Nursing Elites

1. Which type of anemia is associated with chronic kidney disease?

• A. Iron-deficiency anemia
• B. Vitamin B12 deficiency anemia
• C. Aplastic anemia
• D. Erythropoietin deficiency anemia

Correct answer: D

Rationale: The correct answer is D: Erythropoietin deficiency anemia. Chronic kidney disease often leads to anemia due to decreased production of erythropoietin. This hormone, produced by the kidneys, stimulates red blood cell production in the bone marrow. Iron-deficiency anemia (choice A) is more commonly caused by insufficient dietary iron intake or chronic blood loss. Vitamin B12 deficiency anemia (choice B) is usually due to inadequate dietary intake, malabsorption, or pernicious anemia. Aplastic anemia (choice C) is a bone marrow failure disorder characterized by pancytopenia (decreased red blood cells, white blood cells, and platelets) rather than a deficiency in erythropoietin production.

2. The client diagnosed with acute vein thrombosis is receiving a continuous heparin drip, an intravenous anticoagulant. The health care provider orders warfarin (Coumadin), an oral anticoagulant. Which action should the nurse take?

• A. Discontinue the heparin drip prior to initiating the Coumadin
• B. Check the client’s INR prior to beginning Coumadin
• C. Clarify the order with the health care provider as soon as possible
• D. Administer the Coumadin along with the heparin drip as ordered

Correct answer: D

Rationale: The correct action for the nurse to take is to administer the Coumadin along with the heparin drip as ordered. Heparin and warfarin are often given together initially because warfarin takes a few days to become effective. Discontinuing the heparin drip prior to initiating Coumadin could leave the patient without anticoagulation coverage during the period when warfarin's effects are not yet established. Checking the client's INR prior to beginning Coumadin is important but not the immediate action to take when both medications are ordered together. Clarifying the order with the health care provider is unnecessary in this scenario as it is common practice to give heparin and warfarin concurrently in the transition period.

3. Whenever possible, patients evacuated from the theater of operations who are expected to return within 60 days are admitted to which of the following?

• A. Civilian hospitals participating in the National Disaster Medical System
• B. DOD tri-service hospitals
• C. Department of Veterans Affairs hospitals
• D. Temporary field hospitals

Correct answer: B

Rationale: Patients evacuated from the theater of operations and expected to return within 60 days are admitted to DOD tri-service hospitals. These hospitals are well-equipped to handle military personnel and are strategically placed for operational efficiency. Choice A, civilian hospitals participating in the National Disaster Medical System, may not have the specialized care and resources required for military personnel. Choice C, Department of Veterans Affairs hospitals, cater to veterans rather than active-duty personnel in theater. Choice D, temporary field hospitals, might not provide the comprehensive care and resources needed for an extended period of treatment.

4. Under the health services support area concept, how is the medical care under the MEDCOM divided?

• A. Six geographical regions of the United States with command authority in each region
• B. Five levels of health service support, each providing different levels of health care services
• C. Primary and secondary health care regions, each containing a MEDDAC or MEDCEN
• D. Eight geographical areas of responsibility designated as health services support regions, each of which is subdivided into two or more health service areas

Correct answer: D

Rationale: The correct answer is D. Under the health services support area concept, medical care under MEDCOM is divided into eight geographical areas of responsibility. Each of these areas is designated as a health services support region, and they are further subdivided into two or more health service areas. Choices A, B, and C are incorrect because they do not accurately describe how the medical care under MEDCOM is divided.

5. Before administering an MMR (measles, mumps, and rubella) vaccine to a 15-month-old, which question should the nurse ask the mother of the child?

• A. “Has your child had any sore throats?”
• B. “Has your child been eating properly?”
• C. “Is your child allergic to any antibiotics?”
• D. “Has your child been exposed to any infections?”

Correct answer: C

Rationale: The correct question for the nurse to ask the mother before administering the MMR vaccine to a 15-month-old is about the child's allergy to antibiotics. This is crucial because the MMR vaccine contains neomycin, an antibiotic, and being allergic to antibiotics like neomycin is a contraindication for the MMR vaccine. Asking about sore throats, eating habits, or exposure to infections is not directly relevant to the administration of the MMR vaccine.

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