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A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?
- A. Have you had a recent weight loss?
- B. Do you have any history of lung disease?
- C. Have you noticed any dark or bloody stools?
- D. What is your dietary intake of meats and protein?
Correct Answer: B
Rationale: The correct answer is B: Do you have any history of lung disease? A high hemoglobin and hematocrit can be indicative of chronic hypoxia, often seen in lung diseases like COPD. The nurse should ask about lung disease to explore the possibility of chronic hypoxia as the underlying cause. Choices A, C, and D are incorrect as they do not directly relate to the potential cause of elevated hemoglobin and hematocrit levels in this scenario.
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You are caring for a patient with a large localized Ewing sarcoma of the soft tissues of the arm. The surgeon believes that the tumor can be resected without amputation but asks whether you can give some chemotherapy to shrink the tumor before surgery. Which of the following would you tell the surgeon?
- A. If the tumor can be resected without amputation, then the best time to do the resection is before any chemotherapy to improve the prognosis.
- B. You agree with waiting to do the resection until week 12 of therapy and will begin chemotherapy; you recognize that radiotherapy will not be necessary if the tumor is completely resected at week 12 of therapy.
- C. You agree with waiting to do the resection until week 12 of therapy and will begin chemotherapy; you recognize that radiotherapy will be necessary even if the tumor is completely resected at week 12 of therapy.
- D. If the tumor can be resected without amputation, then the best time to do the resection is before any chemotherapy; you recognize that this is the only way to avoid radiotherapy.
Correct Answer: B
Rationale: Step 1: Agreeing to wait until week 12 of therapy before resection allows chemotherapy to shrink the tumor, making surgery easier and potentially less extensive.
Step 2: Waiting until week 12 also helps assess the tumor's response to chemotherapy, guiding further treatment decisions.
Step 3: Choosing not to delay the resection until week 12 may risk more extensive surgery or complications due to the tumor's size.
Step 4: Opting for radiotherapy regardless of tumor resection status at week 12 is not advisable as unnecessary radiation exposure should be avoided unless absolutely necessary.
A patient who is infected with hookworms produces signs and symptoms of anemia. Which of the following can be seen in the peripheral blood smear of the patient?
- A. Howell-Jolly bodies
- B. Basophilic stippling
- C. Target cells
- D. Spherocytes
Correct Answer: B
Rationale: The correct answer is B: Basophilic stippling. Basophilic stippling is a common finding in the peripheral blood smear of patients infected with hookworms due to lead poisoning, which can occur as a result of hookworm infection. Basophilic stippling is seen as the presence of small, dark blue granules within red blood cells and is indicative of impaired heme synthesis. Howell-Jolly bodies (A) are remnants of nuclear material in red blood cells and are typically seen in patients with functional asplenia. Target cells (C) are seen in conditions such as liver disease and hemoglobinopathies. Spherocytes (D) are seen in conditions like hereditary spherocytosis or autoimmune hemolytic anemia, but not specifically in hookworm infection.
A patient is being prepared to receive a prescribed blood transfusion. What is the best way that the LPN can assist the health team to prevent a transfusion reaction?
- A. Monitor vital signs every 15 minutes.
- B. Warm blood to 98.6°F (37°C) before infusion.
- C. Administer diphenhydramine (Benadryl) before the infusion.
- D. Assist the registered nurse (RN) to identify correctly the patient and the blood product.
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. Identifying the patient and blood product is crucial to prevent transfusion reactions.
2. Matching the patient's identity with the blood product minimizes risk of incompatibility.
3. This step ensures the right blood type and product are administered, preventing serious reactions.
4. LPNs play a key role in assisting the RN in verifying and confirming patient and blood product identity.
Summary:
A: Monitoring vital signs is important but doesn't directly prevent transfusion reactions.
B: Warming blood can improve patient comfort but does not prevent reactions.
C: Administering Benadryl addresses possible allergic reactions but doesn't prevent incompatibility issues.
An 8-year-old girl presents with National Cancer Institute (NCI) Standard Risk acute pre-B-cell acute lymphoblastic leukemia. Her family history is significant for her mother having been diagnosed with breast cancer at age 34 years and a maternal uncle who developed osteosarcoma as a teenager. What cytogenetic abnormality is most likely to be detected in this patient?
- A. t(1;19)
- B. CRLF2 rearrangement with a JAK2 mutation
- C. KMT24 rearrangement
- D. Hypodiploidy with a modal chromosome number of 34
Correct Answer: D
Rationale: The correct answer is D, Hypodiploidy with a modal chromosome number of 34. In pediatric pre-B-cell acute lymphoblastic leukemia, hypodiploidy with fewer than 44 chromosomes is associated with a poor prognosis. This cytogenetic abnormality is commonly seen in cases of NCI Standard Risk acute pre-B-cell ALL.
A: t(1;19) is typically associated with T-cell ALL, not pre-B-cell ALL.
B: CRLF2 rearrangement with a JAK2 mutation is more commonly seen in high-risk B-cell ALL.
C: KMT24 rearrangement is not a recognized cytogenetic abnormality in ALL.
In summary, the presence of hypodiploidy with a modal chromosome number of 34 is the most likely cytogenetic abnormality in this patient based on her clinical presentation and family history.
You are seeing a 12-year-old female who presented to the emergency department with the sudden onset of severe abdominal pain. Imaging that was obtained to rule out appendicitis revealed a mass adjacent to the bladder. The mass was surgically resected, and pathology demonstrated a paraganglioma. Which of the studies below would be most useful to determine disease stage for this patient?
- A. Bone Scan
- B. Lumbar puncture for cerebrospinal fluid cytology
- C. Bone marrow aspirate and biopsy
- D. Ga 68-DOTATATE PET/CT
Correct Answer: D
Rationale: The correct answer is D: Ga 68-DOTATATE PET/CT. Paragangliomas are neuroendocrine tumors that can secrete catecholamines and have a high expression of somatostatin receptors. Ga 68-DOTATATE PET/CT is the most appropriate imaging study to determine disease stage in patients with paragangliomas because it can detect the somatostatin receptor expression in these tumors, aiding in localization, staging, and treatment planning.
A: Bone scan is not the most useful study for determining disease stage in paraganglioma.
B: Lumbar puncture for cerebrospinal fluid cytology is not relevant for staging paraganglioma.
C: Bone marrow aspirate and biopsy are not the most appropriate studies for staging paraganglioma.