Nokea
It is the start of your second successive night shift on the labour ward. You have only managed to sleep for 4 h in the previous day. Your usual sleep requirement is 8 h per night. Appropriate statements regarding this situation include:
- A. Your total cumulative sleep deficit is 8 h.
- B. Your alertness will increase between 3 a.m. and 7 a.m. due to natural fluctuation in your circadian rhythm.
- C. Unintentional dural puncture during epidural insertion is more likely to occur during a night shift than during normal working hours.
- D. Sleeping for an extra 4 h will eliminate the sleep deficit.
Correct Answer: C
Rationale: Night shifts disrupt sleep and performance. After one night with 4 hours sleep (8-hour need), the deficit is 4 hours; a second night compounds it variably, but total' implies current state 8 hours overstates it without further context. Alertness dips 3-7 a.m. (circadian nadir), not increases, heightening fatigue. Night-shift studies (e.g., anaesthesia journals) show increased errors like dural puncture due to fatigue, reduced dexterity, and decision-making capacity, especially with sleep deprivation. Four extra hours reduce, not eliminate, a deficit if it's 4-12 hours cumulatively. Modafinil promotes wakefulness, not daytime sleep. The night-shift risk of dural puncture reflects fatigue's real-world impact on technical skills.
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A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching?
- A. The patient ambulates several times a day in the room
- B. The patient's visitors bring in some fresh peaches from home
- C. The patient cleans with a warm washcloth after having a stool
- D. The patient uses soap and shampoo to shower every other day
Correct Answer: B
Rationale: Neutropenia post-chemo low neutrophils craves germ-free zones; fresh peaches from home carry bacteria, a teaching gap as raw produce risks infection in this immune-wrecked state. Ambulation's safe, hygiene's spot-on washcloths and showers cut germs. Nurses reteach, banning unwashed fruit, a vital shield in leukemia's neutropenic peril, ensuring clients grasp this microbial minefield.
Which of the following interventions would be best for the child who has developed mucositis as a side effect of chemotherapy?
- A. Using lemon glycerin swabs for oral hygiene.
- B. Keeping the child NPO until all sores are healed.
- C. Having the child swish and swallow viscous lidocaine.
- D. Giving the child pudding for breakfast.
Correct Answer: D
Rationale: Mucositis, a painful chemotherapy side effect, involves inflamed, ulcerated mucous membranes, often in the mouth, complicating eating and hygiene. Offering pudding a soft, bland, cool food is the best intervention, as it minimizes irritation and pain, encouraging nutrition without exacerbating sores. Lemon glycerin swabs are harsh, with citric acid and chemicals worsening discomfort and delaying healing. Keeping the child NPO (nothing by mouth) for weeks until sores heal is impractical and risks malnutrition, as mucositis can persist throughout chemotherapy. Viscous lidocaine might numb pain but is a last resort if the child refuses all intake, not a first-line comfort measure. Pudding supports hydration and calorie intake safely, aligning with nursing's goal to maintain nutrition and comfort in pediatric oncology, reducing mucositis-related distress effectively.
A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate?
- A. Administer a dose of allopurinol (Aloprim).
- B. Assess the client's serum potassium level.
- C. Gently inquire about advance directives.
- D. Prepare the client for emergency surgery.
Correct Answer: C
Rationale: Superior vena cava syndrome (SVCS) occurs when cancer (often lung or lymphoma) obstructs the superior vena cava, impairing venous return from the head and upper body. It's often a late-stage manifestation with a poor prognosis, though treatable with radiation or stenting. After stabilizing the client (e.g., with oxygen, positioning), gently inquiring about advance directives is most appropriate, as it opens a compassionate discussion about goals of care amid a potentially terminal condition. Allopurinol and potassium levels relate to tumor lysis syndrome, not SVCS. Surgery is rare for SVCS, with non-invasive options preferred. This action respects the client's autonomy and prepares for realistic outcomes, aligning with oncology nursing's holistic approach to end-of-life care in advanced disease.
Patients on insulin therapy should receive essential education on the following EXCEPT:
- A. Insulin injection technique
- B. Stopping all oral hypoglycaemic agents
- C. Recognition and self-management of hypoglycaemia
- D. Sick day management
Correct Answer: B
Rationale: Insulin therapy education for diabetes patients covers injection technique, hypoglycemia recognition and management, sick day rules, and safe driving, per diabetes care standards. However, stopping all oral hypoglycemic agents isn't universally essential many patients continue agents like metformin or SGLT-2 inhibitors alongside insulin for synergistic effects, depending on glycemic control needs. Assuming cessation oversimplifies treatment plans, potentially reducing efficacy. Education must tailor to individual regimens, not mandate stopping orals, making this the exception. Physicians ensure comprehensive teaching to enhance adherence and safety, critical in chronic disease management.
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.