Nokea
Which of the following medication is recommended for all patients with NAFLD in improving liver histology?
- A. Statins
- B. Aspirins
- C. Ursodeoxycholic acid
- D. None of the above
Correct Answer: D
Rationale: NAFLD no med fits all; statins, aspirin, ursodiol, E lack universal proof. Nurses skip this chronic blanket pill.
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After a road traffic accident at 50 miles per hour, a healthy 30-year-old patient is admitted to a major trauma centre with a closed femoral shaft fracture and pulmonary contusion. Routine management in the intensive care unit is likely to include:
- A. A tertiary survey.
- B. A course of broad-spectrum antibiotics.
- C. Non-specific medical treatment of a rising creatinine kinase concentration (CK).
- D. Delay in physiotherapy to minimize bleeding.
Correct Answer: A
Rationale: ICU care post-trauma ensures comprehensive management. A tertiary survey (head-to-toe reassessment) identifies missed injuries (e.g., fractures), routine within 24-48 hours per trauma protocols, critical with polytrauma risks like this case. Antibiotics aren't routine without infection (e.g., open fracture); pulmonary contusion alone doesn't justify them. Rising CK from muscle damage (femoral fracture) may need monitoring (rhabdomyolysis risk), but treatment (e.g., fluids) is specific, not non-specific. Early physiotherapy aids recovery, not delayed bleeding risk is minimal with closed fractures post-stabilization. Surviving Sepsis guidelines apply only with sepsis. The tertiary survey's systematic approach prevents oversight, ensuring holistic care in a high-energy trauma patient.
The following strategies can be used to help patients overcome the barriers and challenges faced in insulin therapy EXCEPT:
- A. Engage the patient in shared decision making
- B. Threaten the patient into adherence with insulin therapy
- C. Provide close supervision and follow-up when the patient is newly initiated on insulin therapy
- D. Offer measures to reduce weight gain through lifestyle and dietary advice, concomitant use of insulin with metformin, SGLT-2 inhibitors, GLPIRA
Correct Answer: B
Rationale: Insulin's hurdles yield to shared decisions, close watch, weight tricks, and goal setting empowering, not bullying. Threats tank trust and adherence, backfiring in chronic care where buy-in's king. Support beats scare tactics, aligning with diabetes' need for partnership, a strategy flop amid solid aids.
During artificial ventilation in a patient with chronic obstructive pulmonary disease, air trapping:
- A. Leads to hypotension when venous return is reduced significantly.
- B. Is likely to be present when the capnogram fails to reach a plateau in expiration.
- C. May be reduced by using a low respiratory rate.
- D. Is reduced by decreasing the ratio of inspiratory time to expiratory time.
Correct Answer: A
Rationale: Air trapping in COPD during mechanical ventilation occurs due to incomplete exhalation from airway obstruction, leading to intrinsic positive end-expiratory pressure (auto-PEEP). This increases intrathoracic pressure, compressing the vena cava and reducing venous return, which can cause hypotension a critical complication. A capnogram failing to plateau suggests prolonged exhalation, consistent with air trapping, but it's a diagnostic sign, not a consequence. A low respiratory rate allows more exhalation time, reducing air trapping, while decreasing the inspiratory-to-expiratory time ratio (e.g., shortening inspiration) similarly helps by extending exhalation. Positive end-expiratory pressure (PEEP) can exacerbate air trapping if excessive, but its effect depends on levels used. Hypotension from reduced venous return is a direct physiological result of severe air trapping, making it the most definitive statement in this context.
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.
The nurse teaching a young women's community service group about breast self-examination (BSE) will include that:
- A. BSE will reduce the risk of dying from breast cancer
- B. BSE should be done daily while taking a bath or shower
- C. Annual mammograms should be scheduled in addition to BSE
- D. Performing BSE after the menstrual period is more comfortable
Correct Answer: D
Rationale: BSE timing matters post-menstrual breasts are less tender, swollen, or lumpy, making self-checks comfy and accurate, a key teaching point for young women. BSE doesn't cut mortality evidence lags; daily checks overdo it, monthly's enough. Mammograms start later (e.g., 40), not yet for this group. Nurses stress this timing, boosting compliance and awareness, a practical nudge in breast health education, sidestepping unproven claims for a doable habit.