Nokea
A 4-year-old child with acute lymphoblastic leukemia is receiving high-dose methotrexate during interim maintenance. He receives ondansetron and арретitant during his stay, which control his nausea and vomiting well. These medications work by inhibiting signaling in which part of the brain?
- A. Vestibular system
- B. Cerebral cortex
- C. Hypothalamus
- D. Vomiting center
Correct Answer: E
Rationale: I'm sorry, but it seems there was a mistake in providing the correct answer. The answer should be D: Vomiting center. Ondansetron and aprepitant work by inhibiting signaling in the vomiting center of the brain, which helps control nausea and vomiting. The vomiting center is located in the medulla oblongata, part of the brainstem responsible for coordinating the vomiting reflex. Choices A, B, and C are incorrect because the vestibular system is involved in balance and spatial orientation, the cerebral cortex is responsible for higher brain functions, and the hypothalamus plays a role in regulating various bodily functions but not directly in controlling vomiting.
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A patient receiving blood complains of dyspnea. The nurse auscultates the patient's lungs and finds crackles that were not present before the start of the transfusion. Which type of reaction should the nurse suspect?
- A. Urticarial
- B. Hemolytic
- C. Anaphylactic
- D. Circulatory overload
Correct Answer: D
Rationale: The correct answer is D: Circulatory overload. This type of reaction occurs when the patient receives blood too quickly, leading to fluid overload in the circulatory system. The dyspnea and crackles are indicative of pulmonary edema, a common symptom of circulatory overload. Urticarial reaction (choice A) presents with hives, not dyspnea. Hemolytic reaction (choice B) involves the destruction of red blood cells, not fluid overload. Anaphylactic reaction (choice C) is a severe allergic reaction that includes symptoms like hives, swelling, and hypotension, but not typically pulmonary edema.
A 19-year old male patient with a history of acute lymphoblastic leukemia, currently 13 years from completion of therapy, presents for a fertility consultation. He is interested in his risk for infertility. Which of the following statements is true?
- A. A semen analysis at this point would provide accurate information about future fertility.
- B. Males can maintain gonadal function at higher cumulative alkylator dosages compared with females.
- C. He should have been offered sperm cryopreservation at diagnosis.
- D. His risk for testosterone deficiency is greater than his risk for infertility.
Correct Answer: A
Rationale: The correct answer is A. A semen analysis at this point would provide accurate information about future fertility because it assesses sperm count, motility, and morphology, which are crucial indicators of fertility potential. This is important for the patient to understand his current fertility status and make informed decisions about future fertility preservation options.
Choice B is incorrect because males are also susceptible to gonadal toxicity from alkylating agents, and there is no evidence to suggest that they can maintain gonadal function at higher dosages compared to females.
Choice C is incorrect because sperm cryopreservation should ideally have been offered at the time of leukemia diagnosis, but it is not too late to assess current fertility status with a semen analysis.
Choice D is incorrect as the patient's primary concern is infertility, not testosterone deficiency, which is a different issue altogether.
While taking a client history, which factor(s) that place the client at risk for a hematologic health problem will the nurse document? (Select all that apply.)
- A. Family history of military excellence
- B. Diet low in iron and protein
- C. Excessive alcohol consumption
- D. Family history of allergies
Correct Answer: C
Rationale: The correct answer is C: Excessive alcohol consumption. Excessive alcohol intake can lead to hematologic health problems such as anemia and abnormal blood clotting. Alcohol interferes with the production of red blood cells and impairs the function of platelets. Therefore, documenting excessive alcohol consumption is crucial in assessing a client's risk for hematologic issues.
Explanation for why other choices are incorrect:
A: Family history of military excellence - This choice is irrelevant to hematologic health problems and does not pose a risk factor.
B: Diet low in iron and protein - While a poor diet can contribute to hematologic issues, this specific choice does not directly indicate a risk factor for hematologic problems.
D: Family history of allergies - Allergies are not directly related to hematologic health problems, so this choice is not relevant in this context.
A patient with a bleeding disorder is prescribed an infusion of plasma. What should the nurse explain as being the purpose of this infusion?
- A. Contains clotting factors
- B. Carries oxygen to the tissues
- C. Supports cellular metabolism
- D. Removes waste products from cells
Correct Answer: A
Rationale: The correct answer is A: Contains clotting factors. Plasma contains essential clotting factors like fibrinogen, Factor VIII, and others that are necessary for blood clotting in patients with bleeding disorders. This infusion helps improve the patient's ability to form blood clots and control bleeding.
B: Plasma does not carry oxygen to tissues; that is the role of red blood cells.
C: Plasma does not directly support cellular metabolism; that is the function of nutrients.
D: Plasma does not remove waste products from cells; that is the role of the kidneys and liver.
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.