Nokea
A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective?
- A. PT
- B. WBC
- C. Hgb
- D. Platelets
Correct Answer: C
Rationale: The correct answer is C: Hgb (hemoglobin). Epoetin is a medication used to stimulate the production of red blood cells, which contain hemoglobin. Therefore, an increase in hemoglobin level indicates that the therapy is effective in treating anemia.
Incorrect choices:
A: PT (prothrombin time) is a measure of blood clotting time and is not directly related to epoetin therapy.
B: WBC (white blood cell count) is not affected by epoetin therapy, as it primarily targets red blood cell production.
D: Platelets are involved in blood clotting and are not directly influenced by epoetin therapy for anemia.
In summary, the increase in hemoglobin level is the most relevant indicator of the effectiveness of epoetin therapy for treating anemia.
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Increase serum iron:-decrease IBC a feature of:
- A. Hookworm infestation
- B. sideroblastic an.
- C. alcoholic liver dis.
- D. th.major
Correct Answer: B
Rationale: The correct answer is B: sideroblastic anemia. In sideroblastic anemia, there is impaired heme synthesis leading to the accumulation of iron in the mitochondria of red blood cell precursors. This results in increased serum iron levels due to the release of iron from the mitochondria. Decreased Iron Binding Capacity (IBC) occurs as a compensatory mechanism due to the increased serum iron levels.
Choice A, hookworm infestation, would typically result in iron deficiency anemia with decreased serum iron levels and normal to increased IBC. Choice C, alcoholic liver disease, is associated with decreased serum iron levels and normal to increased IBC due to impaired iron metabolism. Choice D, thalassemia major, presents with normal to decreased serum iron levels and normal to increased IBC due to ineffective erythropoiesis.
A patient is scheduled for upcoming surgery. He is on nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. You are being asked what to do with his medications for the surgery. What is the mechanism of action of NSAIDS?
- A. Irreversible inhibition of cyclooxygenase 1
- B. Irreversible inhibition of cyclooxygenase 2
- C. Reversible inhibition of cyclooxygenase 1
- D. Reversible inhibition of cyclooxygenase 2
Correct Answer: C
Rationale: Step 1: NSAIDs inhibit cyclooxygenase (COX) enzymes to reduce prostaglandin synthesis.
Step 2: Reversible inhibition means the effect is temporary and can be reversed.
Step 3: COX-1 inhibition leads to GI side effects, which can be concerning in surgery.
Step 4: COX-2 inhibition is more targeted for inflammation but can still pose cardiovascular risks.
Step 5: Reversible COX-1 inhibition allows for temporary discontinuation before surgery to minimize bleeding risk.
Summary: Choice C is correct as reversible COX-1 inhibition allows for safer management pre-surgery compared to irreversible inhibition in choices A and B, and COX-2 inhibition in choice D.
The nurse is staying with a patient who has been started on a blood transfusion. Which assessment should the nurse perform during a blood product infusion to detect a reaction?
- A. Vital signs
- B. Skin turgor
- C. Bowel sounds
- D. Pupil reactivity
Correct Answer: A
Rationale: The correct answer is A: Vital signs. During a blood transfusion, the nurse should monitor the patient's vital signs regularly to detect any signs of a transfusion reaction, such as fever, chills, rash, or hypotension. Vital signs provide crucial information about the patient's overall condition and can help the nurse identify and respond promptly to any adverse reactions. Skin turgor (B), bowel sounds (C), and pupil reactivity (D) are not directly related to monitoring for transfusion reactions and are not sensitive indicators of an adverse reaction during a blood transfusion. Monitoring vital signs is essential for patient safety and early detection of any complications during the transfusion process.
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: The correct answer is D: Nephroblastoma (Wilms tumor). This patient likely has Beckwith-Wiedemann syndrome given the features of overgrowth, macroglossia, and omphalocele. Beckwith-Wiedemann syndrome is associated with an increased risk of Wilms tumor. Wilms tumor is the most common renal malignancy in childhood. Monitoring for Wilms tumor with ultrasound and laboratory evaluations is appropriate due to the increased risk in this patient population.
Choice A: Pleuropulmonary blastoma is a rare lung tumor more commonly seen in children under 2 years old. It is not typically associated with Beckwith-Wiedemann syndrome.
Choice B: Hepatocellular carcinoma is a primary liver cancer more commonly seen in adults, not children with Beckwith-Wiedemann syndrome.
Choice C: Cystic nephroma is a benign kidney tumor typically seen in young children, but it is not associated with Beckwith-Wiedemann syndrome nor is it malignant
The commonest cause of jaundice in thalassemia is:
- A. viral hepatitis c
- B. iron deposition in liver
- C. viral hepatitis B
- D. haemolysis
Correct Answer: D
Rationale: The correct answer is D: haemolysis. In thalassemia, there is an increased breakdown of red blood cells leading to excessive production of bilirubin causing jaundice. Viral hepatitis B and C do not directly cause jaundice in thalassemia. Iron deposition in the liver is seen in iron overload conditions like hemochromatosis, not thalassemia. Haemolysis in thalassemia is the primary reason for jaundice.