Nokea
The definition of Chronic Heart Failure is:
- A. Failure of the heart to adequately pump blood to the body.
- B. Long-term inability of the heart to meet metabolic demands required to maintain homeostasis.
- C. Prolonged enlargement of the left ventricle impacting on the contractility of the muscle.
- D. Long term fluid build-up, causing increase in blood volume and reducing the ability of the heart to maintain blood flow.
Correct Answer: B
Rationale: Chronic heart failure (CHF) is a syndrome, not a singular defect. Failure to pump adequately describes acute failure but lacks chronicity's scope. CHF is the heart's prolonged inability to meet metabolic demands for oxygen and nutrients, disrupting homeostasis per Farrell (2017) encompassing systolic (reduced ejection) and diastolic (impaired filling) dysfunction. Left ventricular enlargement may occur (e.g., dilated cardiomyopathy), but it's a cause or result, not the definition; contractility varies. Fluid buildup (congestion) is a feature, not the essence blood volume rises secondary to neurohormonal activation (e.g., renin-angiotensin system), not as the primary failure. The metabolic demand focus captures CHF's systemic impact fatigue, edema, dyspnea reflecting chronic adaptation failure over structural or fluid-centric descriptions.
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Which percentage of the burden of sickness in the Netherlands can approximately be avoided?
- A. 30%
- B. 40%
- C. 50%
- D. 60%
Correct Answer: B
Rationale: Dutch sickness 40% dodgeable, lifestyle tweaks cut chronic loads, not half or more. Nurses bank this, a prevention slice.
The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery?
- A. Salvage surgery
- B. Palliative surgery
- C. Prophylactic surgery
- D. Reconstructive surgery
Correct Answer: C
Rationale: A bilateral mastectomy here is prophylactic removing nonvital breasts to prevent cancer in a high-risk patient with a positive tumor marker and family history. It's about risk reduction, not treatment of existing disease. Salvage surgery tackles recurrence after a less aggressive initial approach, like resecting a regrown tumor. Palliative surgery eases symptoms (e.g., pain from obstruction) in advanced cases, not prevention. Reconstructive surgery restores form or function post-treatment, like breast reconstruction after curative mastectomy. Prophylactic fits this preemptive strike, driven by genetic or familial risk (e.g., BRCA mutations), a growing trend in oncology to outpace cancer's onset, guided by nurses supporting informed, tough choices.
Which of the following patients would probably not benefit from a >5-10% weight loss?
- A. A 28-year-old female with BMI 37 kg/m² and oligomenorrhea but planning for fertility in the future
- B. A 40-year-old man with BMI 26 kg/m², who has a strong family history of diabetes, recently diagnosed with prediabetes
- C. A 21-year-old man with BMI 42 kg/m² with no known medical problems and a family history of T2DM
- D. A 70-year-old female, BMI 26 kg/m², with well-controlled T2DM on two oral anti-diabetic medications and osteoporosis
Correct Answer: D
Rationale: A 5-10% weight loss benefits most with obesity-related conditions improving fertility (BMI 37), prediabetes (BMI 26), or T2DM risk (BMI 42). The 70-year-old with BMI 26, well-controlled T2DM, and osteoporosis may not benefit significantly; weight loss could worsen bone density, and her diabetes is managed, reducing urgency. Her age and comorbidities shift focus to stability, not weight reduction, guiding physicians in chronic care prioritization.
The nurse is teaching the parents of a 15-year-old who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which of the following symptoms should the parents seek medical care immediately?
- A. Earache, stiff neck or sore throat
- B. Blisters, ulcers or a rash appear
- C. A temperature of 101.5 degrees Fahrenheit
- D. Difficulty or pain when swallowing
Correct Answer: C
Rationale: Chemotherapy for acute myelogenous leukemia suppresses the immune system by reducing white blood cell production, leaving the child highly susceptible to infections. A fever of 101.5°F is a critical sign in this context, as it may indicate an infection that, without a functioning immune response, could rapidly progress to sepsis a life-threatening condition. Parents must seek immediate medical care to evaluate and treat the underlying cause, often requiring emergency department intervention. While earache, stiff neck, or sore throat could suggest infection, they are less urgent without fever and may not necessitate immediate action unless severe. Blisters, ulcers, or rashes might reflect chemotherapy side effects like mucositis or drug reactions, manageable with outpatient care unless infected. Difficulty swallowing could stem from mucositis or infection, but fever trumps it in urgency due to its systemic implications. Educating parents to prioritize fever ensures timely intervention, aligning with oncology nursing's focus on preventing complications in immunocompromised pediatric patients.
A 44 year old man with type 2 DM and hyperlipidemia is currently taking daily simvastatin 40 mg. His lipid profile repeated 12 weeks after treatment shows the following results: Total cholesterol 4.2 mmol/L, HDL-cholesterol 0.9 mmol/L, LDL-cholesterol 2.2 mmol/L, Triglyceride 2.4 mmol/L. Which lipid regulating drug should be MOST appropriately added?
- A. Colestyramine
- B. Omega 3 fatty acid
- C. Fenofibrate
- D. Nicotinic acid
Correct Answer: C
Rationale: Simvastatin's cut LDL to 2.2, but triglycerides linger at 2.4 above 1.7's ideal and HDL's low at 0.9. Fenofibrate slashes triglycerides, lifts HDL, a perfect next step for this type 2 mix. Colestyramine binds bile, not triglycerides; omega-3 helps less here; nicotinic acid's harsh; ezetimibe's LDL focus misses. Nurses see this combo statin plus fibrate as a chronic lipid tune-up, dodging heart risks tied to diabetes.