Nokea
Which of the following is FALSE about brain natriuretic peptide (BNP)?
- A. Plasma levels of BNP often correspond to the severity of underlying cardiac dysfunction and can provide relatively reliable prognostic information
- B. It is secreted in response by the atria and ventricles in response to stretching for increased wall tension
- C. Obesity, diuretics, ACE inhibitors, beta blockers, angiotensin receptor antagonists, and aldosterone antagonists can lead to falsely high levels of BNP
- D. Common conditions that may falsely elevate plasma BNP levels include age and significant renal dysfunction
Correct Answer: C
Rationale: BNP reflects cardiac dysfunction severity and wall tension response true. Age and renal dysfunction elevate BNP falsely true. However, obesity, diuretics, ACEi, beta blockers, ARBs, and MRAs lower BNP (obesity reduces secretion, drugs reduce tension), not raise it making this false. High BNP (>1,000 pg/mL) signals poor prognosis. This corrects BNP interpretation in chronic HF.
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The nurse is discharging home a client at risk for venous thromboembolism on enoxaparin sodium. What instruction is a priority for the nurse to provide to this client?
- A. Notify your health care provider if your stools appear dark or tarry
- B. You must have your prothrombin time (PT)/international normalized ratio (INR) checked every 2 weeks
- C. Massage the injection site after the heparin is injected
- D. You must have your activated partial thromboplastin time (aPTT) checked every 72 hours
Correct Answer: A
Rationale: Enoxaparin, a low-molecular-weight heparin, thins blood dark, tarry stools signal GI bleed, a dire side effect needing instant reporting to halt hemorrhage. PT/INR tracks warfarin, not enoxaparin; aPTT's for unfractionated heparin. Massaging injection sites risks bruising. Nurses prioritize bleed watch, ensuring safety on this clot-busting med, a discharge must-know.
A hospitalized client has a platelet count of 58,000/mm³. What action by the nurse is best?
- A. Implement fall precautions
- B. Encourage high-protein foods
- C. Limit visitors to healthy adults
- D. Institute neutropenic precautions
Correct Answer: A
Rationale: A platelet count of 58,000/mm³ below 150,000 signals thrombocytopenia, raising bleeding risk, especially from falls. Implementing fall precautions curbs trauma, preventing bleeds like intracranial hemorrhage, a practical priority over dietary tweaks. High-protein foods aid healing but don't address immediate danger. Limiting visitors or neutropenic precautions fits low WBCs, not platelets 58,000 isn't neutropenic (below 1,000 neutrophils). Nurses prioritize safety, making fall precautions the best action, directly mitigating this lab's implications in a hospitalized client prone to injury.
Sodium-glucose-co-transporter-2 (SGLT-2) inhibitors were shown to reduce albuminuria and proteinuria by X%. What is X?
- A. 10--30
- B. 20-40
- C. 30-50
- D. 40-60
Correct Answer: C
Rationale: SGLT-2 inhibitors, used in type 2 diabetes, reduce albuminuria and proteinuria by 30-50%, as evidenced in trials like CREDENCE and DAPA-CKD. They lower glomerular hyperfiltration by inhibiting glucose and sodium reabsorption in the proximal tubule, decreasing intraglomerular pressure and thus protecting kidney function. This 30-50% reduction is significant in slowing chronic kidney disease (CKD) progression, a key benefit beyond glycemic control. Lower ranges (10-30%, 20-40%) underestimate this effect, while higher ranges (40-60%) may apply to specific subgroups but aren't the average. This renal protection makes SGLT-2 inhibitors a cornerstone in managing diabetic nephropathy, vital knowledge for physicians optimizing chronic disease outcomes.
A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign?
- A. Liver function tests (LFTs)
- B. Complete blood count (CBC)
- C. Platelet count
- D. Blood urea nitrogen and creatinine
Correct Answer: A
Rationale: Yellow skin signals jaundice, often tied to liver dysfunction, a frequent issue post-chemotherapy due to metastatic spread or drug toxicity. Liver function tests (LFTs) like ALT, AST, and bilirubin directly assess liver health, pinpointing if metastases or chemo agents (e.g., hepatotoxic drugs like methotrexate) are at play. A CBC might show anemia or infection but doesn't target liver issues. Platelet count could hint at clotting problems, possibly liver-related, but it's too narrow. Blood urea nitrogen and creatinine check kidney function, not liver, despite both organs handling chemo clearance. Since the liver's a common metastatic site especially from cancers like breast or lung LFTs are the go-to here, guiding the nurse to catch complications early and adjust care, critical in oncology follow-ups.
The pathophysiology of Asthma differs from COPD as:
- A. It is characterised by airflow limitation
- B. There is abnormal inflammatory response to exposure to noxious particles or gases
- C. The airflow limitation is reversible
- D. It is considered an obstructive lung disease
Correct Answer: C
Rationale: Asthma's twist reversible airflow block sets it apart from COPD's fixed choke. Both obstruct, inflame to triggers, but asthma's airways bounce back with puffs. Nurses spot this, a chronic split for treatment.