Nursing Elites

1. Which of the following nursing diagnoses would provide the most plausible indication for the use of epoetin alfa (Epogen) in a patient with renal failure?

• A. Risk for infection related to decreased erythropoiesis
• B. Activity intolerance related to decreased oxygen-carrying capacity
• C. Powerlessness related to sequelae of renal failure
• D. Ineffective breathing pattern related to inadequate erythropoietin synthesis

Correct answer: B

Rationale: The correct answer is B. In a patient with renal failure, the use of epoetin alfa (Epogen) is primarily aimed at addressing the decreased oxygen-carrying capacity due to impaired erythropoiesis. Epoetin alfa is a medication that stimulates red blood cell production, thereby improving the oxygen-carrying capacity of the blood. This would directly address the activity intolerance commonly seen in patients with renal failure. Choices A, C, and D are incorrect because they do not directly relate to the primary purpose of using epoetin alfa in this context. Risk for infection, powerlessness, and ineffective breathing pattern are important considerations in the care of a patient with renal failure, but they are not the primary indications for using epoetin alfa.

2. What is a critical point the nurse should include in patient education for a patient prescribed tamoxifen (Nolvadex)?

• A. Tamoxifen may increase the risk of venous thromboembolism.
• B. Tamoxifen may decrease the risk of osteoporosis.
• C. Tamoxifen may cause hot flashes and other menopausal symptoms.
• D. Tamoxifen may cause weight gain and fluid retention.

Correct answer: A

Rationale: The critical point the nurse should include in patient education for a patient prescribed tamoxifen is that it may increase the risk of venous thromboembolism. This is crucial information because tamoxifen is known to promote blood clot formation, and patients need to be aware of the signs and symptoms of blood clots to seek prompt medical attention. Choices B, C, and D are incorrect as tamoxifen is not associated with decreasing the risk of osteoporosis, causing hot flashes and other menopausal symptoms, or directly causing weight gain and fluid retention.

3. Which of the following is a clinical manifestation in a patient with renal impairment associated with polycystic kidney disease?

• A. Suprapubic pain
• B. Periorbital edema
• C. Low serum creatinine level
• D. Palpable kidneys

Correct answer: D

Rationale: Palpable kidneys are a common clinical manifestation in patients with polycystic kidney disease due to the enlarged kidneys with multiple cysts. Suprapubic pain is not typically associated with this condition. Periorbital edema is more commonly seen in conditions like nephrotic syndrome. A low serum creatinine level is not a typical finding in renal impairment, as impaired kidneys usually lead to an elevated serum creatinine level.

4. What is the expected outcome of administering a granulocyte colony-stimulating factor (G-CSF)?

• A. Reduction in red blood cell count
• B. Decreased number of infections
• C. Decreased fatigue and increased energy
• D. Increase in white blood cell count

Correct answer: B

Rationale: The correct answer is B: Decreased number of infections. Granulocyte colony-stimulating factor (G-CSF) is a medication used to stimulate the production of white blood cells, specifically granulocytes, in the body. By increasing the number of white blood cells, G-CSF helps in boosting the immune system, leading to a decreased number of infections. Choice A is incorrect as G-CSF does not cause a reduction in red blood cell count. Choice C is incorrect as G-CSF primarily affects white blood cells and is not directly related to fatigue or energy levels. Choice D is incorrect as G-CSF does increase the white blood cell count but does not usually elevate it to 20,000 mm3.

5. A child's thymus gland is fully formed and proportionately larger than an adult's. Which of the following processes that contribute to immunity takes place in the thymus gland?

• A. Differentiation of B cells
• B. Production of natural killer (NK) cells
• C. Proliferation of T cells
• D. Filtration of antigens from the blood

Correct answer: C

Rationale: The correct answer is C: Proliferation of T cells. The thymus gland is responsible for the maturation and proliferation of T cells, which play a crucial role in adaptive immunity. Option A, differentiation of B cells, is incorrect because B cell maturation primarily occurs in the bone marrow. Option B, production of natural killer (NK) cells, is incorrect as NK cells are mainly produced in the bone marrow and lymph nodes. Option D, filtration of antigens from the blood, is incorrect as antigen filtration is not a primary function of the thymus gland.

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