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Mr Soh, a 40-year-old accountant on allopurinol 200 mg OM for the past eight months, reports two recent gout attacks in the past year. He has no other known past medical history. When you probe, he is adherent to allopurinol except for missing it perhaps once or twice a month. His BMI 25 kg/m², BP 144/94 mm Hg. His last uric acid was one month ago, which was 405 mmol/L. He is having a gout attack now. He tells you that his gout attacks are usually aborted with colchicine TDS for two days. Whilst on colchicine, he does not experience diarrhoea except for one episode of loose stools, after which he stops colchicine. Which is the most appropriate next step?
- A. Start Hydrochlorothiazide for hypertension
- B. Start Losartan for hypertension
- C. Stop Allopurinol during this acute gout attack and start colchicine. Consider checking a baseline creatinine if not recently available
- D. Continue allopurinol at 200 mg OM despite the attack and start colchicine. Consider checking an updated uric acid level and creatinine two weeks after the attack resolves. If uric acid is >360, explain that allopurinol 200 mg OM is insufficient and needs to be up titrated
Correct Answer: D
Rationale: Gout mid-attack 405 uric acid on 200 mg allopurinol says it's not enough. Keep it rolling, add colchicine to quash the flare, then recheck labs post-calm to titrate up if >360. Stopping allopurinol spikes urate; HCTZ worsens gout; Losartan's fine but sidesteps; upping now risks confusion. Clinicians stick this path, steering chronic control smart.
You may also like to solve these questions
Many people with obesity have a lower insulin-stimulated glucose uptake compared with people without increased body weight. It is assumed that several factors play a role in the development of insulin resistance. Question: Which of the following factors is LEAST likely to play a role in the development of insulin resistance?
- A. Reduced insulin levels
- B. Increased adipokine levels
- C. Increased triglyceride levels
- D. Low-grade continuous inflammation
Correct Answer: A
Rationale: Insulin resistance brews from fat's adipokines, triglycerides, inflammation not low insulin, that's type 1's game. Obesity's chronic jam needs excess, not lack nurses flag this misfit.
A 54-year-old has a diagnosis of breast cancer and is tearfully discussing her diagnosis with the nurse. The patient states, 'They tell me my cancer is malignant, while my coworker's breast tumor was benign. I just don't understand at all.' When preparing a response to this patient, the nurse should be cognizant of what characteristic that distinguishes malignant cells from benign cells of the same tissue type?
- A. Slow rate of mitosis of cancer cells
- B. Different proteins in the cell membrane
- C. Differing size of the cells
- D. Different molecular structure in the cells
Correct Answer: B
Rationale: Malignant breast cancer cells flaunt tumor-specific antigens (e.g., CEA) on their membranes, unlike benign ones from the same tissue think of it as a wanted' sign for the immune system. Mitosis isn't slow it's fast in malignant cells. Size varies, not the defining split. Molecular structure shifts, but membrane proteins are the standout marker. Nurses use this to explain why her cancer's a threat those antigens tag it as invasive, a core oncology lesson for scared patients piecing it together.
A 10-year-old boy is being prepared for a bone marrow transplant. The nurse can determine that the child understands this treatment when he says:
- A. I'll be much better after this blood goes to my bones.
- B. I won't feel too good until my body makes healthy cells.
- C. This will help all of the medicine they give me to work better.
- D. You won't have to wear a mask and gown after my transplant.
Correct Answer: B
Rationale: A bone marrow transplant (BMT) replaces diseased marrow (e.g., in leukemia) with healthy stem cells, but recovery is slow new, functional blood cells take weeks to months to regenerate, during which the child may feel unwell due to immunosuppression and engraftment challenges. The statement I won't feel too good until my body makes healthy cells' shows the boy grasps this delay, reflecting realistic understanding critical for coping and consent in pediatric care. Feeling better immediately after infusion is inaccurate initial post-BMT phases often worsen symptoms. Enhancing medicine efficacy isn't the goal; BMT is the therapy. Masks and gowns persist post-transplant due to infection risk until immunity recovers. The nurse's validation of this insight ensures the child is prepared, aligning with oncology's focus on patient education and emotional support during complex treatments.
The home health nurse is performing a home visit for an oncology patient discharged 3 days ago after completing treatment for non-Hodgkin lymphoma. The nurse's assessment should include examination for the signs and symptoms of what complication?
- A. Tumor lysis syndrome (TLS)
- B. Syndrome of inappropriate antidiuretic hormone (SIADH)
- C. Disseminated intravascular coagulation (DIC)
- D. Hypercalcemia
Correct Answer: A
Rationale: Non-Hodgkin lymphoma's fast cell turnover, plus recent chemo, primes for TLS dead cells dump potassium, phosphorus, and uric acid, risking kidney failure days post-treatment. SIADH (low sodium) and hypercalcemia (bone mets) are less tied to this timeline. DIC's bleeding chaos isn't lymphoma's usual post-chemo hit. Nurses hunt TLS signs fatigue, nausea, arrhythmias knowing it's a fatal oncology curveball if missed early.
The nurse is assessing a 14-year-old girl with a tumor. Which of the following findings would indicate Ewing sarcoma?
- A. Child complains of dull bone pain just above the knee.
- B. Palpation reveals non-tender swelling on the right ribs.
- C. Parents report a mass on the abdomen that crosses the midline.
- D. Palpation reveals asymptomatic mass on the upper back.
Correct Answer: B
Rationale: Ewing sarcoma is a rare bone cancer primarily affecting children and adolescents, typically arising in flat bones like the pelvis, chest wall (e.g., ribs), or vertebrae, and the diaphysis of long bones. A hallmark is a palpable, non-tender mass, making non-tender swelling on the ribs a strong indicator, as it aligns with the tumor's common chest wall location and lack of initial pain sensitivity. Dull bone pain above the knee suggests a long bone issue, possibly osteosarcoma, which favors the metaphysis, not Ewing's typical diaphysis site. An abdominal mass crossing the midline is more characteristic of Wilms tumor or neuroblastoma, not Ewing sarcoma. An asymptomatic upper back mass could suggest various tumors, but lacks specificity for Ewing's flat bone preference. Nurses must recognize this presentation to facilitate prompt imaging and biopsy, critical for early diagnosis and treatment planning in pediatric oncology.