A 56 yo man presents with a penetrating wound to his leg from a wooden stake. The wound is contaminated with debris. His last tetanus booster was 12 years ago, but records reliably indicate he's had 3 doses of tetanus vaccine. The most appropriate anti-tetanus regimen for him is:
- A. ADT (Adult Diphtheria Tetanus) plus tetanus Ig (immunoglobulin)
- B. Tetanus Ig only
- C. ADT only
- D. Child diphtheria tetanus, as he is immunologically 'immature'
Correct Answer: C
Rationale: Dirty stake, 12 years off ADT boosts his three-dose base, no Ig for primed; kid shots, nothing's off. Nurses jab this chronic recall.
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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.
A 79 year old woman is told by his GP that she has postural hypertension. Which of the following BP is she likely to be having?
- A. A drop of 15 mmHg/10 mmHg within 3 minutes of standing
- B. A drop of 17 mmHg/10 mmHg within 3 minutes of standing
- C. A drop of 21 mmHg/10 mmHg within 3 minutes of standing
- D. A rise of 5 mmHg/10 mmHg within 3 minutes of standing
Correct Answer: C
Rationale: Postural hypotension 21/10 drop flags, not rises or mild dips. Nurses catch this chronic stand slip (assuming typo meant hypotension).
Autonomic neuropathies affecting people with chronic diabetes affect many body systems. Which of the following is not a clinical manifestation of this problem?
- A. Tachycardia
- B. Mental confusion
- C. Urinary retention
- D. Anhidrosis
Correct Answer: B
Rationale: Diabetes' nerve mess fast heart, pee stalls, no sweat autonomic signs. Confusion's brain sugar or stroke, not this. Nurses clock these, a chronic nerve quirk.
The nurse knows that hemolytic to blood transfusions occur most often when the first milliliters of the infusion.
- A. 125
- B. 50
- C. 100
- D. 75
Correct Answer: B
Rationale: Hemolytic reactions strike early 50 mL often triggers as mismatched blood clashes, a rapid antigen-antibody storm. Later volumes (75-125) build on it; 100's common but not peak. Nurses watch those first drops, stopping at 50 mL's hint of fever or pain, a tight window in this transfusion trap.
A nurse sets an infusion pump to infuse 1 L of D5NS at the rate of $100 \mathrm{~mL} / \mathrm{hr}$. How many hours will it take to complete the infusion?
- A. 8
- B. 10
- C. 12
- D. 14
Correct Answer: B
Rationale: Math rules IV timing 1 L (1000 mL) at 100 mL/hr divides to 10 hours, a straightforward calc nurses nail for fluid planning. Missteps like 8 or 12 flub the rate; 14's way off. Precision here ensures hydration or med delivery hits the mark, a basic skill keeping care on track.
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