Nokea
A parent of a child with Wilms tumor asks the nurse about surgery. Which statement concerning the type of surgery for Wilms tumor is most accurate?
- A. Surgery is only done if chemotherapy and radiation fail.
- B. Surgery is usually performed within 24 to 48 hours of admission.
- C. Surgery is the least favorable therapy for the treatment of Wilms tumor.
- D. Surgery will be delayed until the child's overall health status improves.
Correct Answer: B
Rationale: Wilms tumor, a kidney cancer in children, is primarily treated with surgical resection (nephrectomy) as the cornerstone of therapy, typically performed within 24 to 48 hours of diagnosis to remove the tumor before it spreads. This urgency stems from its responsiveness to surgery and the need to stage the cancer accurately, guiding subsequent chemotherapy or radiation. Delaying surgery until chemotherapy or radiation fails is incorrect surgery is the initial step, not a last resort. It's not the least favorable option; rather, it's the preferred first-line treatment due to high cure rates when combined with adjuvant therapies. Waiting for health improvement isn't standard unless the child is critically unstable, which isn't typical at diagnosis. The nurse's accurate explanation reassures parents and underscores surgery's role, aligning with pediatric oncology protocols to optimize outcomes in Wilms tumor management.
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Autonomic neuropathies affecting people with chronic diabetes affect many body systems. Which of the following is not a clinical manifestation of this problem?
- A. Tachycardia
- B. Mental confusion
- C. Urinary retention
- D. Anhidrosis
Correct Answer: B
Rationale: Diabetes' nerve mess fast heart, pee stalls, no sweat autonomic signs. Confusion's brain sugar or stroke, not this. Nurses clock these, a chronic nerve quirk.
Mr Yee, a 45-year-old, reports three recent gout attacks in the ankle or knee. You notice a small tophus over the left elbow. He says that two years ago he took allopurinol 100 mg for one month, then 200 mg OM for one month but stopped as it 'did not help his gout and there was no improvement'. When you probe, he states that he was not very adherent to allopurinol either then as it was some years ago, and he says he probably took it 'once or twice a week'. He states he did not experience any rashes or other side effects to it then. He does not drink alcohol except one glass of wine once or twice a year on special occasions. He has past history of renal stones and also underlying ischaemic cardiomyopathy for which he is still being followed up by the cardiologist. Two weeks ago, he was admitted to the hospital for a gout flare. He had a blood test done, with the following results: Uric acid 620 mmol/L, Creatinine 120 umol/L, eGFR 55 mL/min, BP 144/94 mmHg, he has Hypertension on HCTZ long-term. He is asking you to give him Arcoxia 120 mg OM standby as it usually works for his gout flare. Which is correct advice?
- A. Discuss HLA B5801 testing particularly as febuxostat is being prescribed for him
- B. Advise that he will need stepwise up-titration of allopurinol to reach the uric acid target. Regular blood tests will allow this to be done safely
- C. Advise that colchicine prophylaxis is helpful to prevent gout attacks and increase hydrochlorothiazide to optimise his BP control
- D. Offer to initiate probenecid immediately as allopurinol is ineffective
Correct Answer: B
Rationale: Tophus and frequent flares with uric acid 620 mmol/L indicate chronic gout needing ULT. Prior allopurinol failure' likely stems from non-adherence (once/twice weekly), not ineffectiveness. Stepwise up-titration of allopurinol, starting low (e.g., 100 mg) due to eGFR 55, with regular blood tests (uric acid, creatinine), targets <360 mmol/L safely, per ACR guidelines. HLA-B5801 testing is for high-risk groups (e.g., Han Chinese) before allopurinol, not febuxostat-specific here. Colchicine helps, but increasing HCTZ (urate-retaining) may worsen gout. Probenecid suits renal underexcretors, not proven here. This approach optimizes chronic gout control.
Which of the following statements regarding weight regulation is FALSE?
- A. The reward system of weight regulation cannot override the signals from the homeostatic weight regulation circuitry
- B. Weight regain after weight loss is physiological and not necessarily due to a failure of conscious efforts to lose weight
- C. Liking and wanting of food are subconscious processes
- D. In human studies, functional MRI (fMRI) studies have shown overactivation of reward-encoding brain regions and/or deficiency in cortical inhibitory networks in obese people
Correct Answer: A
Rationale: Reward can trump homeostatic signals dopamine's pull often beats leptin's brake, a false claim busted by obesity's hedonic drive. Regain's wired, liking/wanting's deep, fMRI shows reward overdrive, and corticolimbic rules non-homeostatic. Clinicians tackle this override, a chronic quirk in weight's tug-of-war.
The nurse is caring for a client who was recently diagnosed with hemophilia. Which of the following laboratory tests is consistent with that diagnosis?
- A. Prolonged activated partial thromboplastin time
- B. Prolonged prothrombin time
- C. Decreased platelet count
- D. Decreased bleeding time
Correct Answer: A
Rationale: Hemophilia factor VIII or IX lack stretches aPTT, as intrinsic clotting lags, a lab fit for this X-linked bleed fest. PT stays normal extrinsic path's fine. Platelets don't drop; bleeding time's off-base. Nurses spot prolonged aPTT, confirming hemophilia's clotting chaos, guiding factor therapy in this bloody diagnosis.
You are monitoring your client who is at risk for spinal cord compression related to tumor growth. Which client statement is most likely to suggest early manifestation?
- A. Last night my back really hurt, and I had trouble sleeping
- B. My leg has been giving out when I try to stand
- C. My bowels are just not moving like they usually do
- D. When I try to pass my urine, I have difficulty starting the stream
Correct Answer: A
Rationale: Spinal cord compression from tumors strikes early with back pain reported in 95% of cases as vertebral pressure or nerve irritation flares, a red flag needing urgent imaging to prevent paralysis. Leg weakness signals motor loss, a later sign as compression worsens. Bowel or bladder issues like constipation or hesitancy mark advanced nerve involvement, not initial hints. Nurses prioritize this pain statement, recognizing its prevalence and timing, prompting swift action like steroids or surgery to halt progression, critical in cancer clients where spinal integrity dictates mobility and survival.