Nokea
Which ONE of the following is consistent with scarlet fever:
- A. Punctate rash on neck and trunk
- B. Circumoral erythema
- C. Geographic tongue
- D. Only occurs in association with streptococcal pharyngitis
Correct Answer: B
Rationale: Scarlet fever circumoral pallor, not erythema, rash, tongue, strep, peeling fit. Nurses spot this chronic strep face.
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A 3-year-old girl with a Wilms tumor is returning to the unit after a simple nephrectomy. Which of the following actions have the highest priority in caring for this child?
- A. Maintaining NPO.
- B. Monitoring the BP every 2 hours.
- C. Turning her every 2 hours.
- D. Administering pain medication every 4 hours.
Correct Answer: B
Rationale: After a nephrectomy for Wilms tumor, monitoring blood pressure (BP) every 2 hours is the highest priority because kidney removal disrupts renin-angiotensin regulation, risking hypo- or hypertension, especially in a young child with one remaining kidney. Using the ABCs (airway, breathing, circulation), BP falls under circulation, a critical postoperative focus to detect shock or fluid imbalance early. Maintaining NPO is temporary post-anesthesia but shifts to hydration once awake, less urgent than BP. Turning every 2 hours prevents pressure ulcers, but a mobile 3-year-old post-simple nephrectomy likely moves independently unless sedated, lowering its priority. Pain medication is key but ranks lower (e.g., G' in extended ABCs) than circulation. Frequent BP checks ensure stability, aligning with nursing's role in pediatric surgical care to prevent complications in a child adapting to single-kidney function.
Mr Yee, a 45-year-old, reports three recent gout attacks in the ankle or knee. You notice a small tophus over the left elbow. He says that two years ago he took allopurinol 100 mg for one month, then 200 mg OM for one month but stopped as it 'did not help his gout and there was no improvement'. When you probe, he states that he was not very adherent to allopurinol either then as it was some years ago, and he says he probably took it 'once or twice a week'. He states he did not experience any rashes or other side effects to it then. He does not drink alcohol except one glass of wine once or twice a year on special occasions. He has past history of renal stones and also underlying ischaemic cardiomyopathy for which he is still being followed up by the cardiologist. Two weeks ago, he was admitted to the hospital for a gout flare. He had a blood test done, with the following results: Uric acid 620 mmol/L, Creatinine 120 umol/L, eGFR 55 mL/min, BP 144/94 mmHg, he has Hypertension on HCTZ long-term. He is asking you to give him Arcoxia 120 mg OM standby as it usually works for his gout flare. Which is correct advice?
- A. Discuss HLA B5801 testing particularly as febuxostat is being prescribed for him
- B. Advise that he will need stepwise up-titration of allopurinol to reach the uric acid target. Regular blood tests will allow this to be done safely
- C. Advise that colchicine prophylaxis is helpful to prevent gout attacks and increase hydrochlorothiazide to optimise his BP control
- D. Offer to initiate probenecid immediately as allopurinol is ineffective
Correct Answer: B
Rationale: Tophus and frequent flares with uric acid 620 mmol/L indicate chronic gout needing ULT. Prior allopurinol failure' likely stems from non-adherence (once/twice weekly), not ineffectiveness. Stepwise up-titration of allopurinol, starting low (e.g., 100 mg) due to eGFR 55, with regular blood tests (uric acid, creatinine), targets <360 mmol/L safely, per ACR guidelines. HLA-B5801 testing is for high-risk groups (e.g., Han Chinese) before allopurinol, not febuxostat-specific here. Colchicine helps, but increasing HCTZ (urate-retaining) may worsen gout. Probenecid suits renal underexcretors, not proven here. This approach optimizes chronic gout control.
What is the result of bariatric surgery as a therapy for morbid obesity?
- A. Reduced insulin sensitivity
- B. Increased insulin sensitivity
- C. Reduced lipolysis
- D. Increased lipolysis
Correct Answer: B
Rationale: Bariatric fix insulin sensitivity jumps, fat shrinks, glucose flows, not lipolysis shifts. Nurses cheer this, a chronic reset win.
In the UK, percutaneous cervical cordotomy is likely to be:
- A. Indicated in patients with unilateral pain due to cancer.
- B. Indicated in patients with non-malignant pain.
- C. Effective for neck pain.
- D. Deferred until less invasive techniques have been shown to be unsuccessful.
Correct Answer: A
Rationale: Percutaneous cervical cordotomy (PCC) targets intractable pain in the UK. It's primarily indicated for unilateral cancer pain (e.g., mesothelioma), ablating the contralateral spinothalamic tract for relief below the lesion level. Non-malignant pain rarely justifies PCC due to its invasiveness and risks; alternatives like opioids suffice. Neck pain, above the typical C1-C2 entry, isn't effectively treated by PCC, which addresses lower body pain. CT guidance is common, not just fluoroscopy, for precision. It's a last resort after failed conservative treatments (e.g., nerve blocks), but the cancer-specific indication is primary unilateral pain's anatomical fit with PCC's mechanism (thermoablation) makes it a specialized palliative tool, balancing efficacy with procedural risk.
A nurse is caring for four clients with leukemia. After hand-off report, which client should the nurse see first?
- A. Client who had two bloody diarrhea stools this morning
- B. Client who has been premedicated for nausea prior to chemotherapy
- C. Client who is crying and feeling lonely
- D. Client with an unchanged lesion to the lower right lateral malleolus
Correct Answer: A
Rationale: Leukemia's marrow suppression risks bleeding two bloody stools signal GI hemorrhage, a potential emergency needing urgent assessment for stability, trumping others per ABCs. Premedicated nausea's managed, loneliness needs support but waits, and an unchanged lesion's stable. Nurses prioritize bleeding, anticipating labs or fluids, a life-saving call in this fragile hematologic lineup.