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: Helping the patient manage the opioid analgesic regimen. This is the priority intervention for severe bone pain in multiple myeloma because opioids are the most effective for managing severe pain. Opioids target the central nervous system to reduce pain perception, providing significant relief. Implementing distraction techniques (A) may offer temporary relief but will not address the underlying pain. Educating about hot and cold packs (B) may be helpful for mild pain but is not sufficient for severe bone pain. Teaching NSAIDs (C) is not recommended for multiple myeloma pain management due to potential kidney issues.
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Best tit modality in CML is:
- A. hydroxyurea
- B. allogenic BMT
- C. interferon alpha
- D. radiotherapy
Correct Answer: B
Rationale: The best treatment modality for chronic myeloid leukemia (CML) is allogenic bone marrow transplantation (BMT) because it offers the potential for cure by replacing the abnormal cells with healthy donor cells. This is the only option that can provide long-term disease control and potential cure for CML. Hydroxyurea (choice A) is a cytotoxic drug used for symptom control but does not target the underlying cause. Interferon alpha (choice C) can help control the disease but is less effective in achieving long-term remission compared to BMT. Radiotherapy (choice D) is not a standard treatment for CML and is not curative.
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 16-year-old patient with a left-side pelvic osteosarcoma is taking extended release oxycodone twice daily as well as immediate release oxycodone for breakthrough pain approximately 2 or 3 times per day. She describes her pain as burning, tingling, and shooting in her left leg. Her pain worsens with hot showers. Her most recent EKG has a QTc of 495. What would be the best strategy to manage her pain?
- A. Switch from long-acting oxycodone to methadone.
- B. Recommend more frequent use of her immediate release oxycodone.
- C. Add amitriptyline daily. Start low and titrate upward on dosage.
- D. Add gabapentin three times daily. Start low and titrate upward on dose.
Correct Answer: D
Rationale: The correct answer is D: Add gabapentin three times daily. Gabapentin is a first-line option for neuropathic pain, which is likely the cause of the patient's burning, tingling, and shooting leg pain. The worsening of pain with hot showers is also characteristic of neuropathic pain. Gabapentin's mechanism of action in reducing neuropathic pain makes it a suitable choice for this patient. Switching to methadone (A) may not directly address the neuropathic pain component. Recommending more frequent use of immediate release oxycodone (B) may lead to increased risk of opioid-related adverse effects. While amitriptyline (C) is also used for neuropathic pain, starting with gabapentin is more appropriate given the patient's current opioid regimen and EKG findings.
A female infant is diagnosed with hemophagocytic lymphohistiocytosis (HLH) not associated with an Epstein-Barr virus (EBV) infection. In taking the family history, you learn that another female infant died of HLH 2 years ago. Also, a newborn female child died of an unknown disease 4 years prior and was said have been bleeding profusely, jaundiced, and had a distended abdomen. When counseling the family about the genetics of HLH, how will you explain it?
- A. It is an X-linked syndrome
- B. It is an autosomal recessive syndrome
- C. It is a dominant inheritance syndrome
- D. It is an autosomal recessive syndrome with incomplete penetrance
Correct Answer: B
Rationale: The correct answer is B: It is an autosomal recessive syndrome. HLH is typically inherited in an autosomal recessive pattern, meaning both parents must pass on a copy of the mutated gene for the child to develop the condition. In this case, the family history suggests a pattern of multiple affected female infants, which is more indicative of an autosomal recessive inheritance. Choice A (X-linked syndrome) is incorrect because the pattern of inheritance in this family does not align with X-linked inheritance. Choice C (dominant inheritance syndrome) is incorrect because a dominant inheritance pattern would not typically result in multiple affected offspring. Choice D (autosomal recessive syndrome with incomplete penetrance) is incorrect because incomplete penetrance would not explain the consistent occurrence of HLH in this family.
An 18-month-old boy, whose parents are first cousins, is referred to you because of a significant episode of epistaxis. The parents report that the child had bleeding after circumcision and large hematomas with immunizations. Platelet aggregation studies show the following: This child's platelets are unable to interact with which of the following?
- A. ADP
- B. Fibrinogen
- C. von Willebrand factor
- D. Platelet factor 4
Correct Answer: B
Rationale: The correct answer is B: Fibrinogen. In this case, the child is likely suffering from Glanzmann thrombasthenia, a rare inherited platelet disorder where platelets lack the ability to bind to fibrinogen. This results in impaired platelet aggregation and clot formation, leading to bleeding tendencies. The other options (A, C, D) are not affected in Glanzmann thrombasthenia. Platelets interact normally with ADP (A), von Willebrand factor (C), and Platelet factor 4 (D) in this disorder.