During venipuncture, accidental puncture of the brachial artery and injury to the median nerve are most likely when the nurse selects which vein for cannulation?
Anonymous Quiz
16%
A. Cephalic vein
28%
B. Median cubital vein
47%
C. Basilic vein
10%
D. Dorsal metacarpal vein
Metier Nursing MCQ review
During venipuncture, accidental puncture of the brachial artery and injury to the median nerve are most likely when the nurse selects which vein for cannulation?
Answer: C. Basilic vein
Rationale:
The basilic vein lies on the medial side of the antecubital fossa and is closely associated with the brachial artery and median nerve, making it the vein with the greatest risk of accidental arterial puncture and nerve injury during venipuncture. The median cubital vein is usually the preferred site because it is well anchored and relatively separated from major nerves and arteries. The cephalic vein is located laterally and is generally safer than the basilic vein. The dorsal metacarpal veins on the back of the hand are commonly used for peripheral cannulation and are not closely related to the brachial artery or median nerve, so the risk of these specific complications is much lower.
Rationale:
The basilic vein lies on the medial side of the antecubital fossa and is closely associated with the brachial artery and median nerve, making it the vein with the greatest risk of accidental arterial puncture and nerve injury during venipuncture. The median cubital vein is usually the preferred site because it is well anchored and relatively separated from major nerves and arteries. The cephalic vein is located laterally and is generally safer than the basilic vein. The dorsal metacarpal veins on the back of the hand are commonly used for peripheral cannulation and are not closely related to the brachial artery or median nerve, so the risk of these specific complications is much lower.
A nurse is instilling eye drops in a patient's left eye. After instilling the drops, the patient's heart rate drops to 48 bpm. Which of the following medications is MOST likely responsible?
Anonymous Quiz
66%
A. Timolol
22%
B. Pilocarpine
8%
C. Latanoprost
3%
D. Dorzolamide
Metier Nursing MCQ review
A nurse is instilling eye drops in a patient's left eye. After instilling the drops, the patient's heart rate drops to 48 bpm. Which of the following medications is MOST likely responsible?
Answer: A. Timolol
Rationale:
Timolol is a non-selective beta-blocker used in glaucoma. Even when administered as eye drops, it can be systemically absorbed through the nasolacrimal duct and may cause bradycardia, hypotension, heart block, and bronchospasm. A heart rate of 48 bpm is most consistent with systemic beta-blocker effects.
Why not the others?
Pilocarpine: A cholinergic agonist that primarily causes miosis and accommodation spasm; significant bradycardia from ophthalmic use is uncommon.
Latanoprost: A prostaglandin analog; commonly causes iris pigmentation and conjunctival hyperemia, not bradycardia.
Dorzolamide: A carbonic anhydrase inhibitor; may cause local ocular irritation and a bitter taste, but bradycardia is not a typical adverse effect.
_Exam Pearl:
Among glaucoma eye drops, Timolol is the classic drug associated with systemic beta-blocker adverse effects, including bradycardia, especially in older adults and patients with cardiac disease._
Rationale:
Timolol is a non-selective beta-blocker used in glaucoma. Even when administered as eye drops, it can be systemically absorbed through the nasolacrimal duct and may cause bradycardia, hypotension, heart block, and bronchospasm. A heart rate of 48 bpm is most consistent with systemic beta-blocker effects.
Why not the others?
Pilocarpine: A cholinergic agonist that primarily causes miosis and accommodation spasm; significant bradycardia from ophthalmic use is uncommon.
Latanoprost: A prostaglandin analog; commonly causes iris pigmentation and conjunctival hyperemia, not bradycardia.
Dorzolamide: A carbonic anhydrase inhibitor; may cause local ocular irritation and a bitter taste, but bradycardia is not a typical adverse effect.
_Exam Pearl:
Among glaucoma eye drops, Timolol is the classic drug associated with systemic beta-blocker adverse effects, including bradycardia, especially in older adults and patients with cardiac disease._
The colour coding in IMNCI case management which includes the initiation of specific treatment at an outpatient health facility is:
Anonymous Quiz
13%
A. Pink
63%
B. Yellow
4%
C. Blue
20%
D. Green
Metier Nursing MCQ review
The colour coding in IMNCI case management which includes the initiation of specific treatment at an outpatient health facility is:
Answer: B. Yellow
Rationale:
In Integrated Management of Neonatal and Childhood Illness (IMNCI), the color classifications guide treatment and referral:
Pink → Urgent referral/admission to hospital; severe illness requiring immediate attention.
