Nokea
Which of the following is the most common assessment finding related to autoimmune thrombocytopenic purpura?
- A. A reddish-purple fine petechial rash
- B. Confusion in the elderly
- C. Fever greater than 102.0 degrees F
- D. Extreme fatigue
Correct Answer: A
Rationale: Autoimmune thrombocytopenic purpura (ITP) trashes platelets via antibodies petechiae, tiny reddish-purple spots, bloom from capillary bleeds, the most frequent sign. Confusion, fever, or fatigue might tag along in severe cases or infection, but petechiae's visibility and link to low platelets (below 100,000) make it dominant. Nurses spot this rash, tying it to ITP's core, guiding steroids or IVIG to halt this autoimmune bleed risk.
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In caring for a patient with neutropenia, what tasks can be delegated to the nursing assistant?
- A. Take vital signs every 4 hours
- B. Report temperature elevation >100.4°F
- C. Assess for sore throat, cough, or burning with urination
- D. Gather the supplies to prepare the room for protective isolation
Correct Answer: A
Rationale: Neutropenia heightens infection risk, requiring team vigilance. Taking vital signs every 4 hours fits nursing assistants' scope routine monitoring flags fevers, key in neutropenia, without needing assessment skills. Reporting fever >100.4°F is their duty once detected, but assessing symptoms like sore throat or cough demands RN judgment to interpret infection signs. Gathering supplies for isolation is assistive, not evaluative, suiting their role. Handwashing's universal, not a task to delegate. Vital signs delegation ensures timely data collection, freeing nurses to analyze and act, a practical split in caring for this vulnerable patient.
The nurse is arriving at the beginning of her shift and has taken report on four clients on a medical surgical unit. Which client should the nurse see first?
- A. A Client with pyelonephritis with nausea and vomiting
- B. A client with chronic obstructive pulmonary disease with an oxygen saturation of $90 \%$ on room air
- C. A client post vaginoplasty with bright red blood and clots in her catheter
- D. A client post-total abdominal hysterectomy with 9/10 pain
Correct Answer: C
Rationale: Bright red blood and clots post-vaginoplasty scream hemorrhage ABCs prioritize circulation, needing instant check for shock or transfusion. Pyelonephritis nags, COPD's stable at 90\%, pain's urgent but not bleeding. Nurses hit bleeding first, a life-line call in this post-op rush.
The nurse should suggest which food choice when providing dietary teaching for a patient scheduled to receive external-beam radiation for abdominal cancer?
- A. Fruit salad
- B. Baked chicken
- C. Creamed broccoli
- D. Toasted wheat bread
Correct Answer: B
Rationale: Abdominal radiation zaps the gut, sparking diarrhea from irritated bowels baked chicken's lean protein fuels healing without roughage to rile things up. Fruit salad's fiber and whole-grain toast's bulk worsen diarrhea; dairy in creamed broccoli risks lactose issues post-radiation. Nurses steer patients here to low-residue diets, dodging raw fruits and grains that scrape an already tender GI tract. In oncology, it's about balancing nutrition with symptom control chicken keeps strength up without the bowel chaos, key for tolerating treatment.
Mr XYZ, a 60-year-old, smoker with DM, hypertension and CKD Stage 3 sees you for routine chronic review. He reports recurrent gout flares past five weeks of increasing intensity and duration which he assumes is due to frequent travel and lack of exercise. His current laboratory results are creatinine 106, eGFR 56, uric acid 400, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is currently taking glipizide 5 mg BD, Metformin 250 mg BD, Amlodipine 5 mg OM. What is the most appropriate management in this patient?
- A. Offer dietary advice
- B. Prescribe NSAIDs and medical certificate (MC)
- C. Increased exercise frequency (e.g. jogging at least 3 times per week)
- D. Initiate urate lowering therapy using allopurinol with colchicine prophylaxis
Correct Answer: D
Rationale: Gout flares, uric acid 400, CKD 3 allopurinol with colchicine tames crystals, not just diet, NSAIDs, jogging, or smoke quit. Nurses start this chronic uric brake.
Which of the following investigations cannot be performed easily at General Physician clinic for assessment of NAFLD patients?
- A. BMI
- B. Waist-Hip ratio
- C. MR Elastography
- D. Fasting lipid
Correct Answer: C
Rationale: NAFLD BMI, waist, lipids, glucose snap in clinic; MR elastography's fancy scan turf. Nurses stick to this chronic basics kit.