Nokea
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.
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Regarding PID
- A. Trichomonas and Gardnerella are commonest organisms
- B. Associated with irregular menstruation
- C. Absence of fever and cervical excitation excludes diagnosis
Correct Answer: B
Rationale: PID chlamydia, gonorrhea lead, irregular menses tie, fever and motion can hide. Nurses link this chronic pelvic thread.
A 50-year-old patient, body weight 98 kg and height 1.82 m, has been diagnosed with type 2 diabetes based on increased fasting blood glucose levels (8.2 and 7.9 mmol/L). This gave the patient such a shock that he started a strict calorie-restricted diet. Two weeks later, his fasting blood glucose is 6.8 mmol/L and he has lost 1 kg. Question: What is the most likely explanation for the sharp reduction of the blood glucose level and the limited reduction in weight of only ±1%?
- A. The insulin-stimulated glucose uptake in muscle tissue has increased
- B. The insulin-stimulated inhibition of hepatic glucose production has increased
- C. The insulin-stimulated uptake of free fatty acids in muscle tissue has increased
- D. The insulin-stimulated inhibition of glycerol production in the liver has increased
Correct Answer: B
Rationale: Type 2's glucose drop calorie cut reins in liver's sugar spill, insulin works better there. Muscle uptake helps, fat shifts less, glycerol's minor liver's the quick fix, weight lags nurses see this, a chronic tweak.
Appropriate statements concerning intrathecal drug delivery systems include:
- A. In a patient with progressive cancer-related pain, a low-grade pelvic infection is an absolute contraindication for implanting either an intrathecal catheter or a pump, even under antibiotic cover.
- B. Intrathecally administered opioids circulate to the central neuraxis, including the brainstem, where they are likely to cause drowsiness and respiratory depression.
- C. In difficult cases, ziconotide can be administered with either an opioid or clonidine, or both.
- D. As a mixture of opioid and clonidine is expected to distribute throughout the cerebrospinal fluid, the level of the catheter in the intrathecal space is unlikely to be important.
Correct Answer: B
Rationale: Intrathecal drug delivery systems (IDDS) manage severe pain with nuances. A low-grade pelvic infection isn't an absolute contraindication; implantation may proceed with antibiotics if benefits outweigh risks (e.g., cancer palliation). Intrathecal opioids do reach the brainstem via cerebrospinal fluid, causing drowsiness and respiratory depression, though less than systemic routes due to lower doses still a key risk requiring monitoring. Ziconotide combines with opioids or clonidine for synergy in refractory pain, per clinical practice. Catheter tip position matters; drug distribution isn't uniform higher placement enhances rostral spread, affecting efficacy and side effects. MRI compatibility exists with most modern pumps. The brainstem effect of opioids underscores IDDS's potency and danger, necessitating careful titration and patient selection.
For a patient on the chemotherapeutic drug vincristine (Oncovin), which of the following side effects should be reported to the physician?
- A. Fatigue
- B. Nausea and vomiting
- C. Paresthesia
- D. Anorexia
Correct Answer: C
Rationale: Vincristine, a vinca alkaloid, disrupts nerve function, making paresthesia tingling or numbness a critical side effect signaling neurotoxicity, warranting physician review for dose adjustment or cessation. Fatigue, nausea, and anorexia, while common in chemotherapy, are manageable with nursing interventions rest, antiemetics, small meals unless severe. Paresthesia's specificity to vincristine's mechanism, targeting microtubules, elevates its urgency; unchecked, it risks permanent nerve damage, impacting mobility and quality of life. Reporting it ensures timely intervention, distinguishing it from routine effects, a key nursing responsibility in monitoring chemotherapy's narrow therapeutic window.
The most common and significant symptom associated with cancer and associated treatments, which has a long term impact on quality of life, as reported by patients, is:
- A. Anorexia
- B. Alopecia
- C. Pain
- D. Fatigue
Correct Answer: D
Rationale: Cancer's top drag fatigue saps QOL long-term, outlasting appetite, hair, or pain woes. Nurses hear this, a chronic weary king.