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Dexmedetomidine:
- A. Is recognized as an α₠receptor agonist.
- B. Increases the minimum alveolar concentration of volatile agents.
- C. Causes bradycardia.
- D. Has a loading dose of 0.5-1.0 μg kgâ»Â¹.
Correct Answer: C
Rationale: Dexmedetomidine is a highly selective α₂-adrenergic receptor agonist, not αâ‚, used for sedation with minimal respiratory depression. It reduces the minimum alveolar concentration of volatile anesthetics by enhancing sedation and analgesia, not increasing it. Bradycardia is a well-known side effect due to its sympatholytic action, decreasing heart rate via vagal stimulation and reduced catecholamine release. The standard loading dose is indeed 0.5-1.0 μg kgâ»Â¹ over 10 minutes, followed by infusion, aligning with clinical protocols. At high infusion rates, respiratory depression is unlikely, distinguishing it from opioids. Bradycardia's prominence as a side effect stems from its mechanism activation of α₂ receptors in the brainstem and periphery inhibits sympathetic outflow, making it a critical consideration in perioperative management, especially in patients with cardiovascular comorbidities.
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A primary nursing responsibility is the prevention of lung cancer by assisting patients in smoking/tobacco cessation. Which tasks would be appropriate to delegate to the LPN/LVN?
- A. Develop a quit plan
- B. Explain the application of a nicotine patch
- C. Discuss strategies to avoid relapse
- D. Suggest ways to deal with urges for a tobacco
Correct Answer: B
Rationale: LPN/LVNs shine in standardized teaching like explaining nicotine patch application, a medication-focused task within their scope, detailing placement and timing to aid cessation. Developing a quit plan requires RN-level planning and assessment of individual needs. Discussing relapse strategies involves behavioral counseling, an RN forte. Suggesting urge-coping methods needs tailored insight, beyond LPN/LVN training. Patch explanation leverages their skills, supporting lung cancer prevention through practical cessation aid, a delegated task enhancing team efforts while keeping complex planning with RNs.
Which of these pulmonary conditions is most likely to be seen with a CD4 count between 200 and 500 ?
- A. pulmonary TB
- B. CMV
- C. PCP
- D. Kaposi sarcoma
Correct Answer: A
Rationale: CD4 200-500 TB sneaks in, lungs ripe before deeper drops. CMV, PCP crave <200; Kaposi's skin-first; cryptococcus hits brains more. Nurses clock TB's early strike, a chronic lung foe at this immune ledge.
Which statement about carcinogenesis is accurate?
- A. An initiated cell will always become clinical cancer.
- B. Cancer becomes a health problem once it is 1 cm in size.
- C. Normal hormones and proteins do not promote cancer growth.
- D. Tumor cells need to develop their own blood supply.
Correct Answer: D
Rationale: Carcinogenesis is the multi-step process by which normal cells transform into cancer cells, involving initiation, promotion, and progression. A key aspect of this process is angiogenesis, where tumor cells induce the formation of new blood vessels to supply nutrients and oxygen, enabling their growth beyond a minimal size. This is a critical step, as without a blood supply, tumors cannot sustain themselves or expand significantly. The statement that an initiated cell always becomes cancer is inaccurate because initiation alone is not sufficient; it requires promoters to progress. Similarly, the idea that cancer only becomes a problem at 1 cm oversimplifies the issue tumors can pose health risks earlier depending on location and type, though 1 cm is a detectable size. Normal hormones and proteins, like estrogen or growth factors, can indeed act as promoters in carcinogenesis, contradicting that option. Thus, the need for a tumor to develop its own blood supply is the most accurate statement, reflecting a fundamental biological requirement for cancer progression, which nurses must recognize when caring for oncology patients.
What is the cut-off of blood pressure for the diagnosis of hypertension that is recommended by MOH Clinical Practice Guideline?
- A. 120/70 mmHg
- B. 125/75 mmHg
- C. 130/70 mmHg
- D. 140/90 mmHg
Correct Answer: D
Rationale: MOH guidelines hold hypertension at 140/90 mmHg, a conventional cutoff balancing sensitivity and specificity for diagnosis in primary care, aligning with global norms like WHO. Lower thresholds 120/70, 125/75, 130/70, 135/80 catch prehypertension or align with newer AHA standards, but MOH sticks to 140/90 for actionable clarity, triggering treatment to curb stroke or heart risks. This higher bar avoids overdiagnosis in resource-stretched settings, ensuring focus on clear disease, a practical call for managing chronic vascular load.
Mr Yee, 45 years old, reports three recent gout attacks in the ankle or knee. You notice a small tophus over his left elbow. He says that two years ago he took allopurinol 100 mg for one month followed by 200 mg OM for one month, but stopped as it 'did not help his gout and there was no improvement'. When you probe, he states that he was not very adherent to allopurinol either then as it was some years ago. He says he took it likely 'once or twice a week'. He states that he did not experience any rashes or other side effects to it then. He did not go back to see his previous GP as he has moved house and your clinic is nearer to his home. He does not drink alcohol except one glass of wine once or twice a year on special occasions. Two weeks ago, he was admitted to the hospital for a gout flare. He had blood tests done, which returned the results below. He is asking you to give him Arcoxia standby as it usually works for his gout flare. Uric acid 620 mmol/L, Creatinine 96 umol/L, eGFR >90 mL/min, BP 144/94 mmHg. He has HTN on HCTZ long-term. Which is incorrect advice?
- A. Offer to restart allopurinol and explain that it does not work immediately. You may wish to discuss HLA B5801 testing particularly as it is unclear how frequent and for how long he was taking allopurinol previously
- B. Advise that he will need stepwise up-titration of a urate lowering agent to reach uric acid target. Regular blood tests will allow this to be done safely
- C. Advice that colchicine prophylaxis is helpful to prevent gout attacks, as it takes time for a urate lowering agent to reach uric acid target
- D. Advise him that allopurinol is ineffective. Offer to initiate febuxostat or probenecid immediately
Correct Answer: D
Rationale: Tophus and 620 uric acid yell chronic gout allopurinol's not bunk; past spotty use tanked it, not the drug. Restarting with titration, colchicine cover, and allergy watch fits; HLA testing flags risk. Swapping to febuxostat or probenecid skips allopurinol's shot wrong call when adherence, not efficacy, flopped. Clinicians correct this, steering chronic control right.