Choice A rationale:

Dehydration does not cause polycythemia vera.

Polycythemia vera is a disorder of the bone marrow characterized by an overproduction of red blood cells.

Choice B rationale:

Chronic pulmonary disease is not a cause of polycythemia vera.

Polycythemia vera is typically due to a mutation in the JAK2 gene.

Choice C rationale:

This is the correct answer.

Polycythemia vera is often caused by a mutation in the JAK2 gene, which leads to an abnormal increase in red blood cell production.

Choice D rationale:

Smoking can lead to secondary polycythemia, but it is not the cause of polycythemia vera, which is a primary disorder of the bone marrow.

Choice A rationale:

This statement is incorrect.

Polycythemia vera is a primary disorder where red blood cell production is not regulated properly, leading to an excess of red blood cells.

In primary polycythemia, there is an increase in erythropoietin (EPO) production, not a decrease.

Choice B rationale:

This is the correct answer.

In primary polycythemia (polycythemia vera), the overproduction of red blood cells is stimulated by increased levels of erythropoietin (EPO)

Choice C rationale:

Secondary polycythemia can be caused by a mutation in the JAK2 gene, but this is not the pathophysiology of primary polycythemia (polycythemia vera)

Choice D rationale:

Erythropoietin (EPO) actually stimulates the bone marrow to produce more red blood cells, not fewer.

Therefore, this statement is incorrect.

Choice A rationale:

Fatigue is a common clinical manifestation of polycythemia because the increased number of red blood cells can make the blood thicker, leading to reduced blood flow and oxygen delivery to tissues, resulting in fatigue.

Choice B rationale:

Thrombosis is a complication of polycythemia vera.

The increased number of blood cells can lead to increased viscosity, making the blood more prone to clot formation.

Choice C rationale:

Bradycardia is not typically associated with polycythemia.

In fact, individuals with polycythemia may have an increased heart rate (tachycardia) due to the increased workload on the heart caused by the thicker blood.

Choice D rationale:

Hypoxia can occur in polycythemia due to the decreased ability of thickened blood to carry oxygen, but it is not a direct clinical manifestation of the condition.

Choice E rationale:

Hypotension is not commonly associated with polycythemia.

In fact, hypertension (high blood pressure) is more commonly seen as a result of increased blood viscosity and resistance to blood flow.

Choice A rationale:

Hyperthyroidism can lead to an increase in red blood cell production, known as secondary polycythemia.

However, it is not the most likely cause in this scenario.

The primary cause of secondary polycythemia is usually related to hypoxia or conditions that increase erythropoietin production.

Choice B rationale:

Renal cysts can lead to polycythemia due to increased erythropoietin production by the kidneys.

When the kidneys detect low oxygen levels in the blood (hypoxia), they release erythropoietin, a hormone that stimulates the production of red blood cells in the bone marrow.

Renal cysts can disrupt the normal function of the kidneys and trigger excessive erythropoietin release, causing secondary polycythemia.

Choice C rationale:

Smoking can lead to chronic obstructive pulmonary disease (COPD), which can cause secondary polycythemia due to chronic hypoxia.

However, renal cysts are a more direct cause in this scenario.

Choice D rationale:

Obesity can lead to sleep apnea, which can cause secondary polycythemia due to chronic hypoxia during sleep.

However, renal cysts are a more likely cause of secondary polycythemia than obesity alone.

Choice A rationale:

While primary polycythemia can cause an increase in red blood cell mass, it does not typically lead to decreased platelet production.

Platelet production is not directly affected by primary polycythemia.

Choice B rationale:

Primary polycythemia does increase red blood cell mass, but it also increases the risk of thrombosis (clot formation) due to the increased viscosity of the blood.

This statement is inaccurate.

Choice C rationale:

Primary polycythemia can affect white blood cell production, leading to an increase in white blood cells (leukocytosis)

This statement is inaccurate as well.

Choice D rationale:

The increased red blood cell mass in primary polycythemia does lead to increased blood viscosity.

The thicker blood can impede blood flow, leading to organ damage and ischemia (lack of blood supply to tissues)

This is an accurate statement regarding the risks associated with primary polycythemia.

Choice A rationale:

Frequent headaches can be a symptom of polycythemia due to increased blood viscosity, but it is not as specific as the reddish skin color (plethora) seen in polycythemia.

This statement is relevant but less specific.

Choice B rationale:

Dizziness and lightheadedness can occur in polycythemia, especially when there is impaired blood flow due to increased viscosity.

However, these symptoms are not as specific as the reddish skin color (plethora) seen in polycythemia.

This statement is relevant but less specific.

Choice C rationale:

A common clinical manifestation of polycythemia is the development of reddish or purplish skin (plethora) due to the increased red blood cell mass.

