Nokea
A 17-year-old patient is referred to you for a platelet count of 1,200,000/mm3. On history, she notes that she often has numbness and tingling in her hands and feet and has frequent epistaxis. She is otherwise well-appearing and has no recent infections. On her exam, you note splenomegaly. What do you expect to see on further evaluation?
- A. Elevated C-reactive protein
- B. Low ferritin
- C. A hypocellular bone marrow
- D. Low von Willebrand factor activity
Correct Answer: D
Rationale: The correct answer is D: Low von Willebrand factor activity. This patient likely has Essential Thrombocythemia, a disorder characterized by excessive production of platelets by the bone marrow. This condition can lead to abnormal bleeding and clotting. The patient's symptoms of numbness, tingling, epistaxis, and splenomegaly are consistent with this diagnosis. Low von Willebrand factor activity is expected in Essential Thrombocythemia due to platelet dysfunction. Elevated C-reactive protein, low ferritin, and a hypocellular bone marrow are not typically associated with Essential Thrombocythemia and are less likely to be seen in this patient.
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The nurse is monitoring a patient receiving a blood product and is concerned that the blood is going to deteriorate before it is complete infused. What is the maximum time that blood can hang during infusion before it begins to deteriorate?
- A. 1 hour
- B. 2 hours
- C. 3 hours
- D. 4 hours
Correct Answer: D
Rationale: The correct answer is D: 4 hours. Blood products typically have a maximum hang time of 4 hours to reduce the risk of bacterial contamination and ensure the integrity of the product. Beyond this time, there is an increased risk of bacterial growth, which can lead to serious infections in the patient. It is crucial to adhere to the recommended hang time to maintain the safety and efficacy of the blood product.
Summary of other choices:
A: 1 hour - Too short of a time frame for a blood product to be infused, as it would not allow for the complete administration.
B: 2 hours - While closer to the correct answer, it still falls short of the recommended 4-hour maximum hang time for blood products.
C: 3 hours - Again, this is not the optimal choice as it exceeds the safe hang time for blood products, increasing the risk of contamination and deterioration.
Cooley's anemia is:
- A. Sickle cell an.
- B. thalassemia major
- C. high ESR
- D. aplastic an.
Correct Answer: B
Rationale: Step 1: Cooley's anemia is another term for thalassemia major, a genetic disorder affecting hemoglobin production.
Step 2: Thalassemia major results in severe anemia due to the body's inability to produce enough functional hemoglobin.
Step 3: Sickle cell anemia (Choice A) is a different genetic disorder characterized by abnormal hemoglobin shape.
Step 4: High ESR (Choice C) is a non-specific marker of inflammation, not specific to Cooley's anemia.
Step 5: Aplastic anemia (Choice D) is a condition where the bone marrow does not produce enough blood cells, not specific to Cooley's anemia.
A patient with non-Hodgkin's lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurse's best response?
- A. Everyone should do these things because they're health promotion activities that apply to everyone.
- B. You don't want to develop a second cancer, do you?
- C. You need to do this just to be on the safe side.
- D. It's important to reduce other factors that increase the risk of second cancers.
Correct Answer: D
Rationale: The correct answer is D because reducing factors that increase the risk of second cancers is crucial for a patient with non-Hodgkin's lymphoma. Alcohol, smoking, and sun exposure are known risk factors for developing secondary cancers. By avoiding these behaviors, the patient can lower the chances of developing another cancer. Choice A is incorrect as it does not specifically address the patient's situation. Choice B uses fear tactics and may not be the most effective way to educate the patient. Choice C is vague and does not provide a clear rationale. Overall, choice D is the best response as it directly addresses the patient's concern and provides a logical explanation for the importance of changing these behaviors.
The mean cell volume of the patient is 90 fl and the reticulocyte production index is low. Which of the following is the most possible cause of anemia in this patient?
- A. Thalassemia
- B. Vitamin B12 deficiency
- C. Aplastic anemia
- D. Sideroblastic anemia
Correct Answer: C
Rationale: The correct answer is C: Aplastic anemia. Aplastic anemia is characterized by a low reticulocyte production index due to bone marrow failure, leading to decreased red blood cell production and subsequently causing anemia. Thalassemia (choice A) is a genetic disorder resulting in abnormal hemoglobin production, not bone marrow failure. Vitamin B12 deficiency (choice B) can lead to macrocytic anemia, not a low reticulocyte production index. Sideroblastic anemia (choice D) is characterized by abnormal iron metabolism in the bone marrow, not bone marrow failure.
A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer?
- A. Alteplase
- B. Aspirin
- C. Clopidogrel
- D. Heparin
Correct Answer: A
Rationale: The correct answer is A: Alteplase. Alteplase is a thrombolytic medication used to dissolve blood clots and is crucial in treating acute ischemic cerebrovascular events caused by thrombus. It helps restore blood flow to the affected area of the brain. Aspirin (B) and Clopidogrel (C) are antiplatelet medications that prevent clot formation but do not dissolve existing clots. Heparin (D) is an anticoagulant that does not directly dissolve clots like Alteplase. Administering Alteplase promptly is essential to minimize brain damage in such emergencies.