Nokea
A 72-year-old male with enlargement of superficial lymph nodes and mild hepatosplenomegaly is diagnosed as having chronic lymphatic leukemia (CLL). The most important criteria for diagnosis of this disease is the
- A. Presence of hypogammaglobulinemia
- B. Absolute lymphocytes
- C. Male predominance
- D. Presence of enlarged lymph nodes
Correct Answer: B
Rationale: The correct answer is B: Absolute lymphocytes. In CLL, the most important diagnostic criterion is an absolute lymphocyte count of more than 5,000 cells per microliter in the peripheral blood. This is a key feature of CLL and distinguishes it from other conditions. Hypogammaglobulinemia (choice A) may occur in CLL but is not as specific for diagnosis. Male predominance (choice C) is a general characteristic of CLL but is not a diagnostic criterion. Presence of enlarged lymph nodes (choice D) is a common manifestation of CLL but not the most important criteria for diagnosis.
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Which of the following is false regarding heparin?
- A. Subcutaneous injection of heparin is avoided because of hematomas formation.
- B. Heparin is usually stored in the mast cells.
- C. Heparin binds to plasma anti thrombin III and inhibits activated thrombin.
- D. Protamine sulfate can be used to counteract heparin overdose.
Correct Answer: A
Rationale: The correct answer is A. Subcutaneous injection of heparin is avoided because it can lead to hematomas due to its anticoagulant properties. Heparin is not stored in mast cells (B), but it is synthesized in mast cells. Heparin binds to plasma antithrombin III and inhibits activated thrombin (C). Protamine sulfate can be used to counteract heparin overdose by binding to heparin and neutralizing its anticoagulant effects (D). Therefore, the statement that subcutaneous injection of heparin is avoided due to hematoma formation is the false statement among the options provided.
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 assessing a dark-skinned client for pallor. What action is best?
- A. Assess the conjunctiva of the eye.
- B. Have the client open the hand widely.
- C. Look at the roof of the client's mouth.
- D. Palpate for areas of mild swelling.
Correct Answer: A
Rationale: The correct answer is A: Assess the conjunctiva of the eye. This is because pallor, which is paleness of the skin, can be difficult to detect on dark skin. The conjunctiva of the eye is a mucous membrane that is not pigmented and can provide a more accurate indication of pallor. Options B, C, and D are not ideal for assessing pallor in a dark-skinned client as they may not show paleness accurately. B is more related to checking for pallor in fair-skinned individuals. C and D are not reliable indicators of pallor in any skin type.
A 10-year-old patient with aplastic anemia, who is blood type B negative, is receiving a red blood cell transfusion. About 10 minutes after the transfusion starts, the patient develops anxiety and lower back pain. The transfusion continues for another 5 minutes until it is stopped when he develops a temperature of 40 °C with chills and rigors. A transfusion reaction work-up is most likely to reveal what findings?
- A. Spherocytes on peripheral blood smear
- B. Gram-negative Bacillus on gram stain of remaining RBC unit
- C. Chest x-ray with bilateral pulmonary infiltrates that are new compared to an x-ray done last week
- D. DAT positive for C3
Correct Answer: D
Rationale: The correct answer is D: DAT positive for C3. This finding suggests complement-mediated hemolysis, which is consistent with a transfusion reaction known as transfusion-related acute lung injury (TRALI). TRALI presents with respiratory distress, fever, and chills due to immune complexes activating the complement system. A: Spherocytes indicate hemolysis, which is not specific to TRALI. B: Gram-negative Bacillus suggests bacterial contamination, leading to sepsis, not TRALI. C: Bilateral pulmonary infiltrates are seen in transfusion-associated circulatory overload (TACO), not TRALI.
Busulfan therapy lead to all except:
- A. hyperpigmentation
- B. pulm .Fibrosis
- C. optic neuritis
- D. BM suppression
Correct Answer: C
Rationale: The correct answer is C: optic neuritis. Busulfan therapy is known to cause adverse effects such as hyperpigmentation, pulmonary fibrosis, and bone marrow suppression due to its cytotoxic effects. However, optic neuritis is not a reported side effect of busulfan therapy. Optic neuritis is more commonly associated with other medications or conditions affecting the optic nerve. Therefore, the absence of optic neuritis as a known side effect of busulfan therapy makes choice C the correct answer.