Nokea
Which of the following assessment findings is a priority during blood transfusion?
- A. Chest pain
- B. Fatigue
- C. Joint pain
- D. Headache
Correct Answer: A
Rationale: Blood transfusions carry risks like acute reactions chest pain screams potential hemolytic or allergic response, a life-threatening emergency demanding immediate halt and intervention, prioritizing airway and circulation per ABCs. Fatigue is common, reflecting anemia's baseline, not an acute flag. Joint pain or headaches might hint at milder issues transfusion overload or tension but lack chest pain's urgency. Swift recognition of chest pain prevents escalation to shock or respiratory failure, a nurse's critical duty in transfusion safety, outranking less specific symptoms in this high-stakes scenario.
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Which of the following is the surgical treatment of choice for end-stage heart failure?
- A. Cardiac resynchronization therapy (CRT)
- B. Percutaneous angiogram
- C. Genetic counseling
- D. Ventricular assist devices (VADs)
Correct Answer: D
Rationale: End-stage heart failure, when drugs and pacing fail, leans on ventricular assist devices mechanical pumps aiding circulation, a bridge to transplant or destination therapy. CRT syncs ventricles, less invasive, but VADs tackle severe pump collapse. Angiograms diagnose, not treat; genetic counseling's irrelevant. Nurses prep for VADs, managing post-op risks, the go-to surgical fix in this terminal cardiac scenario.
A person is 178 cm high and weighs 89 kg. What is his BMI?
- A. 26
- B. 28
- C. 31
- D. 34
Correct Answer: B
Rationale: BMI's weight over height squared 89 kg ÷ (1.78 m × 1.78 m) ≈ 28. Height in meters, simple math, lands between 25 and 30, overweight, not obese. Nurses crunch this daily, a chronic weight watch pegging 28 spot-on.
Which of the following appropriately describes diastolic dysfunction?
- A. The rate of filling of the ventricles during diastole is slowed
- B. The left ventricle is dilated
- C. The preload (end ventricular diastolic volume) is increased
- D. The left ventricular ejection fraction is decreased
Correct Answer: A
Rationale: Diastolic dysfunction stiffens ventricles slowed filling in diastole nails it, as relaxation flops, hiking pressure. Dilated LV or high preload fits systolic; low EF's not here preserved in HFpEF. Dyssynchrony's another beast. Clinicians peg this slow fill, a chronic heart kink distinct from pump fail.
Mr Soh, a 40-year-old accountant on allopurinol 200 mg OM for the past eight months, reports two recent gout attacks in the past year. He has no other known past medical history. When you probe, he is adherent to allopurinol except for missing it perhaps once or twice a month. His BMI 25 kg/m², BP 144/94 mm Hg. His last uric acid was one month ago, which was 405 mmol/L. He is having a gout attack now. He tells you that his gout attacks are usually aborted with colchicine TDS for two days. Whilst on colchicine, he does not experience diarrhoea except for one episode of loose stools, after which he stops colchicine. Which is the most appropriate next step?
- A. Start Hydrochlorothiazide for hypertension
- B. Start Losartan for hypertension
- C. Stop Allopurinol during this acute gout attack and start colchicine. Consider checking a baseline creatinine if not recently available
- D. Continue allopurinol at 200 mg OM despite the attack and start colchicine. Consider checking an updated uric acid level and creatinine two weeks after the attack resolves. If uric acid is >360, explain that allopurinol 200 mg OM is insufficient and needs to be up titrated
Correct Answer: D
Rationale: Gout mid-attack 405 uric acid on 200 mg allopurinol says it's not enough. Keep it rolling, add colchicine to quash the flare, then recheck labs post-calm to titrate up if >360. Stopping allopurinol spikes urate; HCTZ worsens gout; Losartan's fine but sidesteps; upping now risks confusion. Clinicians stick this path, steering chronic control smart.
For a patient on the chemotherapeutic drug vincristine (Oncovin), which of the following side effects should be reported to the physician?
- A. Fatigue
- B. Nausea and vomiting
- C. Paresthesia
- D. Anorexia
Correct Answer: C
Rationale: Vincristine, a vinca alkaloid, disrupts nerve function, making paresthesia tingling or numbness a critical side effect signaling neurotoxicity, warranting physician review for dose adjustment or cessation. Fatigue, nausea, and anorexia, while common in chemotherapy, are manageable with nursing interventions rest, antiemetics, small meals unless severe. Paresthesia's specificity to vincristine's mechanism, targeting microtubules, elevates its urgency; unchecked, it risks permanent nerve damage, impacting mobility and quality of life. Reporting it ensures timely intervention, distinguishing it from routine effects, a key nursing responsibility in monitoring chemotherapy's narrow therapeutic window.