Nokea
A 58 year old woman is known to have diabetes mellitus for 20 years. Her glycaemic control has deteriorated over the last three years. She is currently on Insulin and Metformin. Her serum creatinine is 140 μmol/L. Urinalysis performed over the last six months showed persistent proteinuria 1+. What should be the MOST appropriate target blood pressure for this lady?
- A. <125/75 mmHg
- B. <130/85 mmHg
- C. <130/80 mmHg
- D. <120/70 mmHg
Correct Answer: C
Rationale: Diabetes 20 years, proteinuria, creatinine 140 CKD stage 3 needs BP under 130/80 to shield kidneys, per guidelines. Tighter risks perfusion; looser misses protection. Insulin and metformin tag along, but BP's the chronic guard nurses enforce here.
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In order to reduce cardiovascular, renal and all-cause mortality, the American Heart Association (AHA) and the American College of Cardiology (ACC) has set the definition of hypertension as a BP of X in 2017. What is X?
- A. 120/70 mmHg
- B. 125/75 mmHg
- C. 130/80 mmHg
- D. 135/85 mmHg
Correct Answer: C
Rationale: Hypertension's threshold shifted in 2017 when the AHA and ACC pegged it at 130/80 mmHg, aiming to catch cardiovascular and renal risks earlier, slashing mortality via tighter control. Lower cutoffs like 120/70 or 125/75 flag normal or elevated, not yet disease. Higher ones 135/85 or 140/90 stick to older, laxer standards, missing early intervention's benefit. This pivot reflects evidence tying 130/80 to doubled event risk versus <120, pushing clinicians to act sooner with lifestyle or meds, a proactive stance in chronic disease's long game.
Upon percussion of the midclavicular line from cranial to caudal, you can locate the absolute and relative lung-liver borders. Question: What produces the sound you hear between these two borders?
- A. It is caused by lung tissue
- B. It is caused by liver tissue
- C. It is caused by colon tissue
- D. It is caused by the overlap of lung tissue and liver tissue
Correct Answer: D
Rationale: Lung-liver edge overlap dulls the tap, not pure lung, liver, or colon. Nurses hear this, a chronic border beat.
The nurse receives an order to infuse heparin 1200 units/hr IV. The IV bag contains 25,000 units heparin in 500 mL D5W. Calculate the IV rate in mL/hr.
- A. 20
- B. 24
- C. 28
- D. 30
Correct Answer: B
Rationale: Heparin's drip: 1200 units/hr from 25,000 units in 500 mL 500 ÷ 25,000 = 0.02 mL/unit, times 1200 = 24 mL/hr, a nurse's calc to thin blood right. Off numbers (20, 28, 30) skew dosing. Precision keeps clots at bay, a steady flow in this IV dance.
Which of the following has been shown to be useful in managing fatty liver?
- A. Insulin injection
- B. Metformin
- C. Vitamin E
- D. Exercises
Correct Answer: C
Rationale: Vitamin E, an antioxidant, reduces hepatic inflammation in non-alcoholic steatohepatitis (NASH), per AASLD guidelines, aiding NAFLD management. Insulin treats diabetes, not NAFLD directly. Metformin improves insulin sensitivity but lacks strong evidence for NAFLD reversal. Exercise and diet are key but split here; exercise aids weight loss, indirectly helping. Vitamin E's specific benefit makes it notable in chronic liver disease care.
In monitoring patients who are at risk for spinal cord compression related to tumor growth, what is the most likely early manifestation?
- A. Sudden-onset back pain
- B. Motor loss
- C. Constipation
- D. Urinary hesitancy
Correct Answer: A
Rationale: Spinal cord compression from tumors often starts with sudden back pain 95% of cases due to vertebral pressure or nerve irritation, an early red flag demanding urgent imaging and intervention to prevent paralysis. Motor loss, like weakness, emerges later as nerves compress further. Constipation and urinary hesitancy signal advanced autonomic involvement, not initial signs. Pain's prevalence and timing make it the nurse's focus catching it early triggers steroids or surgery, halting progression in cancer patients where spinal integrity dictates function and survival, a critical monitoring priority.