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 red blood cell production, which should increase hemoglobin levels. Higher hemoglobin levels indicate improved oxygen-carrying capacity and overall effectiveness of the therapy. PT (A), WBC (B), and Platelets (D) are not directly affected by epoetin therapy, so an increase in these values would not be indicative of the medication's effectiveness.
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Dohle bodies are patches of dilated endoplasmic reticulum that appear as cerulean blue cytoplasmic puddles. These findings are mostly seen in
- A. Chronic myeloid leukemia
- B. Leukemoid reaction
- C. Chediak-Higashi syndrome
- D. Infectious mononucleosis
Correct Answer: D
Rationale: The correct answer is D: Infectious mononucleosis. Dohle bodies are seen in infectious mononucleosis due to the accumulation of rough endoplasmic reticulum in neutrophils. This is a result of the viral infection causing stress on the neutrophils. In chronic myeloid leukemia (A), leukemoid reaction (B), and Chediak-Higashi syndrome (C), Dohle bodies are not typically observed. In chronic myeloid leukemia, the characteristic finding is the Philadelphia chromosome. Leukemoid reaction is a reactive increase in white blood cells due to infection or inflammation. Chediak-Higashi syndrome is a rare autosomal recessive disorder characterized by defective phagolysosome formation.
A nurse is caring for a client who has hemophilia A and is about to begin taking desmopressin to prevent bleeding. The nurse should monitor the client for which of the following adverse reactions?
- A. Weight loss
- B. Edema
- C. Polyuria
- D. Bradycardia
Correct Answer: B
Rationale: The correct answer is B: Edema. Desmopressin is a synthetic form of vasopressin that can cause fluid retention, leading to edema. This is a common adverse reaction associated with desmopressin use. Weight loss (choice A) is not a typical adverse reaction of desmopressin. Polyuria (choice C) is actually a desired effect of desmopressin, as it helps to concentrate urine. Bradycardia (choice D) is not directly associated with desmopressin use. Monitoring for edema is important to ensure the client's safety and adjust treatment as needed.
Which of the following moves furthest to the anode on cellulose acetate electrophoresis of normal haemoglobin at pH 8.6?
- A. Haemoglobin A
- B. Haemoglobin D
- C. Haemoglobin A2
- D. Haemoglobin S
Correct Answer: A
Rationale: 1. In cellulose acetate electrophoresis at pH 8.6, proteins migrate based on their net charge.
2. Haemoglobin A migrates furthest to the anode as it has the highest net negative charge among the options.
3. Haemoglobin D, A2, and S have different charges compared to Haemoglobin A.
4. Haemoglobin D and A2 have lower net negative charges, so they migrate less than Haemoglobin A.
5. Haemoglobin S has a different charge distribution due to a mutation, causing it to migrate differently than Haemoglobin A.
Basophilic stippling is classically seen in:
- A. CML
- B. myelosclerosis
- C. chronic lead poisoning
- D. iron def anemia
Correct Answer: C
Rationale: Basophilic stippling is caused by the presence of ribosomal RNA in red blood cells, which is a characteristic finding in chronic lead poisoning. Lead inhibits enzymes involved in heme synthesis, leading to accumulation of ribosomal RNA. In CML, there is an increase in immature white blood cells, not red blood cells. Myelosclerosis is associated with bone marrow fibrosis, not basophilic stippling. Iron deficiency anemia presents with microcytic, hypochromic red blood cells, not basophilic stippling.
A 9-month-old boy has been referred to you for the evaluation of an enlarged abdomen. Imaging studies show a large liver mass (PRETEXT III). Alfa-fetoprotein is 98 ng/mL, and a CT scan of the lungs show bilateral lung metastases. A needle biopsy is performed, and you are planning to review the specimen with the pathologist. Which of the following diagnoses are you suspecting?
- A. Pure fetal histology hepatoblastoma
- B. Embryonal sarcoma of the liver
- C. Fibrolamellar hepatocellular carcinoma
- D. Small cell undifferentiated hepatoblastoma
Correct Answer: D
Rationale: The correct answer is D: Small cell undifferentiated hepatoblastoma. In this case, the key features to consider are the patient's age (9 months old), large liver mass with lung metastases, and elevated alpha-fetoprotein level. Small cell undifferentiated hepatoblastoma is commonly seen in infants, presents as a large liver mass, and frequently metastasizes to the lungs. The alpha-fetoprotein level in this case is also elevated, which is typical for hepatoblastoma. Pure fetal histology hepatoblastoma (A) is less common in older infants, and the presence of lung metastases is not typical. Embryonal sarcoma (B) typically presents as a solitary mass without metastases. Fibrolamellar hepatocellular carcinoma (C) is rare in infants and does not typically present with elevated alpha-fetoprotein levels. Thus, based on the clinical presentation and imaging findings, small cell undifferentiated hepatob