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A 56 year old lady with Type 2 DM and a BMI of 30 kg/m2 is reviewed by her family doctor due to poor glycaemic control. She is treated with oral gliclazide since she is diagnosed as diabetic and currently she is on 160 mg bid. Her serum creatinine is 110 μmol/L. Which ONE of the following medications should be most appropriately to be added next?
- A. Metformin
- B. Acarbose
- C. Pioglitazone
- D. Insulin
Correct Answer: A
Rationale: Gliclazide maxed, HbA1c off metformin's next, safe at creatinine 110 (eGFR likely 50+), tackling insulin resistance in obesity. Acarbose slows carbs, pioglitazone risks fluid, insulin's later, linagliptin's fine but less foundational. Nurses add this chronic sugar anchor, boosting control without kidney strain.
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A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose?
- A. 0.25
- B. 0.5
- C. 1
- D. 1.5
Correct Answer: B
Rationale: Digoxin math: 125 mcg ordered, 0.25 mg (250 mcg) per tablet 125 ÷ 250 = 0.5 tablets, a precise dose nurses calc to boost heart failure's pump, avoiding toxicity's narrow edge. Wrong cuts (0.25, 1, 1.5) miss the mark. Accuracy here rules, a daily win in this med game.
Sodium-glucose-co-transporter-2 (SGLT-2) inhibitors were shown to reduce albuminuria and proteinuria by X%. What is X?
- A. 10--30
- B. 20-40
- C. 30-50
- D. 40-60
Correct Answer: C
Rationale: SGLT-2 inhibitors, used in type 2 diabetes, reduce albuminuria and proteinuria by 30-50%, as evidenced in trials like CREDENCE and DAPA-CKD. They lower glomerular hyperfiltration by inhibiting glucose and sodium reabsorption in the proximal tubule, decreasing intraglomerular pressure and thus protecting kidney function. This 30-50% reduction is significant in slowing chronic kidney disease (CKD) progression, a key benefit beyond glycemic control. Lower ranges (10-30%, 20-40%) underestimate this effect, while higher ranges (40-60%) may apply to specific subgroups but aren't the average. This renal protection makes SGLT-2 inhibitors a cornerstone in managing diabetic nephropathy, vital knowledge for physicians optimizing chronic disease outcomes.
The spinothalamic and dorsal column sensation are examined as part of a neurological examination. One of the items belonging to dorsal column sensation is the sense of vibration, which is examined by means of a tuning fork. Question: What is the required frequency of this tuning fork?
- A. 512 Hz
- B. 256 Hz
- C. 128 Hz
- D. 64 Hz
Correct Answer: C
Rationale: Vibration check 128 Hz hums right, dorsal column's sweet spot, not higher or lower. Nurses tune this, a chronic nerve test.
Diabetes is associated with pathophysiological mechanisms that contribute to the development of cardiovascular events. Question: What is the approximate percentage of diabetes patients who also have hypertension?
- A. 25%
- B. 50%
- C. 75%
- D. 100%
Correct Answer: C
Rationale: Diabetes and hypertension 75% overlap, sugar and pressure tag-team hearts. Nurses watch this, a chronic duo hit.
A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo?
- A. Lymphadenectomy
- B. Needle biopsy
- C. Open biopsy
- D. Sentinel node biopsy
Correct Answer: D
Rationale: Sentinel node biopsy (SLNB) is the modern go-to less invasive than old-school dissection (lymphadenectomy), it maps the first lymph node cancer hits, sparing arm swelling (lymphedema) if clean. Needle or open biopsies are less targeted, more for diagnosis than staging here. SLNB's standard for breast cancer now, checking spread without ripping out nodes like her mom's era. Nurses in oncology highlight this shift less trauma, same intel easing her fears with precision care.