Nokea
A client suffering from a narcotic overdose is seen in the Emergency Department. The client is confused, with warm, flushed skin, headache, and weakness. Vital signs of noted are temperature 102.6 F, heart rate 128 beats/minute, respirations 24 breaths/minute, and blood pressure 130/86 mm Hg. A blood gas analysis sample was drawn on room air, and the results are as follows: pH 7.33 PaCO2 53 mm Hg, PaO2 72 mm Hg, HCO3 24 mEq/L. This client is at risk for which of the following?
- A. Metabolic alkalosis
- B. Respiratory alkalosis
- C. Respiratory acidosis
- D. Metabolic acidosis
Correct Answer: C
Rationale: Narcotics depress breathing pH 7.33 (low), PaCO2 53 mm Hg (high) signal respiratory acidosis, as CO2 piles up from hypoventilation, a classic overdose trap. PaO2 72 mm Hg shows mild hypoxia; HCO3 24 mEq/L hasn't compensated yet. Alkalosis needs low CO2 or high HCO3; metabolic acidosis drops HCO3. Nurses spot this, anticipating oxygen or reversal, a breath-stifled risk in this opioid haze.
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There are several different transmembranous glucose transporters (Gluts). Question: Which Gluts occur most frequently in the liver and which in the pancreas?
- A. Glut 1 in the liver and Glut 2 in the pancreas
- B. Glut 2 in the liver and Glut 2 in the pancreas
- C. Glut 2 in the liver and Glut 1 in the pancreas
- D. Glut 4 in the liver and Glut 2 in the pancreas
Correct Answer: B
Rationale: Liver slurps glucose with Glut 2, pancreas senses it the same both lean on this transporter's flow. Glut 1's elsewhere, Glut 4's muscle-fat turf nurses know this, a chronic glucose gate map.
Which patient is at greatest risk for pancreatic cancer?
- A. An elderly black male with a history of smoking and alcohol use
- B. A young, white obese female with no known health issues
- C. A young black male with juvenile onset diabetes
- D. An elderly white female with a history of pancreatitis
Correct Answer: A
Rationale: Pancreatic cancer risk escalates with specific factors: age, race, smoking, and alcohol. An elderly Black male with smoking and alcohol history tops the list incidence peaks in older adults, Black populations face higher rates, and both habits are strong carcinogens, damaging pancreatic tissue over time. A young, obese white female has obesity as a risk, but youth and fewer exposures lower her odds. A young Black male with diabetes links to a risk factor, yet juvenile onset and age reduce immediate concern. An elderly white female with pancreatitis has a notable risk chronic inflammation predisposes but lacks the compounded impact of smoking and alcohol. The elderly Black male's profile aligns with epidemiological data, making him the nurse's focus for vigilant monitoring and early detection efforts.
Percutaneous cervical cordotomy:
- A. Is performed under general anaesthesia.
- B. Occurs by entry of a needle into the intervertebral foramen between cervical vertebrae C4 and C5.
- C. Involves thermoablation of the anterior spinothalamic tract.
- D. Is performed on the same side as the pain.
Correct Answer: C
Rationale: Percutaneous cervical cordotomy (PCC) relieves cancer pain via targeted nerve destruction. It's done under local anesthesia with sedation, not general, to monitor patient response (e.g., pain relief, side effects) during stimulation. The needle enters at C1-C2, not C4-C5, targeting the lateral spinothalamic tract contralateral to the pain not the anterior tract explicitly, though terminology varies. Thermoablation destroys pain fibers, confirmed by test stimulation. It's performed opposite the pain side due to crossed spinothalamic pathways. Complete numbness isn't typical; sensory loss is partial. Thermoablation's specificity using radiofrequency to interrupt pain transmission defines PCC's efficacy, minimizing damage to adjacent motor tracts while achieving analgesia.
An oncology patient has just returned from the postanesthesia care unit after an open hemicolectomy. This patient's plan of nursing care should prioritize which of the following?
- A. Assess the patient hourly for signs of compartment syndrome
- B. Assess the patient's fine motor skills once per shift
- C. Assess the patient's wound for dehiscence every 4 hours
- D. Maintain the patient's head of bed at 45 degrees or more at all times
Correct Answer: C
Rationale: Post-hemicolectomy, wound dehiscence splitting open is a killer risk, tied to infection or poor healing, needing checks every 4 hours. Compartment syndrome's a fracture thing, not gut surgery. Fine motor's irrelevant here neuro's not the issue. High head-of-bed helps breathing but isn't universal post-op. Nurses in oncology prioritize this, catching leaks or redness early, critical after cancer gut surgery.
When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene?
- A. The UAP assists the patient to use dental floss after eating.
- B. The UAP adds baking soda to the patient's saline oral rinses.
- C. The UAP puts fluoride toothpaste on the patient's toothbrush.
- D. The UAP has the patient rinse after meals with a saline solution.
Correct Answer: A
Rationale: Pancytopenia low everything means flossing risks bleeding and infection in a mouth with no platelets or immunity; baking soda , fluoride , and saline are safe. Nurses in oncology stop this UAP need soft-brush guidance, not floss, to protect fragile mucosa.