Nokea
In order to delay the progression of CKD, the single most important intervention is:
- A. Prescription of an ACE or ARB
- B. Reducing dietary sodium
- C. Increasing physical activity
- D. Achieving good blood pressure control
Correct Answer: D
Rationale: CKD's brake BP control tops ACEs, salt cuts, or workouts, slashing glomeruli strain, a chronic slowdown king. Nurses prioritize this, a pressure-driven win.
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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.
Which of the following is NOT an early warning symptom of hypoglycaemia?
- A. Tremors
- B. Palpitations
- C. Diaphoresis
- D. Giddiness, drowsiness
Correct Answer: D
Rationale: Hypo's early buzz tremors, palpitations, sweat, anxiety screams adrenaline, waking patients to act. Giddiness and drowsiness lag, hitting as brain sugar drops, a later neuroglycopenic fade, not the first alarm. Clinicians teach this split, pushing quick carbs at the front signs, a chronic drill to dodge the haze.
A nurse is caring for a 65-year-old male who recently underwent an aortic valve replacement. Which of the following is a post-operative nursing care priority?
- A. Temperature monitoring
- B. Assess for bleeding
- C. Advance diet as tolerated
- D. Dressing change
Correct Answer: B
Rationale: Valve replacement bleeds assessing for hemorrhage at surgical sites or anticoagulation tops post-op care, a life-or-death watch per ABCs. Fever, diet, dressings matter, but bleeding's immediate. Nurses hunt oozing or shock, ensuring stability, a priority in this fresh-cut cardiac zone.
Madam Tan is newly diagnosed to have Type 2 DM. Her fasting plasma glucose is 12 mmol/L. Her blood pressure and fasting lipid profile are normal. She has been provided with patient education and advice on therapeutic life-style modification. Which is the most appropriate course of management for this lady?
- A. Commence her on combination therapy of three oral hypoglycaemic agents
- B. Motivate her to adhere with life-style modification
- C. Commence her on monotherapy of oral hypoglycaemic agent
- D. Commence her on combination therapy of two oral hypoglycaemic agents
Correct Answer: C
Rationale: New type 2, fasting 12 lifestyle's fresh, so metformin monotherapy starts, easing glucose without overload. Triple or dual oral's too much; insulin's for later; pushing lifestyle alone won't cut it yet. Nurses build this chronic base, balancing effort and meds.
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.