Nokea
Mr Tan aged 50 years old has a blood pressure of 160/100 mmHg taken on waking up and 140/90 mmHg at night. He also has a UAE of 200 mg/24 hours. He has type 2 diabetes. Which of the following actions will be most likely reduce the UAE to normal?
- A. Get the patient to lose 10% of his body weight
- B. Prescribe a SGLT2 e.g. empagliflozin
- C. Control the blood pressure to 130/80 mmHg
- D. Get the patient to exercise 150 minutes a week
Correct Answer: C
Rationale: UAE 200, diabetes BP to 130/80 slashes albumin; weight, SGLT2, exercise, nifedipine help less direct. Nurses hit this chronic kidney key.
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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.
Which of the following patients would probably not benefit from a >5-10% weight loss?
- A. A 28-year-old female with BMI 37 kg/m² and oligomenorrhea but planning for fertility in the future
- B. A 40-year-old man with BMI 26 kg/m², who has a strong family history of diabetes, recently diagnosed with prediabetes
- C. A 21-year-old man with BMI 42 kg/m² with no known medical problems and a family history of T2DM
- D. A 70-year-old female, BMI 26 kg/m², with well-controlled T2DM on two oral anti-diabetic medications and osteoporosis
Correct Answer: D
Rationale: A 5-10% weight loss benefits most with obesity-related conditions improving fertility (BMI 37), prediabetes (BMI 26), or T2DM risk (BMI 42). The 70-year-old with BMI 26, well-controlled T2DM, and osteoporosis may not benefit significantly; weight loss could worsen bone density, and her diabetes is managed, reducing urgency. Her age and comorbidities shift focus to stability, not weight reduction, guiding physicians in chronic care prioritization.
Which animal is least associated with rabies?
- A. dogs
- B. skunks
- C. foxes
- D. rats
Correct Answer: D
Rationale: Rabies dogs, skunks, foxes, bats bite big; rats rarely tag along. Nurses eye this chronic zoonotic crew.
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.
A client is receiving treatment for the diagnosis of hemophilia A. Which of the following is the most appropriate to include in the assessment of this client?
- A. Cranial nerves
- B. Appetite
- C. Joint pain and bruising
- D. Urine output
Correct Answer: C
Rationale: Hemophilia A, a factor VIII deficiency, impairs clotting joint pain and bruising from hemarthrosis and bleeds are hallmark signs, demanding assessment to gauge bleeding severity and guide factor replacement. Cranial nerves check neurologic status, irrelevant unless bleeds hit the brain. Appetite or urine output offers general insight, not hemophilia-specific. Nurses zero in on joints and skin, tracking this genetic disorder's impact, critical for managing acute episodes and preventing long-term damage in this bleeding-prone client.