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When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene?
- A. The UAP assists the patient to use dental floss after eating.
- B. The UAP adds baking soda to the patient's saline oral rinses.
- C. The UAP puts fluoride toothpaste on the patient's toothbrush.
- D. The UAP has the patient rinse after meals with a saline solution.
Correct Answer: A
Rationale: Pancytopenia low everything means flossing risks bleeding and infection in a mouth with no platelets or immunity; baking soda , fluoride , and saline are safe. Nurses in oncology stop this UAP need soft-brush guidance, not floss, to protect fragile mucosa.
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Percutaneous cervical cordotomy:
- A. Is performed under general anaesthesia.
- B. Occurs by entry of a needle into the intervertebral foramen between cervical vertebrae C4 and C5.
- C. Involves thermoablation of the anterior spinothalamic tract.
- D. Is performed on the same side as the pain.
Correct Answer: C
Rationale: Percutaneous cervical cordotomy (PCC) relieves cancer pain via targeted nerve destruction. It's done under local anesthesia with sedation, not general, to monitor patient response (e.g., pain relief, side effects) during stimulation. The needle enters at C1-C2, not C4-C5, targeting the lateral spinothalamic tract contralateral to the pain not the anterior tract explicitly, though terminology varies. Thermoablation destroys pain fibers, confirmed by test stimulation. It's performed opposite the pain side due to crossed spinothalamic pathways. Complete numbness isn't typical; sensory loss is partial. Thermoablation's specificity using radiofrequency to interrupt pain transmission defines PCC's efficacy, minimizing damage to adjacent motor tracts while achieving analgesia.
In the UK, appropriate statements concerning the trauma network include:
- A. Major trauma centres, but not minor trauma units, need facilities to deal with polytrauma patients.
- B. Hospitals dealing with trauma are expected to contribute data to the Trauma Audit Research Network (TARN) database.
- C. Within their network, trauma units have transfer arrangements for moving seriously injured patients to major trauma centres.
- D. Trauma networks have an ambulance protocol for bypassing the nearest unit for injuries that may be best treated at a distant specialist centre.
Correct Answer: B
Rationale: The UK trauma network, established pre-2014, enhances care coordination. Major trauma centres (MTCs) handle polytrauma; trauma units manage less severe cases, though both need capabilities severity dictates MTC referral. TARN collects data from all trauma-receiving hospitals, tracking outcomes (e.g., mortality) to improve standards, a core network feature. Transfer protocols ensure escalation from trauma units to MTCs for complex injuries. Ambulance bypass protocols prioritize specialist MTCs (e.g., neurosurgery) over proximity, per triage tools. Rehabilitation is included in network responsibilities. TARN's mandatory data submission drives quality, transparency, and research, distinguishing the system's evidence-based evolution.
The role of the nurse and other health professions in chronic disease is to:
- A. Support the person in managing their condition
- B. Provide direction to the person about their treatment
- C. Ensure the person takes their medications and avoids risk factors
- D. Decide on the best approach to manage the condition and direct the implementation of this care
Correct Answer: A
Rationale: Chronic disease management hinges on patient empowerment, not authoritarian control. Supporting individuals in managing their condition aligns with modern nursing philosophy, fostering self-efficacy through education, emotional support, and resource provision key in texts like Deravin and Anderson (2019). Providing direction implies guidance, but it's less collaborative than support, often overstepping patient autonomy. Ensuring medication adherence and risk avoidance is paternalistic, assuming enforcement over partnership, which conflicts with patient-centered care principles. Deciding and directing care outright disregards patient input, undermining shared decision-making critical for long-term adherence in chronic illness. Support encompasses holistic care physical, psychological, and social enabling patients to navigate their condition, adapt lifestyles, and cope with challenges, reflecting the multidisciplinary team's role in enhancing quality of life rather than dictating it.
A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client should the nurse see first?
- A. A client with a swollen and painful left great toe
- B. Client who reports dyspnea
- C. Client with a blood pressure of 180/98 mm Hg
- D. Client who reports calf tenderness and swelling
Correct Answer: B
Rationale: Polycythemia vera thickens blood, risking clots dyspnea signals possible pulmonary embolism, a life-threatening emergency needing instant assessment per ABCs. Toe pain suggests gout, common but less acute. Hypertension, a chronic issue here, waits behind respiratory distress. Calf tenderness hints at DVT, urgent but not immediately fatal like embolism. Nurses triage dyspnea first, ensuring airway and oxygenation, a critical call in this hyperviscous condition prone to thrombotic crises.
A 59-year-old lady with type 2 diabetes mellitus (T2DM), heart failure from coronary artery disease, and an ejection fraction of 60 percent attends your practice for a routine follow-up. She has mild dyspnea while climbing stairs but reports no other limitations in her usual activities. Her HbA1c was 7.2 percent. She is compliant to extended-release metformin 2,000 mg OD, Rosuvastatin 10 mg ON, Telmisartan 40 mg OD, carvedilol 25 mg BD, and aspirin 100 mg OD. Her vital signs reveal stable body weight at 88 kg, a blood pressure of 126/78 mmHg, a heart rate of 68 bpm and regular, and a respiratory rate of 18 breaths/min. Her examination is otherwise normal. What would be the most appropriate next step in management?
- A. Increase carvedilol to 50 mg BD
- B. Add an SGLT2-inhibitor to her regimen
- C. Add basal insulin to her regimen
- D. Add dipeptidyl peptidase-4 (DPP-4) inhibitor to her regimen
Correct Answer: B
Rationale: HFpEF (EF 60%) with T2DM and dyspnea SGLT2 inhibitors cut heart failure risk and aid sugar, a dual win over carvedilol's max-out, insulin's glucose-only hit, DPP-4's weak HF edge, or unneeded frusemide (no edema). Clinicians add this, boosting chronic outcomes, a smart next step.