Nokea
A nurse is caring for four clients. After reviewing today's laboratory results, which client would the nurse assess first?
- A. Client with an international normalized ratio of 2.8
- B. Client with a platelet count of 128,000/mm3 (128 x 109/L).
- C. Client with a prothrombin time (PT) of 28 seconds
- D. Client with a red blood cell count of 5.1 million/mcl. (5.1 x 1012/L)
Correct Answer: C
Rationale: The correct answer is C because a prothrombin time (PT) of 28 seconds indicates potential issues with blood clotting and can be a sign of bleeding disorders or liver dysfunction, requiring immediate assessment and intervention to prevent complications.
Choice A (INR of 2.8) is within the therapeutic range for clients on anticoagulant therapy, so it's not an immediate concern. Choice B (platelet count of 128,000/mm3) is low but not critically low, so it doesn't require immediate assessment. Choice D (red blood cell count of 5.1 million/mcl) is within the normal range and doesn't indicate urgent issues.
In summary, the nurse should assess the client with a PT of 28 seconds first due to the potential risk of bleeding or clotting disorders, while the other choices are not as urgent.
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A patient receiving blood begins complaining of severe chest pain and a feeling of warmth. What should the nurse do first?
- A. Call the physician.
- B. Administer diuretics as ordered.
- C. Discontinue the blood transfusion.
- D. Assess vital signs and cardiovascular status.
Correct Answer: C
Rationale: The correct first step is to discontinue the blood transfusion (Choice C) because the patient is experiencing symptoms of a transfusion reaction, such as chest pain and warmth. Stopping the transfusion is crucial to prevent further harm. Calling the physician (Choice A) can be done after discontinuing the transfusion. Administering diuretics (Choice B) is not appropriate for this situation. Assessing vital signs and cardiovascular status (Choice D) should be done after stopping the transfusion to monitor the patient's condition.
Blinatumomab, a bispecific T-cell engaging molecule, is active against which CD antigen that is expressed on B-lymphoblasts?
- A. CD10
- B. CD15
- C. CD19
- D. CD20
Correct Answer: C
Rationale: Step-by-step rationale:
1. Blinatumomab is a bispecific molecule designed to engage T-cells to target B-lymphoblasts.
2. It targets CD19, a B-cell-specific antigen expressed on B-lymphoblasts.
3. Engagement of T-cells via CD19 leads to targeted killing of B-lymphoblasts.
4. CD10, CD15, and CD20 are not specific to B-cells, making them incorrect choices.
Summary:
The correct answer is C (CD19) because blinatumomab's mechanism of action specifically targets B-lymphoblasts via CD19. Choices A, B, and D are incorrect as they do not have the same specificity for B-cells as CD19 does.
A 15-year-old female presents with 1 month of fatigue and 3 days of chest pain and shortness of breath. Her physical exam is unremarkable. A chest x-ray shows a large mediastinal mass that is greater than 33% of the diameter of her chest cavity. A biopsy shows nodular sclerosing, classic Hodgkin lymphoma (cHL). Metastatic workup at diagnosis, including CT scan of neck, chest, abdomen, and pelvis and PET scan, shows no other site of disease. According to the Ann Arbor staging system, the patient has which stage of cHL?
- A. Stage I
- B. Stage II
- C. Stage III
- D. Stage IV
Correct Answer: A
Rationale: The correct answer is A: Stage I. In the Ann Arbor staging system for Hodgkin lymphoma, Stage I indicates involvement of a single lymph node region or a single extralymphatic organ or site. In this case, the patient's disease is limited to the mediastinum without involvement of other lymph nodes or organs. The large mediastinal mass is considered as a single site of disease. The absence of disease involvement in other areas based on the metastatic workup supports the classification as Stage I. The other choices (B, C, D) are incorrect because they represent more extensive disease involving multiple lymph node regions or extralymphatic organs, which is not the case in this patient.
Sickle cell an. Is not complicated by:
- A. papillary necrosis
- B. pancreatitis
- C. osteomyelitis
- D. CHF
Correct Answer: B
Rationale: The correct answer is B: pancreatitis. Sickle cell anemia does not typically manifest with pancreatitis. The pathophysiology of sickle cell anemia involves sickle-shaped red blood cells leading to vaso-occlusive crises, resulting in complications such as papillary necrosis, osteomyelitis, and congestive heart failure. Pancreatitis is not a common complication of sickle cell anemia due to the absence of significant involvement of the pancreas in the disease process. Therefore, option B is the correct choice, as it does not align with the typical complications seen in sickle cell anemia.
An oncology nurse is caring for a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood tests, the nurse should anticipate what imbalance?
- A. Hypercalcemia
- B. Hyperproteinemia
- C. Elevated serum viscosity
- D. Elevated RBC count
Correct Answer: A
Rationale: The correct answer is A: Hypercalcemia. In multiple myeloma, bone destruction releases calcium into the bloodstream, leading to hypercalcemia. This can result in symptoms like excessive thirst, fatigue, confusion, and kidney issues. Hyperproteinemia (B) is not typically associated with multiple myeloma. Elevated serum viscosity (C) is more related to conditions like Waldenström macroglobulinemia, not multiple myeloma. Elevated RBC count (D) is not a common finding in multiple myeloma and is more suggestive of polycythemia vera.