Nokea
A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness?
- A. Amylase level
- B. Reticulocyte count
- C. C-reactive protein
- D. Creatinine clearance
Correct Answer: B
Rationale: The correct answer is B: Reticulocyte count. Reticulocytes are immature red blood cells. In megaloblastic anemia, there is a decrease in red blood cell production due to a deficiency in folic acid. Monitoring reticulocyte count helps determine if the folic acid treatment is increasing red blood cell production.
A: Amylase level is not relevant to monitoring the effectiveness of folic acid in treating megaloblastic anemia.
C: C-reactive protein is a marker for inflammation and not specific to monitoring anemia treatment.
D: Creatinine clearance is used to assess kidney function, not the effectiveness of folic acid in treating anemia.
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Non thrombocytopenic purpura is seen in all except:
- A. vasculitis
- B. uraemia
- C. hereditary haemorrhagic telangiectasia
- D. SLE
Correct Answer: D
Rationale: The correct answer is D: SLE. Non-thrombocytopenic purpura refers to purpura without low platelet count. In SLE, thrombocytopenia is common, leading to purpura. A: Vasculitis can cause non-thrombocytopenic purpura due to vessel inflammation. B: Uraemia can lead to non-thrombocytopenic purpura due to vascular damage. C: Hereditary haemorrhagic telangiectasia presents with telangiectasias and recurrent epistaxis, not purpura.
After seven days of treatment with sulfonamides, a patient's hemoglobin had decreased from 14.7 gm/100ml to 10gm/100ml. The most likely cause of hemolysis in this patient is
- A. Sickle cell disease
- B. Thalassemia minor
- C. Hereditary spherocytosis
- D. Glucose 6-phosphate dehydrogenase deficiency (G6PD)
Correct Answer: D
Rationale: The correct answer is D: Glucose 6-phosphate dehydrogenase deficiency (G6PD). G6PD deficiency can cause hemolysis in response to oxidative stress, such as medications like sulfonamides. The decrease in hemoglobin levels after sulfonamide treatment indicates hemolysis, which is a common manifestation of G6PD deficiency. Sickle cell disease (A), thalassemia minor (B), and hereditary spherocytosis (C) do not typically present with hemolysis triggered by sulfonamides. G6PD deficiency is the most likely cause in this scenario due to the timing of hemolysis after the drug exposure and the characteristic response of G6PD-deficient red blood cells to oxidative stress.
You are seeing a 2-year-old girl with new onset of fever and bronchitis. She has maculopapular rash and hepatosplenomegaly. Blood smear shows leukocytosis (100,000/mm3), anemia, and thrombocytopenia. Ancillary tests include fetal hemoglobin of 80% and normal blood karyotype. What is the most likely diagnosis?
- A. Leukemoid Reaction
- B. Acute lymphoblastic leukemia (ALL)
- C. Chronic myeloid leukemia (CML)
- D. Juvenile myelomonocytic leukemia (JMML)
Correct Answer: D
Rationale: The most likely diagnosis in this scenario is Juvenile myelomonocytic leukemia (JMML). This is supported by the presence of hepatosplenomegaly, maculopapular rash, leukocytosis, anemia, and thrombocytopenia in a young child. The elevated fetal hemoglobin level is characteristic of JMML. Additionally, a normal blood karyotype helps differentiate JMML from other leukemias.
Choice A (Leukemoid Reaction) is incorrect because it is typically a reactive condition due to infections, not a primary hematological malignancy like JMML. Choice B (Acute lymphoblastic leukemia) is less likely due to the presence of hepatosplenomegaly and a high fetal hemoglobin level. Choice C (Chronic myeloid leukemia) is less likely in a young child with the given clinical presentation.
An older adult patient is receiving a transfusion of packed red blood cells after being injured in a car accident. On assessment, the nurse notes a new finding of bounding pulse, crackles, and increasing dyspnea. What should the nurse do first, after stopping the transfusion?
- A. Assess vital signs.
- B. Raise the head of the bed.
- C. Encourage the patient to deep breathe and cough.
- D. Administer pm diphenhydramine (Benadryl) as ordered.
Correct Answer: B
Rationale: The correct answer is B: Raise the head of the bed. This action is crucial in managing the potential complication of fluid overload in the patient receiving a blood transfusion. Elevating the head of the bed helps reduce venous return to the heart, decreasing preload and cardiac workload. This can alleviate symptoms like dyspnea and crackles associated with fluid overload. Assessing vital signs (choice A) is important but should follow positioning the patient appropriately. Encouraging deep breathing and coughing (choice C) may exacerbate the patient's respiratory distress. Administering diphenhydramine (choice D) is not indicated for the symptoms described.
A 3-month-old female presents to the emergency room with vomiting and abdominal distension. She has a left-side abdominal mass, and an abdominal ultrasound confirms an 8-cm mass arising from the left kidney. Liver lesions are also noted. Nephrectomy is performed and reveals a histologic diagnosis of malignant rhabdoid tumor of the kidney (MRTK). Which of the following is not a true statement about the management of this patient?
- A. Most patients with rhabdoid tumor of the kidney present in infancy.
- B. Most patients with rhabdoid tumor of the kidney present with metastatic (stage III or IV) disease.
- C. She has an excellent prognosis with surgery, chemotherapy, and radiation.
- D. Germline testing for SMARCB1/INI1 mutation on chromosome 22 is recommended, with brain MRI every 3 months until she is 5 years old, if testing is germline positive for SMARCB1/INI1.
Correct Answer: C
Rationale: The correct answer is C: She has an excellent prognosis with surgery, chemotherapy, and radiation.
Rationale:
1. Malignant rhabdoid tumor of the kidney (MRTK) is an aggressive cancer with poor prognosis.
2. Even with aggressive treatment, including surgery, chemotherapy, and radiation, the prognosis is generally poor due to high rates of recurrence and metastasis.
3. Therefore, stating that the patient has an excellent prognosis with the mentioned treatments is not true.
Summary of other choices:
A: Most patients with rhabdoid tumor of the kidney present in infancy - True, MRTK commonly presents in infancy.
B: Most patients with rhabdoid tumor of the kidney present with metastatic (stage III or IV) disease - True, MRTK often presents with metastatic disease.
D: Germline testing for SMARCB1/INI1 mutation on chromosome 22 is recommended, with brain MRI every 3 months until she is