Nokea
A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase?
- A. Protamine
- B. Desmopressin
- C. Ferrous sulfate
- D. Heparin
Correct Answer: D
Rationale: The correct answer is D: Heparin. Following an acute MI, a client receiving alteplase may also be prescribed heparin to prevent re-thrombosis and further clot formation. Alteplase is a thrombolytic agent that works by breaking down clots, while heparin is an anticoagulant that helps prevent new clots from forming. Protamine (choice A) is used to reverse the effects of heparin, not typically administered alongside alteplase. Desmopressin (choice B) is used for conditions like diabetes insipidus, unrelated to MI treatment. Ferrous sulfate (choice C) is an iron supplement, not indicated in this scenario.
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The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse?
- A. A 2-cm nontender supraclavicular node
- B. A 1-cm mobile and nontender axillary node
- C. An inability to palpate any superficial lymph nodes
- D. Firm inguinal nodes in a patient with an infected foot
Correct Answer: A
Rationale: The correct answer is A: A 2-cm nontender supraclavicular node. This finding is concerning because supraclavicular nodes are not normally palpable. Enlarged supraclavicular nodes can indicate metastatic cancer. B is incorrect because mobile and nontender axillary nodes are usually benign. C is incorrect as the inability to palpate superficial nodes may be normal. D is incorrect as firm inguinal nodes could indicate a localized infection or inflammation.
The nurse is documenting findings after completing data collection with a patient. What term should the nurse use to document a large area of discoloration from hemorrhage under the skin?
- A. Pallor
- B. Rubor
- C. Petechiae
- D. Ecchymosis
Correct Answer: D
Rationale: The correct term for a large area of discoloration from hemorrhage under the skin is "Ecchymosis" (Choice D). Ecchymosis refers to the medical term for a bruise, which is characterized by a large area of skin discoloration caused by bleeding beneath the skin due to trauma or injury. Pallor (Choice A) refers to paleness of the skin due to decreased blood flow or anemia, not discoloration from hemorrhage. Rubor (Choice B) refers to redness of the skin due to increased blood flow, not discoloration from hemorrhage. Petechiae (Choice C) are tiny red or purple spots on the skin caused by broken capillaries, not a large area of discoloration from hemorrhage as described in the question.
Cooley's anemia is:
- A. Sickle cell an.
- B. thalassemia major
- C. high ESR
- D. aplastic an.
Correct Answer: B
Rationale: Cooley's anemia is another term for thalassemia major, a genetic disorder characterized by abnormal hemoglobin production leading to severe anemia. The correct answer is B because Cooley's anemia specifically refers to thalassemia major. Sickle cell anemia (A) is a different genetic disorder caused by abnormal hemoglobin shape. High ESR (C) is a nonspecific marker of inflammation and does not directly relate to Cooley's anemia. Aplastic anemia (D) is a condition where the bone marrow does not produce enough blood cells, not related to Cooley's anemia.
A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?
- A. Give two more courses of intensification chemotherapy.
- B. Perform an autologous hematopoietic stem cell transplant (HSCT).
- C. Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
- D. Give one more course of intensification chemotherapy and then 1 year of maintenance chemotherapy.
Correct Answer: C
Rationale: The correct answer is C: Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
Rationale:
1. The patient achieved morphologic remission and MRD-negative status after the second course of chemotherapy, indicating good response.
2. Given the high-risk AML with negative cytogenetics and molecular markers, HSCT from a matched unrelated donor offers the best chance for long-term remission.
3. HSCT provides a curative option by replacing the patient's diseased bone marrow with healthy donor cells, reducing the risk of relapse.
4. The presence of a large number of potential matched unrelated donors increases the likelihood of finding a suitable donor for the transplant.
Summary:
- Option A: Giving more courses of intensification chemotherapy may not address the high-risk nature of the disease and may not provide a curative outcome.
- Option B: Autologous HSCT uses the patient's own stem cells, which may carry the risk of relapse due
A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding?
- A. Hematocrit of 35%
- B. Hemoglobin of 11.8 g/dL
- C. Platelet count of 400000/L
- D. White blood cell (WBC) count of 2800/L
Correct Answer: D
Rationale: The correct answer is D: White blood cell (WBC) count of 2800/L. A low WBC count (leukopenia) in an older patient can indicate an impaired immune system, making them vulnerable to infections. This is concerning as older adults have a weakened immune response. A: Hematocrit of 35% is within the normal range. B: Hemoglobin of 11.8 g/dL is slightly low but not a major concern as long as it's not significantly lower. C: Platelet count of 400000/L is within the normal range and not typically a cause for concern.