A nurse works in a gerontology clinic. What age-related change(s) related to the hematologic system will the nurse expect during health assessment? (Select all that apply.)
- A. Dentition deteriorates with more cavities.
- B. Nail are stron and smooth
- C. Progressive loss or thinning of hair occurs.
- D. Sclerae begin to turn yellow or pale.
Correct Answer: C
Rationale: Rationale:
Correct Answer (C): Progressive loss or thinning of hair is an age-related change in the hematologic system due to decreased blood flow to hair follicles. This is commonly observed in the elderly population.
Incorrect Choices:
A: Dentition deteriorates with more cavities is related to dental health, not the hematologic system.
B: Nails being strong and smooth are related to nail health, not the hematologic system.
D: Sclerae turning yellow or pale is a sign of jaundice, which is related to liver function, not the hematologic system.
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An older adult patient is receiving a transfusion of packed red blood cells after being injured in a car accident. On assessment, the nurse notes a new finding of bounding pulse, crackles, and increasing dyspnea. What should the nurse do first, after stopping the transfusion?
- A. Assess vital signs.
- B. Raise the head of the bed.
- C. Encourage the patient to deep breathe and cough.
- D. Administer pm diphenhydramine (Benadryl) as ordered.
Correct Answer: B
Rationale: The correct answer is B: Raise the head of the bed. After stopping the transfusion due to signs of fluid overload, the priority is to alleviate symptoms and improve respiratory function. Elevating the head of the bed helps reduce venous return, decreasing preload and cardiac workload, which can help manage symptoms like dyspnea and crackles. This action promotes better oxygenation and reduces the risk of complications like pulmonary edema. Assessing vital signs (Choice A) is important but not the immediate priority. Encouraging deep breathing and coughing (Choice C) may exacerbate respiratory distress in this situation. Administering diphenhydramine (Choice D) is not indicated for fluid overload.
Which of the following statements about myeloablative, myeloablative but reduced toxicity, reduced intensity, and non-myeloablative approaches is not correct?
- A. Myeloablative approaches are needed for high-risk malignancies to maximize depth of remission and decrease the likelihood of relapse.
- B. Reduced intensity regimens can be successfully used for most nonmalignant disorders to minimize risk of late effects.
- C. Reduced intensity regimens can markedly decrease the risk of transplant-related mortality in patients who have underlying significant comorbidities but at the cost of more relapse and possibly more graft-versus-host disease.
- D. Non-myeloablative regimens are used for the very highest risk patients to minimize toxicity and for certain diseases such as aplastic anemia.
Correct Answer: B
Rationale: The correct answer is B because reduced intensity regimens are used to minimize toxicity and late effects, not for most nonmalignant disorders. Myeloablative approaches are needed for high-risk malignancies to maximize remission depth (A), reduced intensity regimens can increase transplant-related mortality in high-risk patients (C), and non-myeloablative regimens are used for the highest risk patients and certain diseases like aplastic anemia (D).
A 12-year-old girl presents to your clinic with significant menstrual bleeding at the onset of menarche and is noted to have a hemoglobin of 9.9, although she is not symptomatic from her anemia. Her mother reports that she has a history of epistaxis when she was a child with some episodes lasting 30 minutes and that she also has heavy menstrual bleeding. Which of the following tests will lead to the most likely diagnosis?
- A. Factor XI level
- B. Factor X level
- C. Factor XIII level
- D. Ristoectin cofactor activity
Correct Answer: D
Rationale: The correct answer is D: Ristoectin cofactor activity. The scenario describes a young girl with significant menstrual bleeding and a history of prolonged epistaxis, suggesting a bleeding disorder. Given the clinical presentation, the most likely diagnosis is von Willebrand disease (vWD), the most common inherited bleeding disorder. Ristocetin cofactor activity is a specific test for vWD, as it assesses the ability of von Willebrand factor to bind to platelets in the presence of ristocetin. Factors XI, X, and XIII are not typically associated with vWD, making choices A, B, and C incorrect. Testing for Factor VIII/von Willebrand factor antigen levels and vWF multimer analysis may also be considered to confirm the diagnosis.
Haemolytic anemia is not produced by:
- A. penicillin
- B. lithium
- C. Quinidine
- D. methyldopa
Correct Answer: B
Rationale: The correct answer is B: lithium. Lithium is not known to cause haemolytic anemia. Penicillin (A), Quinidine (C), and methyldopa (D) are associated with causing haemolytic anemia due to various mechanisms, such as immune-mediated destruction of red blood cells. In contrast, lithium is primarily used to treat mood disorders and does not have a direct link to causing haemolytic anemia. Therefore, by process of elimination and understanding the pharmacological effects of these drugs, we can determine that lithium is the correct answer.
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. Central line type is a nominal data structure because it represents categories without any inherent order or ranking. In this study, the central line types (port, PICC, TEC) are distinct categories with no numerical significance or order. They are simply different types of central lines used for medical purposes. Continuous (A) data involves numerical values with infinite possibilities, which is not the case here. Dichotomous (B) data consists of only two categories, while in this study there are three central line types. Ordinal (D) data involves categories with a specific order or ranking, which is not applicable to central line types as they do not have a natural order.