Nokea
Upon percussion of the midclavicular line from cranial to caudal, you can locate the absolute and relative lung-liver borders. Question: What produces the sound you hear between these two borders?
- A. It is caused by lung tissue
- B. It is caused by liver tissue
- C. It is caused by colon tissue
- D. It is caused by the overlap of lung tissue and liver tissue
Correct Answer: D
Rationale: Lung-liver edge overlap dulls the tap, not pure lung, liver, or colon. Nurses hear this, a chronic border beat.
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In caring for a patient with neutropenia, what tasks can be delegated to the nursing assistant?
- A. Take vital signs every 4 hours
- B. Report temperature elevation >100.4°F
- C. Assess for sore throat, cough, or burning with urination
- D. Gather the supplies to prepare the room for protective isolation
Correct Answer: A
Rationale: Neutropenia heightens infection risk, requiring team vigilance. Taking vital signs every 4 hours fits nursing assistants' scope routine monitoring flags fevers, key in neutropenia, without needing assessment skills. Reporting fever >100.4°F is their duty once detected, but assessing symptoms like sore throat or cough demands RN judgment to interpret infection signs. Gathering supplies for isolation is assistive, not evaluative, suiting their role. Handwashing's universal, not a task to delegate. Vital signs delegation ensures timely data collection, freeing nurses to analyze and act, a practical split in caring for this vulnerable patient.
Melatonin is a hormone that is involved in the regulation of the circadian rhythm. Features of melatonin include:
- A. It circulates in the cerebrospinal fluid and blood.
- B. It has a plasma elimination half-life of 4 h.
- C. It is derived from tryptophan.
- D. It activates the pituitary adenylate cyclase mechanism of circadian wakefulness.
Correct Answer: A
Rationale: Melatonin, produced by the pineal gland, regulates sleep-wake cycles. It circulates in blood and cerebrospinal fluid, crossing the blood-brain barrier to signal darkness via the suprachiasmatic nucleus (SCN). Its half-life is short, about 30-60 minutes, not 4 hours, enabling rapid response to light cues. Synthesized from tryptophan via serotonin, it's a biochemical derivative responsive to environmental triggers. It acts on melatonin receptors (MT1, MT2) in the SCN, suppressing wakefulness-promoting adenylate cyclase, not activating pituitary mechanisms for wakefulness that's a misattribution. Its role dampens alertness, promoting sleep. Circulation in bodily fluids ensures systemic distribution, aligning circadian rhythms with night, making it foundational to sleep physiology and fatigue management.
About special considerations in the management of hypertension in older patients, which of the following is the correct answer?
- A. Systolic hypertension - DBP should be <70 mmHg
- B. Dementia - Target SBP should not be <150/90 mmHg
- C. Care home residents - SBP <130 mmHg
- D. Frailty - Target BP not <140/90 mmHg
Correct Answer: D
Rationale: Frail elders BP >140/90 guards perfusion; systolic, dementia, care home tweaks misfire. Nurses ease this chronic frail line.
In the UK, orthognathic surgery is likely to:
- A. Be undertaken in specialist craniofacial surgery units rather than in maxillofacial surgery units.
- B. Be associated with a high incidence of postoperative nausea and vomiting.
- C. Require a nasal rather than an oral tracheal tube when a Le Fort I osteotomy is performed.
- D. Require admission of the patient to a high-dependency unit.
Correct Answer: B
Rationale: Orthognathic surgery corrects jaw deformities in the UK, typically by maxillofacial surgeons, not solely craniofacial units (reserved for complex congenital cases). Postoperative nausea and vomiting (PONV) are common due to blood swallowing, prolonged surgery, and opioids risk factors per Apfel criteria. Le Fort I osteotomy (maxillary) often uses oral intubation; nasal tubes suit mandibular focus or surgeon preference, not a requirement. High-dependency unit (HDU) admission isn't routine most recover in general wards unless complications (e.g., airway) arise. Cleft palate repair precedes, not follows, orthognathic work. PONV's prevalence reflects surgical and anaesthetic challenges, necessitating robust antiemetic prophylaxis.
A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching?
- A. The patient ambulates around the room.
- B. The patient's visitors bring in fresh peaches.
- C. The patient cleans with a warm washcloth after having a stool.
- D. The patient uses soap and shampoo to shower every other day.
Correct Answer: B
Rationale: Neutropenia post-chemo drops immunity fresh peaches with thin skins harbor bacteria, a no-no on neutropenic diets. Walking , cleaning post-stool , and mild showers are fine safe self-care. Nurses in oncology reteach this raw fruits are infection traps, a critical miss for this fragile patient.