Nokea
In Europe and the USA, drugs licensed for use in intrathecal drug delivery systems include:
- A. Diamorphine.
- B. Methadone.
- C. Morphine.
- D. Ziconotide.
Correct Answer: C
Rationale: Intrathecal drug delivery systems (IDDS) use specific licensed drugs in Europe and the USA. Morphine is widely approved for its efficacy in cancer and chronic pain, binding spinal opioid receptors with a strong evidence base. Ziconotide, a non-opioid, is also licensed, targeting calcium channels for refractory cases. Diamorphine (heroin) isn't licensed intrathecally; it's used epidurally or systemically in some regions (e.g., UK palliative care) but lacks IDDS approval. Methadone's long half-life and oral efficacy preclude intrathecal use; it's not licensed. Ketamine has experimental use but no formal approval. Morphine's prominence stems from its pharmacokinetic suitability high potency and spinal receptor affinity making it a cornerstone of IDDS therapy alongside ziconotide.
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You are seeing Mr Yee two months later. At your last visit, he did not want colchicine prophylaxis as he did not want to take 'too many tablets'. He has started and is adherent to his urate lowering agent. Last month, his uric acid had decreased to 390 mmol/L. He had a gout flare last week. Hence, he came to your clinic today to ask about colchicine prophylaxis. Which is INCORRECT advice regarding colchicine prophylaxis?
- A. Offer to start colchicine at 500 mcg once daily or alternate days as gout prophylaxis as his renal function is normal
- B. Colchicine can help to reduce the frequency of flares, especially during the first six months of Urate lowering therapy
- C. Tell him that if he is started on NEW medications, he should inform his doctor or pharmacist that he is on colchicine regularly as colchicine can have drug interactions. If unsure and he needs to take NEW medications, such as a short course of antibiotics, he is to omit colchicine until the new medication is completed
- D. Regular colchicine prophylaxis in someone with normal renal function and regular monitoring can lead to renal failure
Correct Answer: D
Rationale: Colchicine curbs flares 500 mcg fits normal kidneys, cuts attacks in urate-lowering's rocky start, and needs drug interaction flags or skips with gut upset. But renal failure from regular use with monitoring? False colchicine's safe there, not a kidney killer. Clinicians nix this myth, grounding chronic gout aid in truth.
People with poorly controlled type 2 diabetes often show increased fasting blood glucose levels. Question: What causes these increased fasting blood glucose levels?
- A. Disturbed glucose uptake in adipose tissue due to insulin resistance
- B. Disturbed hepatic glucose uptake due to insulin resistance
- C. Disturbed suppression of hepatic glucose production by insulin
- D. Disturbed hepatic glucose uptake due to reduced insulin levels in portal blood
Correct Answer: C
Rationale: Type 2's fasting high liver pumps glucose, insulin can't hush it, resistance rules. Fat uptake's small, liver uptake's not key production's the leak nurses target this, a chronic dawn gush.
Foam cells are a prominent feature of atherosclerosis. Question: Foam cells develop as a result of which of the following options?
- A. Uptake of LDL in macrophages
- B. Uptake of LDL by LDL-R
- C. Uptake of ox-LDL by scavenger receptors
- D. Uptake of LDL by scavenger receptors
Correct Answer: C
Rationale: Foam cells ox-LDL via scavenger receptors stuff macrophages, not plain LDL or LDL-R. Nurses see this, a chronic plaque birth.
An oncology nurse is contributing to the care of a patient who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRMs). The nurse should know that these achieve a therapeutic effect by what means?
- A. Promoting the synthesis and release of leukocytes
- B. Focusing the patient's immune system exclusively on the tumor
- C. Potentiating the effects of chemotherapeutic agents and radiation therapy
- D. Altering the immunologic relationship between the tumor and the patient
Correct Answer: D
Rationale: BRMs (e.g., interferon, IL-2) tweak the immune-tumor dance revving up the body's attack or slowing cancer's evasion, not just pumping out leukocytes or boosting chemo/radiation. They don't laser-focus immunity but shift the balance, like marking tumors for T-cells. Nurses in oncology grasp this, knowing BRMs offer a Hail Mary when standard stuff flops, targeting that host-tumor interplay.
A nurse is performing discharge teaching for a client who was recently diagnosed with heart failure. Which of the following should be included in the client and family teaching?
- A. Low sodium diet
- B. Weekly weights
- C. Symptoms to report to the provider
- D. Fluid restriction
Correct Answer: A
Rationale: Heart failure management hinges on education to prevent exacerbations. A low sodium diet reduces fluid retention, easing cardiac workload crucial teaching for clients and families to grasp, as salt drives edema and hypertension, common pitfalls in heart failure. Weekly weights track fluid shifts daily is ideal, but weekly still aids while reporting symptoms like dyspnea flags worsening. Medication teaching ensures adherence, and fluid restriction may apply, but sodium's broader impact makes it foundational. Focusing on diet empowers lifestyle change, tackling a root cause over monitoring or restrictions alone, aligning with nursing's role in empowering self-care to stabilize this chronic condition long-term.