Nokea
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 a legal and ethical requirement before any invasive procedure like a bone marrow aspiration and biopsy. Without valid consent, the procedure cannot proceed. Administering pain medication (A) can be important, but ensuring consent comes first. Having the client shower (C) is not a priority before the procedure. Premedicating with sedatives (D) may not be necessary for every client and should be based on individual assessment.
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Basophilic stippling is classically seen in:
- A. CML
- B. myelosclerosis
- C. chronic lead poisoning
- D. iron def anemia
Correct Answer: C
Rationale: Basophilic stippling is caused by the presence of ribosomal RNA in red blood cells, which is a characteristic finding in chronic lead poisoning. Lead inhibits enzymes involved in heme synthesis, leading to accumulation of ribosomal RNA. In CML, there is an increase in immature white blood cells, not red blood cells. Myelosclerosis is associated with bone marrow fibrosis, not basophilic stippling. Iron deficiency anemia presents with microcytic, hypochromic red blood cells, not basophilic stippling.
A patient is scheduled for upcoming surgery. He is on nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. You are being asked what to do with his medications for the surgery. What is the mechanism of action of NSAIDS?
- A. Irreversible inhibition of cyclooxygenase 1
- B. Irreversible inhibition of cyclooxygenase 2
- C. Reversible inhibition of cyclooxygenase 1
- D. Reversible inhibition of cyclooxygenase 2
Correct Answer: C
Rationale: Step 1: NSAIDs inhibit cyclooxygenase (COX) enzymes to reduce prostaglandin synthesis.
Step 2: Reversible inhibition means the effect is temporary and can be reversed.
Step 3: COX-1 inhibition leads to GI side effects, which can be concerning in surgery.
Step 4: COX-2 inhibition is more targeted for inflammation but can still pose cardiovascular risks.
Step 5: Reversible COX-1 inhibition allows for temporary discontinuation before surgery to minimize bleeding risk.
Summary: Choice C is correct as reversible COX-1 inhibition allows for safer management pre-surgery compared to irreversible inhibition in choices A and B, and COX-2 inhibition in choice D.
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.
The nurse is caring for a patient who has a white blood cell (WBC) count of 8000/mm³. What concern should the nurse have about this finding?
- A. The patient has an infection.
- B. The patient is at risk for infection.
- C. The patient has a hematological disorder.
- D. There is no concern; this is a normal finding.
Correct Answer: D
Rationale: The correct answer is D because a WBC count of 8000/mm³ falls within the normal range of 4000-11000/mm³. The normal WBC count indicates the body's ability to fight infections and maintain immunity. The other choices are incorrect because:
A: The patient does not necessarily have an infection based solely on the WBC count.
B: The patient is not necessarily at risk for infection with a normal WBC count.
C: There is no indication of a hematological disorder based on the WBC count within the normal range.