Choice A rationale:

A low level of hepcidin would not cause a decrease in hemoglobin levels. Hepcidin regulates iron homeostasis by inhibiting the absorption of iron from the intestines and promoting its storage in cells.

Choice B rationale:

An increase in iron-binding capacity typically occurs in conditions like iron deficiency anemia, where the body tries to increase its capacity to transport iron. This would not cause a low hemoglobin level in an otherwise healthy individual.

Choice C rationale:

Aging often leads to a decrease in the efficiency of nutrient absorption, including iron. This decrease in intestinal absorption of iron can result in low hemoglobin levels in elderly individuals. It's a common cause of anemia in the elderly population.

Choice D rationale:

Erythropoietin is a hormone produced by the kidneys that stimulates the production of red blood cells. A decrease in erythropoietin secretion from the kidneys would lead to anemia, but it is not a typical effect of aging and is usually associated with kidney disease.

Choice A rationale:

Methotrexate is a medication used for cancer and autoimmune diseases. It does not chelate iron and is not used to treat iron overload conditions like hemochromatosis.

Choice B rationale:

Deferoxamine is an iron chelating agent used to treat iron overload conditions like hemochromatosis. It binds to excess iron and promotes its excretion from the body, preventing complications such as organ damage.

Choice C rationale:

Ferrous gluconate is an iron supplement used to treat iron deficiency anemia. It would not be appropriate for a patient with hemochromatosis, a condition characterized by iron overload.

Choice D rationale:

Iron dextran complex is another form of intravenous iron used to treat iron deficiency anemia. It is not indicated for treating iron overload conditions like hemochromatosis.

Choice A rationale:

Maximizing cardiac output is a primary goal for patients with chronic heart failure (HF) because it helps improve tissue perfusion and oxygen delivery to meet the body's demands. It is a crucial aspect of managing heart failure and preventing further complications.

Choice B rationale:

Maintaining ideal body weight is important for overall health but is not a primary goal specific to chronic heart failure management.

Choice C rationale:

While exercise is beneficial for heart failure patients, it needs to be tailored to the patient's condition. Performing aerobic exercises daily might not be suitable for all heart failure patients and is not a primary goal.

Choice D rationale:

Maintaining a steady pulse oximetry reading is important, but it is a measure of oxygen saturation in the blood and not a primary goal for managing chronic heart failure.

Choice A rationale:

The given ABG results indicate a low pH (acidosis), an elevated PaCO2 (respiratory component), and a normal HCO3 (metabolic component) The low pH and increased PaCO2 suggest respiratory acidosis. The normal HCO3 indicates that the metabolic component is normal. This ABG profile is consistent with metabolic acidosis with respiratory compensation.

Choice B rationale:

Metabolic alkalosis is characterized by an elevated pH and HCO3 levels. The given ABG results do not indicate metabolic alkalosis.

Choice C rationale:

Respiratory acidosis is characterized by a low pH and an elevated PaCO2. While the patient does have an elevated PaCO2, the normal HCO3 levels indicate a metabolic component. This ABG profile is not consistent with pure respiratory acidosis.

Choice D rationale:

Respiratory alkalosis is characterized by a high pH and low PaCO2. The given ABG results do not indicate respiratory alkalosis.

Choice A rationale:

Dizziness with a blood pressure of 150/92 mm Hg indicates hypertension, but it is not an immediate life-threatening condition requiring urgent assessment compared to a severe headache and vomiting.

Choice B rationale:

A severe headache and vomiting could be indicative of a serious neurological condition such as a stroke, intracranial bleeding, or increased intracranial pressure. This patient needs urgent assessment and intervention to prevent potential complications.

Choice C rationale:

A hip fracture with a pain level of 2 on a 1-to-10 scale suggests pain but is not immediately life-threatening compared to symptoms like severe headache and vomiting.

Choice D rationale:

Fatigue after receiving an ACE inhibitor is a common side effect and, while important to monitor, does not pose an immediate threat compared to the symptoms of severe headache and vomiting.

Choice A rationale:

Palpating lymph nodes for swelling is not directly related to thrombocytopenia. Thrombocytopenia is a condition characterized by a low platelet count, which can lead to easy bruising and bleeding. Checking lymph nodes is more relevant in assessing for infection or malignancy.

Choice B rationale:

Checking temperature for elevation is important for assessing infection, which could be a cause of thrombocytopenia. However, in this context, inspecting the skin for bruising or petechiae is more specific to thrombocytopenia. Petechiae are small, red or purple dots that appear on the skin when platelet count is low.

