Nokea
In the treatment of COPD:
- A. Inhaled long-acting β₂ agonists are a first-line treatment for breathlessness.
- B. Most patients require maintenance use of oral corticosteroids.
- C. The dosage of oral theophylline needs to be reduced in patients commenced on erythromycin.
- D. Long-term oxygen therapy is indicated in a stable patient with a Paâ‚“â‚‚ of 8.5 kPa.
Correct Answer: C
Rationale: COPD management focuses on symptom relief and preventing exacerbations. Inhaled long-acting β₂ agonists are indeed used for breathlessness but are not always first-line; short-acting bronchodilators often precede them. Maintenance oral corticosteroids are not standard due to significant side effects; inhaled corticosteroids are preferred. Theophylline, a bronchodilator, has its metabolism inhibited by erythromycin (a CYP3A4 inhibitor), increasing plasma levels and toxicity risk, necessitating dose reduction. Long-term oxygen therapy is indicated for severe hypoxemia (Paₓ₂ < 7.3 kPa or 7.3-8 kPa with complications), not at 8.5 kPa, which is relatively normal. Non-invasive ventilation is reserved for acute exacerbations, not first-line treatment. The interaction between theophylline and erythromycin is a critical pharmacological consideration in COPD management, making it the standout correct statement.
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A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best?
- A. Ensure the client is placed in protective isolation.
- B. Hand off a pregnant client to another nurse.
- C. No special action is necessary to care for this client.
- D. Read the policy on handling radioactive excreta.
Correct Answer: D
Rationale: Iodine-131 is a radioactive isotope used in treatments like thyroid cancer therapy, and it is excreted through body fluids such as urine and sweat. This poses a radiation hazard to healthcare workers and others if not managed properly. The best action for a new nurse is to read the facility's policy on handling radioactive excreta, as this ensures adherence to safety protocols specific to the institution, protecting both the nurse and the client. Protective isolation is not typically required for iodine-131 patients; instead, radiation precautions limit exposure to others. Handing off a pregnant client might be relevant in other contexts but isn't the priority here unless the nurse is pregnant herself, which isn't specified. Assuming no special action is needed is dangerous given the radioactive nature of the treatment. Reviewing the policy equips the nurse with the knowledge to manage waste, maintain a safe distance, and use protective equipment, aligning with radiation safety principles critical in oncology nursing.
Nursing considerations that should be applied in the management of people with type 2 diabetes mellitus include:
- A. Blood glucose level monitoring before and after meals.
- B. Preventing the consumption of all high carbohydrate foods.
- C. Skin, foot, and pressure area care when hospitalised.
- D. Minimising exercise to prevent fatigue and foot ulcers.
Correct Answer: C
Rationale: Nursing care for type 2 diabetes balances monitoring, prevention, and education. Blood glucose monitoring pre/post-meals informs insulin adjustments but isn't universally required frequency varies. Banning all high-carb foods is unrealistic; moderation via glycemic index guides diet, not prohibition. Skin, foot, and pressure area care is critical in hospital peripheral neuropathy and poor healing (e.g., Bob's case) risk ulcers and infections, needing daily inspection and protection, per standards in chronic care texts. Minimizing exercise contradicts management; activity improves insulin sensitivity and glucose uptake ulcer risk is mitigated with proper footwear, not inactivity. Foot care addresses diabetes' microvascular damage (neuropathy, angiopathy), preventing amputation, a leading morbidity, making it a priority intervention in acute settings.
Which drug should not be given with midazolam?
- A. zidovudine
- B. lamivudine
- C. nevirapine
- D. indinavir
Correct Answer: D
Rationale: Indinavir boosts midazolam P450 clash sedates too deep, unlike zidovudine, lamivudine, nevirapine, or ritonavir's fit. Nurses dodge this chronic sleep trap.
The clinic nurse is caring for a patient whose grandmother and sister have both had breast cancer. She requested a screening test to determine her risk of developing breast cancer and it has come back positive. The patient asks you what she can do to help prevent breast cancer from occurring. What would be your best response?
- A. Research has shown that eating a healthy diet can provide all the protection you need against breast cancer
- B. Research has shown that taking the drug tamoxifen can reduce your chance of breast cancer
- C. Research has shown that exercising at least 30 minutes every day can reduce your chance of breast cancer
- D. Research has shown that there is little you can do to reduce your risk of breast cancer if you have a genetic predisposition
Correct Answer: B
Rationale: With a positive screening test and family history, she's high-risk tamoxifen, a SERM, cuts breast cancer odds by 50% in such cases, per NCI trials. It blocks estrogen fueling tumors, a proven chemoprevention move. Diet helps (antioxidants, less fat), but it's not enough solo. Exercise (30 min/day) trims risk via weight control, but tamoxifen's got stronger data here. Saying little can be done' ignores options genetics load the gun, but lifestyle and drugs can unload it. Nurses in oncology push tamoxifen for its edge, tailoring advice to her risk profile.
A patient who has ovarian cancer is crying and tells the nurse, 'My husband rarely visits. He just doesn't care.' The husband indicates to the nurse that he does not know what to say to his wife. Which nursing diagnosis is appropriate for the nurse to add to the plan of care?
- A. Compromised family coping related to disruption in lifestyle
- B. Impaired home maintenance related to perceived role changes
- C. Risk for caregiver role strain related to burdens of caregiving responsibilities
- D. Dysfunctional family processes related to effect of illness on family members
Correct Answer: D
Rationale: Ovarian cancer's toll her tears, his silence points to dysfunctional family processes; illness jams communication, not lifestyle , home upkeep , or caregiving load . He's lost, not burdened. Nurses in oncology peg this cancer's ripple screws up dynamics, needing talks to bridge the gap, not just task fixes.