Nokea
After change-of-shift report on the oncology unit, which patient should the nurse assess first?
- A. Patient who has a platelet count of 82,000/μL after chemotherapy
- B. Patient who has xerostomia after receiving head and neck radiation
- C. Patient who is neutropenic and has a temperature of 100.5°F (38.1°C)
- D. Patient who is worried about getting the prescribed long-acting opioid on time
Correct Answer: C
Rationale: Neutropenia plus fever 100.5°F screams infection risk, a sepsis threat needing instant assessment per ABCs in this chemo-ravaged unit. Platelets at 82,000 bleed less urgently; xerostomia's dry mouth annoys, not kills; opioid timing's comfort, not crisis. Nurses hit fever first, anticipating cultures or antibiotics, a life-saving triage in oncology's fragile lineup.
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A 56 yo man presents with a penetrating wound to his leg from a wooden stake. The wound is contaminated with debris. His last tetanus booster was 12 years ago, but records reliably indicate he's had 3 doses of tetanus vaccine. The most appropriate anti-tetanus regimen for him is:
- A. ADT (Adult Diphtheria Tetanus) plus tetanus Ig (immunoglobulin)
- B. Tetanus Ig only
- C. ADT only
- D. Child diphtheria tetanus, as he is immunologically 'immature'
Correct Answer: C
Rationale: Dirty stake, 12 years off ADT boosts his three-dose base, no Ig for primed; kid shots, nothing's off. Nurses jab this chronic recall.
Which of the following statements regarding factors leading to obesity is FALSE?
- A. The factors known to cause obesity are complex and multiple
- B. Twin, family and adoption studies show that the rate of heritability of BMI is high, ranging from 40% to 70% demonstrating a major genetic component
- C. More recent studies have identified a potential role for the microbial content of the skin
- D. Emotional factors are well-known to be potent modulators of appetite
Correct Answer: C
Rationale: Obesity's mess genes, emotions, drugs stack up; gut microbes, not skin, tip scales. Nurses sift this chronic cause pile, nixing dermal fluff.
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.
The following strategies can be used to help patients overcome the barriers and challenges faced in insulin therapy EXCEPT:
- A. Threaten patient into adherence with insulin therapy
- B. Engage the patient in shared decision-making, select an insulin regimen that they can adhere to
- C. Provide close supervision and follow up when the patient is newly initiated on insulin therapy
- D. Offer measures to reduce weight gain through lifestyle and dietary advice, concomitant use of insulin with metformin, SGLT-2 inhibitors, GLP-1RA
Correct Answer: A
Rationale: Effective insulin therapy strategies include shared decision-making, close supervision at initiation, and weight gain mitigation via lifestyle and adjunctive drugs like metformin all fostering adherence and success. Threatening patients, however, is counterproductive, increasing resistance, anxiety, and non-compliance, contrary to patient-centered care principles. It undermines trust, critical in chronic disease management, where collaboration and support drive outcomes. Physicians must avoid coercive tactics, focusing instead on empowerment and tailored solutions to overcome insulin therapy barriers.
A 3-year-old girl with a Wilms tumor is returning to the unit after a simple nephrectomy. Which of the following actions have the highest priority in caring for this child?
- A. Maintaining NPO.
- B. Monitoring the BP every 2 hours.
- C. Turning her every 2 hours.
- D. Administering pain medication every 4 hours.
Correct Answer: B
Rationale: After a nephrectomy for Wilms tumor, monitoring blood pressure (BP) every 2 hours is the highest priority because kidney removal disrupts renin-angiotensin regulation, risking hypo- or hypertension, especially in a young child with one remaining kidney. Using the ABCs (airway, breathing, circulation), BP falls under circulation, a critical postoperative focus to detect shock or fluid imbalance early. Maintaining NPO is temporary post-anesthesia but shifts to hydration once awake, less urgent than BP. Turning every 2 hours prevents pressure ulcers, but a mobile 3-year-old post-simple nephrectomy likely moves independently unless sedated, lowering its priority. Pain medication is key but ranks lower (e.g., G' in extended ABCs) than circulation. Frequent BP checks ensure stability, aligning with nursing's role in pediatric surgical care to prevent complications in a child adapting to single-kidney function.