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A patient presents with bone pain, fatigue, and frequent infections. Laboratory tests reveal pancytopenia, hypocellular bone marrow, and absence of reticulocytes. Which of the following conditions is most likely to cause these findings?
- A. Aplastic anemia
- B. Iron deficiency anemia
- C. Myelodysplastic syndrome (MDS)
- D. Acute lymphoblastic leukemia (ALL)
Correct Answer: A
Rationale: Aplastic anemia is a condition characterized by a reduction in the number of all three blood cell types: red blood cells, white blood cells, and platelets. The patient's presentation of bone pain, fatigue, frequent infections, pancytopenia (decreased counts of all blood cell types), hypocellular bone marrow (reduced cellularity in the bone marrow), and absence of reticulocytes is indicative of aplastic anemia.
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A patient in the ICU develops acute kidney injury (AKI) secondary to sepsis. What intervention should the healthcare team prioritize to manage the patient's renal function?
- A. Initiate continuous veno-venous hemofiltration (CVVH) for renal replacement therapy.
- B. Administer diuretic medications to promote urine output.
- C. Implement strict fluid restriction to prevent further renal injury.
- D. Perform a renal biopsy to assess the underlying cause of AKI.
Correct Answer: A
Rationale: In a patient with acute kidney injury (AKI) secondary to sepsis in the ICU, the healthcare team should prioritize initiating continuous veno-venous hemofiltration (CVVH) for renal replacement therapy. CVVH is a form of continuous renal replacement therapy that helps support renal function by removing waste products, excess fluids, and electrolytes from the blood while providing hemodynamic stability. This intervention is crucial in managing fluid overload, electrolyte disturbances, and uremia associated with AKI in critically ill patients. It can also help improve overall outcomes and prevent further complications related to renal dysfunction in this setting. Administering diuretics, implementing fluid restriction, or performing a renal biopsy may not directly address the acute renal failure and may not provide the necessary renal support needed in this urgent situation.
A pregnant woman presents with painless, bright red vaginal bleeding at 34 weeks gestation. On examination, the cervix is found to be closed. Which of the following conditions is the most likely cause of these symptoms?
- A. Ectopic pregnancy
- B. Abruptio placentae
- C. Placenta previa
- D. Gestational trophoblastic disease
Correct Answer: C
Rationale: Placenta previa is a condition where the placenta partially or completely covers the cervix, leading to painless vaginal bleeding during pregnancy. In the scenario described, the painless, bright red vaginal bleeding at 34 weeks gestation with a closed cervix is classic for placenta previa. This condition is more common in the third trimester and can be diagnosed through ultrasound. It is important to manage placenta previa carefully to prevent complications such as severe bleeding, preterm birth, and maternal/fetal distress.
Verbal communication is the use of words when talking to your patient. The use of literal words when you speak is the :
- A. Understandable phrases
- B. The circumstances
- C. Content
- D. Understandable sentences
Correct Answer: C
Rationale: Verbal communication involves the use of words and language to convey information. The content refers to the actual words and messages being communicated. In verbal communication with your patient, the content of what you say is key to ensuring effective communication that is clear, accurate, and easily understood. Therefore, the use of literal words when speaking to your patient embodies the content of your communication.
Nursing diagnosis commonly used when working with Sandro is
- A. ineffective role performance
- B. Compromised family coping
- C. impaired social interaction
- D. risk for injury.
Correct Answer: C
Rationale: When working with Sandro, who is taking an MAOI and needs to be educated on avoiding foods with tyramine, the nursing diagnosis commonly used would be "impaired social interaction." This nursing diagnosis focuses on the client's difficulty in establishing or maintaining meaningful relationships with others. In this case, Sandro's dietary restrictions due to his medication may cause challenges in social situations, leading to potential feelings of isolation or inability to engage in social activities involving food. By identifying impaired social interaction as a nursing diagnosis, the nurse can address these issues and support Sandro in maintaining social connections while adhering to his dietary requirements.
A patient with a history of chronic obstructive pulmonary disease (COPD) is prescribed a metered-dose inhaler (MDI) with a spacer. Which instruction should the nurse include in the demonstration of MDI use?
- A. Inhale slowly and deeply while pressing the canister.
- B. Exhale completely before inhaling the medication.
- C. Shake the inhaler vigorously before each puff.
- D. Hold the breath for 10 seconds after inhaling the medication.
Correct Answer: A
Rationale: The correct instruction for using a metered-dose inhaler (MDI) with a spacer for a patient with COPD is to inhale slowly and deeply while pressing the canister. This technique helps ensure that the medication reaches the lungs effectively. Inhaling slowly and deeply allows the medication to be properly delivered to the airways, maximizing its effectiveness in treating the symptoms of COPD. This instruction helps the patient coordinate pressing the canister with their inhalation, which is crucial for proper medication delivery in COPD management.