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A previously well 25 week pregnant lady presents as a neighbours child she was looking after 2 days ago has developed chicken pox. What would you advise?
- A. Check her serology
- B. Zoster immunoglobulin if negative serology
- C. Prophylactic aciclovir if negative serology
- D. A and B
Correct Answer: A
Rationale: Pregnant, 25 weeks check serology; VZIG or aciclovir jumps if negative, not all. Nurses test first, a chronic fetal guard.
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A government initiative to reduce the effects of fatigue in the workforce has recently been rolled out. As anaesthetic lead, you are asked by the chief executive of your institution to develop strategies to reduce fatigue in your department. Appropriate strategies are likely to include:
- A. Changing the frequency of night shifts on the on-call rota from every 3 days to every 2 weeks.
- B. Including a section in the trainee's handbook on the signs of fatigue, along with prevention and management strategies.
- C. Acquiring a departmental exercise bike.
- D. Reducing the number of night shifts worked by colleagues over 55 years of age.
Correct Answer: A
Rationale: Fatigue mitigation in anaesthesia enhances safety. Reducing night shift frequency from every 3 days to every 2 weeks allows recovery (per sleep science, 48-72 hours post-night shift), significantly cutting cumulative fatigue versus less impactful measures. A handbook educates on fatigue signs (e.g., yawning, errors) and strategies (naps, caffeine), but it's passive. An exercise bike offers minor alertness boosts but not sustained relief. Age-based shift reduction addresses older workers' recovery needs, yet evidence favors roster spacing for all. Refreshments help minimally. Frequent night shifts disrupt circadian rhythms and sleep homeostasis, amplifying error risk (e.g., medication misdosing); a 2-week gap aligns with occupational health guidelines for sustained performance.
Set in motion and continue the trajectory projection and scheme' is a goal of management in which of the following trajectory phases?
- A. Pretrajectory
- B. Onset
- C. Comeback
- D. Downward
Correct Answer: C
Rationale: Comeback phase kicks plans alive sustaining chronic care's path, not preventing, starting, or adapting decline. Nurses steer this, a rebound's drive.
A client has a platelet count of 9800/mm^3. What action by the nurse is most appropriate?
- A. Assess the client for calf pain, warmth, and redness.
- B. Instruct the client to call for help to get out of bed.
- C. Obtain cultures as per the facility's standing policy.
- D. Place the client on protective isolation precautions.
Correct Answer: B
Rationale: A platelet count of 9800/mm^3 is severely low (normal is 150,000-450,000/mm^3), indicating thrombocytopenia, a common chemotherapy side effect that heightens bleeding risk. The most appropriate action is instructing the client to call for help before getting out of bed to prevent falls or injuries that could trigger uncontrolled bleeding, such as intracranial hemorrhage. Assessing for calf pain, warmth, and redness checks for thrombosis, which is unrelated to low platelets thrombosis risk rises with high counts. Obtaining cultures relates to infection, tied to low white cells, not platelets. Protective isolation is for neutropenia, not thrombocytopenia. This safety-focused intervention minimizes physical risk, crucial in oncology where low platelets demand proactive prevention to avoid life-threatening bleeds, empowering the client while ensuring nurse oversight.
Appropriate statements concerning intrathecal drug delivery systems include:
- A. In a patient with progressive cancer-related pain, a low-grade pelvic infection is an absolute contraindication for implanting either an intrathecal catheter or a pump, even under antibiotic cover.
- B. Intrathecally administered opioids circulate to the central neuraxis, including the brainstem, where they are likely to cause drowsiness and respiratory depression.
- C. In difficult cases, ziconotide can be administered with either an opioid or clonidine, or both.
- D. As a mixture of opioid and clonidine is expected to distribute throughout the cerebrospinal fluid, the level of the catheter in the intrathecal space is unlikely to be important.
Correct Answer: B
Rationale: Intrathecal drug delivery systems (IDDS) manage severe pain with nuances. A low-grade pelvic infection isn't an absolute contraindication; implantation may proceed with antibiotics if benefits outweigh risks (e.g., cancer palliation). Intrathecal opioids do reach the brainstem via cerebrospinal fluid, causing drowsiness and respiratory depression, though less than systemic routes due to lower doses still a key risk requiring monitoring. Ziconotide combines with opioids or clonidine for synergy in refractory pain, per clinical practice. Catheter tip position matters; drug distribution isn't uniform higher placement enhances rostral spread, affecting efficacy and side effects. MRI compatibility exists with most modern pumps. The brainstem effect of opioids underscores IDDS's potency and danger, necessitating careful titration and patient selection.
Which of the following is NOT associated with obesity?
- A. Non-Alcoholic Fatty Liver Disease
- B. Obstructive Sleep Apnea
- C. Increased mortality
- D. Type 1 Diabetes Mellitus
Correct Answer: D
Rationale: Obesity piles on NAFLD, apnea, death risk, back ache; type 1's autoimmune, not fat-driven. Nurses link this chronic weight web, not islet crash.