Choice D rationale:

Examining oral mucosa for ulceration is essential in the assessment of conditions like oral cancer or infection. While thrombocytopenia could lead to bleeding in the oral mucosa, it is not the most specific or immediate concern in a patient with known thrombocytopenia.

Choice B rationale:

Normocytic red blood cells have a normal size and are typically found in chronic diseases, liver disease, or kidney disease. Acute blood loss would lead to a decrease in red blood cell size, which is described as microcytic anemia.

Choice C rationale:

Hypochromic red blood cells have a decreased color or pallor due to a reduction in hemoglobin content. This is seen in conditions like iron deficiency anemia. Acute blood loss, however, affects the size of red blood cells more than their color.

Choice D rationale:

Megaloblastic red blood cells are larger than normal due to impaired DNA synthesis, often seen in vitamin B12 or folate deficiency anemias. Acute blood loss does not cause megaloblastic changes in red blood cells.

Choice A rationale:

This statement is incorrect. Mexican Americans do not have higher rates of good blood pressure control compared to other populations.

Choice B rationale:

This statement is incorrect. Mexican Americans are not more likely to receive treatment for hypertension compared to other populations.

Choice C rationale:

This statement is incorrect. While hypertension is prevalent among Mexican Americans, stating they have the highest prevalence of hypertension in the world is inaccurate. The prevalence of hypertension is influenced by various factors and can vary across different regions globally.

Choice A rationale:

Silent ischemia refers to a lack of oxygen to the heart that doesn't cause symptoms like chest pain. It is often diagnosed during an electrocardiogram (ECG) done for other reasons. The patient in this scenario is experiencing chest pain, so silent ischemia is not the correct choice.

Choice B rationale:

Angina decubitus refers to chest pain that occurs while lying down and is relieved by standing or sitting. The patient in this scenario is experiencing chest pain at rest, which is not characteristic of angina decubitus.

Choice D rationale:

Chronic stable angina is chest pain or discomfort that typically occurs with activity or stress and is relieved by rest or nitroglycerin. The patient in this scenario is experiencing chest pain at rest, which is not characteristic of chronic stable angina.

Choice A rationale:

While magnesium is indeed the most abundant intracellular cation in the body, this fact alone does not explain why the nurse would assess the patient's magnesium level.

Choice B rationale:

Magnesium imbalance can cause issues in the extracellular fluid compartment, but this choice does not explain why the nurse would specifically assess the patient's magnesium level.

Choice D rationale:

While hypotension can be a symptom of severe magnesium deficiency, this choice does not provide a rationale for assessing the patient's magnesium level. In this case, choice C is correct because magnesium plays a crucial role in neuromuscular excitability and contractility. Abnormal magnesium levels can lead to neuromuscular symptoms such as muscle weakness, tremors, and spasms. Additionally, magnesium is involved in cardiac muscle function, and low magnesium levels can lead to arrhythmias and other cardiac issues. Therefore, assessing the patient's magnesium level is essential in understanding their neuromuscular and cardiac health.

Choice A rationale:

A pH of 7.46 indicates alkalosis, but the PaCO2 of 44 mm Hg and HCO3 of 36 mEq/L fall within normal ranges, not indicative of respiratory alkalosis. Elevated bicarbonate (HCO3) levels are associated with metabolic alkalosis.

Choice B rationale:

The pH of 7.27 suggests acidosis, not alkalosis. Additionally, the PaCO2 is elevated at 70 mm Hg, indicating respiratory acidosis, not respiratory alkalosis.

Choice C rationale:

A low pH of 7.30 indicates acidosis, which aligns with respiratory alkalosis. The low PaCO2 of 35 mm Hg suggests a compensatory response, as the respiratory system attempts to decrease CO2 levels. The low bicarbonate (HCO3) level of 20 mEq/L further supports metabolic compensation, typical in respiratory alkalosis.

Choice D rationale:

A pH of 7.52 is indicative of alkalosis. However, the low PaCO2 of 24 mm Hg suggests respiratory alkalosis, but the normal bicarbonate level of 24 mEq/L indicates the absence of metabolic compensation. Respiratory alkalosis is commonly associated with low PaCO2 and decreased bicarbonate levels due to hyperventilation, which leads to excessive CO2 removal from the body.

Choice A rationale:

Same as explained in . A pH of 7.46 with normal PaCO2 and elevated bicarbonate (HCO3) is not indicative of respiratory alkalosis.

Choice B rationale:

Same as explained in . A low pH and elevated PaCO2 indicate respiratory acidosis, not alkalosis.

