Nokea
Regarding oxygen consumption by the adult human body:
- A. It is approximately 3 ml Oâ‚‚ kgâ»Â¹ minâ»Â¹ at rest in the awake adult patient.
- B. It rises to approximately 11 ml Oâ‚‚ kgâ»Â¹ minâ»Â¹ at peak exercise in healthy young adults.
- C. Increases by approximately 5-fold after major surgery.
- D. Peak oxygen consumption is likely to be quantified accurately by cardiopulmonary exercise testing.
Correct Answer: A
Rationale: Oxygen consumption (VOâ‚‚) reflects metabolic demand. At rest, VOâ‚‚ is approximately 3-4 ml Oâ‚‚ kgâ»Â¹ minâ»Â¹ in awake adults, aligning with basal energy needs (250-300 ml/min total). During peak exercise, healthy young adults can reach 30-40 ml Oâ‚‚ kgâ»Â¹ minâ»Â¹, far exceeding 11 ml, depending on fitness. Post-major surgery, VOâ‚‚ increases 50-100% (1.5-2-fold), not 5-fold, due to stress and healing, though critical illness may spike higher briefly. Cardiopulmonary exercise testing (CPET) accurately measures peak VOâ‚‚, unlike the Duke Activity Status Index, which estimates it via questionnaire. The resting value of 3 ml Oâ‚‚ kgâ»Â¹ minâ»Â¹ is a physiological constant, foundational to understanding perioperative oxygen delivery and demand.
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A nurse is caring for a client diagnosed with atherosclerosis. Which of the following is considered a risk factor for the development of this disorder?
- A. Diet high in vitamin K
- B. Low HDL-C/High LDL-C
- C. High HDL-C/Low LDL-C
- D. Vegan diet
Correct Answer: B
Rationale: Atherosclerosis loves lipids low HDL (good cholesterol) and high LDL (bad cholesterol) pile plaque, a prime risk factor driving vessel narrowing. Vitamin K aids clotting, not plaque. High HDL/low LDL protects. Vegan diets cut fats, lowering risk. Nurses flag lipid imbalance, pushing statins or diet shifts, a cholesterol-fueled root of this vascular scourge.
The nurse is caring for a client with mitral regurgitation. Which of the following would the nurse anticipate the client to develop if left untreated?
- A. Left-sided heart failure
- B. Right-sided heart failure
- C. Renal failure
- D. Myocardial ischemia
Correct Answer: A
Rationale: Mitral regurgitation backflows blood into the left atrium, hiking pressure and volume untreated, it overburdens the left ventricle, leading to left-sided heart failure. Pulmonary congestion follows, with dyspnea and edema, a direct consequence of this valve flaw. Right-sided failure stems from downstream effects or separate causes, not primary here. Renal failure or ischemia might complicate advanced disease, but left-sided failure's progression is the immediate risk, rooted in mitral dysfunction's mechanics. Nurses anticipate this, monitoring for early signs like crackles, ensuring timely intervention to halt this predictable cardiac cascade.
The following strategies can be used to help patients overcome the barriers and challenges faced in insulin therapy EXCEPT:
- A. Threaten patient into adherence with insulin therapy
- B. Engage the patient in shared decision-making, select an insulin regimen that they can adhere to
- C. Provide close supervision and follow up when the patient is newly initiated on insulin therapy
- D. Offer measures to reduce weight gain through lifestyle and dietary advice, concomitant use of insulin with metformin, SGLT-2 inhibitors, GLP-1RA
Correct Answer: A
Rationale: Effective insulin therapy strategies include shared decision-making, close supervision at initiation, and weight gain mitigation via lifestyle and adjunctive drugs like metformin all fostering adherence and success. Threatening patients, however, is counterproductive, increasing resistance, anxiety, and non-compliance, contrary to patient-centered care principles. It undermines trust, critical in chronic disease management, where collaboration and support drive outcomes. Physicians must avoid coercive tactics, focusing instead on empowerment and tailored solutions to overcome insulin therapy barriers.
The nurse is caring for a patient who has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The patient states that he would like to die at home, but the team believes that the patient's care needs are unable to be met in a home environment. What might you suggest as an alternative?
- A. Discuss a referral for rehabilitation hospital
- B. Panel the patient for a personal care home
- C. Discuss a referral for acute care
- D. Discuss a referral for hospice care
Correct Answer: D
Rationale: Extensive small-cell lung cancer with a 6-month clock screams end-stage hospice fits, offering comfort-focused care in settings like home (with support), hospitals, or community sites. It matches his wish to avoid aggressive fixes, unlike rehab (for recovery) or acute care (for crises). Personal care homes lack the palliative punch needed here. Hospice blends patient and family needs, easing symptoms like pain or dyspnea, a cornerstone in oncology for terminal cases where quality trumps quantity.
A nurse is caring for four clients with leukemia. After hand-off report, which client should the nurse see first?
- A. Client who had two bloody diarrhea stools this morning
- B. Client who has been premedicated for nausea prior to chemotherapy
- C. Client who is crying and feeling lonely
- D. Client with an unchanged lesion to the lower right lateral malleolus
Correct Answer: A
Rationale: Leukemia's marrow suppression risks bleeding two bloody stools signal GI hemorrhage, a potential emergency needing urgent assessment for stability, trumping others per ABCs. Premedicated nausea's managed, loneliness needs support but waits, and an unchanged lesion's stable. Nurses prioritize bleeding, anticipating labs or fluids, a life-saving call in this fragile hematologic lineup.