Nokea
A 65-year-old female presented to the emergency room with complaint of progressively worsening fatigue, shortness of breath, and palpitations. Upon assessment, heart rate is 130 beats per minute and irregular, and there is positive jugular vein distention. Heart tones reveal a high-pitched holosystolic murmur. Which of the following disorders are consistent with these findings?
- A. Mitral regurgitation
- B. Mitral stenosis
- C. Mitral valve prolapse
- D. Aortic regurgitation
Correct Answer: A
Rationale: Mitral regurgitation leaks blood back holosystolic murmur, irregular tachycardia, JVD, and dyspnea fit, as left heart flops, backing up into veins. Stenosis murmurs diastolic; prolapse clicks midsystolic; aortic regurgitation's early diastolic. Nurses tie this to MR's volume overload, anticipating echo, a match for this failing valve tale.
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Appropriate statements concerning intrathecal drug delivery systems include:
- A. In a patient with progressive cancer-related pain, a low-grade pelvic infection is an absolute contraindication for implanting either an intrathecal catheter or a pump, even under antibiotic cover.
- B. Intrathecally administered opioids circulate to the central neuraxis, including the brainstem, where they are likely to cause drowsiness and respiratory depression.
- C. In difficult cases, ziconotide can be administered with either an opioid or clonidine, or both.
- D. As a mixture of opioid and clonidine is expected to distribute throughout the cerebrospinal fluid, the level of the catheter in the intrathecal space is unlikely to be important.
Correct Answer: B
Rationale: Intrathecal drug delivery systems (IDDS) manage severe pain with nuances. A low-grade pelvic infection isn't an absolute contraindication; implantation may proceed with antibiotics if benefits outweigh risks (e.g., cancer palliation). Intrathecal opioids do reach the brainstem via cerebrospinal fluid, causing drowsiness and respiratory depression, though less than systemic routes due to lower doses still a key risk requiring monitoring. Ziconotide combines with opioids or clonidine for synergy in refractory pain, per clinical practice. Catheter tip position matters; drug distribution isn't uniform higher placement enhances rostral spread, affecting efficacy and side effects. MRI compatibility exists with most modern pumps. The brainstem effect of opioids underscores IDDS's potency and danger, necessitating careful titration and patient selection.
The most common and significant symptom associated with cancer and associated treatments, which has a long term impact on quality of life, as reported by patients, is:
- A. Anorexia
- B. Alopecia
- C. Pain
- D. Fatigue
Correct Answer: D
Rationale: Cancer's top drag fatigue saps QOL long-term, outlasting appetite, hair, or pain woes. Nurses hear this, a chronic weary king.
The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient?
- A. Impaired nutritional status
- B. Cognitive changes
- C. Diarrhea
- D. Alopecia
Correct Answer: A
Rationale: Neck radiation hits the oral mucosa, salivary glands, and throat, causing mucositis, taste loss, pain, and dysphagia leading to impaired nutrition. Patients struggle to eat, risking weight loss and weakness, a top concern in head-and-neck cases. Cognitive changes tie to brain radiation, not neck. Diarrhea aligns with abdominal radiation, not this site. Alopecia occurs with whole-brain radiation, not localized neck treatment, where hair loss is minimal unless the scalp's in the field. Nurses must prep patients for these site-specific effects, ensuring dietary support (e.g., soft foods, supplements) to maintain strength through therapy, a key part of oncology care planning.
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 cancer therapy with the health care provider?
- A. Frequent loose stools
- B. Nausea and vomiting
- C. Elevated white blood count (WBC)
- D. Increased carcinoembryonic antigen (CEA)
Correct Answer: D
Rationale: Rising CEA screams colorectal cancer's dodging chemo tumor marker jumps mean progression, trumping GI woes (A, B) or high WBC (C maybe infection). Nurses in oncology push this CEA's a red flag, signaling therapy's failing, needing a switch.
The nurse is caring for a client with type 2 diabetes who has been hospitalized with severe hyperglycemia. Which of the following topics will be most important to include in discharge teaching?
- A. Effect of endogenous insulin on transportation of glucose into cells
- B. Function of the liver in formation of glycogen and gluconeogenesis
- C. Impact of the client's family history on likelihood of developing diabetes
- D. Symptoms indicating that the client should contact the health care provider
Correct Answer: D
Rationale: Discharge teaching for type 2 diabetes post-hyperglycemia hinges on crisis prevention knowing when symptoms like thirst or confusion scream for help beats insulin mechanics, liver roles, or family odds. Clients need actionable cues to self-manage, not just theory; recognizing trouble and calling in keeps them out of the ER. Physiology's useful, genetics informative, but spotting escalation's life-saving, a chronic care must nurses drill into patients for real-world control.