Choice C rationale:

A low pH of 7.30 indicates acidosis, in line with respiratory alkalosis. The low PaCO2 of 35 mm Hg suggests respiratory compensation. The low bicarbonate (HCO3) level of 20 mEq/L further supports metabolic compensation, typical in respiratory alkalosis.

Choice D rationale:

Same as explained in . A high pH and low PaCO2 indicate alkalosis, but the normal bicarbonate level does not align with respiratory alkalosis.

Choice A rationale:

Hemophilia is a hereditary disorder caused by a deficiency of specific clotting factors, and it is indeed hereditary in nature. This statement is incorrect.

Choice B rationale:

Hemophilia is a bleeding disorder where the blood does not clot properly. Replacement therapy, which involves infusing clotting factor concentrates, is a standard treatment for hemophilia. This statement is correct.

Choice C rationale:

Hemophilia is an X-linked recessive genetic disorder, not dominant. Males are more commonly affected because they have only one X chromosome, and if it carries the defective gene, they will have hemophilia. Females have two X chromosomes, and if one X chromosome carries the defective gene, the other X chromosome can compensate, making them carriers but not typically affected.

Choice D rationale:

Hemophilia A is the most common form of hemophilia, not hemophilia B.

Choice A rationale:

While pregnancy can contribute to increased blood pressure, it is not the priority question in this scenario. The sudden rise in blood pressure could indicate a hypertensive crisis, which needs immediate attention.

Choice B rationale:

Urination is not directly related to sudden rises in blood pressure. While urinary issues could be a sign of certain conditions, they are not the priority when dealing with a hypertensive emergency.

Choice C rationale:

A sudden rise in blood pressure can lead to symptoms such as headache and confusion, which could indicate a hypertensive crisis. This question is crucial to assess neurological symptoms, which can be indicative of target organ damage due to hypertension.

Choice D rationale:

Antiseizure medications are not directly related to sudden increases in blood pressure. Neurological symptoms (like those in choice C) are more indicative of a hypertensive crisis and require immediate attention.

Choice A rationale:

Restricting all visitors might be beneficial in preventing infections, but it is not the most important strategy for a patient with neutropenia. The main concern is the risk of infections due to the compromised immune system.

Choice B rationale:

Placing the patient in a private room is crucial for a neutropenic patient. Neutropenia, characterized by a low absolute neutrophil count (ANC), significantly compromises the patient's immune system, making them highly susceptible to infections. Isolating the patient helps minimize the risk of exposure to pathogens, reducing the likelihood of infections.

Choice C rationale:

Using an electric shaver instead of a razor is advisable to prevent cuts and minimize the risk of skin infections. While this is a good practice, it is not the most important strategy compared to isolating the patient and using personal protective equipment (PPE) during direct patient care.

Choice D rationale:

Wearing a gown and gloves when in direct contact with the patient is essential to prevent the spread of infections. This is a necessary measure, but isolating the patient in a private room takes precedence as it minimizes the risk of exposure to pathogens, providing a safer environment for the neutropenic patient.

Choice A rationale:
Increased cobalamin levels are not indicative of polycythemia vera. Polycythemia vera is characterized by an increase in the total red blood cell mass. Elevated cobalamin levels are not specific to this condition.
Choice B rationale:
Decreased histamine levels are not a diagnostic marker for polycythemia vera. Histamine levels are not typically associated with this disorder.
Choice C rationale:
Increased hemoglobin levels are a significant finding in polycythemia vera. Polycythemia vera is a disorder characterized by an abnormal increase in the number of red blood cells, leading to elevated hemoglobin levels.
Choice D rationale:
Increased red blood cell levels are a hallmark feature of polycythemia vera. The increased production of red blood cells leads to elevated red blood cell levels, which is a key diagnostic indicator for this condition.

Choice A rationale:
Triple-drug therapy is not the standard treatment for pernicious anemia after a gastrectomy. Pernicious anemia is primarily caused by vitamin B12 deficiency due to the absence of intrinsic factor, which is essential for vitamin B12 absorption.
Choice B rationale:
IV therapy is a broad term and does not specify the treatment for pernicious anemia. In the context of pernicious anemia, cobalamin replacement therapy administered via intramuscular injections is the preferred treatment.
Choice C rationale:
Quadruple-drug therapy is not a recognized treatment for pernicious anemia. The primary treatment for pernicious anemia involves cobalamin replacement therapy to address the vitamin B12 deficiency.
Choice D rationale:
Cobalamin replacement therapy is the appropriate treatment for pernicious anemia after a gastrectomy. Since the patient lacks intrinsic factor, which is necessary for vitamin B12 absorption, cobalamin replacement therapy bypasses the need for intrinsic factor and provides the necessary vitamin B12 directly.

