Nokea
A 4 week old baby is due for her second Hepatitis B vaccine dose. However, you note that the baby is mildly jaundiced. What would be the most appropriate step to take next?
- A. Screen for the Hepatitis B virus and only proceed with immunisation if the results are negative
- B. Immunisation is not required as the baby may already have hepatitis
- C. Give the hepatitis B vaccine and arrange for investigation for the jaundice
- D. Proceed with the vaccination but also give the Hepatitis B immunoglobulin at another site
Correct Answer: C
Rationale: Mild jaundice at 4 weeks likely physiologic or breast milk, not hep B vaccine's safe, so jab and probe cause. Screening delays, skipping's wrong, deferring's cautious overkill, immunoglobulin's for exposure. Nurses roll this, a chronic vax-plus-check play.
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An oncology nurse is caring for a patient who has developed erythema following radiation therapy. What should the nurse instruct the patient to do?
- A. Periodically apply ice to the area
- B. Keep the area cleanly shaven
- C. Apply petroleum jelly to the affected area
- D. Avoid using soap on the treatment area
Correct Answer: D
Rationale: Radiation erythema red, raw skin needs gentle care to dodge worsening. Soap dries and irritates, stripping fragile skin and upping infection risk, so skipping it's key. Ice or heat can burn or blister radiated tissue, already thin and sensitive. Shaving scrapes it raw; petroleum jelly traps moisture, breeding bacteria. Nurses teach this to protect the site, pushing mild cleansers (if needed) and air exposure, standard in oncology to heal radiation burns without sparking new problems.
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider?
- A. Poor oral intake
- B. Frequent loose stools
- C. Complaints of nausea and vomiting
- D. Increase in carcinoembryonic antigen (CEA)
Correct Answer: D
Rationale: Colorectal cancer's chemo tracks via CEA rising levels signal progression or resistance, a red flag for therapy tweak, needing provider input. Poor intake, diarrhea, and nausea are side effects, manageable with nursing care diet, fluids, antiemetics unless extreme. CEA's uptick, a tumor marker, trumps symptoms, hinting at disease outpacing treatment. Nurses flag this, pushing for scans or regimen shifts, a critical catch in this cancer's chemo dance.
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.
Which of the following is a priority nursing intervention for a client in atrial fibrillation with a rate of 180 beats per minute?
- A. Apply compression stockings
- B. Administer medications to slow the rate
- C. Administer anticoagulants
- D. Monitor urine output
Correct Answer: B
Rationale: AF at 180 bpm tanks output meds like beta-blockers or amiodarone slow it, restoring flow, a priority per ABCs over stockings' vein aid. Anticoagulants curb clots later; urine's secondary. Nurses push rate control, steadying this wild heart, a critical fix in this tachycardic storm.
You are caring for a patient with esophageal cancer. Which task could be delegated to the nursing assistant?
- A. Assist the patient with oral hygiene
- B. Observe the patient's response to feedings
- C. Facilitate expression of grief or anxiety
- D. Initiate daily weights
Correct Answer: A
Rationale: Delegating tasks in nursing hinges on scope of practice. Assisting with oral hygiene is a basic care activity nursing assistants are trained to perform, supporting hygiene needs in esophageal cancer patients who may struggle with swallowing. Observing responses to feedings requires clinical judgment to assess tolerance or complications, a nurse's responsibility. Facilitating emotional expression involves therapeutic communication skills beyond an assistant's training, critical for addressing cancer-related distress. Initiating daily weights implies deciding when to start, requiring understanding of fluid status assistants can weigh patients but not initiate the process independently. Oral hygiene delegation optimizes care efficiency, aligns with assistants' capabilities, and frees nurses for higher-level assessments, ensuring safe, effective management of this patient's complex needs.