Nokea
Which vaccination should not be given to HIV sufferers?
- A. ADT
- B. Pneumococcal
- C. MMR
- D. DPT
Correct Answer: C
Rationale: MMR's live HIV's immune slump says no, unlike ADT, pneumococcal, DPT, or dead polio's safety. Nurses nix live shots, a chronic viral risk dodge.
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The nurse is caring for a client with mitral regurgitation. Which of the following would the nurse anticipate the client to develop if left untreated?
- A. Left-sided heart failure
- B. Right-sided heart failure
- C. Renal failure
- D. Myocardial ischemia
Correct Answer: A
Rationale: Mitral regurgitation backflows blood into the left atrium, hiking pressure and volume untreated, it overburdens the left ventricle, leading to left-sided heart failure. Pulmonary congestion follows, with dyspnea and edema, a direct consequence of this valve flaw. Right-sided failure stems from downstream effects or separate causes, not primary here. Renal failure or ischemia might complicate advanced disease, but left-sided failure's progression is the immediate risk, rooted in mitral dysfunction's mechanics. Nurses anticipate this, monitoring for early signs like crackles, ensuring timely intervention to halt this predictable cardiac cascade.
In Netherlands, women who had pregnancy diabetes are advised to be tested regularly for diabetes. Question: This test is an example of which type of prevention?
- A. Universal prevention
- B. Selective prevention
- C. Indicated prevention
- D. Care-related prevention
Correct Answer: C
Rationale: Post-gestational checks indicated, high-risk group, not all, some, or sick. Nurses track this, a chronic red flag watch.
Chronic obstructive pulmonary disease (COPD) is associated with:
- A. Skeletal muscle dysfunction.
- B. Mean pulmonary arterial pressure of ≥ 25 mm Hg.
- C. Significant reversibility in airflow limitation with bronchodilator therapy.
- D. Depression.
Correct Answer: A
Rationale: COPD is a progressive lung disease characterized by airflow limitation that is not fully reversible. Skeletal muscle dysfunction is a well-documented extrapulmonary manifestation due to systemic inflammation, oxidative stress, and reduced physical activity, leading to muscle wasting and weakness. Elevated mean pulmonary arterial pressure (≥ 25 mm Hg) defines pulmonary hypertension, which can occur secondary to COPD but is not a universal feature. Significant reversibility in airflow limitation is more typical of asthma, not COPD, where bronchodilator response is limited. The FEVâ‚/FVC ratio in COPD is typically <0.7, not >0.7, making that option incorrect. Depression is common in COPD patients due to chronic illness and reduced quality of life, but it's not a defining feature. Among these, skeletal muscle dysfunction is most consistently associated with COPD pathophysiology, reflecting its systemic impact beyond the lungs.
Regarding oxygen consumption by the adult human body:
- A. It is approximately 3 ml Oâ‚‚ kgâ»Â¹ minâ»Â¹ at rest in the awake adult patient.
- B. It rises to approximately 11 ml Oâ‚‚ kgâ»Â¹ minâ»Â¹ at peak exercise in healthy young adults.
- C. Increases by approximately 5-fold after major surgery.
- D. Peak oxygen consumption is likely to be quantified accurately by cardiopulmonary exercise testing.
Correct Answer: A
Rationale: Oxygen consumption (VOâ‚‚) reflects metabolic demand. At rest, VOâ‚‚ is approximately 3-4 ml Oâ‚‚ kgâ»Â¹ minâ»Â¹ in awake adults, aligning with basal energy needs (250-300 ml/min total). During peak exercise, healthy young adults can reach 30-40 ml Oâ‚‚ kgâ»Â¹ minâ»Â¹, far exceeding 11 ml, depending on fitness. Post-major surgery, VOâ‚‚ increases 50-100% (1.5-2-fold), not 5-fold, due to stress and healing, though critical illness may spike higher briefly. Cardiopulmonary exercise testing (CPET) accurately measures peak VOâ‚‚, unlike the Duke Activity Status Index, which estimates it via questionnaire. The resting value of 3 ml Oâ‚‚ kgâ»Â¹ minâ»Â¹ is a physiological constant, foundational to understanding perioperative oxygen delivery and demand.
Caution should be exercised in the initiation of an ARNI in all of the following clinical scenarios except:
- A. Significant hyperkalaemia
- B. Significant renal dysfunction (eGFR <30 ml/min)
- C. Patient on a maximal dose ACE-inhibitor
- D. Non-alcoholic fatty liver disease (NAFLD)
Correct Answer: D
Rationale: ARNI (sacubitril/valsartan) risks spike with hyperkalemia, renal flop (eGFR <30), ACE-I overlap, or low BP potassium, filtration, washout, and perfusion all teeter. NAFLD? No biggie liver fat doesn't sway ARNI's game. Clinicians greenlight this, dodging chronic cautions elsewhere.