Nokea
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 because a low WBC count of 2800/L indicates leukopenia, which can compromise the immune system in older adults, leading to increased susceptibility to infections. This finding is concerning as it can pose serious health risks.
A: A hematocrit of 35% is within the normal range for older adults and not a cause for concern.
B: A hemoglobin level of 11.8 g/dL is slightly lower but still within an acceptable range for older adults and unlikely to be a major concern.
C: A platelet count of 400000/L is within the normal range and would not be a significant worry for the nurse.
In summary, a low WBC count can indicate a weakened immune system, making it the most concerning finding among the choices given.
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Half life of plat. Is:
- A. 1-2days
- B. 3-4days
- C. 5-6days
- D. 7-8days
Correct Answer: B
Rationale: The correct answer is B (3-4 days) because the half-life of platinum is known to be around 3-4 days based on scientific research and studies. This means that within this time frame, half of the amount of platinum will decay or disintegrate. The other choices (A, C, D) are incorrect because they do not align with the established half-life value of platinum. Option A (1-2 days), C (5-6 days), and D (7-8 days) do not fall within the typical range of platinum's half-life duration as determined by scientific data and experimentation. Therefore, option B is the most accurate and scientifically supported choice for the half-life of platinum.
A 13-year-old boy presents to the emergency department with complaints of headache and visual changes. History reveals progressive dyspnea on exertion, generalized fatigue, and increased bruising. His labs are significant for a WBC of 350,000/mcL, of which 80% are reported to be blasts and appear to be myeloblasts without the presence of Auer rods. His hemoglobin is 7.2 g/dL, and his platelets are 18,000/mcL. A CT scan of the head shows a small intracerebral hemorrhage. His coags are normal. Which of the following is the most appropriate therapy?
- A. Start induction chemotherapy.
- B. Perform emergent leukapheresis followed the next day by induction chemotherapy.
- C. Perform emergent leukapheresis plus hydroxyurea.
- D. Provide emergent cranial radiation plus hydroxyurea followed the next day by induction chemotherapy.
Correct Answer: C
Rationale: The correct answer is C: Perform emergent leukapheresis plus hydroxyurea. In this scenario, the patient presents with symptoms suggestive of acute myeloid leukemia with hyperleukocytosis and intracerebral hemorrhage. The goal of emergent therapy is to rapidly reduce the high blast count to prevent further complications such as leukostasis and hemorrhage. Leukapheresis can provide immediate reduction in the blast count, while hydroxyurea can further decrease the WBC count. Starting induction chemotherapy immediately can lead to tumor lysis syndrome due to rapid cell destruction. Emergent cranial radiation is not the primary intervention for hyperleukocytosis. Performing leukapheresis alone without adjunctive therapy like hydroxyurea may not adequately control the blast count. Thus, the most appropriate initial therapy is emergent leukapheresis plus hydroxyurea to stabilize the patient before initiating induction chemotherapy.
The nurse is monitoring a patient receiving a blood product and is concerned that the blood is going to deteriorate before it is complete infused. What is the maximum time that blood can hang during infusion before it begins to deteriorate?
- A. 1 hour
- B. 2 hours
- C. 3 hours
- D. 4 hours
Correct Answer: D
Rationale: The correct answer is D: 4 hours. Blood products typically have a maximum hang time of 4 hours to prevent bacterial contamination and ensure the integrity of the product. Beyond 4 hours, the risk of bacterial growth and contamination increases, leading to potential harm for the patient. Therefore, it is crucial to adhere to this time limit to maintain the safety and effectiveness of the blood product.
Summary:
- A (1 hour), B (2 hours), and C (3 hours) are incorrect because they do not align with the standard maximum hang time for blood products, which is 4 hours. Adhering to this time limit is essential to prevent deterioration and ensure patient safety.
A study is designed to investigate the rates of central line–associated blood stream infections (CLABSI) among pediatric hematology/oncology patients. Investigators wish to compare the length of stay (LOS) between subjects receiving three common central line types (totally implanted catheter [port], peripherally inserted central catheter [PICC], and tunneled externalized catheter [TEC]). It is discovered that LOS is not normally distributed. What is the appropriate test for comparing the LOS between patients receiving the three central line types?
- A. Student's t test
- B. ANOVA
- C. Wilcoxon-Mann-Whitney test
- D. Kruskal-Wallis test
Correct Answer: D
Rationale: The correct answer is D: Kruskal-Wallis test. This non-parametric test is used to compare the medians of three or more independent groups when the data is not normally distributed, as in this case with LOS. It is an extension of the Wilcoxon-Mann-Whitney test, which compares two groups. The Kruskal-Wallis test assesses whether the medians of the groups are equal or different by ranking all observations, calculating the sum of ranks for each group, and then comparing these sums. It is appropriate here because it allows for comparison of central line types without assuming normality. The other choices (A: Student's t test and B: ANOVA) require the data to be normally distributed, which is not the case in this scenario. Choice C: Wilcoxon-Mann-Whitney test is for comparing two groups, not three or more.
Koilonychias is a specific feature of
- A. Hemolytic anemia
- B. Sickle cell disease
- C. Thalassemia major
- D. Iron deficiency anemia
Correct Answer: D
Rationale: Step-by-step rationale for why the correct answer is D (Iron deficiency anemia):
1. Koilonychias is characterized by spoon-shaped nails, a classic sign of iron deficiency anemia due to changes in nail structure.
2. Iron deficiency leads to decreased production of keratin, causing nail deformities like koilonychias.
3. Hemolytic anemia (choice A) and Sickle cell disease (choice B) are not typically associated with koilonychias.
4. Thalassemia major (choice C) can cause nail changes, but koilonychias is more commonly seen in iron deficiency anemia.