Chronic Illness NCLEX Questions

Chronic Illness NCLEX Questions Related

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Mr Yee two months later. At your last visit he did not want colchicine prophylaxis as he did not want to take 'too many tablets'. He has started and is adherent to his urate lowering agent. Last month, his uric acid had decreased to 390 mmol/L. He had a gout flare last week, hence he came to your clinic today to ask about colchicine prophylaxis. Which is correct advice regarding colchicine prophylaxis?

  • A. Offer to start colchicine at 500 mcg once daily or alternate days as gout prophylaxis as his renal function is abnormal
  • B. Colchicine cannot help to reduce the frequency of flares especially during the first six months of Urate lowering therapy
  • C. Tell him that if he is started on clarithromycin, he does not need to inform his doctor or pharmacist that he is on colchicine regularly as colchicine can have drug interactions
  • D. Regular colchicine prophylaxis in someone with normal renal function and regular monitoring can lead to renal failure
Correct Answer: A

Rationale: With eGFR 55 mL/min and a recent flare despite uric acid dropping to 390 mmol/L, colchicine prophylaxis at 500 mcg daily or alternate days is appropriate, adjusting for reduced renal clearance to prevent toxicity. Flares are common early in ULT as urate mobilizes, and colchicine reduces this, contrary to the false claim it can't help. Clarithromycin interacts dangerously with colchicine (CYP3A4 inhibition), requiring disclosure. Colchicine doesn't cause renal failure with monitoring; toxicity does. This dose suits chronic gout management safely.

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A 75-year-old lady is listed for an anterior resection to treat a cancer in the descending hemicolon. She has never previously been in hospital. She gives no history of shortness of breath or angina, but admits that she does not take part in strenuous activity. Apart from painkillers, she takes no medications. Appropriate statements regarding preoperative testing include:

  • A. Resting echocardiography is a useful test of her functional capacity.
  • B. Coronary angiography is indicated.
  • C. Cardiopulmonary exercise testing is a useful test of functional capacity.
  • D. Brain natriuretic peptide level is a useful test that indicates heart failure.
Correct Answer: C

Rationale: Preoperative assessment evaluates surgical risk. Resting echocardiography assesses cardiac structure, not functional capacity, which requires dynamic testing. Coronary angiography is invasive and unwarranted without symptoms like angina or ischemia evidence. Cardiopulmonary exercise testing (CPET) measures aerobic capacity (e.g., VOâ‚‚ peak), directly assessing functional reserve for surgical stress ideal for this asymptomatic but inactive patient. Brain natriuretic peptide (BNP) indicates heart failure if elevated but doesn't test capacity; it's a biomarker, not a stress test. Dobutamine stress echocardiography detects ischemia, useful but less comprehensive than CPET for overall fitness. CPET's ability to quantify cardiopulmonary reserve makes it the most appropriate choice for optimizing perioperative management in this elderly patient.

Which of the following are not part of the diabetic retinopathy that cause visual impairment in patients with diabetes?

  • A. Pre proliferative retinopathy
  • B. Macular oedema
  • C. Proliferative retinopathy
  • D. Macular degeneration
Correct Answer: D

Rationale: Diabetic retinopathy pre-proliferative, edema, proliferative blur eyes from sugar's vessel rot. Macular degeneration's age, not diabetes. Nurses spot this, a chronic sight split.

The nurse is assessing a client with severe anemia. Which clinical manifestation does the nurse expect to see in this client?

  • A. Bradycardia
  • B. Pale, cool skin
  • C. Hypertension
  • D. Warm, flushed skin
Correct Answer: B

Rationale: Severe anemia starves oxygen pale, cool skin reflects shunted flow and low hemoglobin, a classic find as body compensates. Bradycardia's rare; tachycardia revs to pump more. Hypertension doesn't fit BP may drop. Warm, flushed skin suits overload, not anemia. Nurses expect pallor, tying it to blood's oxygen flop, a sign guiding transfusion or iron.

In the clinical assessment of heart failure, which of the following is FALSE?

  • A. Jugular venous distention, an S1 heart sound, and non-displaced apical impulse significantly increase the likelihood of the diagnosis
  • B. Hypertension, CAD, and valvular disease are the most common causes
  • C. Fatigue, weakness, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and edema are common symptoms
  • D. Cardiomegaly on CXR is helpful in supporting the diagnosis
Correct Answer: A

Rationale: Jugular venous distention and edema suggest heart failure, but S1 (normal first sound) and non-displaced apical impulse don't increase diagnostic likelihood S3 or displaced impulse do, per clinical criteria. Common causes (HTN, CAD, valvular disease), symptoms, and cardiomegaly on CXR are true. ECG is vital. This corrects diagnostic focus in chronic HF assessment.

Post exposure prophylaxis against Human Immunodeficiency Virus (HIV):

  • A. is probably not effective when commenced 36 hours post exposure
  • B. is administered intramuscularly
  • C. is generally well-tolerated by patients
  • D. when given, precludes the need for follow up serology
Correct Answer: C

Rationale: HIV PEP tolerable pills, not IM, works past 36 hours, needs serology, safe in pregnancy. Nurses dose this chronic shield easy.

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