Nokea
A nurse is caring for a client who presented to the emergency department with complaints of fatigue, palpitations, and chest pains. Upon assessment, the provider notes an S3 and S4 gallop, weak peripheral pulses, and tachycardia. The provider orders a chest x-ray and echocardiogram, which reveals left ventricular dilation. Which of the following disorder is consistent with these findings?
- A. Cardiac tamponade
- B. Dilated cardiomyopathy
- C. Pericarditis
- D. Restrictive cardiomyopathy
Correct Answer: B
Rationale: Left ventricular dilation with S3, S4, weak pulses, and tachycardia paints dilated cardiomyopathy heart muscle stretches, weakening pump, causing fatigue and palpitations. Tamponade compresses, not dilates. Pericarditis inflames without dilation. Restrictive stiffens, resisting stretch. Nurses tie this to DCM's systolic flop, anticipating meds like ACE inhibitors, a fit for this stretched-out heart.
You may also like to solve these questions
Which of the following clients is most at risk for developing endocarditis?
- A. A client who recently had a valve replacement and had dental work recently performed
- B. A client who recently underwent a valve replacement
- C. A client with Marfan's syndrome
- D. A client recently diagnosed with mitral stenosis
Correct Answer: A
Rationale: Endocarditis loves damaged valves and bacteremia recent valve replacement plus dental work (a bacterial gateway) spikes risk, as prosthetic valves are prime targets post-procedure. Valve replacement alone risks less without a trigger. Marfan's or mitral stenosis predispose, but lack acute catalysts like dental work. Nurses flag this combo surgery and oral breach anticipating prophylaxis or monitoring, a top risk in endocarditis's infectious playbook.
In the UK, orthognathic surgery is likely to:
- A. Be undertaken in specialist craniofacial surgery units rather than in maxillofacial surgery units.
- B. Be associated with a high incidence of postoperative nausea and vomiting.
- C. Require a nasal rather than an oral tracheal tube when a Le Fort I osteotomy is performed.
- D. Require admission of the patient to a high-dependency unit.
Correct Answer: B
Rationale: Orthognathic surgery corrects jaw deformities in the UK, typically by maxillofacial surgeons, not solely craniofacial units (reserved for complex congenital cases). Postoperative nausea and vomiting (PONV) are common due to blood swallowing, prolonged surgery, and opioids risk factors per Apfel criteria. Le Fort I osteotomy (maxillary) often uses oral intubation; nasal tubes suit mandibular focus or surgeon preference, not a requirement. High-dependency unit (HDU) admission isn't routine most recover in general wards unless complications (e.g., airway) arise. Cleft palate repair precedes, not follows, orthognathic work. PONV's prevalence reflects surgical and anaesthetic challenges, necessitating robust antiemetic prophylaxis.
You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer?
- A. Palliative
- B. Reconstructive
- C. Salvage
- D. Prophylactic
Correct Answer: A
Rationale: Stage IV colon cancer with liver mets is endgame surgery here's palliative, easing pain, obstruction, or bleeding, not curing. Reconstructive fixes form post-cure, irrelevant now. Salvage hits recurrence after lighter tries, not this late stage. Prophylactic's preemptive, not reactive. Palliative's about comfort, aligning with oncology's shift to quality of life when cure's off the table, a tough but real talk nurses navigate.
When conventional routes of analgesia have been unsuccessful or are contraindicated for chronic pain syndromes, intrathecal drug delivery systems may be considered. Appropriate indications are likely to include:
- A. Patients with cancer-related pain in whom life expectancy is estimated to be >3 months.
- B. Chronic pancreatitis.
- C. Haematuria loin pain syndrome.
- D. Chronic low back pain.
Correct Answer: A
Rationale: Intrathecal drug delivery systems (IDDS) treat severe, refractory pain. Cancer pain with >3 months life expectancy justifies IDDS, balancing implantation risks with prolonged benefit shorter expectancy favors simpler methods. Chronic pancreatitis may respond, but evidence is weaker; it's not a primary indication. Haematuria loin pain syndrome (loin pain haematuria syndrome) is niche, rarely managed with IDDS due to limited data. Chronic low back pain often fails conservative treatment, but IDDS is reserved for extreme cases (e.g., failed back surgery syndrome), not routine. Chronic refractory angina is cardiac, not typically IDDS-eligible. Cancer pain's prevalence, severity, and responsiveness to intrathecal opioids/ziconotide make it the clearest indication, optimizing quality of life in palliative care.
About special considerations in the management of hypertension in older patients, which of the following is the correct answer?
- A. Systolic hypertension - DBP should be <70 mmHg
- B. Dementia - Target SBP should not be <150/90 mmHg
- C. Care home residents - SBP <130 mmHg
- D. Frailty - Target BP not <140/90 mmHg
Correct Answer: D
Rationale: Frail elders BP >140/90 guards perfusion; systolic, dementia, care home tweaks misfire. Nurses ease this chronic frail line.