Nokea
Postoperative care at the completion of bimaxillary surgery:
- A. Is likely to be complicated by the presence of intermaxillary fixation (IMF).
- B. Involves awake rather than asleep extubation.
- C. Requires gentle removal of the tracheal tube to avoid damage of mandibular plates and screws.
- D. Involves reinsertion of a nasal tracheal tube when complicated by airway bleeding or obstruction requiring emergency reintubation.
Correct Answer: A
Rationale: Bimaxillary surgery's postoperative phase is complex. Intermaxillary fixation (IMF) aligns jaws but restricts mouth opening, complicating airway management, vomiting, and oral care raising aspiration or obstruction risks. Awake extubation is preferred, ensuring airway reflexes return, critical with IMF and swelling. Gentle tube removal prevents surgical site trauma (e.g., plates), though mandibular hardware is internal, less tube-accessible. Emergency reintubation may use nasal routes due to IMF, addressing bleeding/obstruction. HDU care is case-specific, not mandatory. IMF's presence drives tailored strategies, prioritizing airway security and patient stability in this high-risk recovery period.
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The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient?
- A. Impaired nutritional status
- B. Cognitive changes
- C. Diarrhea
- D. Alopecia
Correct Answer: A
Rationale: Neck radiation hits the oral mucosa, salivary glands, and throat, causing mucositis, taste loss, pain, and dysphagia leading to impaired nutrition. Patients struggle to eat, risking weight loss and weakness, a top concern in head-and-neck cases. Cognitive changes tie to brain radiation, not neck. Diarrhea aligns with abdominal radiation, not this site. Alopecia occurs with whole-brain radiation, not localized neck treatment, where hair loss is minimal unless the scalp's in the field. Nurses must prep patients for these site-specific effects, ensuring dietary support (e.g., soft foods, supplements) to maintain strength through therapy, a key part of oncology care planning.
A 35-year old teacher on allopurinol 200 mg OM for the past year reports three recent gout attacks. BMI 27 kg/m2, BP 144/94 mm Hg. You notice tophi over both hands and elbows. You will now:
- A. Stop the allopurinol during this acute gout attack
- B. Start hydrochlorothiazide 25 mg OM for BP control
- C. Continue allopurinol despite the attack and aim to reduce uric acid <300 umol/L
- D. Advise to rest and avoid exercise for 3 months as he is having acute pain
Correct Answer: C
Rationale: Tophi, flares allopurinol stays, push uric <300; thiazides worsen, rest flops, losartan's late. Nurses hold this chronic crystal line.
A 66 year old man has recently been diagnosed with hypertension. He has no history of heart disease and diabetes mellitus. His average blood pressure is recorded as 154/82 mmHg. What is the MOST appropriate first line pharmacological therapy?
- A. Angiotensin converting enzyme-inhibitors
- B. Angiotensin receptor blockers
- C. Thiazide diuretics
- D. Calcium channel blockers
Correct Answer: C
Rationale: New hypertension at 66, 154/82 no heart or sugar issues thiazide diuretics kick off gentle, effective control, especially in older adults. ACE inhibitors or ARBs fit if kidneys or diabetes pop up; calcium blockers work but aren't first; beta blockers lag unless heart history. Nurses lean on thiazides cheap, proven for this chronic pressure nudge, keeping it simple and safe.
Which of the following assessment findings is a priority during blood transfusion?
- A. Chest pain
- B. Fatigue
- C. Joint pain
- D. Headache
Correct Answer: A
Rationale: Blood transfusions carry risks like acute reactions chest pain screams potential hemolytic or allergic response, a life-threatening emergency demanding immediate halt and intervention, prioritizing airway and circulation per ABCs. Fatigue is common, reflecting anemia's baseline, not an acute flag. Joint pain or headaches might hint at milder issues transfusion overload or tension but lack chest pain's urgency. Swift recognition of chest pain prevents escalation to shock or respiratory failure, a nurse's critical duty in transfusion safety, outranking less specific symptoms in this high-stakes scenario.
The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment?
- A. I have frequent muscle aches and pains.'
- B. I rarely have the energy to get out of bed.'
- C. I experience chills after I inject the interferon.'
- D. I take acetaminophen (Tylenol) every 4 hours.'
Correct Answer: B
Rationale: Interferon's flu-like hell aches , chills , and Tylenol use are par but crushing fatigue flags dose-limiting toxicity, hinting at overdose or depression. Nurses in oncology dig deeper here rarely out of bed' could mean more than side effects, needing med tweaks or psych consult, critical for home care balance.