect significant improvement in symptoms. Choice B (a week to 10 days) is also too early for noticeable improvement with this medication regimen. Choice D (4 to 6 weeks) is too far out to expect a noticeable improvement in symptoms.

2. A patient is being educated about the use of raloxifene (Evista) for osteoporosis. What is the primary therapeutic action of this medication?

• A. It stimulates the formation of new bone.
• B. It decreases bone resorption and increases bone density.
• C. It increases the excretion of calcium through the kidneys.
• D. It increases calcium absorption in the intestines.

Correct answer: B

Rationale: The correct answer is B: 'It decreases bone resorption and increases bone density.' Raloxifene, a selective estrogen receptor modulator (SERM), works by decreasing bone resorption, which is the breakdown of bone, and increasing bone density. This action helps in preventing bone loss and maintaining bone strength. Choice A is incorrect because raloxifene does not stimulate the formation of new bone but rather prevents its breakdown. Choice C is incorrect as raloxifene does not increase the excretion of calcium but rather helps in maintaining calcium levels in the bones. Choice D is also incorrect as raloxifene does not directly increase calcium absorption in the intestines.

3. A 70-year-old woman has difficulty with driving, and she has been frequently getting lost. Her husband said she has also been acting strangely and seems to want to sleep a lot. He said the other night she kept saying she was seeing animals such as lions in her room. He says her memory is not too bad, but he is very concerned about her health. Physical examination reveals an alert woman with stable vital signs. Bradykinesia and limb rigidity are noted. These findings are consistent with:

• A. Alzheimer's disease.
• B. vascular dementia.
• C. dementia with Lewy bodies.
• D. frontotemporal dementia.

Correct answer: C

Rationale: The correct answer is dementia with Lewy bodies (DLB). Hallucinations, parkinsonian symptoms (like bradykinesia and limb rigidity), and fluctuating cognition are characteristic of DLB. Alzheimer's disease (Choice A) typically presents with memory loss as a prominent feature. Vascular dementia (Choice B) is associated with a history of strokes and step-wise cognitive decline. Frontotemporal dementia (Choice D) often presents with changes in behavior and personality rather than the parkinsonian symptoms seen in this case.

4. Which of the following is the most likely indication for the use of immunosuppressant agents?

• A. Intractable seizure disorders
• B. Increased intracranial pressure
• C. Organ transplantation
• D. HIV/AIDS with multiple drug resistance

Correct answer: C

Rationale: The correct answer is C: Organ transplantation. Immunosuppressant agents are commonly used in organ transplant recipients to prevent organ rejection by suppressing the immune system. Choices A, B, and D are incorrect. Intractable seizure disorders are often managed with antiepileptic drugs, increased intracranial pressure is managed through various means like surgery and medications, and HIV/AIDS with multiple drug resistance is typically treated with antiretroviral therapy, not immunosuppressant agents.

5. How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia?

• A. Administer radioactive cobalamin and measure its excretion time
• B. Measure antigen-antibody immune complexes
• C. Measure serum ferritin and total iron-binding capacity
• D. Administer folate and evaluate folate content in a blood serum sample

Correct answer: A

Rationale: The correct answer is A. To prepare a patient for a Schilling test for pernicious anemia, the nurse should administer radioactive cobalamin and measure its excretion time. This test is specifically designed to assess the absorption of vitamin B12. Choices B, C, and D are incorrect because they do not align with the preparation and procedure of a Schilling test. Measuring antigen-antibody immune complexes, serum ferritin, or total iron-binding capacity, as well as administering folate and evaluating folate content, are not part of the Schilling test protocol.

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