Nokea
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.
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You are discussing prognosis with the mother of a patient with stage 3, group III rhabdomyosarcoma. Which of the following is the most unfavorable primary site?
- A. Extremity
- B. Prostate
- C. Infratemporal fossa
- D. Neck
Correct Answer: A
Rationale: The correct answer is A: Extremity. Rhabdomyosarcoma in extremities has a worse prognosis due to difficulties in achieving complete surgical resection and higher risk of metastasis. Extremity tumors are often larger and more challenging to remove completely, leading to a higher chance of recurrence and poor outcomes. Prostate (B) and neck (D) sites are more favorable as they are easier to access for surgery and have lower rates of metastasis. Infratemporal fossa (C) is also a difficult site, but extremity tumors generally have a worse prognosis due to their anatomical and surgical challenges.
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.
A hospitalized client has a platelet count of 58,000/mm³. What action by the nurse is best?
- A. Encourage high-protein foods.
- B. Institute neutropenic precautions.
- C. Limit visitors to healthy adults.
- D. Place the client on safety precautions.
Correct Answer: D
Rationale: The correct answer is D: Place the client on safety precautions. A platelet count of 58,000/mm³ indicates thrombocytopenia, increasing the risk of bleeding. Placing the client on safety precautions will minimize the risk of injury and bleeding. Encouraging high-protein foods (choice A) is not directly related to managing thrombocytopenia. Neutropenic precautions (choice B) are for clients with low neutrophil counts, not low platelet counts. Limiting visitors to healthy adults (choice C) is important for infection control, not addressing the risk of bleeding.
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: Step-by-step rationale:
1. Sideroblastic anemia results in defective heme synthesis, leading to iron accumulation in the mitochondria.
2. This excess iron saturation decreases the Iron Binding Capacity (IBC) in the serum.
3. Therefore, in sideroblastic anemia, increasing serum iron is associated with a decrease in IBC.
Summary of other choices:
A: Hookworm infestation causes iron deficiency anemia with increased IBC.
C: Alcoholic liver disease can lead to iron overload, not a decrease in IBC.
D: Thalassemia major is associated with increased IBC due to ineffective erythropoiesis.
Basophilic stippling is classically seen in:
- A. CML
- B. myelosclerosis
- C. chronic lead poisoning
- D. iron def anemia
Correct Answer: C
Rationale: Basophilic stippling refers to the presence of blue-staining granules in red blood cells, which is a classic finding in chronic lead poisoning due to the inhibition of heme synthesis. In CML, the primary feature is the presence of the Philadelphia chromosome. Myelosclerosis is characterized by bone marrow fibrosis, not basophilic stippling. Iron deficiency anemia typically presents with microcytic hypochromic red blood cells, not basophilic stippling. Therefore, the correct answer is C: chronic lead poisoning.