Nursing Elites

1. The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which teaching point should the physician include when explaining the child's diagnosis to his parents?

• A. Your child may develop breathing difficulties as the disease progresses.
• B. Your child is likely to benefit from physical therapy and exercise.
• C. This condition can be cured with early intervention and treatment.
• D. The disease is caused by inflammation in the muscles, which leads to weakness.

Correct answer: A

Rationale: The correct teaching point that the physician should include when explaining Duchenne muscular dystrophy to the parents is that 'Your child may develop breathing difficulties as the disease progresses.' Duchenne muscular dystrophy is a progressive condition that affects muscle strength, including respiratory muscles, leading to breathing difficulties as the disease advances. Choice B is incorrect because while physical therapy and exercise can help maintain muscle function and mobility, they do not cure the condition. Choice C is incorrect because Duchenne muscular dystrophy is a genetic disorder with no known cure. Choice D is incorrect as Duchenne muscular dystrophy is primarily characterized by a lack of dystrophin protein due to genetic mutations, not inflammation in the muscles.

2. Which of the following chronic inflammatory skin disorders is characterized by angiogenesis, immune cell activation (particularly T cells), and keratinocyte proliferation?

• A. Psoriasis
• B. Melanoma
• C. Atopic dermatitis
• D. Urticaria

Correct answer: A

Rationale: Psoriasis is the correct answer. Psoriasis is a chronic inflammatory skin disorder characterized by angiogenesis, immune cell activation (particularly T cells), and keratinocyte proliferation. Choice B, Melanoma, is a type of skin cancer involving melanocytes, not characterized by the features mentioned. Choice C, Atopic dermatitis, is a different inflammatory skin condition associated with pruritus and eczematous lesions, not primarily characterized by angiogenesis. Choice D, Urticaria, is a skin condition characterized by hives and wheals due to histamine release, not typically involving the features mentioned in the question.

3. 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.

4. What is the primary cause of angina?

• A. Increased oxygen demand by the heart
• B. Obstruction of the coronary arteries
• C. Lack of oxygen in the lungs
• D. Decreased blood supply to the liver

Correct answer: B

Rationale: The correct answer is B: Obstruction of the coronary arteries. Angina is primarily caused by a reduced blood flow to the heart due to blockages or narrowing in the coronary arteries. Choice A is incorrect because while increased oxygen demand can contribute to angina symptoms, it is not the primary cause. Choice C is incorrect as angina is not caused by a lack of oxygen in the lungs. Choice D is also incorrect as angina is not related to decreased blood supply to the liver.

5. A 17-year-old woman has come to the clinic requesting emergency contraception after having unprotected sex 24 hours ago. What medication is the clinician most likely to prescribe?

• A. Levonorgestrel (Plan B)
• B. Mifepristone (RU-486)
• C. Ulipristal acetate (ella)
• D. Estradiol (Estrace)

Correct answer: A

Rationale: The correct answer is A: Levonorgestrel (Plan B). Levonorgestrel is the most commonly prescribed medication for emergency contraception within 72 hours of unprotected intercourse. It is effective when taken within 72 hours after intercourse, with better efficacy the sooner it is taken. Choice B, Mifepristone (RU-486), is not indicated for emergency contraception but is used for medical abortion. Choice C, Ulipristal acetate (ella), is another option for emergency contraception that is effective up to 120 hours after unprotected intercourse. Choice D, Estradiol (Estrace), is not used for emergency contraception.

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