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A nurse is caring for a client who was received in the emergency department with a heart rate of 220 beats per minute. The client's cardiac monitor displays supraventricular tachycardia (SVT). Which of the following interventions should the nurse anticipate?
- A. Apply compression stockings
- B. Perform Valsalva maneuver
- C. Draw labs
- D. Check blood glucose
Correct Answer: B
Rationale: SVT's 220 bpm blitz needs breaking Valsalva maneuver, bearing down, jolts the vagus nerve, slowing rate, a first-line trick. Stockings aid veins, not rhythm. Labs or glucose inform, don't fix. Nurses anticipate this, calming tachycardia, a quick, non-invasive hit in this racing heart emergency.
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Melatonin is a hormone that is involved in the regulation of the circadian rhythm. Features of melatonin include:
- A. It circulates in the cerebrospinal fluid and blood.
- B. It has a plasma elimination half-life of 4 h.
- C. It is derived from tryptophan.
- D. It activates the pituitary adenylate cyclase mechanism of circadian wakefulness.
Correct Answer: A
Rationale: Melatonin, produced by the pineal gland, regulates sleep-wake cycles. It circulates in blood and cerebrospinal fluid, crossing the blood-brain barrier to signal darkness via the suprachiasmatic nucleus (SCN). Its half-life is short, about 30-60 minutes, not 4 hours, enabling rapid response to light cues. Synthesized from tryptophan via serotonin, it's a biochemical derivative responsive to environmental triggers. It acts on melatonin receptors (MT1, MT2) in the SCN, suppressing wakefulness-promoting adenylate cyclase, not activating pituitary mechanisms for wakefulness that's a misattribution. Its role dampens alertness, promoting sleep. Circulation in bodily fluids ensures systemic distribution, aligning circadian rhythms with night, making it foundational to sleep physiology and fatigue management.
The glycaemic profiles of people living with diabetes is affected by the following EXCEPT:
- A. Monitoring of blood glucose
- B. Dietary intake
- C. Exercise
- D. Stress
Correct Answer: A
Rationale: Diabetes' sugar swings dance to diet, exercise, stress, and meds intake, burn, cortisol, and pills all tug levels. Monitoring tracks, not tweaks, the profile; it's a mirror, not a mover. Clinicians lean on this quintet's interplay, adjusting levers, not the gauge, a chronic puzzle where tools shape, not tally, the game.
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.
You measure the abdominal circumference and the hip circumference of a male patient with hypertension, overweight and recently-diagnosed type 2 diabetes mellitus. Question: Which values are most likely to be found in this patient?
- A. Abdomen: 78 cm, hip: 78 cm
- B. Abdomen: 78 cm, hip: 86 cm
- C. Abdomen: 102 cm, hip: 90 cm
- D. Abdomen: 90 cm, hip: 102 cm
Correct Answer: C
Rationale: Type 2, hypertension, overweight belly bulges past hips, 102 cm to 90 cm fits metabolic syndrome's apple shape, not slim or reverse. Nurses measure this, a chronic girth clue.
The nurse should suggest which food choice when providing dietary teaching for a patient scheduled to receive external-beam radiation for abdominal cancer?
- A. Fruit salad
- B. Baked chicken
- C. Creamed broccoli
- D. Toasted wheat bread
Correct Answer: B
Rationale: Abdominal radiation zaps the gut, sparking diarrhea from irritated bowels baked chicken's lean protein fuels healing without roughage to rile things up. Fruit salad's fiber and whole-grain toast's bulk worsen diarrhea; dairy in creamed broccoli risks lactose issues post-radiation. Nurses steer patients here to low-residue diets, dodging raw fruits and grains that scrape an already tender GI tract. In oncology, it's about balancing nutrition with symptom control chicken keeps strength up without the bowel chaos, key for tolerating treatment.