Nokea
The nurse is providing preoperative care for a 7-year-old patient with a brain tumor. Which of the following is the priority intervention?
- A. Assessing the child's level of consciousness
- B. Providing a tour of the intensive care unit for the child and parents
- C. Educating the child and parents about shunts
- D. Having the child talk to another child who has had this surgery
Correct Answer: A
Rationale: For a child with a brain tumor preoperatively, assessing level of consciousness (LOC) is the priority, as it monitors for increased intracranial pressure (ICP) from tumor mass effect vital signs like alertness or confusion shift rapidly and signal deterioration needing immediate action. No baseline data exists here, making LOC the first step in the nursing process to guide care. An ICU tour reduces anxiety but delays critical assessment. Shunt education applies post-diagnosis of hydrocephalus, not universally pre-op, and lacks urgency without LOC context. Peer support is psychosocial, not physiological, and secondary. LOC assessment aligns with ABCs (circulation includes cerebral perfusion), ensuring the nurse detects neurological decline early, a cornerstone of pediatric neuro-oncology care before surgery.
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A child is seen in the pediatrician's office for complaints of bone and joint pain. Which other assessment finding may indicate leukemia?
- A. Abdominal pain
- B. Increased activity level
- C. Increased appetite
- D. Petechiae
Correct Answer: D
Rationale: Leukemia often presents with bone and joint pain due to marrow infiltration by leukemic cells, but petechiae small red or purple spots from minor bleeds under the skin are a key additional sign of bleeding tendencies from thrombocytopenia, a common leukemia consequence. This reflects bone marrow failure to produce adequate platelets, making it a critical finding for nurses to note during assessment. Abdominal pain might occur from organ enlargement (e.g., splenomegaly), but it's less specific and not a primary complaint here. Increased activity level and appetite contradict leukemia's typical fatigue and anorexia due to metabolic demands of proliferating cells and anemia. Recognizing petechiae prompts urgent blood work and referral, aligning with nursing's role in early detection of pediatric leukemia, ensuring timely intervention to manage this life-threatening condition effectively.
A 50 year old man has a BP of 160/100 mmHg despite being on 10 mg Lisinopril om. Which of the following is not a good choice?
- A. Diuretic
- B. Calcium channel blocker
- C. Bisoprolol
- D. Losartan
Correct Answer: D
Rationale: BP 160/100 diuretic, calcium, beta, upping lisinopril stack; losartan doubles ACE, risks crash. Nurses dodge this chronic overlap.
The hospice nurse has just admitted a new patient to the program. What principle guides hospice care?
- A. Care addresses the needs of the patient as well as the needs of the family
- B. Care is focused on the patient centrally and the family peripherally
- C. The focus of all aspects of care is solely on the patient
- D. The care team prioritizes the patient's physical needs and the family is responsible for the patient's emotional needs
Correct Answer: A
Rationale: Hospice wraps the patient and family in care physical, emotional, spiritual for both, not just one. It's not patient-only or peripheral family focus; it's a unit. Splitting physical and emotional duties misses the holistic vibe. Nurses in oncology's endgame lean on this, ensuring comfort and support ripple out, easing the load for all as death nears.
Mr Soh, a 40-year-old accountant on allopurinol 200 mg OM for the past eight months, reports two recent gout attacks in the last year. He has no other known past medical history. When you probe, he is adherent to allopurinol except for missing it perhaps once or twice a month. His BMI is 25 kg/m², BP 144/94 mmHg. His last uric acid was one month ago, which was 405 mmol/L. He is having a gout attack now. He tells you that his gout attacks are usually aborted with colchicine TDS for two days. Whilst on colchicine, he does not experience diarrhoea except perhaps one episode of loose stools after which he stops colchicine. Which is the most appropriate next step?
- A. Start Hydrochlorothiazide for hypertension
- B. Start Losartan for hypertension
- C. Stop Allopurinol during this acute gout attack and start colchicine
- D. Continue allopurinol at 100 mg OM despite the attack and start colchicine
Correct Answer: B
Rationale: Current gout attack with uric acid 405 mmol/L (above target <360) on allopurinol 200 mg suggests undertreatment. Continue allopurinol (not stop) during flares, add colchicine TDS for acute relief, and address BP 144/94 with Losartan urate-lowering and cardioprotective, unlike HCTZ, which raises urate. Check creatinine and up-titrate allopurinol later. This balances acute and chronic management effectively.
A study by the Dutch Institute for Public Health and Environment (RIVM) called 'Nederland de maat genomen' [Measuring the Dutch], conducted in 2009-2010, shows that more than half of all Dutch people are overweight (BMI >25). Question: What are the results of this study when looking separately at men and women?
- A. 55% of the men and 55% of the women are overweight
- B. 60% of the men and 45% of the women are overweight
- C. 65% of the men and 50% of the women are overweight
- D. 70% of the men and 55% of the women are overweight
Correct Answer: B
Rationale: Over half the Dutch being overweight suggests a split men typically tip higher than women in Western stats. Sixty percent men, 45% women fits: men's bigger frames and habits stack BMI over 25 more, while women hover lower, averaging out above 50%. Even splits or higher jumps overshoot trends nurses see this gender gap in obesity clinics, a chronic load reflecting lifestyle and biology.