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Ziconotide is:
- A. Licensed for administration by the intrathecal route in Europe and North America.
- B. Associated with intrathecal granuloma formation.
- C. Contraindicated in schizophrenic patients.
- D. Likely to lead to hypogonadotropic hypogonadism during long-term infusion.
Correct Answer: A
Rationale: Ziconotide, a non-opioid analgesic, blocks N-type calcium channels intrathecally. It's licensed in Europe and North America for chronic pain (e.g., cancer, neuropathic), delivered via pumps. Unlike opioids, it doesn't form granulomas at catheter tips those are opioid-specific complications. It's contraindicated in psychosis (e.g., schizophrenia) due to neuropsychiatric side effects (confusion, hallucinations), per prescribing guidelines. Hypogonadism isn't linked; that's an opioid effect via hypothalamic suppression. Tolerance occurs, requiring dose escalation, but it's manageable. Its licensure reflects extensive trials showing efficacy and safety for refractory pain, distinguishing it as a targeted, non-addictive option in intrathecal therapy, critical for patients intolerant to opioids.
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A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the client's oral chemotherapy medications. What action by the nurse is most appropriate?
- A. Crush the medications if the client cannot swallow them.
- B. Give one medication at a time with a full glass of water.
- C. No special precautions are needed for these medications.
- D. Wear personal protective equipment when handling the medications.
Correct Answer: D
Rationale: Oral chemotherapy drugs, like their IV counterparts, are hazardous due to their cytotoxic properties, posing risks to healthcare workers through skin contact or inhalation during handling. The most appropriate action is for the nurse to wear personal protective equipment (PPE), such as gloves, to minimize exposure, aligning with oncology safety standards. Crushing these medications is contraindicated, as it increases the risk of aerosolizing toxic particles, endangering both nurse and client many are labeled do not crush.' Giving one at a time with water isn't necessary unless specified and doesn't address safety. Assuming no precautions are needed ignores the drugs' hazardous nature, risking occupational exposure. Using PPE ensures safe administration, protects the nurse's health, and maintains the medication's integrity, reflecting best practices in cancer care where handling precautions are non-negotiable.
Mdm Koh, a 55-year-old housewife with hypertensive nephropathy was recently started on allopurinol 50 mg per day with prophylactic colchicine 500 mg OM 3 weeks ago in your clinic. She is on Lasix 20 mg OM, nifedipine LA 30 mg OM, aspirin 100 mg OM and renalvite 1 tab OM. She came down with flu like symptoms 4 days ago and developed rashes after being given Amoxil by another General Physician. Today, she returns to your clinic. What should be the next step?
- A. Stop Amoxil and continue the chronic medications
- B. Prescribe paracetamol for pain relief and switch to clarithromycin 500 mg BD instead
- C. Continue medications and check for Dengue serology
- D. Stop all medications and refer for possible SJS
Correct Answer: D
Rationale: Rash post-Amoxil, allopurinol new SJS looms, stop all, refer fast; not just Amoxil, clarithro, dengue, or colchicine tweaks. Nurses flag this chronic skin scare.
What is an implementation intention?
- A. The decision of an organisation to implement a specific method or intervention
- B. A concrete plan to show particular behaviour in specific situations
- C. A well-considered idea of how a person can handle a relapse or difficult situations
- D. The intention to live healthier in all important areas of life
Correct Answer: B
Rationale: Implementation intention specific act, set scene, not org moves, relapse plans, or vague health kicks. Nurses cue this, a chronic action lock.
Which of the following is NOT part of the histology of non-alcoholic steatohepatitis?
- A. Fatty infiltration in liver
- B. Fibrosis of liver
- C. Inflammatory infiltrates in lobules
- D. Cirrhosis
Correct Answer: D
Rationale: NASH histology includes steatosis (fatty infiltration), lobular inflammation, and fibrosis, per pathology definitions. Mallory bodies (intracellular inclusions) are classic but not universal. Cirrhosis is an advanced NAFLD outcome, not a defining NASH feature progression, not initial histology. This distinction aids physicians in staging chronic liver disease accurately.
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.