Nokea
The mean cell volume of the patient is 90 fl and the reticulocyte production index is low. Which of the following is the most possible cause of anemia in this patient?
- A. Thalassemia
- B. Vitamin B12 deficiency
- C. Aplastic anemia
- D. Sideroblastic anemia
Correct Answer: C
Rationale: The correct answer is C: Aplastic anemia. Aplastic anemia is characterized by a low reticulocyte production index due to bone marrow failure, leading to decreased red blood cell production and subsequently causing anemia. Thalassemia (choice A) is a genetic disorder resulting in abnormal hemoglobin production, not bone marrow failure. Vitamin B12 deficiency (choice B) can lead to macrocytic anemia, not a low reticulocyte production index. Sideroblastic anemia (choice D) is characterized by abnormal iron metabolism in the bone marrow, not bone marrow failure.
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The nurse is reviewing the parts of the complete blood count and differential with a patient. Where should the nurse state that neutrophils, eosinophils, and basophils are produced?
- A. Spleen
- B. Thymus
- C. Lymph nodes
- D. Red bone marrow
Correct Answer: D
Rationale: The correct answer is D: Red bone marrow. Neutrophils, eosinophils, and basophils are all types of white blood cells that are produced in the red bone marrow through a process called hematopoiesis. The red bone marrow is a primary site for the production of blood cells, including these specific types of white blood cells. Neutrophils are important for fighting bacterial infections, eosinophils are involved in allergic reactions and parasitic infections, and basophils play a role in allergic responses. Therefore, it is crucial for the nurse to inform the patient that these cells are produced in the red bone marrow. The other choices (A: Spleen, B: Thymus, C: Lymph nodes) are incorrect as these organs do not play a primary role in the production of these specific types of white blood cells.
The nurse is reviewing the results of a patient's arterial blood gas analysis. What should the nurse recognize as being a normal blood pH?
- A. 7.29
- B. 7.31
- C. 7.38
- D. 7.48
Correct Answer: C
Rationale: The correct answer is C: 7.38. Normal blood pH ranges from 7.35 to 7.45. A pH of 7.38 falls within this range, indicating a slightly alkaline (basic) pH, which is considered normal. Choices A, B, and D are all outside the normal range, indicating acidosis (A and B) or alkalosis (D). Therefore, C is the correct answer as it falls within the normal blood pH range.
A 4-year-old girl with a history of recurrent epistaxis and easy bruising is referred to you for evaluation. She is found to have a prolonged PTT and a factor VIII level that is less than 1%. Both parents have a history of excessive bleeding. She is admitted with a severe episode of epistaxis, and your colleague orders 40 IU/kg of recombinant factor VIII. Her epistaxis resolves initially but within an hour starts again at the same severity as before. What is the best next step?
- A. Infuse a von Willebrand factor concentrate.
- B. Give another dose of recombinant factor VIII concentrate.
- C. Call otorhinolaryngology to pack her nose.
- D. Check for a factor VIII inhibitor.
Correct Answer: A
Rationale: The correct answer is A: Infuse a von Willebrand factor concentrate. In this case, the 4-year-old girl with a factor VIII deficiency did not respond to recombinant factor VIII, suggesting a possible von Willebrand disease (vWD) as well. Infusing von Willebrand factor concentrate can help address the underlying vWD component, which is necessary for adequate hemostasis. Option B is incorrect because giving another dose of recombinant factor VIII won't address the potential vWD deficiency. Option C is not the best next step as packing the nose does not address the underlying bleeding disorder. Option D is not the immediate next step as checking for a factor VIII inhibitor is important but can be done after addressing the acute bleeding episode with appropriate therapy.
A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia?
- A. Monitoring for infection
- B. Monitoring nutritional status
- C. Monitor electrolyte levels
- D. Monitoring liver function
Correct Answer: A
Rationale: The correct answer is A: Monitoring for infection. Acute leukemia patients are at high risk for infections due to compromised immune function. Infection is the most common cause of death among leukemia patients. Regular monitoring for signs of infection, such as fever and abnormal white blood cell counts, is crucial for early detection and treatment. Option B, monitoring nutritional status, is important but not the most direct cause of death in leukemia patients. Option C, monitoring electrolyte levels, is important but not as directly related to the cause of death in leukemia patients. Option D, monitoring liver function, is not the most common cause of death in leukemia patients and is not directly related to leukemia complications.
What are the six dimensions of quality care according to the Institute of Medicine?
- A. Safe, timely, effective, efficient, equitable, and person-centered
- B. Safe, transparent, effective, efficient, equitable, and person-centered
- C. Safe, timely, effective, low-cost, equitable, and person-centered
- D. Safe, timely, effective, efficient, cutting-edge, and person-centered
Correct Answer: A
Rationale: The correct answer is A: Safe, timely, effective, efficient, equitable, and person-centered. This aligns with the six dimensions of quality care outlined by the Institute of Medicine. Safety ensures patient well-being, timeliness reduces delays, effectiveness means providing evidence-based care, efficiency minimizes waste, equity ensures fair access, and person-centered care considers individual preferences.
Choice B is incorrect because transparency is not included in the Institute of Medicine's six dimensions. Choice C is incorrect as "low-cost" is not a recognized dimension of quality care. Choice D is incorrect because "cutting-edge" is not part of the established dimensions of quality care.