Nokea
A 72 years old man is diagnosed to have Type 2 DM, hypertension and hyperlipidemia with stage 3 chronic kidney disease. He is otherwise well and asymptomatic. He is referred to you for follow-up care. His blood pressure is 142/70 mmHg with HbA1c 6.5%. You would continue his following medications EXCEPT
- A. Hydrochlorothiazide 12.5 mg OD
- B. Simvastatin 40 mg ON
- C. Aspirin 100 mg OD
- D. Glibenclamide 10 mg bid
Correct Answer: D
Rationale: Stage 3 CKD eGFR 30-59 means glibenclamide's out; it piles up, risking hypoglycemia in shaky kidneys. Thiazide holds BP, simvastatin guards lipids, aspirin shields heart, irbesartan protects kidneys all stay. Nurses swap sulphonylureas here, dodging chronic sugar crashes in fragile renal states.
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Triglycerides in VLDL particles can be passed on to HDL particles. Question: Which enzyme mediates this process?
- A. Cholesteryl ester transfer protein (CETP)
- B. Hepatic lipase (HL)
- C. Hormone sensitive lipase (HSL)
- D. Lipoprotein lipase (LPL)
Correct Answer: A
Rationale: CETP swaps triglycerides VLDL to HDL, not lipase cutters. Nurses know this, a chronic lipid shuffle.
Mr Yee, a 45-year-old, reports three recent gout attacks in the ankle or knee. You notice a small tophus over the left elbow. He says that two years ago he took allopurinol 100 mg for one month, then 200 mg OM for one month but stopped as it 'did not help his gout and there was no improvement'. When you probe, he states that he was not very adherent to allopurinol either then as it was some years ago, and he says he probably took it 'once or twice a week'. He states he did not experience any rashes or other side effects to it then. He does not drink alcohol except one glass of wine once or twice a year on special occasions. He has past history of renal stones and also underlying ischaemic cardiomyopathy for which he is still being followed up by the cardiologist. Two weeks ago, he was admitted to the hospital for a gout flare. He had a blood test done, with the following results: Uric acid 620 mmol/L, Creatinine 120 umol/L, eGFR 55 mL/min, BP 144/94 mmHg, he has Hypertension on HCTZ long-term. He is asking you to give him Arcoxia 120 mg OM standby as it usually works for his gout flare. Which is correct advice?
- A. Discuss HLA B5801 testing particularly as febuxostat is being prescribed for him
- B. Advise that he will need stepwise up-titration of allopurinol to reach the uric acid target. Regular blood tests will allow this to be done safely
- C. Advise that colchicine prophylaxis is helpful to prevent gout attacks and increase hydrochlorothiazide to optimise his BP control
- D. Offer to initiate probenecid immediately as allopurinol is ineffective
Correct Answer: B
Rationale: Tophus and frequent flares with uric acid 620 mmol/L indicate chronic gout needing ULT. Prior allopurinol failure' likely stems from non-adherence (once/twice weekly), not ineffectiveness. Stepwise up-titration of allopurinol, starting low (e.g., 100 mg) due to eGFR 55, with regular blood tests (uric acid, creatinine), targets <360 mmol/L safely, per ACR guidelines. HLA-B5801 testing is for high-risk groups (e.g., Han Chinese) before allopurinol, not febuxostat-specific here. Colchicine helps, but increasing HCTZ (urate-retaining) may worsen gout. Probenecid suits renal underexcretors, not proven here. This approach optimizes chronic gout control.
The nurse is admitting an oncology patient to the unit prior to surgery. The nurse reads in the electronic health record that the patient has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem?
- A. Cognitive deficits
- B. Impaired wound healing
- C. Cardiac tamponade
- D. Tumor lysis syndrome
Correct Answer: B
Rationale: Radiation pre-surgery zaps tissue impaired wound healing's the big risk, as it fries skin and vessels, slowing repair post-op. Cognitive deficits need brain radiation, not specified. Tamponade's rare, tied to chest radiation and fluid buildup. TLS hits post-chemo, not pre-surgery. Nurses in oncology lock onto skin checks and infection signs, knowing radiation's legacy can tank surgical outcomes if ignored.
In which illness can hydrophobia be seen?
- A. tetanus
- B. malaria
- C. rabies
- D. EBV
Correct Answer: C
Rationale: Hydrophobia rabies' brain hates water, not tetanus' clench, malaria's sweat, EBV's glands, or HSV's sores. Nurses clock this chronic rabies red flag.
What is the most influential source of self-efficacy?
- A. Mastery
- B. Affective states
- C. Verbal persuasion
- D. Vicarious experience
Correct Answer: A
Rationale: Self-efficacy's backbone is mastery past wins breed belief, a nurse's gold for chronic self-care push. Watching others, pep talks, or mood sway less; doing it trumps all, a confidence anchor in illness battles.