Nokea
Which of these pulmonary conditions is most likely to be seen with a CD4 count between 200 and 500 ?
- A. pulmonary TB
- B. CMV
- C. PCP
- D. Kaposi sarcoma
Correct Answer: A
Rationale: CD4 200-500 TB sneaks in, lungs ripe before deeper drops. CMV, PCP crave <200; Kaposi's skin-first; cryptococcus hits brains more. Nurses clock TB's early strike, a chronic lung foe at this immune ledge.
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The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breathe and the nurse's rapid assessment reveals that the patient's jugular veins are distended. The nurse should suspect the development of what oncologic emergency?
- A. Increased intracranial pressure
- B. Superior vena cava syndrome (SVCS)
- C. Spinal cord compression
- D. Metastatic tumor of the neck
Correct Answer: B
Rationale: Dyspnea plus distended jugulars scream SVCS breast cancer's mets can squeeze the vena cava, blocking venous return from the head and chest. It's an oncology emergency, fast-tracking to edema and airway issues if unchecked. Intracranial pressure needs brain involvement less likely here. Spinal compression hits legs and bladder, not breathing. Neck tumors might press locally, but SVCS fits this picture. Nurses jump on this, pushing for steroids or stenting, knowing seconds count.
As per Johnson and Chang (2014) which of the following is not a component of the Chronic Care Model?
- A. Person centred care
- B. Population health approach
- C. Community setting, collaborative across both primary and secondary care
- D. Reactive, symptom driven
Correct Answer: D
Rationale: The Chronic Care Model thrives on proactive pillars person-centered focus, population health, and community-primary-secondary teamwork aiming to preempt, not just patch, chronic woes. Reactive, symptom-driven care's old-school, clashing with this forward lean. Nurses ditch that lag, embracing prevention, a model shift for chronic mastery.
The pathophysiology of Asthma differs from COPD as:
- A. It is characterised by airflow limitation.
- B. There is abnormal inflammatory response to exposure to noxious particles or gases.
- C. The airflow limitation is reversible.
- D. It is considered an obstructive lung disease.
Correct Answer: C
Rationale: Asthma and COPD both feature airflow obstruction, but their pathophysiology diverges critically. Both have limitation, but asthma's is intermittent and reversible with bronchodilators due to bronchial hyperresponsiveness and inflammation (e.g., eosinophilic), per Farrell (2017). COPD's abnormal inflammatory response to noxious stimuli (e.g., smoking) causes progressive, irreversible damage (e.g., neutrophilic, emphysema), not asthma's profile. Reversibility defines asthma spirometry normalizes post-treatment unlike COPD's fixed obstruction (FEVâ‚/FVC <0.7 persists). Both are obstructive diseases, but this isn't the distinguishing feature. Asthma's reversible limitation stems from smooth muscle spasm and mucosal edema, responsive to therapy, contrasting COPD's structural loss (alveolar destruction), making this the key differential in clinical management and prognosis.
A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most appropriate?
- A. Assess the client's gait and balance.
- B. Ask the client about the ease of urine flow.
- C. Document the report completely.
- D. Inquire about the client's job risks.
Correct Answer: A
Rationale: Prostate cancer commonly metastasizes to bones, especially the spine, causing spinal cord compression a medical emergency that can lead to paralysis if untreated. New, severe low back pain in this context suggests possible metastasis, making gait and balance assessment the most appropriate action to check for neurological deficits (e.g., weakness, unsteady gait) indicating compression. This prioritizes client safety, as falls or worsening paralysis could result without intervention. Asking about urine flow relates to prostate obstruction, less urgent here given the pain's prominence. Documentation is essential but passive without assessment. Job risks might contribute to back pain but are secondary to cancer history. Assessing gait and balance first ensures rapid escalation if needed, reflecting oncology nursing's focus on detecting metastatic complications early.
A primary nursing responsibility is the prevention of lung cancer by assisting patients in smoking/tobacco cessation. Which tasks would be appropriate to delegate to the LPN/LVN?
- A. Develop a quit plan
- B. Explain the application of a nicotine patch
- C. Discuss strategies to avoid relapse
- D. Suggest ways to deal with urges for a tobacco
Correct Answer: B
Rationale: LPN/LVNs shine in standardized teaching like explaining nicotine patch application, a medication-focused task within their scope, detailing placement and timing to aid cessation. Developing a quit plan requires RN-level planning and assessment of individual needs. Discussing relapse strategies involves behavioral counseling, an RN forte. Suggesting urge-coping methods needs tailored insight, beyond LPN/LVN training. Patch explanation leverages their skills, supporting lung cancer prevention through practical cessation aid, a delegated task enhancing team efforts while keeping complex planning with RNs.