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Damage control resuscitation:
- A. Is not indicated unless it is clear the patient's physiology has been deranged by severe injury.
- B. Is not indicated unless the patient is in the hospital.
- C. Is likely to involve restriction of fluid administration in a hypotensive, bleeding patient.
- D. Is likely is be assessed for adequacy by palpation of the radial pulse in patients with a head injury.
Correct Answer: C
Rationale: Damage control resuscitation (DCR) mitigates trauma's lethal triad (hypothermia, acidosis, coagulopathy). It's indicated preemptively in severe bleeding, not just post-derangement, to prevent physiologic collapse. It begins pre-hospital (e.g., paramedics), not only in-hospital, using blood products early. Fluid restriction in hypotensive bleeding limits dilutional coagulopathy, favoring permissive hypotension until haemostasis crucial in uncontrolled haemorrhage. Radial pulse palpation gauges perfusion broadly, but head injury patients need cerebral perfusion pressure prioritization, not DCR adequacy. ABC remains foundational. Fluid restriction's role balancing shock correction with bleeding exacerbation defines DCR's shift from crystalloid overload, improving survival in exsanguinating trauma.
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The antidiabetic also effective in lowering the cholesterol level is
- A. Rosiglitazone
- B. Metformin
- C. Chlorpropamide
- D. Repaglinide
Correct Answer: B
Rationale: Metformin's the cholesterol-trimming antidiabetic cuts glucose and lipids, a dual chronic win. Rosiglitazone ups insulin sensitivity, risks heart fat; chlorpropamide pumps insulin, no lipid perk; repaglinide's quick insulin hit misses cholesterol. Nurses flag metformin's bonus, a type 2 staple with vascular edge.
Risk factors for developing COPD include:
- A. Seasonal respiratory conditions and family history of emphysema
- B. Age, high fat diet and sedentary lifestyle
- C. History of cardiovascular and autoimmune conditions
- D. Indoor and outdoor air pollution
Correct Answer: D
Rationale: COPD risk factors center on chronic airway damage. Seasonal respiratory conditions may exacerbate, not cause, COPD, though family history of emphysema suggests genetic risk (e.g., alpha-1 antitrypsin deficiency), but it's less primary than exposure. Age is a factor as lung function declines naturally, but high fat diet and sedentary lifestyle are more linked to obesity or cardiovascular disease, not directly COPD. Cardiovascular and autoimmune histories don't drive COPD etiology smoking and pollution do. Indoor (e.g., biomass smoke) and outdoor air pollution (e.g., particulates) are major irritants, causing inflammation and irreversible airflow limitation, per Deravin and Anderson (2019). Pollution's role is critical globally, especially in occupational or urban settings, outweighing secondary factors by directly triggering the chronic inflammatory cascade defining COPD pathogenesis.
A nurse reviews the arterial blood gas (ABG) values of a client admitted with end-stage kidney disease; pH 7.26; PaCO2 37 mm Hg; PaO2 94 mm Hg and HCO3 15 mEq/L. What do these values indicate?
- A. Metabolic acidosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Respiratory alkalosis
Correct Answer: A
Rationale: End-stage kidney disease hampers acid excretion pH 7.26 (below 7.35) and HCO3 15 mEq/L (below 22) confirm metabolic acidosis, as kidneys fail to buffer, dropping bicarbonate. PaCO2 37 mm Hg (normal) rules out respiratory issues lungs aren't compensating yet. PaO2 94 mm Hg shows oxygenation's fine. Alkalosis options contradict low pH; respiratory acidosis needs high CO2. Nurses recognize this acid-base shift, anticipating bicarbonate or dialysis, a key intervention in renal failure's metabolic chaos.
In the year 2012, appropriate statements regarding complications of percutaneous cervical cordotomy in the UK include:
- A. Estimates of complication rates are based on pooled data in a national registry.
- B. Complications are similar to those after open surgical cordotomy.
- C. Rates of major complications such as death and paralysis are between 1 in 10000 and 1 in 1000.
- D. Persistent postural hypotension is uncommon.
Correct Answer: D
Rationale: In 2012, UK percutaneous cervical cordotomy (PCC) complication data were limited, not pooled nationally case series or institutional reports dominated. PCC's minimally invasive nature yields fewer complications (e.g., no wound infections) than open cordotomy's extensive approach. Major complications like death or paralysis are rare (<1%), below 1-in-1000 estimates, due to precise imaging and technique. Persistent postural hypotension is uncommon, linked to rare sympathetic disruption (e.g., Horner's syndrome), resolving typically. Headaches occur but aren't persistent. The low incidence of sustained hypotension reflects PCC's targeted spinothalamic focus, sparing autonomic pathways, making it a safer palliative option versus historical benchmarks.
When assigning staff to patients who are receiving chemotherapy, what is the major consideration about chemotherapeutic drugs?
- A. During preparation, drugs may be absorbed through the skin or inhaled
- B. Many chemotherapeutics are vesicants
- C. Chemotherapeutics are frequently given through central venous access devices
- D. Oral and venous routes are the most common
Correct Answer: A
Rationale: Chemotherapy's potency demands safety focus preparation risks skin absorption or inhalation, exposing staff to toxins, necessitating specialized training and protective gear. Vesicants, causing tissue damage if extravasated, are a concern, but preparation hazards affect all drugs, broader in scope. Central venous access is common but a procedural detail, not the primary staffing issue. Route prevalence is logistical, not safety-centric. Prioritizing exposure risk ensures staff handling mixing, drawing minimizes occupational harm, a legal and ethical imperative, shaping assignments to trained personnel, critical in chemotherapy's high-stakes delivery.