Nokea
Strategies to overcome barriers and challenges faced in insulin therapy include the following EXCEPT:
- A. Close supervision for the patient's first jab
- B. Threaten patient into adherence with insulin therapy
- C. Engage patient from the start
- D. Offer the least painful options currently available in the market
Correct Answer: B
Rationale: Insulin wins guide first shots, engage early, ease pain, set sharp goals; threats flop, breed resentment. Nurses coach this chronic game, not bully.
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Which statement about carcinogenesis is accurate?
- A. An initiated cell will always become clinical cancer.
- B. Cancer becomes a health problem once it is 1 cm in size.
- C. Normal hormones and proteins do not promote cancer growth.
- D. Tumor cells need to develop their own blood supply.
Correct Answer: D
Rationale: Carcinogenesis is the multi-step process by which normal cells transform into cancer cells, involving initiation, promotion, and progression. A key aspect of this process is angiogenesis, where tumor cells induce the formation of new blood vessels to supply nutrients and oxygen, enabling their growth beyond a minimal size. This is a critical step, as without a blood supply, tumors cannot sustain themselves or expand significantly. The statement that an initiated cell always becomes cancer is inaccurate because initiation alone is not sufficient; it requires promoters to progress. Similarly, the idea that cancer only becomes a problem at 1 cm oversimplifies the issue tumors can pose health risks earlier depending on location and type, though 1 cm is a detectable size. Normal hormones and proteins, like estrogen or growth factors, can indeed act as promoters in carcinogenesis, contradicting that option. Thus, the need for a tumor to develop its own blood supply is the most accurate statement, reflecting a fundamental biological requirement for cancer progression, which nurses must recognize when caring for oncology patients.
A 75-year-old female presented to the emergency department with shortness of breath. The client's daughter is at the bedside and shares that the client has a history of heart failure. The nurse places the client on the cardiac monitor and finds that the client is in atrial fibrillation at a rate of 180 beats per minute. Which is a likely finding?
- A. Bounding pulses
- B. Lethargy
- C. Hypotension
- D. Edema
Correct Answer: C
Rationale: Atrial fibrillation at 180 beats/minute in heart failure loses atrial kick, slashing output hypotension follows as rapid, erratic beats fail to fill ventricles, a likely finding with this tachycardic chaos. Bounding pulses need strong ejection, not here. Lethargy or edema might emerge, but BP drop's immediate, tied to poor perfusion. Nurses expect this, anticipating rate control or fluids, a critical catch in this acute decompensation.
Ziconotide is:
- A. Licensed for administration by the intrathecal route in Europe and North America.
- B. Associated with intrathecal granuloma formation.
- C. Contraindicated in schizophrenic patients.
- D. Likely to lead to hypogonadotropic hypogonadism during long-term infusion.
Correct Answer: A
Rationale: Ziconotide, a non-opioid analgesic, blocks N-type calcium channels intrathecally. It's licensed in Europe and North America for chronic pain (e.g., cancer, neuropathic), delivered via pumps. Unlike opioids, it doesn't form granulomas at catheter tips those are opioid-specific complications. It's contraindicated in psychosis (e.g., schizophrenia) due to neuropsychiatric side effects (confusion, hallucinations), per prescribing guidelines. Hypogonadism isn't linked; that's an opioid effect via hypothalamic suppression. Tolerance occurs, requiring dose escalation, but it's manageable. Its licensure reflects extensive trials showing efficacy and safety for refractory pain, distinguishing it as a targeted, non-addictive option in intrathecal therapy, critical for patients intolerant to opioids.
During a routine health examination, a 40-yr-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next?
- A. Obtain more information about the family history.
- B. Schedule a sigmoidoscopy to provide baseline data.
- C. Teach the patient about the need for a colonoscopy at age 50.
- D. Teach the patient how to do home testing for fecal occult blood.
Correct Answer: A
Rationale: Family history of colon cancer flags risk first step's digging deeper: who, when, how many cases? That shapes if it's sporadic or hereditary (e.g., Lynch syndrome), guiding screening timing. Jumping to sigmoidoscopy or fecal tests skips assessment too soon without details. Colonoscopy at 50's standard, but family history might bump it earlier (e.g., 40 or 10 years before kin's diagnosis). Nurses in oncology start here, gathering intel to tailor prevention, not rushing tools that might miss the mark without context.
The side effects of radiotherapy used in the treatment of cancer do not include which of the following:
- A. Stomatitis
- B. Fatigue
- C. Alopecia
- D. Anorexia
Correct Answer: C
Rationale: Radiotherapy zaps mouth sores, tired, appetite drop, but hair's chemo's game, not rays' unless scalp-targeted. Nurses split this, a chronic beam truth.