Nokea
A 35-year old teacher on allopurinol 200 mg OM for the past year reports three recent gout attacks. BMI 27 kg/m2, BP 144/94 mm Hg. You notice tophi over both hands and elbows. You will now:
- A. Stop the allopurinol during this acute gout attack
- B. Start hydrochlorothiazide 25 mg OM for BP control
- C. Continue allopurinol despite the attack and aim to reduce uric acid <300 umol/L
- D. Advise to rest and avoid exercise for 3 months as he is having acute pain
Correct Answer: C
Rationale: Tophi, flares allopurinol stays, push uric <300; thiazides worsen, rest flops, losartan's late. Nurses hold this chronic crystal line.
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Mr Tan, a 50-year-old with hypertension, sees you for routine review. He reports three gout flares in the past two months relieved with three days of Arcoxia 120 mg OM for each episode. You perform some blood tests, which returns the following results: Creatinine 95 umol/L, eGFR >90 mL/min, Uric acid 460 mmol/L, HbA1c 5.4%, Random hypo-count 7.5 mmol/L. He is currently on Amlodipine 10 mg OM. He does not drink alcohol except one glass of wine once or twice a year on special occasions. His BMI is 20.5 kg/m². Which is the most appropriate next step?
- A. Prescribe NSAIDs standby for gout flare
- B. Offer dietary advice and advise regular exercise only
- C. Prescribe prednisolone standby for gout flare
- D. Discuss urate lowering therapy as he has had >2 gout flares in the past year, ideally with colchicine prophylaxis
Correct Answer: D
Rationale: Three gout flares in two months with uric acid 460 mmol/L (hyperuricemia) indicate frequent attacks warranting urate-lowering therapy (ULT) like allopurinol, per guidelines (e.g., ACR), especially with >2 flares yearly. Colchicine prophylaxis reduces flare risk during ULT initiation. NSAIDs or prednisolone treat acute flares but don't address recurrence. Diet/exercise alone won't suffice with this frequency and uric acid level. ULT discussion aligns with chronic gout management to prevent joint damage, critical for family physicians.
A 10-year-old boy is being prepared for a bone marrow transplant. The nurse can determine that the child understands this treatment when he says:
- A. I'll be much better after this blood goes to my bones.
- B. I won't feel too good until my body makes healthy cells.
- C. This will help all of the medicine they give me to work better.
- D. You won't have to wear a mask and gown after my transplant.
Correct Answer: B
Rationale: A bone marrow transplant (BMT) replaces diseased marrow (e.g., in leukemia) with healthy stem cells, but recovery is slow new, functional blood cells take weeks to months to regenerate, during which the child may feel unwell due to immunosuppression and engraftment challenges. The statement I won't feel too good until my body makes healthy cells' shows the boy grasps this delay, reflecting realistic understanding critical for coping and consent in pediatric care. Feeling better immediately after infusion is inaccurate initial post-BMT phases often worsen symptoms. Enhancing medicine efficacy isn't the goal; BMT is the therapy. Masks and gowns persist post-transplant due to infection risk until immunity recovers. The nurse's validation of this insight ensures the child is prepared, aligning with oncology's focus on patient education and emotional support during complex treatments.
Which of the following is the surgical treatment of choice for end-stage heart failure?
- A. Cardiac resynchronization therapy (CRT)
- B. Percutaneous angiogram
- C. Genetic counseling
- D. Ventricular assist devices (VADs)
Correct Answer: D
Rationale: End-stage heart failure, when drugs and pacing fail, leans on ventricular assist devices mechanical pumps aiding circulation, a bridge to transplant or destination therapy. CRT syncs ventricles, less invasive, but VADs tackle severe pump collapse. Angiograms diagnose, not treat; genetic counseling's irrelevant. Nurses prep for VADs, managing post-op risks, the go-to surgical fix in this terminal cardiac scenario.
For a patient with osteogenic sarcoma, you would be particularly vigilant for elevations in which laboratory value?
- A. Sodium
- B. Calcium
- C. Potassium
- D. Hematocrit
Correct Answer: B
Rationale: Osteogenic sarcoma, a bone cancer, often triggers hypercalcemia bone destruction releases calcium into blood, risking arrhythmias or kidney damage, a life-threatening shift demanding close watch. Sodium and potassium imbalances aren't bone-specific, more tied to general metabolism or treatment side effects. Hematocrit reflects anemia, common in cancer but not osteogenic sarcoma's hallmark. Calcium's spike, linked to osteolysis, makes it the nurse's focus elevations signal tumor activity or progression, prompting urgent interventions like fluids or bisphosphonates, a vigilance rooted in this cancer's skeletal impact and metabolic havoc.
12 lead Electrocardiography (ECG) is a diagnostic tool used to assess the cardiovascular system. Which of the following are not diagnosed by ECG?
- A. Arrhythmias
- B. Conduction abnormalities
- C. Fluid overload
- D. Enlargement of heart chambers
Correct Answer: C
Rationale: ECG maps heart's electric arrhythmias, blocks, chamber bulges show up. Fluid overload? Physical, echo territory ECG hints, doesn't nail it. Nurses pair tools, a chronic heart's partial scope.