Yellow → Specific treatment at an outpatient health facility (e.g., oral antibiotics, antimalarials, treatment for pneumonia, dehydration management).
Green → Home care and counseling; no specific medical treatment needed.
Blue → Not a standard IMNCI classification color.
Rationale:
In Integrated Management of Neonatal and Childhood Illness (IMNCI), the color classifications guide treatment and referral:
Pink → Urgent referral/admission to hospital; severe illness requiring immediate attention.
Yellow → Specific treatment at an outpatient health facility (e.g., oral antibiotics, antimalarials, treatment for pneumonia, dehydration management).
Green → Home care and counseling; no specific medical treatment needed.
Blue → Not a standard IMNCI classification color.
50 mL syringe, rate = 12.5 mL/hr. Syringe contains 8 mg noradrenaline in 50 mL D5W. Patient weight = 75 kg. What dose in mcg/kg/min is being delivered?
Anonymous Quiz
41%
A. 0.44 mcg/kg/min
27%
B. 0.28 mcg/kg/min
27%
C. 0.52 mcg/kg/min
6%
D. 0.38 mcg/kg/min
A 3-month-old infant presents with recurrent respiratory infections, tetany, and a congenital heart defect. Laboratory investigations reveal hypocalcemia and markedly reduced T-lymphocyte count.
Which syndrome is the most likely diagnosis?
Which syndrome is the most likely diagnosis?
Anonymous Quiz
6%
A. Turner syndrome
84%
B. DiGeorge syndrome
4%
C. Down syndrome
5%
D. Klinefelter syndrome
Metier Nursing MCQ review
A 3-month-old infant presents with recurrent respiratory infections, tetany, and a congenital heart defect. Laboratory investigations reveal hypocalcemia and markedly reduced T-lymphocyte count.
Which syndrome is the most likely diagnosis?
Which syndrome is the most likely diagnosis?
*Answer: B. DiGeorge syndrome*
*Rationales*
A. Turner syndrome
Characterized by short stature, webbed neck, and gonadal dysgenesis. It is not associated with thymic aplasia.
B. DiGeorge syndrome
Caused by 22q11 deletion. Classic features are remembered by CATCH-22:
* Cardiac defects
* Abnormal facies
* Thymic aplasia
* Cleft palate
* Hypocalcemia
* 22q11 deletion
C. Down syndrome
Associated with intellectual disability, hypotonia, and congenital heart disease, but not thymic aplasia with T-cell deficiency.
D. Klinefelter syndrome
Occurs in males (47,XXY) and presents with hypogonadism and infertility.
*Rationales*
A. Turner syndrome
Characterized by short stature, webbed neck, and gonadal dysgenesis. It is not associated with thymic aplasia.
B. DiGeorge syndrome
Caused by 22q11 deletion. Classic features are remembered by CATCH-22:
* Cardiac defects
* Abnormal facies
* Thymic aplasia
* Cleft palate
* Hypocalcemia
* 22q11 deletion
C. Down syndrome
Associated with intellectual disability, hypotonia, and congenital heart disease, but not thymic aplasia with T-cell deficiency.
D. Klinefelter syndrome
Occurs in males (47,XXY) and presents with hypogonadism and infertility.
❤1
Which rescue medication is routinely administered with high-dose methotrexate therapy?
Anonymous Quiz
9%
A. Mesna
15%
B. Filgrastim
67%
C. Leucovorin
10%
D. Ondansetron
A farmer with organophosphate poisoning presents with salivation, lacrimation, diarrhea, and bradycardia. Atropine has already been given. Which agent directly reactivates acetylcholinesterase?
Anonymous Quiz
1%
A. Mesna
21%
B. Flumazenil
65%
C. Pralidoxime
13%
D. Naloxone
Metier Nursing MCQ review
A farmer with organophosphate poisoning presents with salivation, lacrimation, diarrhea, and bradycardia. Atropine has already been given. Which agent directly reactivates acetylcholinesterase?
Correct Answer: C. Pralidoxime
Rationale:
Organophosphate poisoning inhibits acetylcholinesterase, leading to excess acetylcholine and cholinergic symptoms such as salivation, lacrimation, diarrhea, and bradycardia. Atropine relieves muscarinic symptoms but does not reverse the enzyme inhibition.
