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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.
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A patient with abdominal injuries from a motor vehicle crash is scheduled for surgery to remove the spleen. What bodily function will be affected by the removal of this organ?
- A. Filtration of waste products
- B. Removal of old red blood cells from circulation
- C. Clearance of mucous in the tracheobronchial tree
- D. Facilitation of glucose to be used by the cell for energy
Correct Answer: B
Rationale: The correct answer is B: Removal of old red blood cells from circulation. The spleen plays a crucial role in filtering and removing old or damaged red blood cells from circulation. When the spleen is removed, this function is compromised, leading to a decrease in the body's ability to clear out these cells efficiently. This can result in an increased risk of anemia and other complications related to the buildup of old red blood cells in the bloodstream.
A: Filtration of waste products - While the spleen does play a role in filtering blood, its primary function is related to red blood cells, not waste products.
C: Clearance of mucous in the tracheobronchial tree - This function is primarily carried out by the respiratory system, particularly the cilia and mucous membranes in the airways, not the spleen.
D: Facilitation of glucose to be used by the cell for energy - This function is primarily related to the pancreas and insulin production, not the
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 client is having a bone marrow aspiration and biopsy. What action by the nurse takes priority?
- A. Administer pain medication first.
- B. Ensure that valid consent is in the medical record.
- C. Have the client shower in the morning.
- D. Premedicate the client with sedatives.
Correct Answer: B
Rationale: The correct answer is B: Ensure that valid consent is in the medical record. This is the priority because obtaining informed consent is essential before any invasive procedure like a bone marrow aspiration and biopsy. It ensures that the client understands the procedure, risks, benefits, and alternatives. Administering pain medication (A), having the client shower (C), and premedicating with sedatives (D) are important aspects of care but obtaining valid consent is crucial for legal and ethical reasons before proceeding with the procedure.
In iron deficiency anemia there is characteristically
- A. An atrophic gastritis
- B. A low mean corpuscular volume
- C. A reduced total iron binding capacity
- D. Megaloblastic changes in the bone marrow
Correct Answer: B
Rationale: Step-by-step rationale:
1. Iron deficiency leads to decreased hemoglobin synthesis, resulting in smaller red blood cells.
2. Mean corpuscular volume (MCV) measures the average size of red blood cells.
3. In iron deficiency anemia, MCV is low due to the smaller red blood cells.
4. Therefore, choice B is correct as it reflects the characteristic feature of iron deficiency anemia.
Summary:
A: Atrophic gastritis is seen in pernicious anemia, not iron deficiency anemia.
C: Total iron binding capacity is increased, not reduced, in iron deficiency anemia.
D: Megaloblastic changes in the bone marrow are seen in megaloblastic anemias, not iron deficiency anemia.
An 8-year-old boy undergoes a resection of a tumor in the right cerebrum next to the lateral ventricle (supratentorial). The pathologist feels the histology is most consistent with an ependymoma. The tumor is sent for advanced molecular and genetic testing. Which of the following findings would further support a diagnosis of ependymoma?
- A. BRAFKIAA1549 fusion
- B. BRAFV600E mutation
- C. RELA fusion
- D. H3K27M mutation
Correct Answer: C
Rationale: The correct answer is C: RELA fusion. Ependymomas are known to have specific genetic alterations, including RELA fusions. The fusion of RELA gene is a hallmark genetic abnormality observed in certain subtypes of ependymomas, aiding in the diagnosis. Conversely, choices A, B, and D are associated with other types of brain tumors such as pilocytic astrocytoma (A), melanoma (B), and diffuse intrinsic pontine glioma (D), respectively. These genetic alterations are not characteristic of ependymomas, making them incorrect choices in this context.