Nokea
Percutaneous cervical cordotomy:
- A. Is performed under general anaesthesia.
- B. Occurs by entry of a needle into the intervertebral foramen between cervical vertebrae C4 and C5.
- C. Involves thermoablation of the anterior spinothalamic tract.
- D. Is performed on the same side as the pain.
Correct Answer: C
Rationale: Percutaneous cervical cordotomy (PCC) relieves cancer pain via targeted nerve destruction. It's done under local anesthesia with sedation, not general, to monitor patient response (e.g., pain relief, side effects) during stimulation. The needle enters at C1-C2, not C4-C5, targeting the lateral spinothalamic tract contralateral to the pain not the anterior tract explicitly, though terminology varies. Thermoablation destroys pain fibers, confirmed by test stimulation. It's performed opposite the pain side due to crossed spinothalamic pathways. Complete numbness isn't typical; sensory loss is partial. Thermoablation's specificity using radiofrequency to interrupt pain transmission defines PCC's efficacy, minimizing damage to adjacent motor tracts while achieving analgesia.
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A nurse is caring for a client diagnosed with peripheral artery disease. Which of the following is a common assessment finding?
- A. 4+ pedal pulses
- B. 3+ pedal pulses
- C. Bounding pulses in all 4 extremities
- D. 1+ pedal pulses
Correct Answer: D
Rationale: Peripheral artery disease (PAD) clogs arteries, slashing flow 1+ pedal pulses (weak, thready) are typical, reflecting ischemia below blockages. 4+ or 3+ pulses (strong) contradict PAD's hypoperfusion; bounding pulses suggest hyperdynamic states, not occlusion. Nurses expect weak pulses, checking for pain or pallor, key to tracking PAD's limb-threatening march, guiding interventions like revascularization.
Which drug should not be given with midazolam?
- A. zidovudine
- B. lamivudine
- C. nevirapine
- D. indinavir
Correct Answer: D
Rationale: Indinavir boosts midazolam P450 clash sedates too deep, unlike zidovudine, lamivudine, nevirapine, or ritonavir's fit. Nurses dodge this chronic sleep trap.
A client suffering from a narcotic overdose is seen in the Emergency Department. The client is confused, with warm, flushed skin, headache, and weakness. Vital signs of noted are temperature 102.6 F, heart rate 128 beats/minute, respirations 24 breaths/minute, and blood pressure 130/86 mm Hg. A blood gas analysis sample was drawn on room air, and the results are as follows: pH 7.33 PaCO2 53 mm Hg, PaO2 72 mm Hg, HCO3 24 mEq/L. This client is at risk for which of the following?
- A. Metabolic alkalosis
- B. Respiratory alkalosis
- C. Respiratory acidosis
- D. Metabolic acidosis
Correct Answer: C
Rationale: Narcotics depress breathing pH 7.33 (low), PaCO2 53 mm Hg (high) signal respiratory acidosis, as CO2 piles up from hypoventilation, a classic overdose trap. PaO2 72 mm Hg shows mild hypoxia; HCO3 24 mEq/L hasn't compensated yet. Alkalosis needs low CO2 or high HCO3; metabolic acidosis drops HCO3. Nurses spot this, anticipating oxygen or reversal, a breath-stifled risk in this opioid haze.
Which of the following findings would be most indicative of retinoblastoma for an 18-month old child?
- A. Orbital inflammation of the right eye and head tilt when standing.
- B. Cat's eye reflex and yellow discharge from the left eye.
- C. Leukokoria and hyphema noted for the right eye.
- D. Strabismus in the left eye and light sensitivity in the opposite eye.
Correct Answer: C
Rationale: Retinoblastoma, a retinal cancer in young children, commonly presents with leukokoria (white pupil reflection) and hyphema (blood in the anterior eye chamber), making these findings most indicative due to tumor effects on retinal light reflection and vascular fragility. Orbital inflammation and head tilt suggest brain tumors or orbital cellulitis, not retinoblastoma's typical intraocular focus. Cat's eye reflex (leukokoria) fits, but yellow discharge points to infection (e.g., conjunctivitis), not cancer. Strabismus and light sensitivity may occur in retinoblastoma but are less specific strabismus from muscle imbalance and sensitivity from inflammation lacking hyphema's diagnostic weight. Nurses spotting leukokoria and hyphema trigger urgent ophthalmology referral, critical in pediatric oncology for early detection and vision-saving or life-saving intervention in this age group.
The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient?
- A. These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and x-ray studies
- B. These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer
- C. Try not to be concerned about these symptoms. Every patient feels this way after having radiation therapy
- D. Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying
Correct Answer: A
Rationale: Radiation zaps energy fatigue and weakness are par for the course, tied to inflammation and repair in treated tissues. Saying this, plus promising lab and imaging checks, reassures him it's expected, not a red flag, and keeps him in the loop. Blaming cancer alone dodges the treatment link, unsettling him. Dismissing it as universal or a good sign' feels flippant normal cells die too. Nurses in oncology lean on honesty and vigilance, easing fears while tracking for worse issues like anemia or infection.