Nokea
The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider?
- A. Hematocrit of 32%
- B. Pain with deep inspiration
- C. Serum sodium of 126 mEq/L
- D. Decreased breath sounds on left side
Correct Answer: C
Rationale: Lung cancer can spark SIADH sodium at 126 risks seizures, outpacing anemia , pleuritic pain , or expected breath loss . Nurses in oncology report this low sodium's a metabolic emergency, needing swift fix.
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Which of the following is a treatment option for a client with infective endocarditis?
- A. Bedrest
- B. Antimicrobials
- C. Diet modification
- D. Antihypertensive
Correct Answer: B
Rationale: Infective endocarditis bacterial valve infection needs antimicrobials to kill pathogens like *Streptococcus*, the root cause, halting damage and sepsis. Bedrest aids recovery but doesn't treat. Diet tweaks support health, not infection. Antihypertensives manage pressure, irrelevant to endocarditis's microbial core. Nurses anticipate antibiotics, often IV for weeks, targeting the source, a priority to save valves and lives in this high-mortality condition, aligning with infectious disease protocols.
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. Different topics and focus can be covered at different stages of insulin therapy
- D. It can only be done by diabetes nurse educators
Correct Answer: D
Rationale: Patient education for insulin therapy enhances experience and adherence, requires time, and varies by stage e.g., injection skills at initiation, hypoglycemia management later all true per diabetes guidelines. However, stating it can only be done by diabetes nurse educators is false. While specialized educators excel, other healthcare professionals (physicians, pharmacists) can deliver effective education, especially in resource-limited settings. Multidisciplinary involvement ensures broader access and periodic understanding checks, vital for chronic disease management. This flexibility empowers diverse teams to support patients, debunking the exclusivity myth.
Mr Tan, a 50-year-old with hypertension, sees you for routine review. He reports three gout flares in the past two months relieved with three days of Arcoxia 120 mg OM for each episode. You perform some blood tests, which returns the following results: Creatinine 95 umol/L, eGFR >90 mL/min, Uric acid 460 mmol/L, HbA1c 5.4%, Random hypo-count 7.5 mmol/L. He is currently on Amlodipine 10 mg OM. He does not drink alcohol except one glass of wine once or twice a year on special occasions. His BMI is 20.5 kg/m². Which is the most appropriate next step?
- A. Prescribe NSAIDs standby for gout flare
- B. Offer dietary advice and advise regular exercise only
- C. Prescribe prednisolone standby for gout flare
- D. Discuss urate lowering therapy as he has had >2 gout flares in the past year, ideally with colchicine prophylaxis
Correct Answer: D
Rationale: Three gout flares in two months with uric acid 460 mmol/L (hyperuricemia) indicate frequent attacks warranting urate-lowering therapy (ULT) like allopurinol, per guidelines (e.g., ACR), especially with >2 flares yearly. Colchicine prophylaxis reduces flare risk during ULT initiation. NSAIDs or prednisolone treat acute flares but don't address recurrence. Diet/exercise alone won't suffice with this frequency and uric acid level. ULT discussion aligns with chronic gout management to prevent joint damage, critical for family physicians.
The signs and symptoms of heart failure include:
- A. Polyphagia and polydipsia.
- B. Orthopnoea and gastrointestinal disruption.
- C. Urinary frequency and acute pulmonary oedema.
- D. Dyspnoea and peripheral oedema.
Correct Answer: D
Rationale: Heart failure (HF) manifests through circulatory and fluid overload effects. Polyphagia and polydipsia align with diabetes, not HF. Orthopnoea (breathlessness lying flat) is HF-specific, but gastrointestinal disruption (e.g., nausea) is secondary, less hallmark. Urinary frequency occurs nocturnally in HF (nocturia), but acute pulmonary edema is an acute crisis, not a chronic sign. Dyspnoea (shortness of breath) from pulmonary congestion and peripheral edema (swelling) from venous backup are classic, per Farrell (2017) reflecting left and right HF respectively. These stem from reduced cardiac output and fluid retention (e.g., elevated jugular venous pressure), driving clinical presentation. Dyspnoea limits activity, edema signals systemic impact, making them definitive over less specific or acute-only symptoms.
Which of the following assessment findings is a priority during blood transfusion?
- A. Chest pain
- B. Fatigue
- C. Joint pain
- D. Headache
Correct Answer: A
Rationale: Blood transfusions carry risks like acute reactions chest pain screams potential hemolytic or allergic response, a life-threatening emergency demanding immediate halt and intervention, prioritizing airway and circulation per ABCs. Fatigue is common, reflecting anemia's baseline, not an acute flag. Joint pain or headaches might hint at milder issues transfusion overload or tension but lack chest pain's urgency. Swift recognition of chest pain prevents escalation to shock or respiratory failure, a nurse's critical duty in transfusion safety, outranking less specific symptoms in this high-stakes scenario.