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Which is FALSE regarding PCP pneumonia in AIDS?
- A. it is usually only seen when the CD4 count <200
- B. prophylaxis should be given in all pts with CD4 count <200
- C. CXR characteristically shows bilateral diffuse infiltrates
- D. Once a patient has had it they are unlikely to get it again
Correct Answer: D
Rationale: PCP relapse haunts AIDS CD4 <200 stays vulnerable, not a one-off. Prophylaxis holds below 200, CXR's diffuse or blank 20%, all true. Nurses know this chronic lung leech bites again sans lifelong guard.
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Which of the following is a possible treatment plan for a client diagnosed with leukemia?
- A. Dialysis
- B. Therapeutic phlebotomy
- C. Splenectomy
- D. Stem cell transplant
Correct Answer: D
Rationale: Leukemia's marrow takeover needs a reset stem cell transplant swaps diseased cells for healthy ones, a potential cure or remission shot. Dialysis aids kidneys, not blood. Phlebotomy drains polycythemia. Splenectomy's rare, symptom-based. Nurses prep for transplant, eyeing this radical fix, a game-changer in leukemia's brutal playbook.
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.
A nurse is performing discharge teaching for a client who was recently diagnosed with heart failure. Which of the following should be included in the client and family teaching?
- A. Low sodium diet
- B. Weekly weights
- C. Symptoms to report to the provider
- D. Fluid restriction
Correct Answer: A
Rationale: Heart failure management hinges on education to prevent exacerbations. A low sodium diet reduces fluid retention, easing cardiac workload crucial teaching for clients and families to grasp, as salt drives edema and hypertension, common pitfalls in heart failure. Weekly weights track fluid shifts daily is ideal, but weekly still aids while reporting symptoms like dyspnea flags worsening. Medication teaching ensures adherence, and fluid restriction may apply, but sodium's broader impact makes it foundational. Focusing on diet empowers lifestyle change, tackling a root cause over monitoring or restrictions alone, aligning with nursing's role in empowering self-care to stabilize this chronic condition long-term.
The nurse caring for oncology clients knows that which form of metastasis is the most common?
- A. Bloodborne
- B. Direct invasion
- C. Lymphatic spread
- D. Via bone marrow
Correct Answer: A
Rationale: Metastasis is the process by which cancer spreads from its original site to distant parts of the body, a critical concern in oncology nursing. Among the various mechanisms, bloodborne metastasis is the most common, as cancer cells often enter the bloodstream and travel to organs like the lungs, liver, or brain. This occurs because the circulatory system provides an efficient pathway for tumor cells to disseminate widely, especially in cancers like breast or lung cancer. Lymphatic spread is also frequent, particularly in carcinomas, where cells travel via lymph nodes, but it is less dominant than bloodborne spread across all cancer types. Direct invasion involves cancer growing into adjacent tissues, which is a local process rather than true metastasis. Bone marrow is not a medium for metastasis but a potential site where cancer can settle, such as in leukemia or multiple myeloma. Understanding that bloodborne metastasis predominates helps nurses prioritize monitoring for systemic symptoms and complications, such as organ dysfunction, in clients with advanced cancer.
In Europe and the USA, drugs licensed for use in intrathecal drug delivery systems include:
- A. Diamorphine.
- B. Methadone.
- C. Morphine.
- D. Ziconotide.
Correct Answer: C
Rationale: Intrathecal drug delivery systems (IDDS) use specific licensed drugs in Europe and the USA. Morphine is widely approved for its efficacy in cancer and chronic pain, binding spinal opioid receptors with a strong evidence base. Ziconotide, a non-opioid, is also licensed, targeting calcium channels for refractory cases. Diamorphine (heroin) isn't licensed intrathecally; it's used epidurally or systemically in some regions (e.g., UK palliative care) but lacks IDDS approval. Methadone's long half-life and oral efficacy preclude intrathecal use; it's not licensed. Ketamine has experimental use but no formal approval. Morphine's prominence stems from its pharmacokinetic suitability high potency and spinal receptor affinity making it a cornerstone of IDDS therapy alongside ziconotide.