Nokea
A patient is scheduled for upcoming surgery. He is on nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. You are being asked what to do with his medications for the surgery. What is the mechanism of action of NSAIDS?
- A. Irreversible inhibition of cyclooxygenase 1
- B. Irreversible inhibition of cyclooxygenase 2
- C. Reversible inhibition of cyclooxygenase 1
- D. Reversible inhibition of cyclooxygenase 2
Correct Answer: C
Rationale: The correct answer is C: Reversible inhibition of cyclooxygenase 1. NSAIDs work by reversibly inhibiting cyclooxygenase enzymes, particularly COX-1 and COX-2, which are involved in the synthesis of prostaglandins. In this case, reversible inhibition is crucial because it allows for the temporary suppression of prostaglandin production, leading to pain relief and anti-inflammatory effects.
Explanation of other choices:
A: Irreversible inhibition of cyclooxygenase 1 - This is incorrect because NSAIDs typically do not irreversibly inhibit COX-1.
B: Irreversible inhibition of cyclooxygenase 2 - This is incorrect because NSAIDs do not irreversibly inhibit COX-2.
D: Reversible inhibition of cyclooxygenase 2 - This is incorrect because while NSAIDs can inhibit COX-2, the primary target is COX-1 for their therapeutic effects.
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The commonest cause of jaundice in thalassemia is:
- A. viral hepatitis c
- B. iron deposition in liver
- C. viral hepatitis B
- D. haemolysis
Correct Answer: D
Rationale: The correct answer is D: haemolysis. In thalassemia, there is an abnormality in hemoglobin production leading to the destruction of red blood cells, causing hemolysis. This results in the release of bilirubin, leading to jaundice. Iron deposition in the liver (choice B) is seen in conditions like hemochromatosis, not thalassemia. Viral hepatitis B and C (choices A and C) can cause jaundice, but they are not the commonest cause in thalassemia patients, as hemolysis is the primary mechanism in this population.
The main vector transmitting malaria in Sabah is Anopheles balabacensis. This vector breeds in
- A. Artificial containers in urban centres
- B. Drains
- C. Temporary collecting of water in jungles
- D. Rock pools in control areas
Correct Answer: C
Rationale: The correct answer is C because Anopheles balabacensis, the main vector transmitting malaria in Sabah, breeds in temporary water collections in jungles. This is supported by research showing that this mosquito species prefers breeding in natural habitats like jungle pools. Choices A, B, and D are incorrect because Anopheles balabacensis is not typically found breeding in artificial containers in urban centers, drains, or rock pools in control areas. These habitats do not provide the specific environmental conditions required for the breeding and survival of this particular mosquito species.
The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?
- A. Do you take salicylates?
- B. Are you taking any oral contraceptives?
- C. Have you been prescribed antiseizure drugs?
- D. How long have you taken antihypertensive drugs?
Correct Answer: A
Rationale: Correct Answer: A: Do you take salicylates?
Rationale:
1. Petechiae are tiny red or purple spots caused by bleeding under the skin.
2. Salicylates (like aspirin) can cause bleeding issues leading to petechiae.
3. Asking about salicylate use helps identify a potential cause for the petechiae.
Summary of Incorrect Choices:
B: Oral contraceptives are not typically associated with petechiae.
C: Antiseizure drugs do not commonly cause petechiae.
D: Antihypertensive drugs are not known to be a common cause of petechiae.
A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective?
- A. PT
- B. WBC
- C. Hgb
- D. Platelets
Correct Answer: C
Rationale: The correct answer is C: Hgb (hemoglobin). Epoetin is a medication used to stimulate red blood cell production, which should increase hemoglobin levels. Higher hemoglobin levels indicate improved oxygen-carrying capacity and overall effectiveness of the therapy. PT (A), WBC (B), and Platelets (D) are not directly affected by epoetin therapy, so an increase in these values would not be indicative of the medication's effectiveness.
A leukemia investigator plans to obtain bone marrow under general anesthesia to measure minimal residual disease (MRD) and to see if this time point can predict early relapse. The specimen will be obtained at a time point when otherwise no bone marrow would be sampled. The results are not shared with the treating oncologist, and no therapeutic interventions are decided or based on the results. Which of the following statements is most accurate about this intervention?
- A. It constitutes a minimal-risk procedure because bone marrow assessments are considered routine for patients diagnosed with acute lymphoblastic leukemia.
- B. It constitutes a minimal-risk procedure because it is a single additional procedure being performed during the course of treatment.
- C. It constitutes a greater than minimal-risk procedure because it is being done under general anesthesia.
- D. It is justifiable because future patients may benefit from knowledge gained by the research.
Correct Answer: C
Rationale: The correct answer is C because obtaining bone marrow under general anesthesia carries inherent risks that make it greater than minimal-risk. Here's a step-by-step rationale:
1. General anesthesia poses risks such as allergic reactions, breathing problems, and potential complications, making the procedure more than minimal-risk.
2. Even though bone marrow assessments are routine for leukemia patients, the use of general anesthesia elevates the risk level.
3. The fact that the results are not shared with the treating oncologist and no therapeutic interventions are based on them indicates that the procedure is solely for research purposes, emphasizing the risk-benefit analysis.
4. Choice A is incorrect because the use of general anesthesia increases the procedure's risk level beyond routine.
5. Choice B is incorrect as the focus should be on the inherent risks of general anesthesia, not just the number of procedures performed.
6. Choice D is irrelevant to the risk assessment of the specific procedure and does not address the immediate safety concerns associated with general anesthesia.