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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The nurse is teaching the parents of a 15-year-old who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which of the following symptoms should the parents seek medical care immediately?
- A. Earache, stiff neck or sore throat
- B. Blisters, ulcers or a rash appear
- C. A temperature of 101.5 degrees Fahrenheit
- D. Difficulty or pain when swallowing
Correct Answer: C
Rationale: Chemotherapy for acute myelogenous leukemia suppresses the immune system by reducing white blood cell production, leaving the child highly susceptible to infections. A fever of 101.5°F is a critical sign in this context, as it may indicate an infection that, without a functioning immune response, could rapidly progress to sepsis a life-threatening condition. Parents must seek immediate medical care to evaluate and treat the underlying cause, often requiring emergency department intervention. While earache, stiff neck, or sore throat could suggest infection, they are less urgent without fever and may not necessitate immediate action unless severe. Blisters, ulcers, or rashes might reflect chemotherapy side effects like mucositis or drug reactions, manageable with outpatient care unless infected. Difficulty swallowing could stem from mucositis or infection, but fever trumps it in urgency due to its systemic implications. Educating parents to prioritize fever ensures timely intervention, aligning with oncology nursing's focus on preventing complications in immunocompromised pediatric patients.
A patient's most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patient's cancer cells spread?
- A. Hematologic spread
- B. Lymphatic circulation
- C. Invasion
- D. Angiogenesis
Correct Answer: B
Rationale: Lung cancer loves lymphatics its cells hitch rides via nodes, the most common metastasis route, hitting bones and liver downstream. Blood (hematologic) spread happens too, but lymph's king for lung primaries. Invasion's local creep, not distant jumps. Angiogenesis feeds tumors, not moves them. Nurses track this pattern, knowing lymph drainage from lungs seeds those far-off sites, a grim oncology reality shaping staging and prognosis.
A 58-year-old man with a known history of heart failure from cardiomyopathy, with an ejection fraction of 30 percent returns for a 3-week follow-up visit after being started on frusemide 40 mg od for increasing symptoms of dyspnea. Since starting frusemide, his symptoms have returned to baseline and he has lost 3 kg. He is maintained on guideline-directed medical therapy for heart failure including sacubitril/valsartan 97 mg/103 mg BD, carvedilol 12.5 mg BD, Simvastatin 40 mg ON, and aspirin 81 mg OD. His physical examination reveals: blood pressure of 128/80 mmHg, regular heart rate of 78 bpm, respiratory rate of 18 breaths/min, and room air oxygen saturation of 96 percent with no saturation decrease with hallway ambulation. He has no peripheral edema. A clinic electrocardiogram reveals a left bundle branch block with a QRS duration of >150 msec. What would be the most appropriate next step in management?
- A. Refer him to an electrophysiologist
- B. Discontinue the sacubitril/valsartan 97 mg/103 mg BD
- C. Change his diuretic to spironolactone 25 mg OD
- D. Increase the frusemide to 40 mg BD
Correct Answer: A
Rationale: HFrEF at 30% EF with LBBB >150 msec stabilized on meds hints at dyssynchrony, ripe for cardiac resynchronization therapy, so an electrophysiologist's next. Ditching sacubitril/valsartan or swapping diuretics lacks cause; upping frusemide or re-echoing waits. Clinicians tap this referral, boosting chronic pump sync, a guideline nod.
Which of the following interventions would be best for the child who has developed mucositis as a side effect of chemotherapy?
- A. Using lemon glycerin swabs for oral hygiene.
- B. Keeping the child NPO until all sores are healed.
- C. Having the child swish and swallow viscous lidocaine.
- D. Giving the child pudding for breakfast.
Correct Answer: D
Rationale: Mucositis, a painful chemotherapy side effect, involves inflamed, ulcerated mucous membranes, often in the mouth, complicating eating and hygiene. Offering pudding a soft, bland, cool food is the best intervention, as it minimizes irritation and pain, encouraging nutrition without exacerbating sores. Lemon glycerin swabs are harsh, with citric acid and chemicals worsening discomfort and delaying healing. Keeping the child NPO (nothing by mouth) for weeks until sores heal is impractical and risks malnutrition, as mucositis can persist throughout chemotherapy. Viscous lidocaine might numb pain but is a last resort if the child refuses all intake, not a first-line comfort measure. Pudding supports hydration and calorie intake safely, aligning with nursing's goal to maintain nutrition and comfort in pediatric oncology, reducing mucositis-related distress effectively.
A 44 year old man with type 2 DM and hyperlipidemia is currently taking daily simvastatin 40 mg. His lipid profile repeated 12 weeks after treatment shows the following results: Total cholesterol 4.2 mmol/L, HDL-cholesterol 0.9 mmol/L, LDL-cholesterol 2.2 mmol/L, Triglyceride 2.4 mmol/L. Which lipid regulating drug should be MOST appropriately added?
- A. Colestyramine
- B. Omega 3 fatty acid
- C. Fenofibrate
- D. Nicotinic acid
Correct Answer: C
Rationale: Simvastatin's cut LDL to 2.2, but triglycerides linger at 2.4 above 1.7's ideal and HDL's low at 0.9. Fenofibrate slashes triglycerides, lifts HDL, a perfect next step for this type 2 mix. Colestyramine binds bile, not triglycerides; omega-3 helps less here; nicotinic acid's harsh; ezetimibe's LDL focus misses. Nurses see this combo statin plus fibrate as a chronic lipid tune-up, dodging heart risks tied to diabetes.