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All of the following are potential factors leading to weight gain EXCEPT:
- A. Disrupted circadian rhythm
- B. Use of anti-histamines and sulphonylureas
- C. Changes in gut microbiota
- D. Controlled food portions that are of low energy density
Correct Answer: D
Rationale: Weight gain factors include disrupted circadian rhythm (metabolic dysregulation), antihistamines/sulphonylureas (appetite increase, insulin secretion), and gut microbiota shifts (altered energy harvest). Controlled food portions of low energy density (e.g., vegetables) reduce calorie intake, aiding weight loss, not gain, per obesity research. This exception highlights dietary control's role in managing chronic conditions like diabetes or obesity, guiding physicians in patient counseling for sustainable weight regulation.
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Renal failure is the second cause of death in patients with diabetes mellitus. Question: What is the end (histological) stage in the development of diabetic nephropathy?
- A. Arteriolar hyalinosis
- B. GBM thickening
- C. Kimmerstiel Wilson lesions
- D. Mesangial matrix expansion
Correct Answer: C
Rationale: Diabetic nephropathy's end Kimmerstiel Wilson nodules scar kidneys, past thickening or expansion. Nurses dread this, a chronic renal doom mark.
Oxygen radicals play a role in the development of which of the following options?
- A. Diabetic dyslipidaemia
- B. Insulin resistance
- C. Mitochondrial dysfunction
- D. B+C
Correct Answer: D
Rationale: Oxygen radicals torch cells insulin resistance via inflammation, mitochondrial dysfunction via damage. Dyslipidaemia rides along, not direct nurses see this duo, a chronic stress pair.
Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients should the nurse assess first?
- A. Client with dry, itchy, peeling skin
- B. Client with a serum calcium of $9.2 mg/dL
- C. Client with a serum potassium of $2.8 mEq/L
- D. Client with a weight gain of 0.5 pound (1.1 kg) in 1 day
Correct Answer: C
Rationale: Tyrosine kinase inhibitors (TKIs) target cancer cell signaling pathways but can cause electrolyte imbalances, among other side effects. A serum potassium of 2.8 mEq/L (normal 3.5-5.0 mEq/L) is critically low, risking cardiac arrhythmias or muscle dysfunction, making this client the priority for immediate assessment. Dry, itchy, peeling skin is a common TKI side effect, uncomfortable but not immediately life-threatening, warranting later attention for infection risk. A calcium level of 9.2 mg/dL is normal (8.5-10.2 mg/dL), requiring no urgent action. A 0.5-pound weight gain in a day is minor and less critical unless part of a pattern suggesting fluid retention. The nurse prioritizes the potassium imbalance due to its potential for rapid, severe consequences, reflecting oncology's emphasis on addressing physiological instability first.
Appropriate statements regarding markers of outcome after major surgery in England in 2014 include:
- A. Data about each hospital's complication rates after surgery are readily available.
- B. Data about each hospital's 30-day mortality after surgery are readily available.
- C. For most procedures, 90-day mortality rate are similar to 30-day mortality rates.
- D. National Hospital Episode Statistics (HES) data are useful for monitoring the performance of units.
Correct Answer: B
Rationale: In 2014 England, surgical outcome transparency increased. Complication rates weren't universally published per hospital, varying by procedure and trust. However, 30-day mortality data were widely available, notably via NHS initiatives and specialty audits (e.g., National Joint Registry), reflecting short-term success. Ninety-day mortality often exceeds 30-day rates (e.g., in vascular surgery), capturing delayed deaths, so they're not typically similar. HES data, capturing inpatient episodes, help monitor trends and performance, though coding accuracy limits granularity. Weekend admission mortality was higher, per studies like 2015 BMJ, due to staffing and care differences. The availability of 30-day mortality data was a key quality metric, driving accountability and improvement in surgical care.
The following strategies can be used to help patients overcome the barriers and challenges faced in insulin therapy EXCEPT:
- A. Engage the patient in shared decision making
- B. Threaten the patient into adherence with insulin therapy
- 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, GLPIRA
Correct Answer: B
Rationale: Insulin's hurdles yield to shared decisions, close watch, weight tricks, and goal setting empowering, not bullying. Threats tank trust and adherence, backfiring in chronic care where buy-in's king. Support beats scare tactics, aligning with diabetes' need for partnership, a strategy flop amid solid aids.