This statement is accurate and specific to the condition.

Choice D rationale:

Increased urination is not typically associated with polycythemia.

This statement is not directly related to the condition and is less relevant.

Choice A rationale:

"I've been feeling fatigued and weak lately." Rationale: Fatigue and weakness are common symptoms of polycythemia due to the increased viscosity of the blood resulting from elevated red blood cell counts, making it more difficult for the heart to pump blood efficiently.

Choice B rationale:

"I've had some itching on my skin." Rationale: Itching, particularly after exposure to warm water or a hot shower, is a classic symptom of polycythemia vera (primary polycythemia)

This itching is known as pruritus, and it occurs due to the release of histamines and other substances from white blood cells.

Choice C rationale:

"I've been experiencing chest pain." Rationale: While chest pain can be associated with polycythemia in severe cases due to an increased risk of thrombosis and ischemia, it is not as specific of a symptom as itching in the context of polycythemia.

Choice D rationale:

"I've been coughing up blood." Rationale: Coughing up blood is not a typical symptom of polycythemia.

It may be associated with other conditions or complications, but it is not a direct indication of polycythemia.

Choice A rationale:

Headache.

Rationale: Headaches are a common symptom of polycythemia due to the increased blood volume and viscosity, which can lead to impaired blood flow and oxygen delivery to the brain.

Choice B rationale:

Fatigue.

Rationale: Fatigue is also a common symptom of polycythemia due to the increased workload on the heart and decreased oxygen-carrying capacity of the blood.

Choice C rationale:

Epistaxis.

Rationale: Epistaxis, or nosebleeds, can occur in individuals with polycythemia because of the increased pressure on blood vessels and the fragility of the nasal mucosa caused by elevated red blood cell counts.

Choice D rationale:

Increased blood pressure.

Rationale: Elevated blood pressure can result from polycythemia due to the increased volume of blood in circulation, which can strain the cardiovascular system.

Choice E rationale:

Gout.

Rationale: Gout is a potential complication of polycythemia because the increased production of red blood cells can lead to elevated levels of uric acid, a risk factor for gout.

Choice A rationale:

Elevated serum EPO levels.

Rationale: Primary polycythemia, also known as polycythemia vera, is characterized by the overproduction of red blood cells independent of normal regulatory mechanisms.

In response to the increased red blood cell count, the body typically tries to compensate by decreasing the production of erythropoietin (EPO), a hormone that stimulates red blood cell production.

Therefore, elevated serum EPO levels are often seen in primary polycythemia as the body tries to regulate the overproduction of red blood cells.

Choice B rationale:

Decreased platelet count.

Rationale: Platelet count is typically not decreased in primary polycythemia.

In fact, it may be increased due to the overall increase in blood cell production.

Choice C rationale:

Normal hemoglobin levels.

Rationale: Hemoglobin levels are typically elevated in primary polycythemia due to the increase in red blood cell mass.

Choice D rationale:

Low red blood cell count.

Rationale: In primary polycythemia, the hallmark is an elevated red blood cell count, not a low count.

The condition is characterized by the overproduction of red blood cells.

Choice A rationale:

A renal ultrasound is not commonly used to rule out secondary polycythemia.

Polycythemia is primarily related to an increase in red blood cell production, and renal ultrasound is used to assess kidney function and anatomy, which is not directly related to the cause of polycythemia.

Choice B rationale:

A bone marrow biopsy is commonly used to rule out secondary polycythemia.

Polycythemia can be primary (due to a problem within the bone marrow itself) or secondary (due to external factors like hypoxia or tumors)

A bone marrow biopsy can help differentiate between primary and secondary causes by examining the bone marrow's production of red blood cells.

Choice C rationale:

A chest x-ray may be ordered to evaluate the lungs and chest, but it is not the primary diagnostic test used to rule out secondary polycythemia.

It may help identify lung conditions that contribute to hypoxia, which can lead to secondary polycythemia, but it does not directly assess the bone marrow or red blood cell production.

Choice D rationale:

Thyroid function tests are not typically used to rule out secondary polycythemia.

Thyroid function tests assess the thyroid gland's hormone production and are unrelated to the primary causes of polycythemia.

Choice A rationale:

Feeling tired and weak is a common symptom of polycythemia due to the increased viscosity of the blood.

However, this is a general symptom and not specific to polycythemia alone.

Many conditions can cause fatigue.

Choice B rationale:

Red and flushed skin is a characteristic sign of polycythemia.

Increased red blood cell count can lead to increased blood flow to the skin, resulting in a flushed appearance.

This is a specific symptom of polycythemia and should be assessed during the physical examination.

Choice C rationale:

Frequent nosebleeds can occur in polycythemia due to increased blood viscosity and pressure on blood vessels.

