Nokea
A nurse is caring for a client diagnosed with polycythemia vera. Which of the following should the nurse include in the client and family education?
- A. Resume normal activity
- B. Wear support hose while awake
- C. Decrease fluid intake to no more than 1 liter per day
- D. Diet high in vitamin K intake
Correct Answer: B
Rationale: Polycythemia vera thickens blood, slowing venous return support hose boost circulation, cutting clot risk, a practical teaching point for clients and families. Normal activity's fine but misses prevention. Less fluid thickens blood further, dangerous here; high vitamin K aids clotting, counterproductive. Nurses push hose use, easing symptoms like swelling, a key strategy in managing this hyperviscous state.
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Mr Soh, a 40-year-old accountant on allopurinol 200 mg OM for the past eight months, reports two recent gout attacks in the last 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 is 25 kg/m², BP 144/94 mmHg. 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 perhaps 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
- D. Continue allopurinol at 100 mg OM despite the attack and start colchicine
Correct Answer: B
Rationale: Current gout attack with uric acid 405 mmol/L (above target <360) on allopurinol 200 mg suggests undertreatment. Continue allopurinol (not stop) during flares, add colchicine TDS for acute relief, and address BP 144/94 with Losartan urate-lowering and cardioprotective, unlike HCTZ, which raises urate. Check creatinine and up-titrate allopurinol later. This balances acute and chronic management effectively.
A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication?
- A. I've had a backache for several days
- B. I feel nauseated and have no appetite
- C. I can walk a mile a day
- D. I am urinating more frequently
Correct Answer: B
Rationale: Digoxin's tightrope nausea and anorexia flag toxicity, a common adverse hit as levels climb, risking arrhythmias. Backache's vague, walking's a win, urination's unrelated. Nurses catch this, checking levels, a red light in this heart-boosting med's dance.
Which of the following is FALSE about reduced ejection fraction heart failure (HFrEF)?
- A. The goals of therapy are to reduce morbidity (i.e., reducing symptoms, improving health-related quality of life and functional status, decreasing the rate of hospitalisation) and to reduce mortality
- B. Beta blockers, angiotensin converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), or angiotensin receptor-neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonist (MRA) are the preferred antihypertensive agents because these agents improve survival
- C. Recommended lifestyle modifications include smoking cessation, restriction of alcohol consumption, salt restriction, weight reduction in obese patients, as well as daily weight monitoring to detect fluid accumulation before it becomes symptomatic
- D. Patients at high risk for re-hospitalisation should be referred to a long-term care facility
Correct Answer: D
Rationale: HFrEF goals, preferred drugs (beta blockers, ACEi, ARBs, ARNI, MRA), and lifestyle changes are true, per ESC/ACC guidelines. However, high re-hospitalization risk doesn't mandate long-term care referral outpatient management or cardiac rehab is preferred unless dependency justifies it. This false claim refines chronic HFrEF management focus.
A nurse is caring for a 19-year-old male recently diagnosed with leukemia. Which of the following nursing interventions is appropriate for the care of this client?
- A. Fluid restriction
- B. Low residual diet
- C. Therapeutic phlebotomy
- D. Strict hand hygiene to prevent infection
Correct Answer: D
Rationale: Leukemia's marrow mess drops immunity strict hand hygiene shields this 19-year-old from infections, a top intervention as neutrophils crash. Fluid restriction fits overload, not here. Low residual diets aid bowels, irrelevant. Phlebotomy's for polycythemia. Nurses scrub up, guarding this young client, a germ-free must in leukemia's fragile fight.
Insulin is an anabolic hormone. Question: A catabolic state induced by insulin deficiency has an effect on which metabolism?
- A. Protein metabolism
- B. Glucose metabolism
- C. Fat metabolism
- D. A+B+C
Correct Answer: D
Rationale: Insulin gone, catabolism rages proteins break, glucose spikes, fats burn all unravel. No picking one; it's a full-body crash nurses see this in type 1's ketosis, a chronic fuel flip.