Nokea
A patient with a history of chronic liver disease presents with ecchymoses, mucosal bleeding, and altered mental status. Laboratory tests reveal prolonged PT and aPTT, low fibrinogen levels, and elevated D-dimer. Which of the following conditions is most likely to cause these findings?
- A. Liver cirrhosis
- B. Disseminated intravascular coagulation (DIC)
- C. Hemophilia A
- D. Vitamin K deficiency
Correct Answer: B
Rationale: The correct answer is B: Disseminated intravascular coagulation (DIC). In DIC, there is widespread activation of coagulation leading to consumption of clotting factors, resulting in prolonged PT and aPTT, low fibrinogen levels, and elevated D-dimer. This pattern matches the laboratory findings in the patient. In liver cirrhosis (choice A), there is a decrease in clotting factors synthesis, leading to prolonged PT but not aPTT. Hemophilia A (choice C) is a genetic disorder that affects specific clotting factors, typically leading to prolonged aPTT but not PT. Vitamin K deficiency (choice D) impairs the synthesis of clotting factors, leading to prolonged PT but not aPTT and low levels of factors II, VII, IX, and X.
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Which of the following conditions is characterized by inflammation of the plantar fascia, resulting in heel pain that is typically worse with the first steps in the morning?
- A. Achilles tendinitis
- B. Plantar fasciitis
- C. Morton's neuroma
- D. Stress fracture of the calcaneus
Correct Answer: B
Rationale: Plantar fasciitis is the correct answer. It is characterized by inflammation of the plantar fascia, leading to heel pain, especially in the morning. The plantar fascia is a band of tissue that connects the heel bone to the toes. The pain is usually worse with the first steps after resting.
Achilles tendinitis involves inflammation of the Achilles tendon, which connects the calf muscles to the heel bone, causing pain at the back of the heel and ankle. Morton's neuroma is a condition involving a thickening of tissue around a nerve in the ball of the foot, leading to sharp, burning pain in the toes.
Stress fracture of the calcaneus refers to a small crack in the heel bone due to repetitive stress or overuse, resulting in heel pain that may worsen with activity, but not specifically with the first steps in the morning.
Korino has been using meperidine and codeine for personal consumption. Which of the following does the nurse understand as the physiologic effect of these drugs?
- A. Increases sexual stimulation.
- B. Relieves pain by increasing pain threshold.
- C. Decrease craving for alcoholic intake.
- D. Heightens concentration and alertness
Correct Answer: B
Rationale: The correct answer is B: Relieves pain by increasing pain threshold. Meperidine and codeine are opioid analgesics that work by binding to opioid receptors in the brain and spinal cord, thus increasing the pain threshold and reducing the perception of pain. This leads to pain relief without necessarily affecting sexual stimulation (choice A), craving for alcohol (choice C), or concentration/alertness (choice D). The primary physiological effect of these drugs is to modulate the perception of pain, making choice B the most appropriate answer in this context.
A patient presents with petechiae, ecchymoses, and gingival bleeding. Laboratory tests reveal prolonged bleeding time, normal platelet count, and normal PT and aPTT. Which of the following conditions is most likely to cause these findings?
- A. Glanzmann thrombasthenia
- B. Bernard-Soulier syndrome
- C. Acquired von Willebrand syndrome
- D. Hemophilia A
Correct Answer: C
Rationale: The correct answer is C: Acquired von Willebrand syndrome. This condition is characterized by a defect in von Willebrand factor function, leading to prolonged bleeding time and mucocutaneous bleeding. Normal platelet count rules out Glanzmann thrombasthenia and Bernard-Soulier syndrome which are platelet disorders. Normal PT and aPTT rule out Hemophilia A, a coagulation factor deficiency. Acquired von Willebrand syndrome is the most likely cause based on the clinical presentation and laboratory findings.
Which of the following data sets can be analyzed on the ratio level of measurement?
- A. eye color
- B. pulse rates
- C. ethnicity
- D. gender
Correct Answer: B
Rationale: The correct answer is B: pulse rates. Pulse rates can be analyzed on the ratio level of measurement because they have a true zero point and allow for meaningful ratios to be calculated. This means that we can perform operations such as addition, subtraction, multiplication, and division on pulse rate data. In contrast, the other options (A: eye color, C: ethnicity, D: gender) are categorical data that do not have a true zero point and therefore cannot be analyzed on the ratio level. Eye color, ethnicity, and gender are all examples of nominal data which only allow for qualitative classification and do not have a numerical value that can be used in mathematical operations.
The nurse assesses the uterine fundus of the mother. Which part of the abdomen will the nurse begin?
- A. Symphysis pubis
- B. Midline
- C. Umbilicus
- D. Sides of the abdomen
Correct Answer: C
Rationale: The correct answer is C: Umbilicus. The nurse begins assessing the uterine fundus at the level of the umbilicus as it is a standard reference point for postpartum fundal height measurement. This location allows for consistency and accuracy in tracking the descent of the uterus back into the pelvic cavity. Starting at the umbilicus also helps in monitoring the involution process and prevents potential errors in fundal height assessment.
Symphysis pubis (A) is too low and not typically used as a reference point for uterine fundal assessment. Midline (B) is vague and does not provide a specific anatomical landmark. Sides of the abdomen (D) do not give a standardized starting point for measuring the uterine fundus, leading to potential variability in assessment.