Nokea
A male client is presenting with radiating chest pain. Which of the following would the nurse recognize as indicators that an acute myocardial infarction may be occurring?
- A. Positive troponin markers
- B. ST elevation on EKG on two contiguous leads
- C. Pain relieved with rest
- D. Diaphoresis
Correct Answer: B
Rationale: MI's hallmark ST elevation in contiguous leads flags acute infarction, showing transmural injury, a nurse's red alert for cath lab prep. Troponins rise later, confirming damage. Rest-relieved pain fits angina, not MI. Diaphoresis tags along but isn't diagnostic alone. EKG's immediacy nails this, driving urgent care in this chest pain crisis.
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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 therapy with the health care provider?
- A. Poor oral intake
- B. Frequent loose stools
- C. Complaints of nausea and vomiting
- D. Increase in carcinoembryonic antigen (CEA)
Correct Answer: D
Rationale: Colorectal cancer's chemo tracks via CEA rising levels signal progression or resistance, a red flag for therapy tweak, needing provider input. Poor intake, diarrhea, and nausea are side effects, manageable with nursing care diet, fluids, antiemetics unless extreme. CEA's uptick, a tumor marker, trumps symptoms, hinting at disease outpacing treatment. Nurses flag this, pushing for scans or regimen shifts, a critical catch in this cancer's chemo dance.
The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective?
- A. The biopsy will remove the cancer in my prostate gland.
- B. The biopsy will determine how much longer I have to live.
- C. The biopsy will help decide the treatment for my enlarged prostate.
- D. The biopsy will indicate whether the cancer has spread to other organs.
Correct Answer: C
Rationale: Prostate biopsy snags tissue to check if enlargement's benign (BPH) or malignant guiding treatment like surgery or radiation. It's not therapeutic , doesn't predict lifespan , and staging spread needs more (e.g., scans). Nurses in oncology stress this it's a diagnostic linchpin, setting the course for managing prostate issues, critical for patient buy-in and clarity.
Pulmonary rehabilitation is one of the most effective interventions in the management of COPD. The primary goals of this program are to:
- A. Ensure the patient eats appropriately, takes their medication as prescribed and exercises every day
- B. Involve the patient in the multidisciplinary team and knows how to manage their condition
- C. Reduce symptoms, improved QOL, increase physical and emotional participation in everyday life
- D. Prevent deterioration, avoid hospitalisation and support the carers
Correct Answer: C
Rationale: Pulmonary rehab reclaims COPD life less wheeze, better QOL, more daily grit, physical and emotional. Diet-meds-exercise is narrow; team play's a means; prevention's a perk, not core. Nurses drive this, a chronic lift.
Mr Soh, a 40-year-old accountant on allopurinol 200 mg OM for the past eight months, reports two recent gout attacks in the past year. He has no other known past medical history. When you probe, he is adherent to allopurinol except for missing it perhaps once or twice a month. His BMI 25 kg/m², BP 144/94 mm Hg. His last uric acid was one month ago, which was 405 mmol/L. He is having a gout attack now. He tells you that his gout attacks are usually aborted with colchicine TDS for two days. Whilst on colchicine, he does not experience diarrhoea except for one episode of loose stools, after which he stops colchicine. Which is the most appropriate next step?
- A. Start Hydrochlorothiazide for hypertension
- B. Start Losartan for hypertension
- C. Stop Allopurinol during this acute gout attack and start colchicine. Consider checking a baseline creatinine if not recently available
- D. Continue allopurinol at 200 mg OM despite the attack and start colchicine. Consider checking an updated uric acid level and creatinine two weeks after the attack resolves. If uric acid is >360, explain that allopurinol 200 mg OM is insufficient and needs to be up titrated
Correct Answer: D
Rationale: Gout mid-attack 405 uric acid on 200 mg allopurinol says it's not enough. Keep it rolling, add colchicine to quash the flare, then recheck labs post-calm to titrate up if >360. Stopping allopurinol spikes urate; HCTZ worsens gout; Losartan's fine but sidesteps; upping now risks confusion. Clinicians stick this path, steering chronic control smart.
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.