Nokea
A 14-year-old boy presents with cough, shortness of breath, and difficulty lying down. His face and neck swell when his arms are raised. Chest x-ray reveals a large mediastinal mass. A tissue diagnosis is desired. A biopsy is performed with local anesthesia because the anesthesiologist thinks that the patient has a very high general anesthesia risk. Which of the following findings does not make general anesthesia unsafe?
- A. Tumor diameter greater than 45% of transthoracic diameter
- B. Tracheal cross-sectional area less than 50% of predicted
- C. Peak expiratory flow rate less than 50% of predicted
- D. A malignancy of hematopoietic origin
Correct Answer: D
Rationale: The correct answer is D. A malignancy of hematopoietic origin does not inherently make general anesthesia unsafe. This is because anesthesia risk is typically influenced by factors such as airway patency, respiratory function, and cardiac status. Choices A, B, and C all indicate potential complications that could make general anesthesia unsafe, such as airway obstruction due to a large mediastinal mass (A), compromised tracheal cross-sectional area (B), and impaired respiratory function (C). These factors would necessitate careful consideration and potential modifications in the anesthesia plan to ensure patient safety.
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Which of the following requires IL-2 and IL-4 in the conversion of unilineage progenitor cell into mature circulating cell?
- A. Neutrophil
- B. Eosinophil
- C. Basophil
- D. B lymphocyte
Correct Answer: D
Rationale: The correct answer is D: B lymphocyte. IL-2 and IL-4 are essential for the differentiation of B lymphocytes from unilineage progenitor cells into mature circulating cells. IL-2 is crucial for B cell proliferation and survival, while IL-4 is required for B cell activation and class switching. Neutrophils do not require IL-2 and IL-4 for differentiation. Eosinophils are primarily influenced by IL-5. Basophils are influenced by IL-3 and IL-5. Therefore, B lymphocytes are the only cell type among the choices that specifically requires IL-2 and IL-4 for their maturation.
A nurse is caring for a patient with Hodgkin lymphoma at the oncology clinic. The nurse should be aware of what main goal of care?
- A. Cure of the disease
- B. Enhancing quality of life
- C. Controlling symptoms
- D. Palliation
Correct Answer: A
Rationale: The correct answer is A: Cure of the disease. The main goal of care for a patient with Hodgkin lymphoma is to achieve a cure whenever possible. This is because Hodgkin lymphoma is a potentially curable cancer with appropriate treatment. Achieving a cure means eradicating the cancer cells completely and preventing its recurrence in the future. This is the most desirable outcome for the patient's long-term health and well-being.
Incorrect choices:
B: Enhancing quality of life - While improving the patient's quality of life is important, the primary goal in treating Hodgkin lymphoma is to cure the disease.
C: Controlling symptoms - Symptom management is important in providing comfort to the patient, but the main goal is to cure the disease.
D: Palliation - Palliative care focuses on relieving symptoms and improving quality of life in patients with advanced or incurable diseases. For Hodgkin lymphoma, the main goal is to aim for a cure rather than palliation.
A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?
- A. Hypertension
- B. Muscle pain
- C. Edema
- D. Dry mouth
Correct Answer: A
Rationale: The correct answer is A: Hypertension. Epoetin is a medication used to stimulate red blood cell production in patients with renal failure. One of the potential adverse effects of epoetin therapy is an increase in blood pressure due to the rapid rise in red blood cell count. This can lead to hypertension. Monitoring for hypertension is crucial to prevent any complications. The other choices, muscle pain, edema, and dry mouth, are not directly associated with epoetin therapy in renal failure patients. Muscle pain could be a general issue but not specific to this medication. Edema is more commonly associated with fluid retention in renal failure, and dry mouth is not a typical adverse effect of epoetin therapy.
A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?
- A. Uncontrolled bleeding
- B. Myocardial infarction
- C. Respiratory depression
- D. Decreased renal perfusion
Correct Answer: A
Rationale: Rationale: Aspirin is an antiplatelet medication that inhibits platelet aggregation, increasing the risk of uncontrolled bleeding during surgical procedures. By taking aspirin, the client's blood clotting ability is impaired, leading to potential excessive bleeding during and after surgery. This can result in complications such as prolonged bleeding, hematoma formation, and delayed wound healing. Therefore, the correct answer is A: Uncontrolled bleeding.
Summary:
- B: Myocardial infarction is not directly related to taking aspirin; it is actually used to prevent heart attacks.
- C: Respiratory depression is not a common complication associated with aspirin use.
- D: Decreased renal perfusion is not a typical risk of taking aspirin; it primarily affects the cardiovascular system.
A 9-year-old boy is being treated for standard-risk acute lymphoblastic leukemia. His treatment protocol calls for administration of intravenous methotrexate and intramuscular L-asparaginase during interim maintenance chemotherapy. What is the most appropriate sequence of drug administration?
- A. Administer L-asparaginase during the methotrexate infusion.
- B. Administer L-asparaginase immediately after the methotrexate infusion.
- C. Administer both drugs at the same time to maximize synergistic activity.
- D. Administer methotrexate 24 hours after the asparaginase.
Correct Answer: B
Rationale: The correct answer is B: Administer L-asparaginase immediately after the methotrexate infusion. This is the most appropriate sequence because methotrexate can impair the activity of L-asparaginase if administered together. By waiting to administer L-asparaginase after the methotrexate infusion, the efficacy of both drugs is maximized without interference. Administering L-asparaginase during the methotrexate infusion (Choice A) would lead to decreased effectiveness of L-asparaginase. Administering both drugs at the same time (Choice C) is not recommended due to potential drug interactions. Administering methotrexate 24 hours after the asparaginase (Choice D) does not optimize the synergistic effects of the drugs during interim maintenance chemotherapy.