Nokea
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.
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You are caring for a patient with esophageal cancer. Which task could be delegated to the nursing assistant?
- A. Assist the patient with oral hygiene
- B. Observe the patient's response to feedings
- C. Facilitate expression of grief or anxiety
- D. Initiate daily weights
Correct Answer: A
Rationale: Delegating tasks in nursing hinges on scope of practice. Assisting with oral hygiene is a basic care activity nursing assistants are trained to perform, supporting hygiene needs in esophageal cancer patients who may struggle with swallowing. Observing responses to feedings requires clinical judgment to assess tolerance or complications, a nurse's responsibility. Facilitating emotional expression involves therapeutic communication skills beyond an assistant's training, critical for addressing cancer-related distress. Initiating daily weights implies deciding when to start, requiring understanding of fluid status assistants can weigh patients but not initiate the process independently. Oral hygiene delegation optimizes care efficiency, aligns with assistants' capabilities, and frees nurses for higher-level assessments, ensuring safe, effective management of this patient's complex needs.
Which of the following is the surgical treatment of choice for end-stage heart failure?
- A. Cardiac resynchronization therapy (CRT)
- B. Percutaneous angiogram
- C. Genetic counseling
- D. Ventricular assist devices (VADs)
Correct Answer: D
Rationale: End-stage heart failure, when drugs and pacing fail, leans on ventricular assist devices mechanical pumps aiding circulation, a bridge to transplant or destination therapy. CRT syncs ventricles, less invasive, but VADs tackle severe pump collapse. Angiograms diagnose, not treat; genetic counseling's irrelevant. Nurses prep for VADs, managing post-op risks, the go-to surgical fix in this terminal cardiac scenario.
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider?
- A. Poor oral intake
- B. Frequent loose stools
- C. Complaints of nausea and vomiting
- D. Increase in carcinoembryonic antigen (CEA)
Correct Answer: D
Rationale: Colorectal cancer's chemo tracks via CEA rising levels signal progression or resistance, a red flag for therapy tweak, needing provider input. Poor intake, diarrhea, and nausea are side effects, manageable with nursing care diet, fluids, antiemetics unless extreme. CEA's uptick, a tumor marker, trumps symptoms, hinting at disease outpacing treatment. Nurses flag this, pushing for scans or regimen shifts, a critical catch in this cancer's chemo dance.
A nurse has taught a client about dietary changes that can reduce the chances of developing cancer. What statement by the client indicates the nurse needs to provide additional teaching?
- A. Foods high in vitamin A and vitamin C are important.
- B. I'll have to cut down on the amount of bacon I eat.
- C. I'm so glad I don't have to give up my juicy steaks.
- D. Vegetables, fruit, and high-fiber grains are important.
Correct Answer: C
Rationale: Diet plays a significant role in cancer prevention, and nurses often educate clients on evidence-based dietary adjustments. Foods rich in vitamins A and C, such as carrots and citrus fruits, are known to have antioxidant properties that may reduce cancer risk by neutralizing free radicals. Reducing processed meats like bacon is advised due to their association with colorectal cancer, linked to nitrates and high fat content. Similarly, high vegetable, fruit, and fiber intake is recommended for their protective effects against various cancers, including colon cancer. However, excessive red meat consumption, such as steaks, is a known risk factor for cancers like colorectal and prostate cancer due to saturated fats and carcinogenic compounds formed during cooking. The client's statement about not giving up steaks suggests a misunderstanding, indicating the nurse must clarify that limiting red meat, not just processed meat, is part of a cancer-preventive diet. This additional teaching is essential to ensure the client adopts a comprehensive approach to reducing cancer risk.
Which of the following statements on NAFLD is false?
- A. Weight loss is the prime way of management
- B. Long-term management is needed
- C. Patients should be referred to specialists for further evaluation
- D. Metformin should be used as first-line treatment in patients with NAFLD and diabetes mellitus
Correct Answer: D
Rationale: Weight loss (5-10%) is prime for NAFLD, long-term care is essential, and specialist referral aids complex cases all true. Statins manage dyslipidemia safely in NAFLD. Metformin, though first-line for diabetes, isn't for NAFLD itself lacking evidence for steatosis reversal making this false. Physicians must clarify this in chronic care planning.