Untitled Quiz

CT Revision - Results

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Question 1 (Mandatory)

• Scenario 1 (Question 1-9): Ismail, a 59-year-old male, presented to the emergency department (ED) complaining of acute shortness of breath, wheezing and cough.
• Symptoms began 3 days prior and progressively worsened.
• Inhalers were ineffective.
• Cough was productive, with thick yellowish sputum.
• Assessment on Arrival (OA): Neurological: Alert and orientated, but in distress with difficulty breathing. Respiratory: Wheezes throughout lung fields, with use of accessory muscles. Sputum is mucoid and purulent.
• Parameters:
  • Heart Rate: 125 bpm
  • Blood Pressure: 130/72 mmHg
  • Respiratory Rate: 28 breaths per minute
  • SpO2: 90% on room air
  • Temperature: 38.4°C
• Doctor's Order:
  • Oxygen at 28%, 4 litres per minute (LPM) via venturi mask
  • Nebulisation of salbutamol: ipratropium: sodium chloride 2:2:1 every 4 hourly/PRN
  • PO prednisolone 40 mg OM
  • PO paracetamol 1 g 6 hourly/PRN
  • IV ampicillin / sulbactam (Unasyn) 1.5g q6h
• Diagnosis: Acute exacerbation of asthma and pneumonia.

Question 2 (Mandatory)

• Scenario 1 (Question 1-9): Ismail (59 years old) presented to the ED complaining of acute shortness of breath, wheezing, and cough. Symptoms progressively worsened over 3 days, with ineffective inhalers and a productive cough of thick yellowish sputum.
• Assessment on Arrival (OA): Neurological: Alert and orientated, but in distress. Respiratory: Wheezes throughout lung fields; accessory muscle use. Sputum is mucoid and purulent.
• Parameters:
  • Heart Rate: 125 bpm
  • Blood Pressure: 130/72 mmHg
  • Respiratory Rate: 28 breaths per minute
  • SpO2: 90% room air
  • Temperature: 38.4°C
• Doctor's Order: Oxygen at 28%, 4 litres per minute (LPM) via venturi mask, Nebulisation of salbutamol: ipratropium: sodium chloride 2:2:1 every 4 hourly/PRN, PO prednisolone 40 mg OM, PO paracetamol 1 g 6 hourly/PRN, IV ampicillin/sulbactam (Unasyn) 1.5 g q6h.
• Diagnosis: Acute exacerbation of asthma and pneumonia.
• Pharmacotherapy goals: Relieve symptoms, prevent recurrence, and eradicate infection. Medications like Nebulisation of salbutamol: ipratropium: sodium chloride 2:2:1 every 4 hourly/PRN, PO prednisolone 40 mg OM, and IV ampicillin / sulbactam (Unasyn) 1.5g q6h were prescribed.

Question 3 (Mandatory)

• Scenario 1 (Question 1-9): Mr. X has acute exacerbation of COPD and pneumonia.
• Prescribed medications: inhalation Tiotropium / olodaterol 25/25mcg 1 puff daily. Inhalation Fluticasone 100 mcg 1 puff daily. PO Amoxicillin / clavulanate 625 mg 1 tab TDS.
• Match each medication to its mechanism of action:
  • Salbutamol - Stimulates Beta 2 receptors.
  • Ipratropium - Blocks cholinergic receptors.
  • Prednisolone - None of the above.

Question 4 (Mandatory)

• Scenario 1 (Question 1-9): State the pharmacological classes of the two medications in IV Ampicillin / Sulbactam (Unasyn).
• Explain the purpose of giving combination-type antibiotics.
• Answer: Ampicillin (Penicillin) and Sulbactam (Beta-lactamase inhibitor). Combination antibiotics increase spectrum of activity, overcoming resistance.

Question 5 (Mandatory)

• Scenario 1 (Question 1-9): Nebulisation of salbutamol: ipratropium: sodium chloride 2:2:1 every 4 hourly/PRN.
• Dosage: 2mL of salbutamol, 2 mL of ipratropium, and 1 mL of sodium chloride.

Question 6 (Mandatory)

• Scenario 1 (Question 1-9): Ismail (59 years old), presented 2 years later.
• Symptoms: Has had 4 admissions for acute exacerbation of asthma. Functionally limited with breathlessness at rest, RR 35 breath/min, SpO2 of 89% on 2L/min.Chronic cough with thick secretions, becoming more congested with coughing and yielding thick yellowish greenish sputum. Fever and chills.
• Doctor's Assessment: Developed Asthma-COPD Overlap Syndrome (ACOS). Needs admission
• Nursing Diagnosis: Ineffective airway clearance.
• Evidence: Chronic cough with thick secretions, yielding thick yellowish sputum.

Question 7 (Mandatory)

• Scenario 1 (Question 1-9): Ismail was prescribed low-flow oxygen (2L/min via nasal cannula).
• The reason was due to hypercapnia drive being blunted in COPD. High concentration of oxygen can reduce/suppress the trigger to breathe.

Question 8 (Mandatory)

• Scenario 1 (Question 1-9): Ismail was discharged on inhalation glycopyrronium /formoterol/betamethasone (Trimbow) 100/6/12.5 mcg MDI 2 puffs BD.
• Pharmacological class: Glycopyrronium (Anticholinergic/Muscarinic antagonist), Formoterol (Beta-2 adrenergic agonist), Beclomethasone (Corticosteroid).

