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 criteria is an absolute lymphocyte count greater than 5,000/microliter. This is crucial for distinguishing CLL from other lymphoproliferative disorders. The presence of hypogammaglobulinemia (choice A) is not specific to CLL and can be seen in other conditions. Male predominance (choice C) is an epidemiological feature and not a diagnostic criterion. Enlarged lymph nodes (choice D) are a common clinical finding but do not solely confirm the diagnosis of CLL.
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A patient who is taking warfarin (Coumadin) 5 mg daily has an international normalized ratio (INR) of 2.5. It is time to administer the next dose of Coumadin. What should the nurse do?
- A. Notify the physician STAT.
- B. Hold the dose of Coumadin.
- C. Prepare to administer vitamin K.
- D. Administer the daily Coumadin as ordered.
Correct Answer: D
Rationale: The correct answer is D: Administer the daily Coumadin as ordered.
Rationale:
1. INR of 2.5 is within the therapeutic range (2-3) for patients on warfarin.
2. Holding the dose may lead to fluctuation in INR and risk of thrombosis or bleeding.
3. Notifying the physician is not necessary as the INR is within the target range.
4. Administering vitamin K is not indicated unless the patient is experiencing significant bleeding.
In summary, administering the daily Coumadin as ordered is appropriate as the INR is within the therapeutic range, ensuring continuity of anticoagulation therapy without unnecessary intervention.
All produce microcytic anemia except:
- A. sideroblastic an.
- B. thalassemia
- C. pernicious anemia
- D. lead poisoning
Correct Answer: C
Rationale: The correct answer is C: pernicious anemia. Pernicious anemia is a macrocytic anemia caused by vitamin B12 deficiency, leading to large red blood cells. Sideroblastic anemia (A) is a type of microcytic anemia due to ineffective iron utilization. Thalassemia (B) causes microcytic anemia due to decreased production of hemoglobin. Lead poisoning (D) can also lead to microcytic anemia by disrupting heme synthesis. Therefore, pernicious anemia is the only choice that does not produce microcytic anemia.
NADPH is a product of the hexose monophosphate pathway (HMP) in the red blood cell. The NADPH is used for the
- A. Synthesis of fatty acids
- B. Reduction of glutathione
- C. Formation of ATP
- D. Removal of oxygen radicals
Correct Answer: B
Rationale: The correct answer is B: Reduction of glutathione. In the HMP pathway, glucose-6-phosphate is converted to ribulose-5-phosphate, generating NADPH. NADPH is essential for the reduction of glutathione, which helps in detoxifying reactive oxygen species and protecting red blood cells from oxidative damage. Fatty acid synthesis (choice A) primarily requires NADPH from the pentose phosphate pathway. ATP formation (choice C) is not a direct function of NADPH production in the HMP pathway. NADPH is not directly involved in the removal of oxygen radicals (choice D), as it is the reduced form of NADP+ that participates in antioxidant defense mechanisms.
A 17-year-old female presents with cervical adenopathy and a history of daily fevers and drenching night sweats. A biopsy is performed and reveals classic Hodgkin lymphoma. Which of the following is least appropriate as part of the staging workup?
- A. Chest x-ray
- B. CT scan of chest, abdomen, and pelvis
- C. Functional imaging (PET scan)
- D. Lumbar puncture and cerebrospinal fluid (CSF) analysis
Correct Answer: D
Rationale: The correct answer is D: Lumbar puncture and cerebrospinal fluid (CSF) analysis. In Hodgkin lymphoma staging, CNS involvement is rare at initial presentation. Therefore, routine CSF analysis is not recommended unless there are specific neurological symptoms suggestive of CNS disease. A lumbar puncture carries risks of complications and should not be performed routinely. Choices A, B, and C are appropriate for staging in Hodgkin lymphoma to evaluate for distant metastases and characterize disease extent.
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. Alcohol can lead to various hematologic health problems such as anemia, bleeding disorders, and impaired immune function. Excessive alcohol intake can disrupt the production of red blood cells and platelets, leading to an increased risk of hematologic issues. Family history of military excellence (A) and family history of allergies (D) are not directly related to hematologic health problems. A diet low in iron and protein (B) can contribute to hematologic issues, but it is not as direct a risk factor as excessive alcohol consumption.