Nokea
A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the client's oral chemotherapy medications. What action by the nurse is most appropriate?
- A. Crush the medications if the client cannot swallow them.
- B. Give one medication at a time with a full glass of water.
- C. No special precautions are needed for these medications.
- D. Wear personal protective equipment when handling the medications.
Correct Answer: D
Rationale: Oral chemotherapy drugs, like their IV counterparts, are hazardous due to their cytotoxic properties, posing risks to healthcare workers through skin contact or inhalation during handling. The most appropriate action is for the nurse to wear personal protective equipment (PPE), such as gloves, to minimize exposure, aligning with oncology safety standards. Crushing these medications is contraindicated, as it increases the risk of aerosolizing toxic particles, endangering both nurse and client many are labeled do not crush.' Giving one at a time with water isn't necessary unless specified and doesn't address safety. Assuming no precautions are needed ignores the drugs' hazardous nature, risking occupational exposure. Using PPE ensures safe administration, protects the nurse's health, and maintains the medication's integrity, reflecting best practices in cancer care where handling precautions are non-negotiable.
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A 75-year-old female presented to the emergency department with shortness of breath. The client's daughter is at the bedside and shares that the client has a history of heart failure. The nurse places the client on the cardiac monitor and finds that the client is in atrial fibrillation at a rate of 180 beats per minute. Which is a likely finding?
- A. Bounding pulses
- B. Lethargy
- C. Hypotension
- D. Edema
Correct Answer: C
Rationale: Atrial fibrillation at 180 beats/minute in heart failure loses atrial kick, slashing output hypotension follows as rapid, erratic beats fail to fill ventricles, a likely finding with this tachycardic chaos. Bounding pulses need strong ejection, not here. Lethargy or edema might emerge, but BP drop's immediate, tied to poor perfusion. Nurses expect this, anticipating rate control or fluids, a critical catch in this acute decompensation.
Self-management is an important principle in optimal management and prevention of exacerbation. In order for the patient to self-manage appropriately, which of the following is not required?
- A. Understanding of the pathophysiology of disease, nature of inflammation and bronchoconstriction and trigger avoidance
- B. Education on medication compliance, use of devices and correct inhalation technique, as well as when to increase dosage
- C. Assessment by multidisciplinary team to address additional health concerns
- D. Development of an action plan in knowledge on when to implement and when to seek assistance
Correct Answer: C
Rationale: Asthma self-rule needs know-how pathology, meds, triggers, action plans not a full team probe. That's extra, not must-have; core's patient-led. Nurses train this, a chronic solo skill.
Traditionally, nurses have been involved with tertiary cancer prevention. However, an increasing emphasis is being placed on both primary and secondary prevention. What would be an example of primary prevention?
- A. Yearly Pap tests
- B. Testicular self-examination
- C. Teaching patients to wear sunscreen
- D. Screening mammograms
Correct Answer: C
Rationale: Primary prevention stops cancer before it starts by reducing risk factors in healthy folks. Teaching sunscreen use blocks UV radiation a prime cause of skin cancer like melanoma fitting this category perfectly. Pap tests and mammograms are secondary prevention, detecting cervical and breast cancer early for treatment. Testicular self-exams also fall under secondary, aiming to catch testicular cancer sooner. The shift to primary efforts, like sun protection, reflects a proactive stance, cutting UV-induced DNA damage that kicks off carcinogenesis. Nurses pushing this can slash skin cancer rates, especially in fair-skinned populations, by fostering habits that shield against environmental triggers, unlike reactive screening or post-diagnosis care.
The nurse is assessing a 3-year-old child whose mother complains that he is listless and has been having trouble swallowing. Which of the following findings would suggest the child has a brain tumor?
- A. Observation reveals nystagmus and head tilt
- B. Vital signs show blood pressure measures 120/80
- C. Examination shows temperature of 38.5°C and headache
- D. Observation reveals a cough and labored breathing
Correct Answer: A
Rationale: Brain tumors in young children often cause neurological signs from mass effect or increased intracranial pressure (ICP). Nystagmus (involuntary eye movement) and head tilt suggest cerebellar or brainstem involvement, common in pediatric brain tumors like medulloblastoma, disrupting coordination and posture key findings in a listless child with swallowing issues (possibly cranial nerve dysfunction). Blood pressure of 120/80 is elevated but lacks widened pulse pressure typical of ICP; it's non-specific without context. Fever and headache might indicate meningitis, not a tumor, unless paired with focal signs. Cough and labored breathing point to respiratory issues, not neurological ones. Nurses noting nystagmus and tilt prompt urgent imaging, critical in pediatric oncology for diagnosing brain tumors early and preventing further deterioration.
During general anaesthesia for orthognathic surgery:
- A. A head-down supine position is popular to minimize the risk of airway soiling.
- B. Lidocaine with adrenaline 1:80000 is used for infiltration.
- C. Non-steroidal anti-inflammatory drugs (NSAIDs) are avoided even after haemostasis is achieved.
- D. Blocks of both mandibular and maxillary nerves are possible and useful.
Correct Answer: D
Rationale: Anaesthesia for orthognathic surgery balances airway and bleeding risks. Head-up positioning, not head-down, reduces venous congestion and airway soiling from blood head-down risks aspiration. Lidocaine with adrenaline (typically 1:80,000-1:200,000) minimizes bleeding via vasoconstriction, a standard infiltration. NSAIDs are used post-haemostasis for analgesia, not universally avoided, unless bleeding risk persists. Mandibular and maxillary nerve blocks (e.g., V2, V3) reduce opioid needs and enhance pain control, leveraging regional anaesthesia's precision in jaw surgery. Propofol TIVA may improve recovery versus volatiles, per studies, but isn't definitive. Nerve blocks' utility optimizes perioperative pain management, critical in extensive osteotomies.