Nokea
The client is diagnosed with laryngeal cancer and is scheduled for a laryngectomy next week. Which intervention would be priority for the clinic nurse?
- A. Assess the client's ability to swallow
- B. Refer the client to a speech therapist
- C. Order the client's preoperative lab work
- D. Discuss the client's operative unit
Correct Answer: B
Rationale: Laryngectomy severs voice referring to a speech therapist pre-op sets up post-surgical communication, a priority as clients lose speech, facing isolation without aids like electrolarynx training. Swallowing matters, but airway and cancer trump function now. Labs are routine, delegated often; unit talk's secondary. Nurses push this referral, easing the mute transition, a proactive step in laryngeal cancer's life-altering prep, ensuring clients adapt to this voiceless future from day one.
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In a patient with COPD, the risk of postoperative pulmonary complications increases with:
- A. Wheezing on preoperative examination.
- B. A history of preoperative cough.
- C. Low body mass index (BMI).
- D. A serum albumin concentration less than 35 mg litreâ»Â¹.
Correct Answer: A
Rationale: Postoperative pulmonary complications in COPD patients are influenced by disease severity and patient condition. Wheezing indicates active airway obstruction and inflammation, directly increasing the risk of complications like atelectasis or pneumonia due to impaired ventilation and secretion clearance. A preoperative cough may suggest irritation or infection but is less specific than wheezing as a risk predictor. Low BMI reflects malnutrition, a known risk factor, but its impact is less immediate than active respiratory symptoms. Low serum albumin (<35 g/L, not mg/L as stated) also indicates poor nutritional status and healing capacity, elevating risk, but wheezing is more directly tied to airway dynamics. Regional anesthesia may reduce complications compared to general anesthesia, but the question focuses on risk factors. Wheezing's presence signals acute respiratory compromise, making it the strongest preoperative indicator of postoperative issues.
According to Johnson and Chang (2014), compared to the non-indigenous population, the Australian indigenous population is more likely to:
- A. Live in the bush, eat native food and have increased exposure to the elements
- B. Have a higher incidence of chronic disease, be less healthy, die at a much younger age, and have lower quality of life
- C. Access health care and implement appropriate lifestyle changes equitably
- D. Experience death at a rate of twice that of the non-indigenous population
Correct Answer: B
Rationale: Indigenous Australians face a heavier chronic disease load diabetes, heart issues dying younger, with life expectancy gaps of 10+ years, and poorer quality of life from systemic inequities. Bush living's a stereotype, not a health driver; equitable care's a myth access lags; death rate's high but not precisely double. Nurses see this burden, tackling social determinants, a stark chronic care reality rooted in data, not just location or access claims.
Mr Soh, a 40-year-old accountant on allopurinol 200 mg OM for the past eight months, reports two recent gout attacks in the last year. He has no other known past medical history. When you probe, he is adherent to allopurinol except for missing it perhaps once or twice a month. His BMI is 25 kg/m², BP 144/94 mmHg. His last uric acid was one month ago, which was 405 mmol/L. He is having a gout attack now. He tells you that his gout attacks are usually aborted with colchicine TDS for two days. Whilst on colchicine, he does not experience diarrhoea except perhaps one episode of loose stools after which he stops colchicine. Which is the most appropriate next step?
- A. Start Hydrochlorothiazide for hypertension
- B. Start Losartan for hypertension
- C. Stop Allopurinol during this acute gout attack and start colchicine
- D. Continue allopurinol at 100 mg OM despite the attack and start colchicine
Correct Answer: B
Rationale: Current gout attack with uric acid 405 mmol/L (above target <360) on allopurinol 200 mg suggests undertreatment. Continue allopurinol (not stop) during flares, add colchicine TDS for acute relief, and address BP 144/94 with Losartan urate-lowering and cardioprotective, unlike HCTZ, which raises urate. Check creatinine and up-titrate allopurinol later. This balances acute and chronic management effectively.
Which of the following is FALSE regarding patient education for insulin therapy?
- A. It improves the patients experience and adherence to insulin therapy
- B. It requires time and preparation
- C. It can only be done by diabetes nurse educators
- D. Different topics and focus can be covered at different stages of insulin therapy
Correct Answer: C
Rationale: Insulin education boosts adherence and takes prep varied topics hit stages, and checking understanding's key. But pinning it to diabetes nurse educators alone flops; GPs, pharmacists, even peers can teach, widening reach. Team effort trumps solo specialty, ensuring chronic care's flexible, not bottlenecked, a practical truth in diabetes' long haul.
A nurse is caring for a 19-year-old male recently diagnosed with leukemia. Which of the following nursing interventions is appropriate for the care of this client?
- A. Fluid restriction
- B. Low residual diet
- C. Therapeutic phlebotomy
- D. Strict hand hygiene to prevent infection
Correct Answer: D
Rationale: Leukemia's marrow mess drops immunity strict hand hygiene shields this 19-year-old from infections, a top intervention as neutrophils crash. Fluid restriction fits overload, not here. Low residual diets aid bowels, irrelevant. Phlebotomy's for polycythemia. Nurses scrub up, guarding this young client, a germ-free must in leukemia's fragile fight.