Nokea
A nurse is caring for a client who has chronic stable angina. The nurse should identify that which of the following drugs inhibits the action of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction?
- A. Clopidogrel
- B. Heparin
- C. Warfarin
- D. Alteplase
Correct Answer: A
Rationale: 1. Clopidogrel inhibits ADP receptors on platelets, reducing platelet aggregation and clot formation.
2. By reducing platelet aggregation, clopidogrel decreases the risk of myocardial infarction in patients with chronic stable angina.
3. Heparin acts by inhibiting thrombin and factor Xa, not ADP receptors.
4. Warfarin inhibits vitamin K-dependent clotting factors, not ADP receptors.
5. Alteplase is a thrombolytic agent that dissolves blood clots, not an ADP receptor inhibitor.
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You are seeing a 12-year-old female who presented to the emergency department with the sudden onset of severe abdominal pain. Imaging that was obtained to rule out appendicitis revealed a mass adjacent to the bladder. The mass was surgically resected, and pathology demonstrated a paraganglioma. Which of the studies below would be most useful to determine disease stage for this patient?
- A. Bone Scan
- B. Lumbar puncture for cerebrospinal fluid cytology
- C. Bone marrow aspirate and biopsy
- D. Ga 68-DOTATATE PET/CT
Correct Answer: D
Rationale: The correct answer is D: Ga 68-DOTATATE PET/CT. Paragangliomas are neuroendocrine tumors that can secrete catecholamines and have a high expression of somatostatin receptors. Ga 68-DOTATATE PET/CT is the most appropriate imaging study to determine disease stage in patients with paragangliomas because it can detect the somatostatin receptor expression in these tumors, aiding in localization, staging, and treatment planning.
A: Bone scan is not the most useful study for determining disease stage in paraganglioma.
B: Lumbar puncture for cerebrospinal fluid cytology is not relevant for staging paraganglioma.
C: Bone marrow aspirate and biopsy are not the most appropriate studies for staging paraganglioma.
A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma derived factor IX. The nurse should explain that the recombinant factor IX practically eliminates the risk for which of the following?
- A. HIV
- B. Cytomegalovirus
- C. Creutzfeldt-Jakob disease
- D. Anaphylaxis
Correct Answer: C
Rationale: Rationale: The correct answer is C: Creutzfeldt-Jakob disease (CJD). Recombinant factor IX is produced synthetically in a laboratory, eliminating the risk of transmitting prion diseases like CJD. Plasma-derived products, on the other hand, carry a theoretical risk of transmitting CJD due to potential contamination. HIV and cytomegalovirus can be transmitted through blood products, but both plasma-derived and recombinant factor IX are rigorously tested for these viruses. Anaphylaxis is a potential risk with any factor IX product, regardless of the source. Therefore, the nurse should explain to the client that recombinant factor IX practically eliminates the risk of CJD transmission compared to plasma-derived factor IX.
A nurse is caring for a client who is about to begin factor VIII therapy to treat hemophilia A. When administering factor VIII, which of the following actions should the nurse take?
- A. Administer the powdered form orally.
- B. Premedicate with aspirin.
- C. Administer it via rapid IV bolus.
- D. Have emergency equipment ready.
Correct Answer: D
Rationale: The correct answer is D because having emergency equipment ready is crucial due to the risk of allergic reactions or complications associated with factor VIII therapy. This includes supplies for managing anaphylaxis or other adverse reactions, such as epinephrine, antihistamines, and airway support. Administering the powdered form orally (A) is incorrect as factor VIII is given intravenously. Premedicating with aspirin (B) is contraindicated as aspirin can increase the risk of bleeding. Administering it via rapid IV bolus (C) is dangerous as it can lead to adverse effects like hypotension or clotting. Having emergency equipment ready ensures prompt and effective management of any potential complications.
The nurse is concerned that a patient is demonstrating signs of red blood cell production. What laboratory value did the nurse most likely use to make this decision?
- A. Iron
- B. Bilirubin
- C. Thrombin
- D. Intrinsic factor
Correct Answer: B
Rationale: The correct answer is B: Bilirubin. Elevated levels of bilirubin can indicate increased red blood cell breakdown or hemolysis, prompting the body to produce more red blood cells to compensate for the loss. Iron (A) is involved in red blood cell production but is not a direct indicator. Thrombin (C) is a clotting factor, not related to red blood cell production. Intrinsic factor (D) is necessary for vitamin B12 absorption, not directly linked to red blood cell production. Therefore, Bilirubin is the most likely laboratory value used to indicate increased red blood cell production.
An 8-year-old girl presents with National Cancer Institute (NCI) Standard Risk acute pre-B-cell acute lymphoblastic leukemia. Her family history is significant for her mother having been diagnosed with breast cancer at age 34 years and a maternal uncle who developed osteosarcoma as a teenager. What cytogenetic abnormality is most likely to be detected in this patient?
- A. t(1;19)
- B. CRLF2 rearrangement with a JAK2 mutation
- C. KMT24 rearrangement
- D. Hypodiploidy with a modal chromosome number of 34
Correct Answer: D
Rationale: The correct answer is D: Hypodiploidy with a modal chromosome number of 34. In pediatric pre-B-cell acute lymphoblastic leukemia, hypodiploidy (fewer than 44 chromosomes) is associated with poor prognosis. A modal chromosome number of 34 is specifically linked to high-risk disease.
A: t(1;19) is characteristic of pre-B-cell acute lymphoblastic leukemia but is associated with intermediate prognosis, not standard risk.
B: CRLF2 rearrangement with a JAK2 mutation is seen in a subset of high-risk acute lymphoblastic leukemia cases, not standard risk.
C: KMT24 rearrangement is not a known cytogenetic abnormality in acute lymphoblastic leukemia.