Nokea
The nurse is caring for a 65-year-old female who presented to the emergency department with shortness of breath and chest discomfort. The client has not been feeling well for the past few days and complains of a productive cough of blood-tinged sputum. Laboratory tests reveal an elevated brain natriuretic peptide (BNP), and chest x-ray reveals pulmonary congestion. Based on the assessment findings, which of the following diagnosis are consistent with these findings?
- A. Heart failure (left-sided)
- B. Lung cancer
- C. Heart failure (right-sided)
- D. Pulmonary embolism
Correct Answer: A
Rationale: Elevated BNP and pulmonary congestion plus dyspnea, chest pain, hemoptysis point to left-sided heart failure, where ventricle falters, flooding lungs with fluid. Lung cancer might bleed but lacks BNP spike. Right-sided failure swells periphery, not lungs initially. Pulmonary embolism clots, not congests, with normal BNP. Nurses link this to left heart strain, anticipating diuretics, a diagnosis fitting this wet-lung picture.
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It is the start of your second successive night shift on the labour ward. You have only managed to sleep for 4 h in the previous day. Your usual sleep requirement is 8 h per night. Appropriate statements regarding this situation include:
- A. Your total cumulative sleep deficit is 8 h.
- B. Your alertness will increase between 3 a.m. and 7 a.m. due to natural fluctuation in your circadian rhythm.
- C. Unintentional dural puncture during epidural insertion is more likely to occur during a night shift than during normal working hours.
- D. Sleeping for an extra 4 h will eliminate the sleep deficit.
Correct Answer: C
Rationale: Night shifts disrupt sleep and performance. After one night with 4 hours sleep (8-hour need), the deficit is 4 hours; a second night compounds it variably, but total' implies current state 8 hours overstates it without further context. Alertness dips 3-7 a.m. (circadian nadir), not increases, heightening fatigue. Night-shift studies (e.g., anaesthesia journals) show increased errors like dural puncture due to fatigue, reduced dexterity, and decision-making capacity, especially with sleep deprivation. Four extra hours reduce, not eliminate, a deficit if it's 4-12 hours cumulatively. Modafinil promotes wakefulness, not daytime sleep. The night-shift risk of dural puncture reflects fatigue's real-world impact on technical skills.
A patient with metastatic cancer of the colon experiences severe vomiting after each administration of chemotherapy. Which action, if taken by the nurse, is appropriate?
- A. Have the patient eat large meals when nausea is not present.
- B. Offer dry crackers and carbonated fluids during chemotherapy.
- C. Administer prescribed antiemetics 1 hour before the treatments.
- D. Give the patient a glass of a citrus fruit beverage during treatments.
Correct Answer: C
Rationale: Chemo vomiting's a beast pre-dosing antiemetics (e.g., ondansetron) an hour before blocks the gut-brain puke loop, the gold standard. Big meals overload; crackers and soda or citrus during treatment spark nausea acidity and fizz don't help. Nurses in oncology time this right prevention trumps mopping up, keeping patients steady.
You are seeing Mr Yee two months later. At your last visit, he did not want colchicine prophylaxis as he did not want to take 'too many tablets'. He has started and is adherent to his urate lowering agent. Last month, his uric acid had decreased to 390 mmol/L. He had a gout flare last week. Hence, he came to your clinic today to ask about colchicine prophylaxis. Which is INCORRECT advice regarding colchicine prophylaxis?
- A. Offer to start colchicine at 500 mcg once daily or alternate days as gout prophylaxis as his renal function is normal
- B. Colchicine can help to reduce the frequency of flares, especially during the first six months of Urate lowering therapy
- C. Tell him that if he is started on NEW medications, he should inform his doctor or pharmacist that he is on colchicine regularly as colchicine can have drug interactions. If unsure and he needs to take NEW medications, such as a short course of antibiotics, he is to omit colchicine until the new medication is completed
- D. Regular colchicine prophylaxis in someone with normal renal function and regular monitoring can lead to renal failure
Correct Answer: D
Rationale: Colchicine curbs flares 500 mcg fits normal kidneys, cuts attacks in urate-lowering's rocky start, and needs drug interaction flags or skips with gut upset. But renal failure from regular use with monitoring? False colchicine's safe there, not a kidney killer. Clinicians nix this myth, grounding chronic gout aid in truth.
Which of these clients assigned to the nurse is most likely to need planning for long-term nursing management?
- A. 22-year-old with appendicitis who has had an emergency appendectomy
- B. 56-year-old with bilateral knee osteoarthritis who weighs 159 kg
- C. 34-year-old with cholecystitis who has had a laparoscopic cholecystectomy
- D. 62-year-old with acute sinusitis who will require antibiotic therapy for 5 days
Correct Answer: B
Rationale: Osteoarthritis at 159 kg screams chronic long-term PT, diet plans beat appendectomy, gallbladder, or sinus quickies. Nurses plot this, a marathon, not sprints.
A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first?
- A. Give the patient the prescribed PRN opioid.
- B. Assess for sensation and strength in the legs.
- C. Notify the health care provider about the symptoms.
- D. Teach the patient how to use relaxation to reduce pain.
Correct Answer: B
Rationale: Stage IV lung cancer plus back pain flags spinal cord compression leg checks for numbness or weakness come first; paralysis kills fast. Opioids , calls , or relaxation follow. Nurses in oncology prioritize this neuro's the lifeline, catching mets' chaos early.