Early warning signs of laryngeal cancer can vary depending on tumor location. Hoarseness lasting 2 weeks should be evaluated because it is one of the most common warning signs. Patients are typically male with a history of current or past tobacco smoking. Hoarseness is often an early presenting symptom of glottic cancers due to vocal cord immobility or fixation, with pain with swallowing and referred ear pain indicating advanced disease.

Option A: Stomatitis is one of the early signs of oral cancer. Oral mucosal cancer presents clinically in various ways depending on its location. Early disease may manifest as irregular white, red, or mixed patches on the mucosa. More established cancers appear as an indurated raised nodule, often with an ulcerated surface that may cause little pain.
Option B: Airway obstruction occurs in the late stage, when the swelling or lump in the neck increases in size, enough to obstruct the larynx. Nodal metastases present as fixed, firm, painless masses in the neck. Late symptoms across all subsites include weight loss, dysphagia, aspiration, and its sequelae, and airway compromise. The most crucial component of a physical examination is an invasive assessment of the primary lesion, including indirect laryngoscopy, mirror exam, and often fiberoptic endoscopy.
Option D: Dysphagia is one of the symptoms of laryngeal cancer, but it does not occur in the early stages. The majority of patients first present with hoarseness, otalgia, dysphagia and weight loss to the nurse practitioner or primary care provider. Patients are typically male with a history of current or past tobacco smoking. A referral to an ENT surgeon should be made if the hoarseness is prolonged and associated with other features indicating a malignancy.

Steroids decrease the body’s immune response thus decreasing the production of antibodies that attack the acetylcholine receptors at the neuromuscular junction. Immunotherapy is used to upregulate or downregulate the immune system to achieve a therapeutic effect in immunological mediated disorders including immunodeficiencies, hypersensitivity reactions, autoimmune diseases, tissue and organ transplantations, malignancies, inflammatory disorders, infectious diseases, and any other disease, where immunotherapy can improve the quality and life expectancy.

Option A: Immunosuppressive therapies do not remove the antibodies, they reduce the production of these antibodies that attack the acetylcholine receptors at the neuromuscular junction. Steroids inhibit cytokine synthesis, affect cell migration, and inhibit the production of leukocytes. Cyclophosphamide acts by covalent alkylation, together with chlorambucil, exert an immunomodulatory effect. They inhibit strand separation of DNA during replication.
Option B: The production of acetylcholine is unaffected during immunosuppressive therapy. Methotrexate is an analog of folic acid and blocks pathways essential for DNA synthesis. Azathioprine is a drug that can convert to 6-mercaptopurine, and its effect is incorporation into DNA as a fraudulent base.
Option D: Pyridostigmine is an anticholinesterase inhibitor that works at the neuromuscular junction and prevents the breakdown of acetylcholine. The use of cytokines to successfully treat certain malignancies is a reality, for example, the use of IL-2 in combination with interferon-gamma for renal carcinoma; use of interferon-alpha and beta for hairy leukemia; and TNF-alpha used in various tumors caused a notable reduction of the mass. These cytokines upregulated the immune system through stimulation of T cell and NK cell activation and increased MHC class I expression.

The osmotic diuretic mannitol is contraindicated in the presence of inadequate renal function or heart failure because it increases the intravascular volume that must be filtered and excreted by the kidney. Urine output also requires monitoring; failure for urine output to increase after administration of mannitol should prompt cessation of mannitol and evaluation for possible renal or genitourinary issues.

Option A: Vital signs monitoring is a must for every shift, not just for mannitol administration. It is essential to monitor cardiac function as the fluid shifts can precipitate heart failure. Additional electrolytes, including sodium, potassium, and osmolality, require monitoring by the nurses and physicians. Abnormalities in these laboratory values necessitate prompt communication to all members of the team.
Option B: The patient’s weight is a less reliable indicator especially for safe administration of mannitol. The nursing staff should pay particular attention to urine output and monitor it carefully, reporting any concerns to the treating clinician. The pharmacist can verify dosing and perform medication reconciliation and alert the team if any interactions are present.
Option D: It would be more appropriate to monitor the patient’s neurological status if she has an increase in intracranial pressure. When giving mannitol, it is essential to monitor cardiac function as the fluid shifts can precipitate heart failure. Additional electrolytes, including sodium, potassium, and osmolality, all require monitoring. The clinician should stop mannitol if significant electrolyte abnormalities develop or the osmolality reaches 320 mOsm or higher.

These devices are more accurate because they are easy to use and have improved adherence to insulin regimens by young people because the medication can be administered discreetly. Once in use, most insulin analog vials, cartridges, and prefilled pens must be discarded after 28 days. This means that many patients who use a 10-ml vial end up either wasting insulin or using insulin beyond its recommended discard date. This is rarely a problem for patients using either a 3-ml prefilled pen or a reusable pen containing a 3-ml insulin cartridge.

Option B: Injection time of insulin pens and the traditional insulin syringes have no significant difference. Patients must therefore keep the device in place with the button pressed in for 5–10 seconds. If the patient is using more than 50 units of insulin per dose, a good rule of thumb might be to instruct them to count to 10 regardless of the pen they are using to ensure complete absorption of the insulin.
Option C: An additional issue is the greater prescription cost of insulin cartridges and prefilled insulin pens compared with insulin vials, although the cost to the patient may be the same depending on their coverage; in fact, if they have one copay per box of pens, the cost to the patient may actually be less per unit of insulin. It should be noted, however, that despite the higher unit cost of insulin in pen devices versus vials, several studies have found that overall diabetes-related treatment costs are lower with pen devices than with vial and syringe.
Option D: For all insulin pen devices, a separate prescription for pen needles is required, with gauges ranging from 29 to 32 and in lengths from 5 to 12.7 mm, much like the traditional insulin syringes used. More recent developments have resulted in the introduction of safety needles with protective shields that not only reduce needle-stick injuries but may also allay patient anxieties about needle use.

Damage to blood vessels may decrease the circulatory perfusion of the toes, this would indicate the lack of blood supply to the extremity. If the intracompartmental pressure becomes higher than arterial pressure, a decrease in arterial inflow will also occur. The reduction of venous outflow and arterial inflow result in decreased oxygenation of tissues causing ischemia. If the deficit of oxygenation becomes high enough, irreversible necrosis may occur.

Option A: Compartment syndrome is one of the most serious complications of casting. Symptoms may include swelling, delayed capillary refill, or dusky appearance of exposed extremities. Beware that the presence or absence of a palpable arterial pulse may not accurately indicate relative tissue pressure or predict the risk for compartment syndrome. In some patients, a pulse is still present, even in a severely compromised extremity.
Option B: Thermal injuries to the skin can occur as a result of casting. In the initial stages, pain may be characterized as a burning sensation or as a deep ache of the involved compartment. Paresthesia, hypoesthesia, or poorly localized deep muscular pain may also be present.
Option D: Increased blood pressure is not a symptom of damage to the major blood vessels. Classically, the presentation of acute compartment syndrome has been remembered by “The Five P’s”: pain, pulselessness, paresthesia, paralysis, and pallor. However, aside from paresthesia, which may occur earlier in the course of the condition, these are typically late findings.