Nokea
Which of the following is FALSE regarding patient education for insulin therapy?
- A. It improves the patients experience and adherence to insulin therapy
- B. It requires time and preparation
- C. Different topics and focus can be covered at different stages of insulin therapy
- D. It can only be done by diabetes nurse educators
Correct Answer: D
Rationale: Patient education for insulin therapy enhances experience and adherence, requires time, and varies by stage e.g., injection skills at initiation, hypoglycemia management later all true per diabetes guidelines. However, stating it can only be done by diabetes nurse educators is false. While specialized educators excel, other healthcare professionals (physicians, pharmacists) can deliver effective education, especially in resource-limited settings. Multidisciplinary involvement ensures broader access and periodic understanding checks, vital for chronic disease management. This flexibility empowers diverse teams to support patients, debunking the exclusivity myth.
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Mr Tan, a 50-year-old with hypertension, sees you for routine review. He reports three gout flares in the past two months relieved with three days of Arcoxia 120 mg OM for each episode. You perform some blood tests, which returns the following results: Creatinine 95 umol/L, eGFR >90 mL/min, Uric acid 460 mmol/L, HbA1c 5.4%, Random hypo-count 7.5 mmol/L. He is currently on Amlodipine 10 mg OM. He does not drink alcohol except one glass of wine once or twice a year on special occasions. His BMI is 20.5 kg/m². Which is the most appropriate next step?
- A. Prescribe NSAIDs standby for gout flare
- B. Offer dietary advice and advise regular exercise only
- C. Prescribe prednisolone standby for gout flare
- D. Discuss urate lowering therapy as he has had >2 gout flares in the past year, ideally with colchicine prophylaxis
Correct Answer: D
Rationale: Three gout flares in two months with uric acid 460 mmol/L (hyperuricemia) indicate frequent attacks warranting urate-lowering therapy (ULT) like allopurinol, per guidelines (e.g., ACR), especially with >2 flares yearly. Colchicine prophylaxis reduces flare risk during ULT initiation. NSAIDs or prednisolone treat acute flares but don't address recurrence. Diet/exercise alone won't suffice with this frequency and uric acid level. ULT discussion aligns with chronic gout management to prevent joint damage, critical for family physicians.
A 35-year old teacher on allopurinol 200 mg OM for the past year reports three recent gout attacks. BMI 27 kg/m2, BP 144/94 mm Hg. You notice tophi over both hands and elbows. You will now:
- A. Stop the allopurinol during this acute gout attack
- B. Start hydrochlorothiazide 25 mg OM for BP control
- C. Continue allopurinol despite the attack and aim to reduce uric acid <300 umol/L
- D. Advise to rest and avoid exercise for 3 months as he is having acute pain
Correct Answer: C
Rationale: Tophi, flares allopurinol stays, push uric <300; thiazides worsen, rest flops, losartan's late. Nurses hold this chronic crystal line.
The immediate nursing care to be provided to a patient presenting with a suspected ischaemic stroke include:
- A. Position on left lateral side, insert nasogastric tube, conduct an ECG and insert an IV line
- B. Primary/Secondary survey, give analgesia, 4th hourly neuro obs and vital signs, maintain oral intake
- C. Primary/Secondary survey, 4th hourly neuro obs and vital signs, monitor BGL and maintain nil by mouth
- D. 4th hourly neuro obs and vital signs, monitor BGL, insert an IV line and reduce intracranial pressure by positioning and reduced stimulation
Correct Answer: C
Rationale: Stroke hits fast surveys spot deficits, neuro obs track brain, vitals catch crashes, BGL rules out mimics, and nil by mouth preps for scans or clots, a tight first step. Lateral's for airways, not here; analgesia's late; IVs and ICP control follow. Nurses nail this, racing for tPA windows, a chronic precursor's acute kickoff.
Choose the CORRECT statement Babies born from mothers with gestational diabetes:
- A. Are at a high risk of being born with diabetes
- B. Are usually hypoglycaemic due to maternal insulin drug therapy
- C. Are usually of higher birth weight
- D. Are always given a glucose challenge test
Correct Answer: C
Rationale: Gestational diabetes fattens babies high maternal sugar pumps fetal growth, a hefty birth norm. They don't inherit diabetes at birth, hypo's rare unless mom's on insulin, tests aren't routine. Nurses track this, a chronic womb echo.
Postoperative care at the completion of bimaxillary surgery:
- A. Is likely to be complicated by the presence of intermaxillary fixation (IMF).
- B. Involves awake rather than asleep extubation.
- C. Requires gentle removal of the tracheal tube to avoid damage of mandibular plates and screws.
- D. Involves reinsertion of a nasal tracheal tube when complicated by airway bleeding or obstruction requiring emergency reintubation.
Correct Answer: A
Rationale: Bimaxillary surgery's postoperative phase is complex. Intermaxillary fixation (IMF) aligns jaws but restricts mouth opening, complicating airway management, vomiting, and oral care raising aspiration or obstruction risks. Awake extubation is preferred, ensuring airway reflexes return, critical with IMF and swelling. Gentle tube removal prevents surgical site trauma (e.g., plates), though mandibular hardware is internal, less tube-accessible. Emergency reintubation may use nasal routes due to IMF, addressing bleeding/obstruction. HDU care is case-specific, not mandatory. IMF's presence drives tailored strategies, prioritizing airway security and patient stability in this high-risk recovery period.