Nokea
Mdm Koh, a 55-year-old housewife with hypertensive nephropathy was recently started on allopurinol 50 mg per day with prophylactic colchicine 500 mg OM 3 weeks ago in your clinic. She is on Lasix 20 mg OM, nifedipine LA 30 mg OM, aspirin 100 mg OM and renalvite 1 tab OM. She came down with flu like symptoms 4 days ago and developed rashes after being given Amoxil by another General Physician. Today, she returns to your clinic. What should be the next step?
- A. Stop Amoxil and continue the chronic medications
- B. Prescribe paracetamol for pain relief and switch to clarithromycin 500 mg BD instead
- C. Continue medications and check for Dengue serology
- D. Stop all medications and refer for possible SJS
Correct Answer: D
Rationale: Rash post-Amoxil, allopurinol new SJS looms, stop all, refer fast; not just Amoxil, clarithro, dengue, or colchicine tweaks. Nurses flag this chronic skin scare.
You may also like to solve these questions
A patient with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location precludes the use of enteral feeding. What intervention should the nurse identify as best meeting this patient's nutritional needs?
- A. Administration of parenteral feeds via a peripheral IV
- B. TPN administered via a peripherally inserted central catheter
- C. Insertion of an NG tube for administration of feeds
- D. Maintaining NPO status and IV hydration until treatment completion
Correct Answer: B
Rationale: Gastric cancer blocking oral and enteral routes needs TPN via a PICC delivering calories and protein centrally, bypassing the gut. Peripheral IV can't handle TPN's osmolarity veins fry. NG's out with tumor placement. NPO with just fluids starves her long-term. Nurses in oncology peg TPN as the lifeline, keeping strength up when cancer chokes other options.
Which of the following would predispose a client to mitral stenosis?
- A. Obesity
- B. Rheumatic fever
- C. Intravenous drug use
- D. Diabetes
Correct Answer: B
Rationale: Mitral stenosis narrows the valve rheumatic fever's scarring, from streptococcal aftermath, is the prime culprit, stiffening leaflets over years. Obesity, IV drug use (tied to endocarditis), or diabetes don't directly scar valves. Nurses link rheumatic history to this, watching for dyspnea or murmurs, a legacy of infection shaping this cardiac bottleneck.
The nurse is assessing a 3-year-old child whose mother complains that he is listless and has been having trouble swallowing. Which of the following findings would suggest the child has a brain tumor?
- A. Observation reveals nystagmus and head tilt
- B. Vital signs show blood pressure measures 120/80
- C. Examination shows temperature of 38.5°C and headache
- D. Observation reveals a cough and labored breathing
Correct Answer: A
Rationale: Brain tumors in young children often cause neurological signs from mass effect or increased intracranial pressure (ICP). Nystagmus (involuntary eye movement) and head tilt suggest cerebellar or brainstem involvement, common in pediatric brain tumors like medulloblastoma, disrupting coordination and posture key findings in a listless child with swallowing issues (possibly cranial nerve dysfunction). Blood pressure of 120/80 is elevated but lacks widened pulse pressure typical of ICP; it's non-specific without context. Fever and headache might indicate meningitis, not a tumor, unless paired with focal signs. Cough and labored breathing point to respiratory issues, not neurological ones. Nurses noting nystagmus and tilt prompt urgent imaging, critical in pediatric oncology for diagnosing brain tumors early and preventing further deterioration.
Which of the following is not complication associated with NAFLD?
- A. Ischemic heart disease
- B. Cerebrovascular accident
- C. Colon cancer
- D. All of the above
Correct Answer: D
Rationale: NAFLD heart, stroke, colon, liver cancer all link; no outlier. Nurses track this chronic risk chain.
During general anaesthesia for orthognathic surgery:
- A. A head-down supine position is popular to minimize the risk of airway soiling.
- B. Lidocaine with adrenaline 1:80000 is used for infiltration.
- C. Non-steroidal anti-inflammatory drugs (NSAIDs) are avoided even after haemostasis is achieved.
- D. Blocks of both mandibular and maxillary nerves are possible and useful.
Correct Answer: D
Rationale: Anaesthesia for orthognathic surgery balances airway and bleeding risks. Head-up positioning, not head-down, reduces venous congestion and airway soiling from blood head-down risks aspiration. Lidocaine with adrenaline (typically 1:80,000-1:200,000) minimizes bleeding via vasoconstriction, a standard infiltration. NSAIDs are used post-haemostasis for analgesia, not universally avoided, unless bleeding risk persists. Mandibular and maxillary nerve blocks (e.g., V2, V3) reduce opioid needs and enhance pain control, leveraging regional anaesthesia's precision in jaw surgery. Propofol TIVA may improve recovery versus volatiles, per studies, but isn't definitive. Nerve blocks' utility optimizes perioperative pain management, critical in extensive osteotomies.