Nokea
A leukemia patient has a relative who wants to donate blood for transfusion. Which of the following donor medical conditions would prevent this?
- A. A history of hepatitis C five years previously
- B. Cholecystitis requiring cholecystectomy one year previously
- C. Asymptomatic diverticulosis
- D. Crohn's disease in remission
Correct Answer: A
Rationale: A history of hepatitis C five years previously would prevent a donor from donating blood for transfusion. Hepatitis C is a viral infection transmitted through bodily fluids, such as blood, causing inflammation of the liver. Patients with hepatitis C may not donate blood for transfusion due to the high risk of infection in the recipient. Cholecystitis requiring cholecystectomy one year previously, asymptomatic diverticulosis, and Crohn's disease in remission are not contraindications for blood donation as they do not pose a risk of transmitting infections to the recipient.
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The nurse is assessing an 8-year-old child whose growth rate measures below the third percentile for
a child his age. He appears significantly younger than his stated age and is chubby with infantile
facial features. Which condition does this child likely have?
- A. Acromegaly
- B. Marfan syndrome
- C. Hypopituitary dwarfism
- D. Achondroplastic dwarfism
Correct Answer: C
Rationale: Hypopituitary dwarfism is caused by a deficiency in growth hormone in childhood and results in a
retardation of growth below the third percentile, delayed puberty, and other problems. The child's
appearance fits this description. Achondroplastic dwarfism is a genetic disorder resulting in
characteristic deformities; Marfan syndrome is an inherited connective tissue disorder characterized
by a tall, thin stature and other features. Acromegaly is the result of excessive secretion of growth
hormone in adulthood which causes overgrowth of bone in the face, head, hands, and feet.
When considering the concepts related to blood pressure, which statement best describes the concept of mean arterial pressure (MAP)?
- A. MAP is the pressure of the arterial pulse.
- B. MAP reflects the stroke volume of the heart.
- C. MAP is the pressure forcing blood into the tissues, averaged over the cardiac cycle.
- D. MAP is an average of the systolic and diastolic blood pressures and reflects tissue perfusion.
Correct Answer: C
Rationale: Mean Arterial Pressure (MAP) is the pressure that forces blood into the tissues, averaged over the cardiac cycle. It is not the pressure of the arterial pulse (Choice A), nor does it directly reflect the stroke volume of the heart (Choice B). While MAP involves systolic and diastolic pressures, it is not simply an average of these two values as diastole lasts longer. Instead, MAP is closer to diastolic pressure plus one third of the pulse pressure. The best description of MAP is that it represents the pressure forcing blood into the tissues, averaged over the cardiac cycle.
The nurse is taking an initial blood pressure reading on a 72-year-old patient with documented hypertension. How should the nurse proceed?
- A. Cuff should be placed on the patient's arm and inflated 30 mm Hg above the point at which the palpated pulse disappears.
- B. Cuff should be inflated to 200 mm Hg in an attempt to obtain the most accurate systolic reading.
- C. Cuff should be inflated 30 mm Hg above the patient's pulse rate.
- D. After confirming the patient's previous blood pressure readings, the cuff should be inflated 30 mm Hg above the highest systolic reading recorded.
Correct Answer: C
Rationale: When measuring blood pressure, it's important to account for the possibility of an auscultatory gap, which occurs in about 5% of individuals, particularly those with hypertension due to a noncompliant arterial system. To detect an auscultatory gap, the cuff should be inflated 20 to 30 mm Hg beyond the point at which the palpated pulse disappears. This ensures an accurate measurement of blood pressure by overcoming the potential gap in sounds. Choice A is correct as it follows this guideline. Choices B and C are incorrect because inflating the cuff to 200 mm Hg or above the patient's pulse rate does not address the specific issue of an auscultatory gap. Choice D is incorrect as it focuses on the patient's previous readings rather than the current measurement technique needed to detect an auscultatory gap.
When assessing the force or strength of a pulse, what would the nurse recall about the pulse?
- A. Is a reflection of the heart's stroke volume
- B. Typically recorded on a 0- to 3-point scale
- C. Demonstrates elasticity of the blood vessel wall
- D. Reflects the blood volume in the arteries during diastole
Correct Answer: A
Rationale: When assessing the force or strength of a pulse, the nurse should recall that it is a reflection of the heart's stroke volume. The heart pumps an amount of blood (the stroke volume) into the aorta, causing arterial walls to flare and generate a pressure wave felt as the pulse in the periphery. The force of the pulse is typically recorded on a 0- to 3-point scale, not a 0- to 2-point scale. The force of the pulse does not demonstrate the elasticity of blood vessel walls or reflect the blood volume in the arteries during diastole. Therefore, choices B, C, and D are incorrect.
The healthcare professional notices that a colleague is preparing to check the blood pressure of a patient who is obese by using a standard-sized blood pressure cuff. How would this likely affect the blood pressure reading?
- A. Yield a falsely low blood pressure
- B. Yield a falsely high blood pressure
- C. Be the same, regardless of cuff size
- D. Vary as a result of the technique of the person performing the assessment
Correct Answer: B
Rationale: Using a cuff that is too narrow for an obese patient would likely yield a falsely high blood pressure reading. This occurs because the standard cuff is too small for the arm's circumference, requiring more pressure to compress the artery. A tight cuff can lead to inaccurate and elevated blood pressure readings. Choices A, C, and D are incorrect because using an improperly sized cuff would not yield a falsely low blood pressure, the blood pressure reading does vary with cuff size, and the technique of the person performing the assessment is not the primary factor affecting the reading in this situation.