Choice A rationale:
Skeletal pain is not a typical finding in stage I Hodgkin lymphoma. Hodgkin lymphoma typically presents with painless enlarged lymph nodes, which is a hallmark symptom of the disease.
Choice B rationale:
Enlarged lymph nodes are a characteristic feature of Hodgkin lymphoma. In stage I, the disease is localized to one group of lymph nodes.
Choice C rationale:
T-cell blasts in the lymph node are not specific to Hodgkin lymphoma. Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells, which are large abnormal B cells, not T-cell blasts.
Choice D rationale:
Lymphoblasts in the cerebrospinal fluid are not associated with Hodgkin lymphoma. Involvement of the central nervous system is rare in Hodgkin lymphoma and typically does not lead to the presence of lymphoblasts in the cerebrospinal fluid.

Choice A rationale:

Eliminating excess H+ ions (hydrogen ions) is a primary mechanism the kidneys use to buffer acidosis. In acidosis, there is an excess of hydrogen ions in the body, leading to a decrease in pH. The kidneys help regulate the body's pH by excreting hydrogen ions to lower acidity.

Choice B rationale:

Excreting excess water is not a specific acid-base mechanism related to acidosis. While maintaining proper hydration is important for overall health, it does not directly influence the body's acid-base balance in the context of acidosis.

Choice C rationale:

Eliminating excess CO2 is primarily a respiratory mechanism, not a kidney function. CO2 elimination is more related to the lungs' ability to regulate the body's pH by adjusting respiratory rate and depth.

Choice D rationale:

Reabsorbing additional HCO3- ions (bicarbonate ions) is a renal mechanism to buffer acidosis. Bicarbonate ions act as a base and can neutralize excess hydrogen ions, raising the pH of the body fluids.

Choice E rationale:

Reabsorbing additional sodium ions is not a specific acid-base mechanism related to acidosis. While sodium ions are important for various physiological processes, they do not play a direct role in buffering acidosis.

Choice A rationale:

Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate level (<22 mEq/L) The given arterial blood gas (ABG) values indicate a pH of 7.48 (which is alkalotic), a PaCO2 of 38 (within the normal range of 35-45 mm Hg), and an HCO3- of 30 (which is elevated) These values indicate metabolic alkalosis, not metabolic acidosis.

Choice B rationale:

Metabolic alkalosis is characterized by a high pH (>7.45) and an elevated bicarbonate level (>26 mEq/L) The given ABG values indicate a pH of 7.48 (which is alkalotic) and an elevated HCO3- of 30, indicating metabolic alkalosis. This condition can result from excessive loss of acids (e.g., vomiting) or excessive intake of bicarbonate or alkali substances.

Choice C rationale:

Respiratory acidosis is characterized by a low pH (<7.35) and a high PaCO2 (>45 mm Hg) The given ABG values indicate a normal pH of 7.48 and a PaCO2 of 38 (within the normal range), ruling out respiratory acidosis.

Choice D rationale:

Respiratory alkalosis is characterized by a high pH (>7.45) and a low PaCO2 (<35 mm Hg) The given ABG values indicate a pH of 7.48 (which is alkalotic) and a PaCO2 of 38 (within the normal range), ruling out respiratory alkalosis.

Choice A rationale:

Serotonin is a neurotransmitter that plays a role in mood regulation, sleep, and other functions in the body. It is not a component that forms an adhesive bridge between platelets and vascular subendothelial structures in the clotting process.

Choice B rationale:

Platelet factor III is not a component that forms an adhesive bridge between platelets and vascular subendothelial structures in the clotting process. Platelet factor III is not widely recognized in the context of clotting; it is more commonly referred to as tissue factor and is involved in the extrinsic pathway of coagulation.

Choice C rationale:

Von Willebrand factor (VWF) is a protein that plays a crucial role in hemostasis. It forms an adhesive bridge between platelets and vascular subendothelial structures, particularly at sites of vascular injury. VWF helps platelets adhere to the injured vessel wall, leading to the formation of a stable blood clot. This process is essential for preventing excessive bleeding. A deficiency or dysfunction in VWF can lead to von Willebrand disease, a bleeding disorder characterized by prolonged bleeding times.

