Nokea
A nurse is caring for a patient who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the patient's sacral area and petechiae in her forearms. In addition to informing the patient's primary care provider, the nurse should perform what action?
- A. Initiate measures to prevent venous thromboembolism (VTE).
- B. Check the patient's most recent platelet level.
- C. Place the patient on protective isolation.
- D. Ambulate the patient to promote circulatory function.
Correct Answer: B
Rationale: Rationale:
1. Ecchymoses and petechiae indicate potential thrombocytopenia in leukemia.
2. Checking platelet levels will confirm if thrombocytopenia is present.
3. Low platelet levels increase bleeding risk, warranting intervention.
4. Initiating VTE prevention, isolation, or ambulation are not directly related to managing thrombocytopenia in leukemia.
Summary:
- A: VTE measures are not indicated with the given symptoms.
- C: Protective isolation is unnecessary for thrombocytopenia.
- D: Ambulation does not directly address thrombocytopenia.
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A leukemia investigator plans to obtain bone marrow under general anesthesia to measure minimal residual disease (MRD) and to see if this time point can predict early relapse. The specimen will be obtained at a time point when otherwise no bone marrow would be sampled. The results are not shared with the treating oncologist, and no therapeutic interventions are decided or based on the results. Which of the following statements is most accurate about this intervention?
- A. It constitutes a minimal-risk procedure because bone marrow assessments are considered routine for patients diagnosed with acute lymphoblastic leukemia.
- B. It constitutes a minimal-risk procedure because it is a single additional procedure being performed during the course of treatment.
- C. It constitutes a greater than minimal-risk procedure because it is being done under general anesthesia.
- D. It is justifiable because future patients may benefit from knowledge gained by the research.
Correct Answer: C
Rationale: The correct answer is C because obtaining bone marrow under general anesthesia carries inherent risks that make it greater than minimal-risk. Here's a step-by-step rationale:
1. General anesthesia poses risks such as allergic reactions, breathing problems, and potential complications, making the procedure more than minimal-risk.
2. Even though bone marrow assessments are routine for leukemia patients, the use of general anesthesia elevates the risk level.
3. The fact that the results are not shared with the treating oncologist and no therapeutic interventions are based on them indicates that the procedure is solely for research purposes, emphasizing the risk-benefit analysis.
4. Choice A is incorrect because the use of general anesthesia increases the procedure's risk level beyond routine.
5. Choice B is incorrect as the focus should be on the inherent risks of general anesthesia, not just the number of procedures performed.
6. Choice D is irrelevant to the risk assessment of the specific procedure and does not address the immediate safety concerns associated with general anesthesia.
A nurse is preparing to assist with a bone marrow biopsy. Which anatomical site should the nurse anticipate will be used to obtain the specimen?
- A. Ribs
- B. Humerus
- C. Posterior iliac crest
- D. Long bones in the legs
Correct Answer: C
Rationale: The correct answer is C: Posterior iliac crest. This site is commonly used for bone marrow biopsies due to its accessibility and abundance of red bone marrow. The iliac crest is a flat bone, making it easier to access for the procedure compared to the round shape of other bones listed. Ribs (A) are not commonly used due to the risk of pneumothorax. The humerus (B) is not an ideal site as it contains mostly yellow bone marrow. Long bones in the legs (D) are not typically used for bone marrow biopsies due to the difficulty in accessing and the higher risk of complications.
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.
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
A 14-year-old boy presents with cough, shortness of breath, and difficulty lying down. His face and neck swell when his arms are raised. Chest x-ray reveals a large mediastinal mass. A tissue diagnosis is desired. A biopsy is performed with local anesthesia because the anesthesiologist thinks that the patient has a very high general anesthesia risk. Which of the following findings does not make general anesthesia unsafe?
- A. Tumor diameter greater than 45% of transthoracic diameter
- B. Tracheal cross-sectional area less than 50% of predicted
- C. Peak expiratory flow rate less than 50% of predicted
- D. A malignancy of hematopoietic origin
Correct Answer: D
Rationale: The correct answer is D. A malignancy of hematopoietic origin does not inherently make general anesthesia unsafe. This is because anesthesia risk is typically influenced by factors such as airway patency, respiratory function, and cardiac status. Choices A, B, and C all indicate potential complications that could make general anesthesia unsafe, such as airway obstruction due to a large mediastinal mass (A), compromised tracheal cross-sectional area (B), and impaired respiratory function (C). These factors would necessitate careful consideration and potential modifications in the anesthesia plan to ensure patient safety.