Nokea
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. Pallor is difficult to detect in dark-skinned individuals due to the lack of contrast. The conjunctiva of the eye provides a reliable area to assess for pallor as it is mucous membrane with blood vessels that can show changes in color. It is not accurate to assess for pallor by having the patient open the hand widely (B) as skin color on hands may vary. Looking at the roof of the mouth (C) may not accurately reflect pallor. Palpating for areas of mild swelling (D) does not assess for pallor, but rather for edema.
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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 types of lymphocytes, a crucial component of the immune system responsible for fighting infections. T cells regulate immune responses, while B cells produce antibodies. Platelets (A), eosinophils (B), and red blood cells (D) are not involved in immune responses and do not possess the functions of T and B cells. 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.
A 2-month-old girl is found to have a small, hard mass on her scalp. The mass increases in size over the next 4 weeks. A biopsy is performed that confirms a diagnosis of embryonal rhabdomyosarcoma. You initiate chemotherapy with vincristine, dactinomycin, and cyclophosphamide. The child presents to clinic for day 1 of cycle 3 of chemotherapy, and the mass on her scalp is smaller. She is afebrile, absolute neutrophil count is 1,405 cells/mcL, platelet count is 154,000/mcL, and total bilirubin is 0.8 mg/dL. Her mother reports she looks very tired because her eyelids have been 'very droopy,' and she thinks she has a sore throat because her cry is hoarse. Her last bowel movement was 2 days ago. What is the most appropriate chemotherapy plan?
- A. Continue vincristine, dactinomycin, and cyclophosphamide at full dosage.
- B. Do not administer any chemotherapy; rhabdomyosarcoma is progressing and she needs different therapy.
- C. Administer dactinomycin and cyclophosphamide but hold the vincristine and reevaluate weekly. If the ptosis and hoarse cry resolve, vincristine can be resumed with a dose reduction and, if tolerated, re-escalated to the full dose in the future.
- D. Administer dactinomycin and cyclophosphamide but discontinue vincristine permanently.
Correct Answer: C
Rationale: The correct answer is C: Administer dactinomycin and cyclophosphamide but hold the vincristine and reevaluate weekly. If the ptosis and hoarse cry resolve, vincristine can be resumed with a dose reduction and, if tolerated, re-escalated to the full dose in the future.
Rationale:
1. Ptosis and hoarse cry are symptoms of vincristine-induced neurotoxicity.
2. Holding vincristine allows for resolution of these side effects.
3. Reevaluating weekly ensures close monitoring of symptoms.
4. If symptoms resolve, vincristine can be cautiously reintroduced with a dose reduction to prevent further neurotoxicity.
Summary:
A: Continuing all chemotherapy may worsen neurotoxicity.
B: Withholding all chemotherapy is not appropriate if two agents are effective.
D: Discontinuing vincristine permanently may limit treatment options.
The health care provider tells the nurse that a client is to be started on a platelet inhibitor. About what drug does the nurse plan to teach the client?
- A. Clopidogrel (Plavix)
- B. Enoxaparin (Lovenox)
- C. Reteplase (Retavase)
- D. Warfarin (Coumadin)
Correct Answer: A
Rationale: The correct answer is A: Clopidogrel (Plavix). Clopidogrel is a platelet inhibitor that helps prevent blood clots by inhibiting platelet aggregation. It is commonly used to reduce the risk of heart attack or stroke. Enoxaparin (Lovenox) is a low molecular weight heparin that works by preventing blood clots by inhibiting clotting factors. Reteplase (Retavase) is a thrombolytic agent used to dissolve blood clots in emergency situations. Warfarin (Coumadin) is an anticoagulant that works by inhibiting vitamin K-dependent clotting factors. Clopidogrel is the most appropriate choice for a platelet inhibitor in this scenario due to its mechanism of action and indication for preventing blood clots.
Which of the following is not true in thrombasthenia:
- A. prolonged bleeding time
- B. normal plat .Count
- C. plat .Aggregation defect
- D. prolonged clotting time
Correct Answer: D
Rationale: In thrombasthenia, there is a deficiency or dysfunction of the glycoprotein IIb/IIIa receptor complex on platelets, leading to impaired platelet aggregation. This results in prolonged bleeding time due to ineffective platelet plug formation (choice A). Platelet count is typically normal (choice B). Platelet aggregation is defective (choice C). However, clotting time is not affected in thrombasthenia as it primarily involves platelet function, not the clotting factors involved in coagulation (choice D). Therefore, the correct answer is D.
You are caring for a patient with a large localized Ewing sarcoma of the soft tissues of the arm. The surgeon believes that the tumor can be resected without amputation but asks whether you can give some chemotherapy to shrink the tumor before surgery. Which of the following would you tell the surgeon?
- A. If the tumor can be resected without amputation, then the best time to do the resection is before any chemotherapy to improve the prognosis.
- B. You agree with waiting to do the resection until week 12 of therapy and will begin chemotherapy; you recognize that radiotherapy will not be necessary if the tumor is completely resected at week 12 of therapy.
- C. You agree with waiting to do the resection until week 12 of therapy and will begin chemotherapy; you recognize that radiotherapy will be necessary even if the tumor is completely resected at week 12 of therapy.
- D. If the tumor can be resected without amputation, then the best time to do the resection is before any chemotherapy; you recognize that this is the only way to avoid radiotherapy.
Correct Answer: B
Rationale: The correct answer is B because starting chemotherapy before resection at week 12 can help shrink the tumor, making it more manageable for surgery. A is incorrect because preoperative chemotherapy can improve outcomes. C is incorrect because radiotherapy may not be necessary if the tumor is completely resected. D is incorrect because radiotherapy may still be necessary even if the tumor is resected before chemotherapy.