Nokea
The nurse is caring for a patient who has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The patient states that he would like to die at home, but the team believes that the patient's care needs are unable to be met in a home environment. What might you suggest as an alternative?
- A. Discuss a referral for rehabilitation hospital
- B. Panel the patient for a personal care home
- C. Discuss a referral for acute care
- D. Discuss a referral for hospice care
Correct Answer: D
Rationale: Extensive small-cell lung cancer with a 6-month clock screams end-stage hospice fits, offering comfort-focused care in settings like home (with support), hospitals, or community sites. It matches his wish to avoid aggressive fixes, unlike rehab (for recovery) or acute care (for crises). Personal care homes lack the palliative punch needed here. Hospice blends patient and family needs, easing symptoms like pain or dyspnea, a cornerstone in oncology for terminal cases where quality trumps quantity.
You may also like to solve these questions
A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan?
- A. Donor bone marrow is transplanted through a sternal or hip incision.
- B. Hospitalization is required for several weeks after the stem cell transplant.
- C. The transplant procedure takes place in a sterile operating room to minimize the risk for infection.
- D. Transplant of the donated cells can be very painful because of the nerves in the tissue lining the bone.
Correct Answer: B
Rationale: HSCT for leukemia means 2-4 weeks in hospital engraftment's slow, and infection risk's sky-high in isolation. No incision it's IV. No OR it's bedside. Pain's minimal no bone nerves hit. Nurses in oncology stress this long haul, sterile stay, not surgical drama, prepping patients for the real grind.
Mr Yee, a 45-year-old, reports three recent gout attacks in the ankle or knee. You notice a small tophus over the left elbow. He says that two years ago he took allopurinol 100 mg for one month, then 200 mg OM for one month but stopped as it 'did not help his gout and there was no improvement'. When you probe, he states that he was not very adherent to allopurinol either then as it was some years ago, and he says he probably took it 'once or twice a week'. He states he did not experience any rashes or other side effects to it then. He does not drink alcohol except one glass of wine once or twice a year on special occasions. He has past history of renal stones and also underlying ischaemic cardiomyopathy for which he is still being followed up by the cardiologist. Two weeks ago, he was admitted to the hospital for a gout flare. He had a blood test done, with the following results: Uric acid 620 mmol/L, Creatinine 120 umol/L, eGFR 55 mL/min, BP 144/94 mmHg, he has Hypertension on HCTZ long-term. He is asking you to give him Arcoxia 120 mg OM standby as it usually works for his gout flare. Which is correct advice?
- A. Discuss HLA B5801 testing particularly as febuxostat is being prescribed for him
- B. Advise that he will need stepwise up-titration of allopurinol to reach the uric acid target. Regular blood tests will allow this to be done safely
- C. Advise that colchicine prophylaxis is helpful to prevent gout attacks and increase hydrochlorothiazide to optimise his BP control
- D. Offer to initiate probenecid immediately as allopurinol is ineffective
Correct Answer: B
Rationale: Tophus and frequent flares with uric acid 620 mmol/L indicate chronic gout needing ULT. Prior allopurinol failure' likely stems from non-adherence (once/twice weekly), not ineffectiveness. Stepwise up-titration of allopurinol, starting low (e.g., 100 mg) due to eGFR 55, with regular blood tests (uric acid, creatinine), targets <360 mmol/L safely, per ACR guidelines. HLA-B5801 testing is for high-risk groups (e.g., Han Chinese) before allopurinol, not febuxostat-specific here. Colchicine helps, but increasing HCTZ (urate-retaining) may worsen gout. Probenecid suits renal underexcretors, not proven here. This approach optimizes chronic gout control.
The nurse knows that hemolytic to blood transfusions occur most often when the first milliliters of the infusion.
- A. 125
- B. 50
- C. 100
- D. 75
Correct Answer: B
Rationale: Hemolytic reactions strike early 50 mL often triggers as mismatched blood clashes, a rapid antigen-antibody storm. Later volumes (75-125) build on it; 100's common but not peak. Nurses watch those first drops, stopping at 50 mL's hint of fever or pain, a tight window in this transfusion trap.
The followings are risk factors associated with non-alcoholic fatty liver disease (NAFLD) except:
- A. Elevated uric acid
- B. Elevated blood pressure
- C. Diabetes mellitus
- D. Elevated LDL-cholesterol
Correct Answer: A
Rationale: NAFLD ties to metabolic mess hypertension, diabetes, high LDL, and triglycerides fuel fat's liver pile-up, all in. Uric acid links to gout, not NAFLD's core, despite metabolic overlap. Clinicians eye this quartet, not urate, in chronic liver fat's risk map, a key split.
A client hospitalized for chemotherapy has a hemoglobin of $6.1 mg/dL. What medication should the nurse prepare to administer?
- A. Epoetin alfa (Epogen)
- B. Filgrastim (Neupogen)
- C. Mesna (Mesnex)
- D. Oprelvekin (Neumega)
Correct Answer: A
Rationale: A hemoglobin of 6.1 mg/dL (normal 12-16 g/dL for women, 13-18 g/dL for men) indicates severe anemia, often from chemotherapy suppressing bone marrow red cell production. The nurse should prepare epoetin alfa (Epogen), a synthetic erythropoietin that stimulates red blood cell production, addressing anemia directly. Filgrastim (Neupogen) boosts white cells for neutropenia, not hemoglobin. Mesna (Mesnex) protects the bladder from chemotherapy toxicity, irrelevant here. Oprelvekin (Neumega) increases platelets, not red cells. Administering epoetin alfa corrects the anemia, improving oxygen delivery and reducing symptoms like fatigue and dyspnea, a critical intervention in oncology to support the client's recovery and quality of life during treatment.