Nokea
Which of the following should be not be routinely performed for patients with suspected non-alcoholic fatty liver disease?
- A. Liver biopsy
- B. Imaging studies like US scan
- C. Fasting lipids
- D. Fasting glucose
Correct Answer: A
Rationale: Liver biopsy, while diagnostic for NAFLD/NASH, isn't routine due to invasiveness and risks, reserved for unclear cases or staging needs, per AASLD. Ultrasound (fatty liver detection), fasting lipids, glucose, and liver function tests are non-invasive, routine screens for metabolic risk and diagnosis confirmation. This approach optimizes chronic disease evaluation safely.
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A client diagnosed with stable angina is complaining of substernal chest pain, rating the pain 5 out of 10. What would be the priority action by the nurse?
- A. Administer the client's prescribed beta-blocker
- B. Administer nitroglycerin intravenously immediately
- C. Administer morphine
- D. Administer 325 mg of chewable aspirin immediately
Correct Answer: D
Rationale: Stable angina's oxygen pinch 5/10 pain bows to aspirin's antiplatelet punch, cutting clot risk fast, a priority over beta-blockers' slow rate drop. IV nitroglycerin's for MI, morphine's overkill, aspirin's chewed for quick absorption. Nurses hit this, easing ischemia, a front-line move in this chest squeeze.
When using induced hypotension during orthognathic surgery:
- A. Mean arterial blood pressure may be reduced to 30% of normal in patients of ASA grade I.
- B. The stress response to surgery is attenuated.
- C. Drugs that cause relative bradycardia are useful adjuncts.
- D. The desired effects of clonidine are mediated by αâ‚-adrenoceptors.
Correct Answer: C
Rationale: Induced hypotension in orthognathic surgery reduces bleeding, enhancing visibility. Mean arterial pressure (MAP) drops to 50-65 mmHg (not 30% of normal, ~20-25 mmHg, which risks ischemia), safe in ASA I patients with monitoring. Stress response attenuation occurs with deep anaesthesia, not hypotension alone. Bradycardia-inducing drugs (e.g., β-blockers, remifentanil) stabilize haemodynamics, aiding controlled hypotension by lowering cardiac output safely. Clonidine, an α₂-agonist (not αâ‚), reduces sympathetic outflow, supporting hypotension and sedation. Invasive monitoring mitigates pressure injury risk. Bradycardia's role enhances technique precision, minimizing transfusion needs while maintaining perfusion in healthy patients.
It is the start of your second successive night shift on the labour ward. You have only managed to sleep for 4 h in the previous day. Your usual sleep requirement is 8 h per night. Appropriate statements regarding this situation include:
- A. Your total cumulative sleep deficit is 8 h.
- B. Your alertness will increase between 3 a.m. and 7 a.m. due to natural fluctuation in your circadian rhythm.
- C. Unintentional dural puncture during epidural insertion is more likely to occur during a night shift than during normal working hours.
- D. Sleeping for an extra 4 h will eliminate the sleep deficit.
Correct Answer: C
Rationale: Night shifts disrupt sleep and performance. After one night with 4 hours sleep (8-hour need), the deficit is 4 hours; a second night compounds it variably, but total' implies current state 8 hours overstates it without further context. Alertness dips 3-7 a.m. (circadian nadir), not increases, heightening fatigue. Night-shift studies (e.g., anaesthesia journals) show increased errors like dural puncture due to fatigue, reduced dexterity, and decision-making capacity, especially with sleep deprivation. Four extra hours reduce, not eliminate, a deficit if it's 4-12 hours cumulatively. Modafinil promotes wakefulness, not daytime sleep. The night-shift risk of dural puncture reflects fatigue's real-world impact on technical skills.
A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate?
- A. Administer a dose of allopurinol (Aloprim).
- B. Assess the client's serum potassium level.
- C. Gently inquire about advance directives.
- D. Prepare the client for emergency surgery.
Correct Answer: C
Rationale: Superior vena cava syndrome (SVCS) occurs when cancer (often lung or lymphoma) obstructs the superior vena cava, impairing venous return from the head and upper body. It's often a late-stage manifestation with a poor prognosis, though treatable with radiation or stenting. After stabilizing the client (e.g., with oxygen, positioning), gently inquiring about advance directives is most appropriate, as it opens a compassionate discussion about goals of care amid a potentially terminal condition. Allopurinol and potassium levels relate to tumor lysis syndrome, not SVCS. Surgery is rare for SVCS, with non-invasive options preferred. This action respects the client's autonomy and prepares for realistic outcomes, aligning with oncology nursing's holistic approach to end-of-life care in advanced disease.
Regarding infective endocarditis in an IVDU
- A. Usually presents with fever and respiratory symptoms
- B. Usually involves the mitral valve
- C. The commonest organism is staph epidermidis
- D. Negative blood cultures exclude the diagnosis
Correct Answer: A
Rationale: IVDU endocarditis fever, lung emboli from tricuspid, not mitral, Staph aureus, cultures miss some. Nurses hear this chronic right-side roar.