Nokea
When using induced hypotension during orthognathic surgery:
- A. Mean arterial blood pressure may be reduced to 30% of normal in patients of ASA grade I.
- B. The stress response to surgery is attenuated.
- C. Drugs that cause relative bradycardia are useful adjuncts.
- D. The desired effects of clonidine are mediated by αâ‚-adrenoceptors.
Correct Answer: C
Rationale: Induced hypotension in orthognathic surgery reduces bleeding, enhancing visibility. Mean arterial pressure (MAP) drops to 50-65 mmHg (not 30% of normal, ~20-25 mmHg, which risks ischemia), safe in ASA I patients with monitoring. Stress response attenuation occurs with deep anaesthesia, not hypotension alone. Bradycardia-inducing drugs (e.g., β-blockers, remifentanil) stabilize haemodynamics, aiding controlled hypotension by lowering cardiac output safely. Clonidine, an α₂-agonist (not αâ‚), reduces sympathetic outflow, supporting hypotension and sedation. Invasive monitoring mitigates pressure injury risk. Bradycardia's role enhances technique precision, minimizing transfusion needs while maintaining perfusion in healthy patients.
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Which of the following should be not be routinely performed for patients with suspected non-alcoholic fatty liver disease?
- A. Liver biopsy
- B. Imaging studies like US scan
- C. Fasting lipids
- D. Fasting glucose
Correct Answer: A
Rationale: Liver biopsy, while diagnostic for NAFLD/NASH, isn't routine due to invasiveness and risks, reserved for unclear cases or staging needs, per AASLD. Ultrasound (fatty liver detection), fasting lipids, glucose, and liver function tests are non-invasive, routine screens for metabolic risk and diagnosis confirmation. This approach optimizes chronic disease evaluation safely.
Patients on insulin therapy should receive essential education on the following EXCEPT:
- A. Insulin injection technique
- B. Stopping all oral hypoglycaemic agents
- C. Recognition and self-management of hypoglycaemia
- D. Sick day management
Correct Answer: B
Rationale: Insulin therapy education for diabetes patients covers injection technique, hypoglycemia recognition and management, sick day rules, and safe driving, per diabetes care standards. However, stopping all oral hypoglycemic agents isn't universally essential many patients continue agents like metformin or SGLT-2 inhibitors alongside insulin for synergistic effects, depending on glycemic control needs. Assuming cessation oversimplifies treatment plans, potentially reducing efficacy. Education must tailor to individual regimens, not mandate stopping orals, making this the exception. Physicians ensure comprehensive teaching to enhance adherence and safety, critical in chronic disease management.
Regarding HIV/AIDS
- A. Shingles, seborrhoeic dermatitis and recurrent HSV infections are typical of early infection
- B. A CD4 count of 1.0 x 10^9/L is associated with late stage AIDS
- C. Pre and post test counselling for HIV serology is now no longer mandatory
- D. Pneumococcus is a more likely pathogen than TB in AIDS patients with pneumonia
Correct Answer: D
Rationale: HIV early skin woes, CD4's units flop, counseling holds, TB trumps pneumococcus, toxo hits brain. Nurses chase this chronic lung truth.
After receiving the hand-off report, which client should the oncology nurse see first?
- A. Client who is afebrile with a heart rate of 108 beats/min
- B. Older client on chemotherapy with mental status changes
- C. Client who is neutropenic and in protective isolation
- D. Client scheduled for radiation therapy today
Correct Answer: B
Rationale: In oncology nursing, prioritizing care is critical due to the complexity of cancer patients' conditions. An older client on chemotherapy with mental status changes is the priority because this could signal sepsis or infection, especially since chemotherapy-induced neutropenia often masks typical signs like fever in the elderly. Mental confusion might be the only early clue, and delayed assessment could lead to rapid deterioration or death. A heart rate of 108 beats/min without fever suggests tachycardia, possibly from dehydration or anxiety, but it's less urgent without other red flags. A neutropenic client in isolation needs monitoring, but no acute change is noted. The client scheduled for radiation has a planned treatment, not an immediate crisis. Assessing the older client first allows the nurse to rule out or address a life-threatening issue, aligning with the principle of prioritizing unstable patients in acute care settings.
Animal experiments have shown that destruction of the ventromedial nuclei of the hypothalamus leads to unrestrained eating, because a specific structure is lost. Question: Which structure is lost?
- A. The amygdala
- B. The vagus nerve
- C. The satiety centre
- D. The feeding centre
Correct Answer: C
Rationale: Ventromedial zap satiety centre dies, eating runs wild, not amygdala's fear, vagus' gut, or feeding's drive. Nurses link this, a chronic overeat switch.