Nokea
A female patient's hematocrit level is 50% and oxygen saturation is 98% on room air. What should the nurse suspect as being the cause for this patient's hematocrit level?
- A. Dehydration
- B. Chronic renal failure
- C. Bone marrow suppression
- D. Bleeding esophageal varices
Correct Answer: A
Rationale: The correct answer is A: Dehydration. Dehydration can lead to hemoconcentration, resulting in an elevated hematocrit level. When a person is dehydrated, the plasma volume decreases, causing an increase in the proportion of red blood cells in the blood, leading to a higher hematocrit level. In this case, the patient's high hematocrit level of 50% is likely due to dehydration rather than the other options. Oxygen saturation being 98% on room air indicates adequate oxygenation, ruling out chronic renal failure, bone marrow suppression, and bleeding esophageal varices as potential causes for the high hematocrit level in this patient.
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Which of the following anemia is associated with splenomegaly:
- A. chronic renal failure
- B. aplastic anemia
- C. hereditary spherocytosis
- D. sickle cell anaemia
Correct Answer: C
Rationale: Rationale: Hereditary spherocytosis is associated with splenomegaly due to the spleen's increased destruction of abnormal red blood cells. In this condition, red blood cells have a spherical shape, making them more prone to destruction by the spleen. Chronic renal failure (A) is not typically associated with splenomegaly. Aplastic anemia (B) is characterized by bone marrow failure and does not directly involve the spleen. Sickle cell anemia (D) leads to splenomegaly in children but not in adults due to splenic sequestration crises, making it less likely to be the correct choice.
A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?
- A. Vitamin K
- B. Aminocaproic acid
- C. Protamine
- D. Deferoxamine
Correct Answer: B
Rationale: Rationale: Aminocaproic acid is used to manage bleeding complications associated with thrombolytic therapy, like alteplase. In case of severe adverse reaction such as uncontrolled bleeding, aminocaproic acid can help by inhibiting fibrinolysis. Vitamin K (A) is not used for this purpose. Protamine (C) is used to reverse heparin anticoagulation, not for thrombolytic therapy. Deferoxamine (D) is used for iron toxicity, not related to thrombolytic therapy. Thus, having aminocaproic acid available is crucial for managing potential adverse reactions during alteplase therapy.
A pediatric fellow is planning a project intended to decrease the incidence of acute chest syndrome among patients with sickle cell disease who are already admitted to the hospital for other reasons. The fellow discussed with her mentor whether the project proposal should be submitted for review by the Institutional Review Board (IRB). The mentor explains that, at their intuition, quality improvement activities do not require IRB review but research projects must be submitted to the IRB. Which of the following is NOT a relevant consideration in determining whether the project is research or quality improvement?
- A. The aim to create new knowledge for the individual institution versus discovering new and generalizable knowledge
- B. The chosen methodology which will include repeated Plan-Do-Study-Act cycles
- C. The intent to publish the results in a peer reviewed hematology journal
- D. The efforts to hold biases/confounders stable over time, rather than control for them with, for example, randomization
Correct Answer: C
Rationale: The correct answer is C because the intent to publish results in a peer-reviewed journal is not a relevant consideration in determining whether a project is research or quality improvement. Here's a step-by-step rationale:
1. Quality improvement aims to enhance processes within a specific institution, while research seeks to generate generalizable knowledge.
2. Methodology using Plan-Do-Study-Act cycles is common in both quality improvement and research projects.
3. Efforts to stabilize biases/confounders over time align with both quality improvement and research principles.
4. Intent to publish in a peer-reviewed journal does not define the project as research; it is possible to publish quality improvement initiatives as well.
A 4-year-old male child presents to the emergency department with his fourth invasive Staph infection. CBC consistently identifies moderate neutropenia. Sophisticated lab testing identifies lack of Toll-like receptor responses. The patient undergoes whole exome sequencing and is found to have pathogenic variants in IRAK4. What does 'IRAK4' stand for?
- A. Interferon gamma receptor-associated kinase 4
- B. Inducible RAS activating kinase 4
- C. Interleukin-1 receptor-associated kinase 4
- D. Immune response activating kinase 4
Correct Answer: C
Rationale: Step 1: Identify the function of IRAK4.
IRAK4 is involved in the signaling pathway of the immune system, particularly in response to interleukin-1 (IL-1) receptor activation.
Step 2: Break down the acronym IRAK4.
IRAK4 stands for Interleukin-1 Receptor-Associated Kinase 4.
Step 3: Link the information in the question to the correct answer.
Given that the patient has a lack of Toll-like receptor responses and pathogenic variants in IRAK4, it indicates a problem with the interleukin-1 signaling pathway, making choice C (Interleukin-1 receptor-associated kinase 4) the correct answer.
Summary:
A: Incorrect - Interferon gamma receptor-associated kinase does not match the function of IRAK4.
B: Incorrect - Inducible RAS activating kinase does not match the function of IRAK4.
C: Correct - Matches the function of IRAK4
A patient with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the patient?
- A. Chew with care to avoid inadvertently biting the tongue.
- B. Use the oral anesthetic 1 hour prior to meal time.
- C. Brush teeth before and after eating.
- D. Swallow slowly and deliberately.
Correct Answer: A
Rationale: The correct answer is A: Chew with care to avoid inadvertently biting the tongue. Stomatitis causes mouth sores, making it crucial for the patient to be cautious while chewing to prevent accidental injury to the mouth. This helps in reducing pain and promoting healing.
Choice B is incorrect because using the oral anesthetic 1 hour prior to mealtime may not provide immediate relief during eating. Choice C is incorrect as brushing teeth before and after eating can irritate the mouth sores further. Choice D is incorrect as swallowing slowly and deliberately does not address the issue of preventing accidental biting of the tongue.