Nokea
A home health nurse is caring for a patient with multiple myeloma. Which of the following interventions should the nurse prioritize when addressing the patient's severe bone pain?
- A. Implementing distraction techniques
- B. Educating the patient about the effective use of hot and cold packs
- C. Teaching the patient to use NSAIDs effectively
- D. Helping the patient manage the opioid analgesic regimen
Correct Answer: D
Rationale: The correct answer is D because severe bone pain in multiple myeloma often requires strong analgesics like opioids for effective pain management. Distraction techniques (A) may provide temporary relief but may not address the underlying pain. Hot and cold packs (B) are more suited for musculoskeletal injuries, not severe bone pain. NSAIDs (C) are usually not sufficient for managing severe bone pain in multiple myeloma. Therefore, helping the patient manage the opioid analgesic regimen (D) is the priority for effective pain control.
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Which of the following is wrong concerning Philadelphia chromosome:
- A. shortening of long arm of chromosome 22
- B. Philadelphia:-ve cases have bad prognosis
- C. diagnostic of CML
- D. found in lymphocytes
Correct Answer: D
Rationale: The correct answer is D because the Philadelphia chromosome is found in myeloid (not lymphoid) cells in Chronic Myeloid Leukemia (CML). This is due to a reciprocal translocation between chromosomes 9 and 22, resulting in a shortened chromosome 22q, not chromosome 22 itself. Choice A is incorrect because the long arm of chromosome 22 is affected. Choice B is incorrect as Philadelphia chromosome-negative cases can have a favorable prognosis. Choice C is incorrect as the presence of the Philadelphia chromosome is diagnostic of CML.
You receive a phone call from a community pediatrician who is caring for a 2-year-old toddler with a cancer predisposition syndrome. The pediatrician describes a child at the 95th percentile for height and weight with a history of corrective oral surgery to reduce a large tongue and a history of an omphalocele in infancy. The pediatrician is currently performing ultrasound of the abdomen and laboratory evaluation for this patient every 3 months. Which tumor is this patient most at risk of developing?
- A. Pleuropulmonary blastoma
- B. Hepatocellular carcinoma
- C. Cystic nephroma
- D. Nephroblastoma
Correct Answer: D
Rationale: Step-by-step rationale for why the correct answer is D, Nephroblastoma:
1. The child has a cancer predisposition syndrome, likely Beckwith-Wiedemann syndrome (BWS).
2. BWS is associated with an increased risk of developing Wilms tumor (nephroblastoma).
3. The large tongue, omphalocele, and overgrowth placing the child at the 95th percentile for height and weight are all characteristic features of BWS.
4. Therefore, the patient is most at risk of developing nephroblastoma.
Summary of why the other choices are incorrect:
A: Pleuropulmonary blastoma - Not typically associated with BWS or the described clinical features.
B: Hepatocellular carcinoma - Not commonly linked to BWS or the clinical presentation provided.
C: Cystic nephroma - Not a typical tumor associated with BWS or the clinical findings described in the patient.
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.
Which of the following characteristics are similar with respect to Factor VIII and von Willebrand factor (vWF)?
- A. Both are made in endothelial cells and megakaryocytes.
- B. Both are activated by thrombin.
- C. They are present in normal to high relative amounts in newborns.
- D. They are stored in Weibel-Palade bodies in endothelial cells.
Correct Answer: C
Rationale: Rationale:
- Factor VIII and vWF are present in normal to high amounts in newborns due to the physiological immaturity of the hemostatic system.
- Choice A is incorrect as vWF is mainly produced in endothelial cells while Factor VIII is produced in both endothelial cells and liver.
- Choice B is incorrect as Factor VIII is activated by thrombin, but vWF is not.
- Choice D is incorrect as vWF is stored in Weibel-Palade bodies, but Factor VIII is not.
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.