Nokea
The nurse is arriving at the beginning of her shift and has taken report on four clients on a medical surgical unit. Which client should the nurse see first?
- A. A Client with pyelonephritis with nausea and vomiting
- B. A client with chronic obstructive pulmonary disease with an oxygen saturation of $90 \%$ on room air
- C. A client post vaginoplasty with bright red blood and clots in her catheter
- D. A client post-total abdominal hysterectomy with 9/10 pain
Correct Answer: C
Rationale: Bright red blood and clots post-vaginoplasty scream hemorrhage ABCs prioritize circulation, needing instant check for shock or transfusion. Pyelonephritis nags, COPD's stable at 90\%, pain's urgent but not bleeding. Nurses hit bleeding first, a life-line call in this post-op rush.
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A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching?
- A. The patient ambulates around the room.
- B. The patient's visitors bring in fresh peaches.
- C. The patient cleans with a warm washcloth after having a stool.
- D. The patient uses soap and shampoo to shower every other day.
Correct Answer: B
Rationale: Neutropenia post-chemo drops immunity fresh peaches with thin skins harbor bacteria, a no-no on neutropenic diets. Walking , cleaning post-stool , and mild showers are fine safe self-care. Nurses in oncology reteach this raw fruits are infection traps, a critical miss for this fragile patient.
A nurse is caring for a client who presented to the emergency department with complaints of fatigue, palpitations, and chest pains. Upon assessment, the provider notes an S3 and S4 gallop, weak peripheral pulses, and tachycardia. The provider orders a chest x-ray and echocardiogram, which reveals left ventricular dilation. Which of the following disorder is consistent with these findings?
- A. Cardiac tamponade
- B. Dilated cardiomyopathy
- C. Pericarditis
- D. Restrictive cardiomyopathy
Correct Answer: B
Rationale: Left ventricular dilation with S3, S4, weak pulses, and tachycardia paints dilated cardiomyopathy heart muscle stretches, weakening pump, causing fatigue and palpitations. Tamponade compresses, not dilates. Pericarditis inflames without dilation. Restrictive stiffens, resisting stretch. Nurses tie this to DCM's systolic flop, anticipating meds like ACE inhibitors, a fit for this stretched-out heart.
A 7-year-old child with osteosarcoma is being treated with chemotherapy. Which medication would the nurse expect the physician to order most commonly as a prophylaxis against Pneumocystis jirovecii?
- A. Trimethoprim-sulfamethoxazole
- B. Ketoconazole
- C. Filgastim
- D. Prednisone
Correct Answer: A
Rationale: Osteosarcoma chemotherapy compromises the immune system, increasing susceptibility to opportunistic infections like Pneumocystis jirovecii pneumonia (PCP), a serious risk in immunocompromised children. Trimethoprim-sulfamethoxazole (TMP-SMX) is the most common prophylactic antibiotic for PCP, effectively preventing this lung infection by targeting its causative organism. Ketoconazole treats fungal infections but not PCP, which is caused by a fungus-like organism requiring specific therapy. Filgrastim stimulates neutrophil production to combat neutropenia, not PCP directly. Prednisone, a corticosteroid, suppresses immunity and reduces tumor-related edema but doesn't prevent infections and may increase risk. The nurse anticipates TMP-SMX due to its established role in pediatric oncology protocols, ensuring protection against a preventable, potentially fatal complication during chemotherapy.
In the UK, orthognathic surgery is likely to:
- A. Be undertaken in specialist craniofacial surgery units rather than in maxillofacial surgery units.
- B. Be associated with a high incidence of postoperative nausea and vomiting.
- C. Require a nasal rather than an oral tracheal tube when a Le Fort I osteotomy is performed.
- D. Require admission of the patient to a high-dependency unit.
Correct Answer: B
Rationale: Orthognathic surgery corrects jaw deformities in the UK, typically by maxillofacial surgeons, not solely craniofacial units (reserved for complex congenital cases). Postoperative nausea and vomiting (PONV) are common due to blood swallowing, prolonged surgery, and opioids risk factors per Apfel criteria. Le Fort I osteotomy (maxillary) often uses oral intubation; nasal tubes suit mandibular focus or surgeon preference, not a requirement. High-dependency unit (HDU) admission isn't routine most recover in general wards unless complications (e.g., airway) arise. Cleft palate repair precedes, not follows, orthognathic work. PONV's prevalence reflects surgical and anaesthetic challenges, necessitating robust antiemetic prophylaxis.
About special considerations in the management of hypertension in older patients, which of the following is the correct answer?
- A. Systolic hypertension - DBP should be <70 mmHg
- B. Dementia - Target SBP should not be <150/90 mmHg
- C. Care home residents - SBP <130 mmHg
- D. Frailty - Target BP not <140/90 mmHg
Correct Answer: D
Rationale: Frail elders BP >140/90 guards perfusion; systolic, dementia, care home tweaks misfire. Nurses ease this chronic frail line.