Nokea
A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan?
- A. Donor bone marrow is transplanted through a sternal or hip incision.
- B. Hospitalization is required for several weeks after the stem cell transplant.
- C. The transplant procedure takes place in a sterile operating room to minimize the risk for infection.
- D. Transplant of the donated cells can be very painful because of the nerves in the tissue lining the bone.
Correct Answer: B
Rationale: HSCT for leukemia means 2-4 weeks in hospital engraftment's slow, and infection risk's sky-high in isolation. No incision it's IV. No OR it's bedside. Pain's minimal no bone nerves hit. Nurses in oncology stress this long haul, sterile stay, not surgical drama, prepping patients for the real grind.
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Which of the following diseases has the highest proportion of chronic illness deaths in Canada?
- A. Cancer
- B. Diabetes
- C. Cardiovascular disease
- D. Chronic respiratory disease
Correct Answer: C
Rationale: Cardiovascular disease tops Canada's chronic death chart 37% globally in 2012 outpacing cancer's 27%, respiratory's 8%, and diabetes' 4%. Heart attacks and strokes dominate, fueled by aging and lifestyle, a stat nurses lean on for prevention focus. Cancer's big, breathing woes and sugar issues trail, but heart's the killer king, a chronic burden demanding vigilance.
The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider?
- A. Hematocrit 30%
- B. Platelets 95,000/µL
- C. Hemoglobin 10 g/L
- D. White blood cells (WBC) 2700/µL
Correct Answer: D
Rationale: WBC at 2700/µL post-chemo yells neutropenia infection risk's sky-high, outranking anemia (A, C) or platelets (B bleeding's later, under 20,000). Nurses in oncology report this stat low white cells can spiral to sepsis, a chemo killer needing urgent tweaks.
The best way to prevent chronic complications of diabetes is to:
- A. Take medications as prescribed and remove sugar from the diet completely.
- B. Check feet daily for cuts, long toe nails and infections between the toes.
- C. Maintain a BGL that is as close to normal as possible.
- D. Undertake daily exercise to burn up the excess glucose in the system.
Correct Answer: C
Rationale: Preventing diabetes complications (e.g., neuropathy, retinopathy) hinges on glycemic control. Medications and sugar elimination help, but total sugar removal is impractical carbohydrates are broader, and control, not absence, matters. Daily foot checks prevent ulcers but address consequences, not root causes. Maintaining blood glucose levels (BGL) near normal (e.g., HbA1c <7%) via diet, exercise, and drugs prevents microvascular (kidney, eye) and macrovascular (heart) damage, per ADA guidelines. Exercise burns glucose, aiding control, but isn't singularly best' it's part of a triad. Tight BGL management reduces oxidative stress, glycation, and vascular injury, evidenced by trials (e.g., DCCT), making it the cornerstone strategy over isolated tactics, ensuring long-term organ protection.
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.
The Pulmonary rehabilitation program consists of several specific components. Which of the following are not a part of the program?
- A. Education and self-management
- B. Exercise training
- C. Coping measures to relieve anxiety, depression and changes in behaviour
- D. Spirometry
Correct Answer: D
Rationale: Pulmonary rehab builds COPD strength education, exercise, coping tools for mind and mood, all in. Spirometry's a test, not therapy diagnoses, doesn't train. Nurses skip it here, a chronic fix's focus.