Nokea
Which of the following is wrong concerning Philadelphia chromosome:
- A. shortening of long arm of chromosome 22
- B. Philadelphia:-ve cases have bad prognosis
- C. diagnostic of CML
- D. found in lymphocytes
Correct Answer: D
Rationale: The correct answer is D because the Philadelphia chromosome is found in myeloid (not lymphoid) cells in Chronic Myeloid Leukemia (CML). This is due to a reciprocal translocation between chromosomes 9 and 22, resulting in a shortened chromosome 22q, not chromosome 22 itself. Choice A is incorrect because the long arm of chromosome 22 is affected. Choice B is incorrect as Philadelphia chromosome-negative cases can have a favorable prognosis. Choice C is incorrect as the presence of the Philadelphia chromosome is diagnostic of CML.
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The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?
- A. Aspirin
- B. Heparin
- C. Warfarin
- D. Erythropoietin
Correct Answer: B
Rationale: The correct answer is B: Heparin. An aPTT level of 28 seconds is below the therapeutic range for heparin, indicating a subtherapeutic dose. The nurse should notify the healthcare provider to adjust the heparin dosage to achieve the desired anticoagulant effect. Aspirin (choice A) does not affect aPTT levels. Warfarin (choice C) affects PT/INR, not aPTT. Erythropoietin (choice D) is not related to aPTT levels.
Which of the following characteristics are similar with respect to Factor VIII and von Willebrand factor (vWF)?
- A. Both are made in endothelial cells and megakaryocytes.
- B. Both are activated by thrombin.
- C. They are present in normal to high relative amounts in newborns.
- D. They are stored in Weibel-Palade bodies in endothelial cells.
Correct Answer: C
Rationale: Rationale:
- Factor VIII and vWF are present in normal to high amounts in newborns due to the physiological immaturity of the hemostatic system.
- Choice A is incorrect as vWF is mainly produced in endothelial cells while Factor VIII is produced in both endothelial cells and liver.
- Choice B is incorrect as Factor VIII is activated by thrombin, but vWF is not.
- Choice D is incorrect as vWF is stored in Weibel-Palade bodies, but Factor VIII is not.
A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which of the following actions should the nurse take?
- A. Clarify the prescription with the provider.
- B. Administer the drug with an analgesic.
- C. Administer the required dose orally.
- D. Assess factor IX levels.
Correct Answer: A
Rationale: The correct answer is A: Clarify the prescription with the provider. Desmopressin is a medication that can cause hyponatremia, especially in patients with low sodium levels like this client. Before administering desmopressin, the nurse should consult with the provider to ensure it is safe to administer the medication given the client's sodium level. Administering the drug without clarifying may worsen the hyponatremia.
Choice B is incorrect because administering the drug with an analgesic is not necessary or relevant in this situation. Choice C is incorrect because desmopressin is typically administered via injection, not orally. Choice D is incorrect because assessing factor IX levels is not directly related to the administration of desmopressin in this scenario.
An 18-month-old boy, whose parents are first cousins, is referred to you because of a significant episode of epistaxis. The parents report that the child had bleeding after circumcision and large hematomas with immunizations. Platelet aggregation studies show the following: This child's platelets are unable to interact with which of the following?
- A. ADP
- B. Fibrinogen
- C. von Willebrand factor
- D. Platelet factor 4
Correct Answer: B
Rationale: The correct answer is B: Fibrinogen. In this case, the child is likely suffering from Glanzmann thrombasthenia, a rare inherited platelet disorder where platelets lack the ability to bind to fibrinogen. This results in impaired platelet aggregation and clot formation, leading to bleeding tendencies. The other options (A, C, D) are not affected in Glanzmann thrombasthenia. Platelets interact normally with ADP (A), von Willebrand factor (C), and Platelet factor 4 (D) in this disorder.
Splenectomy is contraindicated in:
- A. pyruvate kinase def.
- B. ITP
- C. BM failure
- D. angiogenic myeloid metaplasia
Correct Answer: C
Rationale: The correct answer is C: BM failure. Splenectomy is contraindicated in patients with bone marrow failure due to conditions such as aplastic anemia or myelodysplastic syndromes. The spleen plays a role in removing abnormal blood cells, and removing it can worsen cytopenias in these patients. Choices A, B, and D are not contraindications for splenectomy as they do not directly involve the bone marrow function. Pyruvate kinase deficiency (A) does not affect bone marrow function, ITP (B) is a platelet disorder, and angiogenic myeloid metaplasia (D) is a condition related to abnormal blood cell production, not bone marrow failure.