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A nurse is assessing a dark-skinned client for pallor. What nursing assessment is best to assess for pallor in this client?
- A. Assess the conjunctiva of the eye.
- B. Have the patient open the hand widely.
- C. Look at the roof of the patient's mouth.
- D. Palpate for areas of mild swelling.
Correct Answer: A
Rationale: The correct answer is A: Assess the conjunctiva of the eye. The conjunctiva is a thin, transparent layer covering the white part of the eye. Pallor, which is paleness of the skin or mucous membranes, is more easily observed in the conjunctiva of the eye in dark-skinned individuals. This area provides a contrast to the skin tone, making it easier to detect subtle changes in color. Assessing the conjunctiva allows for a more accurate evaluation of pallor in dark-skinned clients compared to other areas like the palm, mouth, or palpation for swelling, which may not provide as clear of an indication of pallor.
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Several gene mutations have been associated with juvenile myelomonocytic leukemia (JMML), and they may or may not have prognostic implications. A gene expression–based classification system has been found to be an independent predictor of clinical outcome in these patients. What is the disease signature that predicts a poor outcome?
- A. Tyrosine kinase inhibitors
- B. Acute myeloid leukemia–like
- C. Chronic myeloid leukemia-like
- D. BRAF pathway abnormalities
Correct Answer: B
Rationale: The correct answer is B: Acute myeloid leukemia-like. In JMML, a disease signature resembling acute myeloid leukemia (AML) has been associated with a poor outcome. This signature includes features such as increased blasts, abnormal karyotypes, and mutations in genes like NRAS and KRAS. AML-like JMML cases often have aggressive disease progression and poorer response to treatment. Tyrosine kinase inhibitors (choice A) are not typically used in JMML treatment. Chronic myeloid leukemia-like (choice C) is not associated with a poor outcome in JMML. BRAF pathway abnormalities (choice D) may be present in some cases of JMML but are not the primary disease signature predicting poor outcomes.
A patient has an altered level of T and B cells. The nurse realizes that these cells are members of which cell type?
- A. Platelets
- B. Eosinophils
- C. Lymphocytes
- D. Red blood cells
Correct Answer: C
Rationale: The correct answer is C: Lymphocytes. T and B cells are subtypes of lymphocytes, which are crucial components of the immune system. T cells are involved in cell-mediated immunity, while B cells are responsible for producing antibodies. Platelets (A), eosinophils (B), and red blood cells (D) do not have the same functions or roles as T and B cells in the immune system. Platelets are involved in blood clotting, eosinophils are a type of white blood cell involved in allergic reactions, and red blood cells are responsible for oxygen transport.
Which of the following is not the criteria in the international prognostic index for non Hodgkin's lymphoma?
- A. Number of extranodal sites
- B. LDH level
- C. Lymphocyte count
- D. Performance status
Correct Answer: C
Rationale: The correct answer is C: Lymphocyte count. In the International Prognostic Index for Non Hodgkin's Lymphoma, the criteria are based on the number of extranodal sites, LDH level, and performance status. Lymphocyte count is not included in the IPI criteria because it does not play a significant role in predicting the prognosis of Non Hodgkin's Lymphoma. Lymphocyte count is not a commonly used parameter in prognostic scoring systems for this type of cancer. Therefore, the absence of lymphocyte count as a criteria in the IPI is justified.
A patient who is infected with hookworms produces signs and symptoms of anemia. Which of the following can be seen in the peripheral blood smear of the patient?
- A. Howell-Jolly bodies
- B. Basophilic stippling
- C. Target cells
- D. Spherocytes
Correct Answer: B
Rationale: The correct answer is B: Basophilic stippling. Basophilic stippling is a common finding in the peripheral blood smear of patients infected with hookworms due to lead poisoning, which can occur as a result of hookworm infection. Basophilic stippling is seen as the presence of small, dark blue granules within red blood cells and is indicative of impaired heme synthesis. Howell-Jolly bodies (A) are remnants of nuclear material in red blood cells and are typically seen in patients with functional asplenia. Target cells (C) are seen in conditions such as liver disease and hemoglobinopathies. Spherocytes (D) are seen in conditions like hereditary spherocytosis or autoimmune hemolytic anemia, but not specifically in hookworm infection.
A client is having a radioisotopic imaging scan. What action by the nurse is most important?
- A. Assess the client for shellfish allergies.
- B. Place the client on radiation precautions.
- C. Sedate the client before the scan.
- D. Teach the client about the procedure.
Correct Answer: D
Rationale: The correct answer is D because educating the client about the procedure is crucial for informed consent, cooperation, and reducing anxiety. This empowers the client to participate actively in their care. Assessing for shellfish allergies (A) is irrelevant unless a specific contrast agent is used. Placing the client on radiation precautions (B) is unnecessary for radioisotopic imaging. Sedating the client (C) may not be indicated and should be avoided if possible. Teaching the client about the procedure (D) addresses the immediate need and supports client safety and understanding.