Nokea
Which of the following is not associated with non-alcoholic fatty liver disease?
- A. Diabetes mellitus
- B. Lung cancer
- C. Pre-diabetes mellitus
- D. Hyperuricemia
Correct Answer: B
Rationale: NAFLD diabetes, pre-sugar, uric, colon tie; lung cancer's out. Nurses link this chronic fat net.
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The nurse is providing preoperative care for a 7-year-old patient with a brain tumor. Which of the following is the priority intervention?
- A. Assessing the child's level of consciousness
- B. Providing a tour of the intensive care unit for the child and parents
- C. Educating the child and parents about shunts
- D. Having the child talk to another child who has had this surgery
Correct Answer: A
Rationale: For a child with a brain tumor preoperatively, assessing level of consciousness (LOC) is the priority, as it monitors for increased intracranial pressure (ICP) from tumor mass effect vital signs like alertness or confusion shift rapidly and signal deterioration needing immediate action. No baseline data exists here, making LOC the first step in the nursing process to guide care. An ICU tour reduces anxiety but delays critical assessment. Shunt education applies post-diagnosis of hydrocephalus, not universally pre-op, and lacks urgency without LOC context. Peer support is psychosocial, not physiological, and secondary. LOC assessment aligns with ABCs (circulation includes cerebral perfusion), ensuring the nurse detects neurological decline early, a cornerstone of pediatric neuro-oncology care before surgery.
According to the theory of planned behaviour, what is the best predictor of behaviour?
- A. Attitude
- B. Habit
- C. Intention
- D. Social norm
Correct Answer: C
Rationale: Planned behaviour intention rules, not just liking, routine, or peer push. Nurses bet on this, a chronic action cue.
With regards to adverse effects of first-line antihypertensive medications, angioedema has been associated with which ONE of the following classes of antihypertensives?
- A. Angiotensin receptor blockers
- B. Angiotensin-converting enzyme inhibitors
- C. Calcium channel blockers (dihydropyridine)
- D. Thiazide diuretics
Correct Answer: B
Rationale: Angioedema, a potentially life-threatening swelling of deep skin layers or mucous membranes, is a well-documented adverse effect of angiotensin-converting enzyme (ACE) inhibitors, occurring in about 0.1-0.7% of patients due to bradykinin accumulation from enzyme inhibition. This distinguishes ACE inhibitors from other first-line antihypertensives. Angiotensin receptor blockers (ARBs) rarely cause angioedema, as they don't affect bradykinin levels. Calcium channel blockers (e.g., dihydropyridines like amlodipine) may cause peripheral edema but not angioedema. Thiazide diuretics are linked to electrolyte imbalances or rashes, not angioedema. Family physicians must recognize this ACE inhibitor risk, ensuring prompt discontinuation and airway management if it occurs, critical for safe chronic disease management.
Damage control resuscitation:
- A. Is not indicated unless it is clear the patient's physiology has been deranged by severe injury.
- B. Is not indicated unless the patient is in the hospital.
- C. Is likely to involve restriction of fluid administration in a hypotensive, bleeding patient.
- D. Is likely is be assessed for adequacy by palpation of the radial pulse in patients with a head injury.
Correct Answer: C
Rationale: Damage control resuscitation (DCR) mitigates trauma's lethal triad (hypothermia, acidosis, coagulopathy). It's indicated preemptively in severe bleeding, not just post-derangement, to prevent physiologic collapse. It begins pre-hospital (e.g., paramedics), not only in-hospital, using blood products early. Fluid restriction in hypotensive bleeding limits dilutional coagulopathy, favoring permissive hypotension until haemostasis crucial in uncontrolled haemorrhage. Radial pulse palpation gauges perfusion broadly, but head injury patients need cerebral perfusion pressure prioritization, not DCR adequacy. ABC remains foundational. Fluid restriction's role balancing shock correction with bleeding exacerbation defines DCR's shift from crystalloid overload, improving survival in exsanguinating trauma.
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.