Nokea
Mr XYZ, a 60-year-old, smoker with DM, hypertension and CKD Stage 3 sees you for routine chronic review. He reports recurrent gout flares past five weeks of increasing intensity and duration which he assumes is due to frequent travel and lack of exercise. His current laboratory results are creatinine 106, eGFR 56, uric acid 400, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is currently taking glipizide 5 mg BD, Metformin 250 mg BD, Amlodipine 5 mg OM. What is the most appropriate management in this patient?
- A. Offer dietary advice
- B. Prescribe NSAIDs and medical certificate (MC)
- C. Increased exercise frequency (e.g. jogging at least 3 times per week)
- D. Initiate urate lowering therapy using allopurinol with colchicine prophylaxis
Correct Answer: D
Rationale: Gout flares, uric acid 400, CKD 3 allopurinol with colchicine tames crystals, not just diet, NSAIDs, jogging, or smoke quit. Nurses start this chronic uric brake.
You may also like to solve these questions
One of the features of type 2 diabetes mellitus is the abnormally increased blood glucose values after meals. Question: What causes this abnormal rise of postprandial blood glucose?
- A. Insufficient glucose uptake in the liver due a shortage of Glut-2 transporters
- B. Insufficient glucose uptake in muscle tissue due to a defect in the Glut-4 transporters
- C. Insufficient glucose uptake in adipose tissue due to a defect in the intracellular insulin signal cascade
- D. Insufficient glucose uptake in muscle tissue due to a defect in the intracellular insulin signal cascade
Correct Answer: D
Rationale: Type 2's post-meal spike muscle's insulin signal jams, Glut-4 stalls, glucose piles up. Liver's Glut-2's fine, fat's minor, muscle's the big miss nurses peg this resistance core, a chronic uptake bust.
What is the highest likelihood that a doctor acquires HIV from a needlestick injury from an HIV pt?
- A. 0.30%
- B. 2%
- C. 5%
- D. 10%
Correct Answer: A
Rationale: HIV needlestick 0.3% odds, not 2-30's wild leaps. Nurses glove up, a chronic prick stat.
Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration?
- A. Teach the patient to rest the brain by avoiding new activities.
- B. Teach that 'chemo-brain' is a short-term effect of chemotherapy.
- C. Report patient symptoms immediately to the health care provider.
- D. Suggest use of a daily planner and encourage adequate rest and sleep.
Correct Answer: D
Rationale: Chemo-brain foggy focus is common; planners and rest help manage, not cure. Resting fully stalls life; it's not always short-term can linger. No emergency it's expected. Nurses in oncology offer this tools and sleep ease the mental muck, supporting function.
A scalp block aims to stop conduction in the following nerves:
- A. Zygomaticotemporal.
- B. Infraorbital.
- C. Greater occipital.
- D. Auriculotemporal.
Correct Answer: C
Rationale: A scalp block is used in awake craniotomy to provide regional anesthesia by blocking sensory nerves innervating the scalp. The greater occipital nerve supplies the posterior scalp, making it a key target. The zygomaticotemporal nerve innervates the temple area, and the auriculotemporal nerve covers the lateral scalp and ear region both are also commonly blocked. The infraorbital nerve supplies the midface, not the scalp, and the trochlear nerve (likely a misnomer for supraorbital or supratrochlear) innervates the forehead, another typical target. However, the greater occipital stands out as essential for posterior coverage, consistently cited in scalp block techniques. The rationale hinges on anatomical innervation: effective scalp anesthesia requires blocking nerves from both trigeminal (V1, V2, V3 branches) and cervical (C2, C3) origins, with the greater occipital being a primary cervical contributor, ensuring comprehensive pain control during surgery.
A 50-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic?
- A. Smoking is the reason you are here
- B. The doctor left orders for you not to smoke
- C. You are anxious about the surgery. Do you see smoking as helping?
- D. Smoking is OK right now, but after your surgery it is contraindicated
Correct Answer: C
Rationale: Anxiety's screaming here naming it and asking if smoking helps opens a door to his feelings, not a lecture. Blaming smoking shames him, spiking stress. Citing orders shuts down dialogue. Greenlighting it's reckless nicotine constricts vessels, risking surgical healing, especially post-lung resection. Therapeutic nursing in oncology digs into emotions, guiding patients through fear without judgment, key for pre-op calm.