Nokea
A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage?
- A. Rapid pulse
- B. Yellowing of the sclera
- C. Elevated blood pressure
- D. Pale-colored stools
Correct Answer: A
Rationale: The correct answer is A: Rapid pulse. When a client is undergoing anticoagulant therapy with heparin, the nurse should monitor for signs of hemorrhage. A rapid pulse can indicate internal bleeding, a common complication of anticoagulant therapy. Other choices such as B: Yellowing of the sclera, C: Elevated blood pressure, and D: Pale-colored stools are not typically associated with hemorrhage. Yellowing of the sclera may indicate jaundice, elevated blood pressure may be related to other conditions, and pale-colored stools may indicate liver or gallbladder issues. Rapid pulse is the most pertinent finding related to hemorrhage in this context.
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Which of the following is a cause of secondary neutropaenia in adults?
- A. Congenital
- B. Anti-hypertensive drugs
- C. Part of general pancytopaenia
- D. Familial
Correct Answer: C
Rationale: Rationale: Secondary neutropenia in adults is often a part of general pancytopenia, which involves a decrease in all three blood cell types. This can be caused by factors such as bone marrow suppression from chemotherapy, radiation therapy, or certain medications. Neutropenia is not typically congenital or familial in adults, and anti-hypertensive drugs are not commonly known to directly cause secondary neutropenia. Therefore, the correct answer is C as it aligns with the common etiology of secondary neutropenia in adults.
A study is designed to investigate the rates of central line–associated blood stream infections among pediatric hematology/oncology patients. Three common central line types (totally implanted catheter [port], peripherally inserted central catheter [PICC], and tunneled externalized catheter [TEC]) were included in the study. What data structure is central line type?
- A. Continuous
- B. Dichotomous
- C. Nominal
- D. Ordinal
Correct Answer: C
Rationale: The correct answer is C: Nominal. The central line types in this study (port, PICC, TEC) are categorical and do not have a natural order or ranking. They are simply names or labels representing different types of central lines. This makes them fall under the nominal data structure category. Continuous data (choice A) would involve measurements with infinite possible values. Dichotomous data (choice B) would have only two categories. Ordinal data (choice D) would imply a natural ranking or order among the categories, which is not applicable in this context.
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.
A 36-year-old woman presented with weakness, lassitude, and feeling easily tired. Her bone marrow aspirate showed 15% myeloblasts and reduced erythropoiesis. The most likely cause is
- A. Acute myeloid leukemia
- B. Acute lymphoid leukemia
- C. Myelofibrosis
- D. Myelodysplastic syndrome
Correct Answer: D
Rationale: The correct answer is D: Myelodysplastic syndrome. Given the patient's age, symptoms, and bone marrow findings of myeloblasts with reduced erythropoiesis, it aligns with the characteristics of myelodysplastic syndrome. This condition involves abnormal blood cell production leading to cytopenias and an increased risk of progression to acute myeloid leukemia. Acute myeloid leukemia (Choice A) typically presents with higher blast percentages and more aggressive symptoms. Acute lymphoid leukemia (Choice B) is less likely due to the presence of myeloblasts in the bone marrow. Myelofibrosis (Choice C) is characterized by fibrosis in the bone marrow, which is not indicated in this case.
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 determining factor in distinguishing between quality improvement and research activities. Here's a step-by-step rationale:
1. Quality improvement focuses on improving processes within an institution to enhance patient care, while research aims to generate new knowledge that is generalizable beyond the institution.
2. The chosen methodology (B) such as using Plan-Do-Study-Act cycles is often associated with quality improvement projects to test and implement changes iteratively.
3. Efforts to hold biases stable over time (D) are more aligned with research, as quality improvement projects may not necessarily require controlling for biases like randomization.
4. The intent to publish in a peer-reviewed journal (C) can apply to both quality improvement and research projects, but the key factor in determining the need for IRB review is whether the project aims to generate generalizable knowledge (research) or improve local processes (quality improvement).