Nokea
Which of the following is FALSE about reduced ejection fraction heart failure (HFrEF)?
- A. The goals of therapy are to reduce morbidity (i.e., reducing symptoms, improving health-related quality of life and functional status, decreasing the rate of hospitalisation) and to reduce mortality
- B. Beta blockers, angiotensin converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), or angiotensin receptor-neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonist (MRA) are the preferred antihypertensive agents because these agents improve survival
- C. Recommended lifestyle modifications include smoking cessation, restriction of alcohol consumption, salt restriction, weight reduction in obese patients, as well as daily weight monitoring to detect fluid accumulation before it becomes symptomatic
- D. Patients at high risk for re-hospitalisation should be referred to a long-term care facility
Correct Answer: D
Rationale: HFrEF goals, preferred drugs (beta blockers, ACEi, ARBs, ARNI, MRA), and lifestyle changes are true, per ESC/ACC guidelines. However, high re-hospitalization risk doesn't mandate long-term care referral outpatient management or cardiac rehab is preferred unless dependency justifies it. This false claim refines chronic HFrEF management focus.
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Mr Soh, a 40-year-old accountant on allopurinol 200 mg OM for the past eight months, reports two recent gout attacks in the last 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 is 25 kg/m², BP 144/94 mmHg. 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 perhaps 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
- D. Continue allopurinol at 100 mg OM despite the attack and start colchicine
Correct Answer: B
Rationale: Current gout attack with uric acid 405 mmol/L (above target <360) on allopurinol 200 mg suggests undertreatment. Continue allopurinol (not stop) during flares, add colchicine TDS for acute relief, and address BP 144/94 with Losartan urate-lowering and cardioprotective, unlike HCTZ, which raises urate. Check creatinine and up-titrate allopurinol later. This balances acute and chronic management effectively.
A nurse is caring for a 19-year-old male recently diagnosed with leukemia. Which of the following nursing interventions is appropriate for the care of this client?
- A. Fluid restriction
- B. Low residual diet
- C. Therapeutic phlebotomy
- D. Strict hand hygiene to prevent infection
Correct Answer: D
Rationale: Leukemia's marrow mess drops immunity strict hand hygiene shields this 19-year-old from infections, a top intervention as neutrophils crash. Fluid restriction fits overload, not here. Low residual diets aid bowels, irrelevant. Phlebotomy's for polycythemia. Nurses scrub up, guarding this young client, a germ-free must in leukemia's fragile fight.
A 36 year old woman visits her family doctor requesting blood test to check her cholesterol. She has family history of premature coronary heart disease. Physical examinations are unremarkable. Lipid profile is done and shows it the following results: Total cholesterol 5.8 mmol/L, HDL-cholesterol 1.1 mmol/L, LDL-cholesterol 3.6 mmol/L, Triglyceride 2.4 mmol/L. What is the MOST likely diagnosis?
- A. Familial hyperlipidemia
- B. Mixed hyperlipidemia
- C. Hypercholesterolaemia
- D. Familial combined hyperlipidemia
Correct Answer: B
Rationale: Cholesterol 5.8, LDL 3.6, triglycerides 2.4 both up, HDL lowish screams mixed hyperlipidemia, not lone cholesterol or triglyceride spikes. Family heart history hints genetics, but numbers don't pin familial types yet. Nurses flag this chronic dual lipid mess, tied to early coronary risk.
Which statement is not true?
- A. negative thick and thin smears does not adequately rule out malaria
- B. falciparum malaria will always show up on thick and thin smears where the others may not
- C. chloroquine is the drug of choice to treat falciparum
- D. vivax and ovale are more likely to reactivate at a later stage
Correct Answer: C
Rationale: Chloroquine flops for falciparum resistance rules, not smears' miss, relapse, or anemia truths. Nurses dodge this chronic treatment trap.
The public health nurse is presenting a health-promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America?
- A. Monthly self-breast exams
- B. Smoking cessation
- C. Annual colonoscopies
- D. Monthly testicular exams
Correct Answer: B
Rationale: Lung cancer tops the list of cancer deaths in North America for both men and women, as noted in the feedback, with over 570,000 deaths projected in 2011 alone. Smoking is the primary risk factor for lung cancer, making cessation the most direct intervention to tackle this killer. Self-breast and testicular exams target breast and testicular cancers, respectively, which rank lower in mortality (breast is second for women, prostate second for men). Colonoscopies address colorectal cancer, third in frequency, but lung cancer's dominance ties directly to smoking's prevalence. By pushing cessation, nurses hit the root cause head-on, reducing exposure to carcinogens like tar and nicotine that drive malignant transformation in lung tissue. This aligns with primary prevention, cutting incidence before it starts, unlike screening which catches disease later.