This is another specific symptom that should be assessed in a patient with suspected polycythemia.

Choice D rationale:

Shortness of breath can also be a symptom of polycythemia, especially when there is an excessive increase in red blood cells.

However, like fatigue, it is not specific to polycythemia and can be caused by various respiratory and cardiac conditions.

Choice A rationale:

Drinking an adequate amount of fluids is essential for patients with polycythemia to prevent blood clots and maintain blood flow.

This statement indicates a good understanding of self-care.

Choice B rationale:

Avoiding hot baths and showers is essential because heat can cause vasodilation and further increase blood flow, potentially exacerbating symptoms of polycythemia.

This statement also shows appropriate self-care knowledge.

Choice C rationale:

Smoking is a significant risk factor for polycythemia and other cardiovascular conditions.

Continuing to smoke, even with the intention to cut down, is not advisable and indicates a need for further education.

Smoking cessation is essential for managing polycythemia effectively.

Choice D rationale:

Monitoring vital signs regularly is crucial for patients with polycythemia to detect any changes in blood pressure, heart rate, or oxygen saturation.

This statement demonstrates an understanding of the importance of self-monitoring and is not a cause for further education.

Choice A rationale:

Encourage alcohol consumption.

Rationale: This option is incorrect.

Encouraging alcohol consumption is not a suitable nursing intervention for a patient with polycythemia.

Alcohol can contribute to dehydration and may exacerbate the condition by increasing blood viscosity.

Choice B rationale:

Monitor oxygen saturation.

Rationale: This is a correct nursing intervention for a patient with polycythemia.

Polycythemia can lead to increased blood viscosity and reduced oxygen delivery to tissues.

Monitoring oxygen saturation helps assess tissue oxygenation and guides appropriate interventions.

Choice C rationale:

Administer anticoagulants.

Rationale: This is a correct nursing intervention for a patient with polycythemia.

Polycythemia increases the risk of blood clot formation.

Administering anticoagulants can help prevent clot formation and reduce the risk of thrombotic complications.

Choice D rationale:

Elevate the head of the bed.

Rationale: This is a correct nursing intervention for a patient with polycythemia.

Elevating the head of the bed can promote venous return and reduce the risk of blood pooling in the extremities, which is important in managing polycythemia.

Choice E rationale:

Apply moisturizing lotion to dry skin.

Rationale: This option is not a priority nursing intervention for a patient with polycythemia.

While dry skin may be a symptom of the condition, it is not a primary concern compared to managing blood viscosity, clot risk, and oxygenation.

Choice A rationale:

Reduce blood volume and viscosity.

Rationale: The primary goal of treatment for a patient with primary polycythemia is to reduce blood volume and viscosity.

This helps prevent complications such as thrombosis, which can occur due to increased blood thickness.

Phlebotomy is commonly used to achieve this goal by removing excess red blood cells.

Choice B rationale:

Administer low-dose aspirin.

Rationale: Administering low-dose aspirin may be a part of the treatment plan to reduce the risk of blood clots, but it is not the primary goal.

The primary goal is to decrease blood volume and viscosity.

Choice C rationale:

Correct dehydration and fluid loss.

Rationale: Correcting dehydration and fluid loss is important but not the primary goal of treatment for primary polycythemia.

The primary goal is to address the increased red blood cell production and thickened blood.

Choice D rationale:

Perform phlebotomy to reduce hematocrit.

Rationale: This is a correct statement and aligns with the primary goal of treatment for primary polycythemia.

Phlebotomy is a key intervention to reduce hematocrit levels and, consequently, blood volume and viscosity.

Choice A rationale:

Administer ruxolitinib to reduce spleen size.

Rationale: This option is not a priority in the care plan for a client with secondary polycythemia.

Secondary polycythemia is typically associated with an underlying condition, such as chronic hypoxia.

The primary focus should be on addressing the underlying cause and managing polycythemia-related complications.

Choice B rationale:

Monitor electrolyte levels and renal function.

Rationale: This is the correct priority in the care plan for a client with secondary polycythemia.

Secondary polycythemia can result from conditions like chronic obstructive pulmonary disease (COPD) or renal disease, which may affect electrolyte balance and renal function.

Monitoring these parameters is essential to assess the patient's overall health and manage the underlying condition.

Choice C rationale:

Administer radioactive phosphorus.

Rationale: Administering radioactive phosphorus is not a standard treatment for secondary polycythemia.

Treatment for secondary polycythemia focuses on managing the underlying condition and its complications.

Choice D rationale:

Perform phlebotomy to reduce hematocrit.

Rationale: Phlebotomy may be considered in some cases of secondary polycythemia, but it is not the primary priority.

The primary focus should be on addressing the underlying cause, such as treating COPD or renal disease, to manage polycythemia effectively.