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Pulmonary rehabilitation is one of the most effective interventions in the management of COPD. The primary goals of this program are to:
- A. Ensure the patient eats appropriately, takes their medication as prescribed and exercises every day
- B. Involve the patient in the multidisciplinary team and knows how to manage their condition
- C. Reduce symptoms, improved QOL, increase physical and emotional participation in everyday life
- D. Prevent deterioration, avoid hospitalisation and support the carers
Correct Answer: C
Rationale: Pulmonary rehab reclaims COPD life less wheeze, better QOL, more daily grit, physical and emotional. Diet-meds-exercise is narrow; team play's a means; prevention's a perk, not core. Nurses drive this, a chronic lift.
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A 65-year-old female presented to the emergency room with complaint of progressively worsening fatigue, shortness of breath, and palpitations. Upon assessment, heart rate is 130 beats per minute and irregular, and there is positive jugular vein distention. Heart tones reveal a high-pitched holosystolic murmur. Which of the following disorders are consistent with these findings?
- A. Mitral regurgitation
- B. Mitral stenosis
- C. Mitral valve prolapse
- D. Aortic regurgitation
Correct Answer: A
Rationale: Mitral regurgitation leaks blood back holosystolic murmur, irregular tachycardia, JVD, and dyspnea fit, as left heart flops, backing up into veins. Stenosis murmurs diastolic; prolapse clicks midsystolic; aortic regurgitation's early diastolic. Nurses tie this to MR's volume overload, anticipating echo, a match for this failing valve tale.
Appropriate statements concerning intrathecal drug delivery systems include:
- A. In a patient with progressive cancer-related pain, a low-grade pelvic infection is an absolute contraindication for implanting either an intrathecal catheter or a pump, even under antibiotic cover.
- B. Intrathecally administered opioids circulate to the central neuraxis, including the brainstem, where they are likely to cause drowsiness and respiratory depression.
- C. In difficult cases, ziconotide can be administered with either an opioid or clonidine, or both.
- D. As a mixture of opioid and clonidine is expected to distribute throughout the cerebrospinal fluid, the level of the catheter in the intrathecal space is unlikely to be important.
Correct Answer: B
Rationale: Intrathecal drug delivery systems (IDDS) manage severe pain with nuances. A low-grade pelvic infection isn't an absolute contraindication; implantation may proceed with antibiotics if benefits outweigh risks (e.g., cancer palliation). Intrathecal opioids do reach the brainstem via cerebrospinal fluid, causing drowsiness and respiratory depression, though less than systemic routes due to lower doses still a key risk requiring monitoring. Ziconotide combines with opioids or clonidine for synergy in refractory pain, per clinical practice. Catheter tip position matters; drug distribution isn't uniform higher placement enhances rostral spread, affecting efficacy and side effects. MRI compatibility exists with most modern pumps. The brainstem effect of opioids underscores IDDS's potency and danger, necessitating careful titration and patient selection.
A 4 week old baby is due for her second Hepatitis B vaccine dose. However, you note that the baby is mildly jaundiced. What would be the most appropriate step to take next?
- A. Screen for the Hepatitis B virus and only proceed with immunisation if the results are negative
- B. Immunisation is not required as the baby may already have hepatitis
- C. Give the hepatitis B vaccine and arrange for investigation for the jaundice
- D. Proceed with the vaccination but also give the Hepatitis B immunoglobulin at another site
Correct Answer: C
Rationale: Mild jaundice at 4 weeks likely physiologic or breast milk, not hep B vaccine's safe, so jab and probe cause. Screening delays, skipping's wrong, deferring's cautious overkill, immunoglobulin's for exposure. Nurses roll this, a chronic vax-plus-check play.
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 nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider?
- A. Frequent loose stools
- B. Nausea and vomiting
- C. Elevated white blood count (WBC)
- D. Increased carcinoembryonic antigen (CEA)
Correct Answer: D
Rationale: Rising CEA screams colorectal cancer's dodging chemo tumor marker jumps mean progression, trumping GI woes (A, B) or high WBC (C maybe infection). Nurses in oncology push this CEA's a red flag, signaling therapy's failing, needing a switch.