Question 9 (Mandatory)

• Scenario 1 (Question 1-9): Identify 4 health education tips for Mr. X to prevent further exacerbations.
• Four Health Recommendations for Mr X to prevent further health issues:
  • Medication compliance
  • Good inhaler technique.
  • Recognizing and managing triggers.
  • Following prescribed lifestyle changes

Question 10 (Mandatory)

• Scenario 2 (Question 10-15):  Lee-hom, a 58 year old, presented to the ED complaining of chest pain, lasting 20-30 minutes, which radiated from the left shoulder to the jaw.
• Symptoms: Occurs at rest, one hour after breakfast, not relieved by sublingual glyceryl trinitrate (GTN) tablets. Intermittent chest pain for 3-4 weeks. Accessory muscles for breathing, and sitting in upright position with head leaning forward, observed.
• Past medical history: Hypertension x 10 years, Hyperlipidaemia x 2 years, Myocardial infarction X 1 year ago (1 stent).
• Social history: Smoker (for 20 years), drinks beer on weekends

Question 11 (Mandatory)

• Scenario 2 (Question 10-15): Identify 5 characteristics of an ECG.
• ECG Characteristics:
  • Rate
  • Rhythm
  • P Wave
  • QRS Complex
  • Interpretation

Question 12 (Mandatory)

• Scenario 2 (Question 10-15): Lee-Hom, 58-year-old, presented to the emergency room complaining of chest pain.
• Past medical history: Hypertension (10 years), hyperlipidemia (2 years), myocardial infarction (1 year ago), with 1 stent.
• Investigation results:
  • CK: 168
  • CKMB: 4.5
  • Troponin I: 0.01
• Probable diagnosis: Unstable angina. Troponin I is normal which indicates no myocardial damage .ST depression indicates myocardial ischemia.

Question 13 (Mandatory)

• Scenario 2 (Question 10-15): Lee-hom, a 58-year-old, presented to the ED with chest pain.

• Past medical history: Hypertension (10 years), hyperlipidemia (2 years), myocardial infarction (1 year ago) + stent insertion.

• Presenting complaints: Chest pain for 20-30 minutes at rest, radiating to jaw, unrelieved by glyceryl trinitrate. Intermittent chest pain for 3-4 weeks.

• Clinical findings: Uses accessory muscles to breathe, sits upright, with head leaning forward.

• Investigation results:

  • Elevated CK, CKMB levels, but normal Troponin I.
  • Normal or slightly elevated ST levels and no T-wave inversion.

• Possible diagnoses: Unstable angina.

Question 14 (Mandatory)

• Scenario 2 (Question 10-15): Lee-hom, 58-year-old, presented to the ED with chest pain.
• Medications: PO aspirin 325 mg stat, PO clopidogrel 300mg stat, PO carvedilol 25 mg BD,  IV nitroglycerin 10-40 mcg/min, IV morphine 4 mg stat (if pain persists), PO atorvastatin 80 mg ON
• Adverse effect: Bleeding

Question 15 (Mandatory)

• Scenario 2 (Question 10-15): Lee-hom is preparing for discharge.
• Medications: PO soluble aspirin 100 mg OM, PO clopidogrel 75 mg PM, PO carvedilol 25 mg BD, S/L glyceryl trinitrate 0.5mg PRN
• Health education: Compliance with medication, recognition of chest pain symptoms, low-sodium and low fat diet, and cardiac rehabilitation

Question 16 (Mandatory)

• Scenario 3 (Question 16-21): Danny, presented to hospital showing symptoms of progressive breathlessness, upright positioning, prominent neck veins, and diminished peripheral pulses.
• Diagnosis: Congestive cardiac failure
• Nursing diagnosis: Excess fluid volume

Question 17 (Mandatory)

• Scenario 3 (Question 16-21): Danny, presented with progressing breathlessness and elevated heart rate, requiring immediate nursing interventions.
• Doctor's orders: IN Oxygen 30% 9L/min via venti mask,IV Nitroglycerin 10-20 mcg/min, IV Bumetanide 2mg BD.

Question 18 (Mandatory)

• Scenario 3 (Question 16-21): Danny's condition improved and he was planned for discharge. He was prescribed several medications for home.

• Nursing considerations: Monitor intake and output, patient's vital signs, and report symptoms of dizziness or hypotension.

• Rationales: Diuretics can cause dehydration.

Question 19 (Mandatory)

• Scenario 3 (Question 16-21): Danny's condition improved.
• Medications: PO warfarin, PO bisoprolol, PO sacubitril/valsartan, PO bumetanide, PO spironolactone, PO digoxin
• Health education: Recognize signs and symptoms of heart failure (chest pain, palpitations, swelling). Following a low-sodium and low-fat diet, medication compliance and correct medication administration, and attending cardiac rehabilitation

Question 20 (Mandatory)

• Scenario 3 (Question 16-21): Danny has atrial fibrillation and congestive heart failure.
• Medications:
  • PO bisoprolol 5 mg OM
  • PO sacubitril/valsartan 49/51 mg
  • PO bumetanide 1 mg BD
  • PO spironolactone 25 mg OM
  • PO digoxin 0.0625 mg OM
• Goals: Control heart rate, decrease workload, improve cardiac function, and prevent blood clots.

Question 21 (Mandatory)

• Scenario 3 (Question 16-21): Danny is discharged with several medications.
• Medications: PO warfarin, PO bisoprolol, sacubitril/valsartan, PO bumetanide, PO spironolactone, PO digoxin
• Match pharmacologic classes to medications:
  • Warfarin - Vitamin K antagonist
  • Bisoprolol - Beta blocker
  • Sacubitril/valsartan - Angiotensin Receptor Blocker/Neprilysin Inhibitor (ARNI)
  • Bumetanide - Loop Diuretic
  • Spironolactone - Potassium-sparing diuretic or mineralocorticoid receptor antagonist
  • Digoxin - Cardiac glycoside