Choice D rationale:

Adenosine diphosphate (ADP) is a molecule released by platelets when they are activated. ADP helps in the aggregation of platelets, but it does not directly form an adhesive bridge between platelets and vascular subendothelial structures.

Choice A rationale:

Flossing using thick tape floss can cause trauma to the gums and may lead to bleeding in patients with thrombocytopenia. Patients with low platelet counts are at risk of excessive bleeding from minor injuries, and using thick tape floss could potentially harm the gums and exacerbate bleeding.

Choice B rationale:

Shaving using an electric razor is a safe option for patients with thrombocytopenia. Electric razors do not pose a significant risk of cuts or nicks, reducing the likelihood of bleeding, which is crucial for patients with low platelet counts.

Choice C rationale:

Wearing flip-flops to go walking may not be the safest option for a patient with thrombocytopenia. If the patient accidentally stubs their toe or injures their foot while wearing flip-flops, it could lead to bleeding. Closed-toe, comfortable shoes provide better protection against foot injuries.

Choice D rationale:

Brushing using a stiff-bristle toothbrush can be harmful to the gums, especially for patients with thrombocytopenia. Stiff-bristle toothbrushes can cause gum irritation and bleeding. Patients with low platelet counts should use a soft-bristle toothbrush to minimize the risk of gum injury.

Choice A rationale:

Taking a daily walk is a beneficial activity for patients with venous leg ulcers. Walking promotes blood circulation, which can aid in wound healing. This statement indicates that the patient understands the importance of physical activity for their condition.

Choice B rationale:

Trying to lose weight is another positive step for a patient with venous leg ulcers, especially if the patient is overweight. Excess body weight can put additional pressure on the veins in the legs, worsening venous insufficiency. Losing weight can alleviate this pressure and improve venous circulation, supporting the healing process of leg ulcers.

Choice C rationale:

Wearing stockings after getting out of bed is a proper technique for managing venous leg ulcers. Compression stockings help improve blood flow in the legs and reduce swelling, which is beneficial for patients with venous insufficiency and leg ulcers. This statement indicates that the patient understands the importance of wearing compression stockings consistently.

Choice D rationale:

Not wearing knee-high socks that are tight around the calf is essential advice for patients with venous leg ulcers. Tight clothing, including socks or stockings, can impede blood circulation in the legs, worsening venous insufficiency and delaying wound healing. This statement indicates the need for further education because the patient should avoid any tight clothing around the affected area to promote optimal blood flow and wound healing.

Choice A rationale:

Fatigue can be a symptom of uncontrolled hypertension. Elevated blood pressure can strain the heart, leading to decreased cardiac output and inadequate oxygen supply to body tissues, which can result in fatigue.

Choice B rationale:

Dizziness is a common symptom of uncontrolled hypertension. High blood pressure can cause the blood vessels in the inner ear to rupture or leak, leading to dizziness and balance issues.

Choice C rationale:

Palpitations, which are sensations of rapid, strong, or irregular heartbeats, can occur in individuals with uncontrolled hypertension. Hypertension can lead to changes in the structure and function of the heart, causing palpitations.

Choice D rationale:

Cluster headaches are not directly associated with uncontrolled hypertension. Cluster headaches are severe headaches that occur in clusters, often at the same time of day for several weeks. These headaches are not a typical symptom of hypertension.

Choice A rationale:

Fullness from ascites is a symptom associated with conditions like liver cirrhosis, not directly related to chronic heart failure. Ascites is the accumulation of fluid in the abdominal cavity, causing a feeling of fullness and abdominal discomfort.

Choice B rationale:

Hypoproteinemia, a condition characterized by low levels of proteins in the blood, can lead to fluid retention and edema. However, it is not a direct cause of frequent urination. Frequent urination in this context is more likely related to increased fluid volume in the body, which can be caused by increased renal perfusion in the supine position due to fluid redistribution from the lower extremities to the kidneys.

Choice C rationale:

Hypoperfusion to the brain can lead to neurological symptoms, but it does not directly cause frequent urination. Frequent urination is often related to the kidneys' ability to filter excess fluid and excrete it as urine.

Choice D rationale:

Increased renal perfusion in the supine position can cause frequent urination, especially at night. When a person with chronic heart failure lies down, fluid that has accumulated in the lower extremities (edema) during the day is redistributed to the kidneys due to the change in body position. This increased renal perfusion results in an increased production of urine, leading to nocturia (frequent urination at night) and disrupting the patient's ability to sleep well. This symptom is characteristic of heart failure-related fluid overload and is an important clinical sign indicating worsening heart failure.