Pralidoxime directly reactivates acetylcholinesterase by removing the organophosphate from the enzyme, especially if given early before aging occurs. Mesna prevents hemorrhagic cystitis, Flumazenil reverses benzodiazepines, and Naloxone reverses opioids
Rationale:
Organophosphate poisoning inhibits acetylcholinesterase, leading to excess acetylcholine and cholinergic symptoms such as salivation, lacrimation, diarrhea, and bradycardia. Atropine relieves muscarinic symptoms but does not reverse the enzyme inhibition.
Pralidoxime directly reactivates acetylcholinesterase by removing the organophosphate from the enzyme, especially if given early before aging occurs. Mesna prevents hemorrhagic cystitis, Flumazenil reverses benzodiazepines, and Naloxone reverses opioids
Metier Nursing MCQ review
Which rescue medication is routinely administered with high-dose methotrexate therapy?
The correct answer is C. Leucovorin
Leucovorin (folinic acid) is routinely administered as a "rescue" agent after high-dose methotrexate therapy. It provides reduced folate to normal cells, bypassing the enzyme blocked by methotrexate, thereby preventing severe toxicity like myelosuppression and mucositis without neutralizing the anti-cancer effect.
· Mesna is used to prevent hemorrhagic cystitis caused by ifosfamide or cyclophosphamide.
· Filgrastim is a G-CSF used to stimulate white blood cell production in neutropenia.
· Ondansetron is an antiemetic used to prevent nausea and vomiting.
Leucovorin (folinic acid) is routinely administered as a "rescue" agent after high-dose methotrexate therapy. It provides reduced folate to normal cells, bypassing the enzyme blocked by methotrexate, thereby preventing severe toxicity like myelosuppression and mucositis without neutralizing the anti-cancer effect.
· Mesna is used to prevent hemorrhagic cystitis caused by ifosfamide or cyclophosphamide.
· Filgrastim is a G-CSF used to stimulate white blood cell production in neutropenia.
· Ondansetron is an antiemetic used to prevent nausea and vomiting.
A 70 kg DKA patient is started on IV regular insulin. Protocol: 0.1 units/kg/hr after bolus. The insulin solution is 50 units in 250 mL 0.9% NaCl. What infusion rate (mL/hr) delivers the required dose?
Anonymous Quiz
55%
A. 35 mL/hr
14%
B. 28 mL/hr
21%
C. 70 mL/hr
10%
D. 17.5 mL/hr
Metier Nursing MCQ review
A 70 kg DKA patient is started on IV regular insulin. Protocol: 0.1 units/kg/hr after bolus. The insulin solution is 50 units in 250 mL 0.9% NaCl. What infusion rate (mL/hr) delivers the required dose?
Answer : A
Step 1: Calculate required insulin dose
Dose = 0.1 units/kg/hr × 70 kg
= 7 units/hr
Step 2: Determine insulin concentration
50 units in 250 mL
= 0.2 units/mL
Step 3: Calculate infusion rate
Infusion Rate (mL/hr) = Required Dose (units/hr) ÷ Concentration (units/mL)
= 7 ÷ 0.2
= 35 mL/hr
Step 1: Calculate required insulin dose
Dose = 0.1 units/kg/hr × 70 kg
= 7 units/hr
Step 2: Determine insulin concentration
50 units in 250 mL
= 0.2 units/mL
Step 3: Calculate infusion rate
Infusion Rate (mL/hr) = Required Dose (units/hr) ÷ Concentration (units/mL)
= 7 ÷ 0.2
= 35 mL/hr
A 28-year-old man has chronic inflammatory low back pain with morning stiffness that improves with exercise. X-ray shows a "bamboo spine." What is the most likely diagnosis?
Anonymous Quiz
8%
A. Osteoarthritis
16%
B. Rheumatoid arthritis
72%
C. Ankylosing spondylitis
3%
D. Gout
A 32-year-old man develops ptosis, ophthalmoplegia, dysphagia, and respiratory weakness after a nocturnal snake bite. There is no local swelling, and the 20-minute whole blood clotting test is normal. Which snake is most likely responsible?
Anonymous Quiz
15%
A. Russell's viper
29%
B. Saw-scaled viper
55%
C. Common krait
2%
D. Pit viper