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Which of the following assessment findings are consistent with aortic stenosis?
- A. Systolic click
- B. Pitting edema
- C. Harsh systolic crescendo decrescendo murmur
- D. Atrial fibrillation
Correct Answer: C
Rationale: Aortic stenosis narrows the valve, obstructing outflow producing a harsh systolic crescendo-decrescendo murmur, loudest at the aortic area, a classic sign from turbulent flow. Systolic clicks tie to mitral prolapse, not stenosis. Pitting edema reflects heart failure, a late complication, not direct. Atrial fibrillation may coexist but isn't specific. Nurses expect this murmur, auscultating for its distinct pattern, key to spotting stenosis early, guiding diagnostics like echocardiography to prevent progression to failure.
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A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate?
- A. Don't you have any friends that will raise the children for you?'
- B. Would you like to talk about options for the care of your children?'
- C. For now you need to concentrate on getting well and not worrying about your children.'
- D. Many patients with cancer live for a long time, so there is time to plan for your children.'
Correct Answer: B
Rationale: Metastatic ovarian cancer's end-stage she's scared for her kids. Asking about options opens a lifeline, validating her fear without shutting it down. Friends assumes too much; get well' dodges reality; long time' sugarcoats. Nurses in oncology lean in here listening, planning ease her burden, a human touch amid grim odds.
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.
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.
Which of the following is the most common assessment finding related to autoimmune thrombocytopenic purpura?
- A. A reddish-purple fine petechial rash
- B. Confusion in the elderly
- C. Fever greater than 102.0 degrees F
- D. Extreme fatigue
Correct Answer: A
Rationale: Autoimmune thrombocytopenic purpura (ITP) trashes platelets via antibodies petechiae, tiny reddish-purple spots, bloom from capillary bleeds, the most frequent sign. Confusion, fever, or fatigue might tag along in severe cases or infection, but petechiae's visibility and link to low platelets (below 100,000) make it dominant. Nurses spot this rash, tying it to ITP's core, guiding steroids or IVIG to halt this autoimmune bleed risk.
Which of the following statements regarding weight regulation is FALSE?
- A. Functional MRI (fMRI) studies have shown overactivation of reward-encoding brain regions and/or deficiency in cortical inhibitory networks in obese people
- B. The homeostatic weight regulation circuitry centres around the corticolimbic structures of the brain
- C. Liking and wanting of food are subconscious processes
- D. The reward system of weight regulation is nonhomeostatic in nature
Correct Answer: B
Rationale: Weight regulation involves homeostatic (hypothalamic) and nonhomeostatic (reward-driven) systems. fMRI studies showing reward region overactivation in obesity, subconscious liking/wanting, and the reward system's nonhomeostatic nature are true. However, homeostatic regulation centers on the hypothalamus, not corticolimbic structures (involved in reward/emotion), making this false. Understanding this distinction aids physicians in addressing both physiological and behavioral drivers in chronic obesity management.