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Caution should be exercised in the initiation of an ARNI in all of the following clinical scenarios except:
- A. Significant hyperkalaemia
- B. Significant renal dysfunction (eGFR <30 ml/min)
- C. Patient on a maximal dose ACE-inhibitor
- D. Non-alcoholic fatty liver disease (NAFLD)
Correct Answer: D
Rationale: ARNI (sacubitril/valsartan) risks spike with hyperkalemia, renal flop (eGFR <30), ACE-I overlap, or low BP potassium, filtration, washout, and perfusion all teeter. NAFLD? No biggie liver fat doesn't sway ARNI's game. Clinicians greenlight this, dodging chronic cautions elsewhere.
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An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider?
- A. Patient complains of severe fatigue.
- B. Patient voids every hour during the day.
- C. Patient takes only 50% of meals and refuses snacks.
- D. Patient has crackles up to the midline posterior chest.
Correct Answer: D
Rationale: High-rate fluids (175 mL/hr) plus chemo in an older colorectal patient can swamp the heart crackles to midline yell heart failure, trumping fatigue , peeing , or poor eating . Nurses in oncology flag this lungs drowning need stat help, a fluid overload crisis.
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.
In which illness can hydrophobia be seen?
- A. tetanus
- B. malaria
- C. rabies
- D. EBV
Correct Answer: C
Rationale: Hydrophobia rabies' brain hates water, not tetanus' clench, malaria's sweat, EBV's glands, or HSV's sores. Nurses clock this chronic rabies red flag.
The followings are risk factors associated with non-alcoholic fatty liver disease (NAFLD) except:
- A. Elevated uric acid
- B. Elevated blood pressure
- C. Diabetes mellitus
- D. Elevated LDL-cholesterol
Correct Answer: A
Rationale: NAFLD ties to metabolic mess hypertension, diabetes, high LDL, and triglycerides fuel fat's liver pile-up, all in. Uric acid links to gout, not NAFLD's core, despite metabolic overlap. Clinicians eye this quartet, not urate, in chronic liver fat's risk map, a key split.
In the UK, percutaneous cervical cordotomy is likely to be:
- A. Indicated in patients with unilateral pain due to cancer.
- B. Indicated in patients with non-malignant pain.
- C. Effective for neck pain.
- D. Deferred until less invasive techniques have been shown to be unsuccessful.
Correct Answer: A
Rationale: Percutaneous cervical cordotomy (PCC) targets intractable pain in the UK. It's primarily indicated for unilateral cancer pain (e.g., mesothelioma), ablating the contralateral spinothalamic tract for relief below the lesion level. Non-malignant pain rarely justifies PCC due to its invasiveness and risks; alternatives like opioids suffice. Neck pain, above the typical C1-C2 entry, isn't effectively treated by PCC, which addresses lower body pain. CT guidance is common, not just fluoroscopy, for precision. It's a last resort after failed conservative treatments (e.g., nerve blocks), but the cancer-specific indication is primary unilateral pain's anatomical fit with PCC's mechanism (thermoablation) makes it a specialized palliative tool, balancing efficacy with procedural risk.