Nokea
A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions?
- A. Myocardial infarction
- B. Peptic ulcer disease
- C. Pancreatitis
- D. Myasthenia gravis
Correct Answer: B
Rationale: Clopidogrel is contraindicated for clients with peptic ulcer disease due to its antiplatelet effect, which can increase the risk of gastrointestinal bleeding. Myocardial infarction, pancreatitis, and myasthenia gravis are not direct contraindications for clopidogrel. Myocardial infarction can actually be an indication for clopidogrel use to prevent further cardiovascular events. Pancreatitis and myasthenia gravis are not known to have specific contraindications with clopidogrel.
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A laboratory finding of aplastic anaemia
- A. Pancytopaenia
- B. Erythrocytosis
- C. Bone marrow hypercellularity
- D. Reticulocytosis
Correct Answer: A
Rationale: The correct answer is A: Pancytopenia. Aplastic anemia is characterized by a decrease in all blood cell types (red blood cells, white blood cells, and platelets), leading to pancytopenia. This is due to bone marrow failure, resulting in decreased production of blood cells. Erythrocytosis (B) is an increase in red blood cells, which is the opposite of what is seen in aplastic anemia. Bone marrow hypercellularity (C) is not typically observed in aplastic anemia, as the bone marrow is usually hypocellular. Reticulocytosis (D) is an increase in immature red blood cells and is not a characteristic finding in aplastic anemia where there is decreased production of all blood cell types.
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.
You have a new 7-year-old female patient with a WBC count of 6,000/mm3, hemoglobin of 7.2 g/dL, and platelet count of 30,000/mm3. A bone marrow aspirate reveals 14% blasts with a monocytic morphologic appearance that are surface marker positive for CD33. You receive a call from the fluorescence in situ hybridization (FISH) lab that the bone marrow is positive for KMT2A rearrangement in 68% of cells. Your staff asks whether this represents a diagnosis of acute leukemia in the current classification scheme for this type of hematologic malignancy. What would you say?
- A. No, because for a diagnosis of acute leukemia you must have 30% or more blasts in the marrow.
- B. No, because for a diagnosis of acute leukemia you must have 20% or more blasts in the marrow.
- C. No, because the cytogenetics do not include +21, monosomy 7, or trisomy 8.
- D. Yes, because the FISH is positive for KMT2A rearrangement.
Correct Answer: D
Rationale: The correct answer is D: Yes, because the FISH is positive for KMT2A rearrangement.
Rationale:
1. KMT2A rearrangement is a genetic abnormality commonly associated with acute leukemia.
2. Presence of blasts (14%) with monocytic appearance and positive for CD33 also supports the diagnosis.
3. The percentage of blasts (14%) is not below the threshold for acute leukemia diagnosis.
4. The specific cytogenetic findings mentioned in choice C are not absolute requirements for diagnosing acute leukemia.
In summary, the presence of KMT2A rearrangement, along with morphologic and flow cytometry findings, supports the diagnosis of acute leukemia in this case, making choice D the correct answer.
You are seeing a 2-year-old girl with new onset of fever and bronchitis. She has maculopapular rash and hepatosplenomegaly. Blood smear shows leukocytosis (100,000/mm3), anemia, and thrombocytopenia. Ancillary tests include fetal hemoglobin of 80% and normal blood karyotype. What is the most likely diagnosis?
- A. Leukemoid Reaction
- B. Acute lymphoblastic leukemia (ALL)
- C. Chronic myeloid leukemia (CML)
- D. Juvenile myelomonocytic leukemia (JMML)
Correct Answer: D
Rationale: The most likely diagnosis in this case is Juvenile myelomonocytic leukemia (JMML). JMML is a rare myelodysplastic/myeloproliferative neoplasm seen in young children. The clinical presentation of fever, rash, hepatosplenomegaly, leukocytosis, anemia, and thrombocytopenia is consistent with JMML. The presence of fetal hemoglobin of 80% is a key finding in JMML, as it is a distinguishing feature. Additionally, a normal blood karyotype rules out chromosomal abnormalities commonly seen in other leukemias. Leukemoid reaction (Choice A) is characterized by a reactive increase in leukocyte count due to an underlying condition, but it does not explain the other findings in this case. Acute lymphoblastic leukemia (ALL - Choice B) primarily affects lymphoid cells, not myeloid cells as seen in this case. Chronic myeloid leukemia (C
A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage?
- A. Rapid pulse
- B. Yellowing of the sclera
- C. Elevated blood pressure
- D. Pale-colored stools
Correct Answer: A
Rationale: The correct answer is A: Rapid pulse. When a client is undergoing anticoagulant therapy with heparin, the nurse should monitor for signs of hemorrhage. A rapid pulse can indicate internal bleeding, a common complication of anticoagulant therapy. Other choices such as B: Yellowing of the sclera, C: Elevated blood pressure, and D: Pale-colored stools are not typically associated with hemorrhage. Yellowing of the sclera may indicate jaundice, elevated blood pressure may be related to other conditions, and pale-colored stools may indicate liver or gallbladder issues. Rapid pulse is the most pertinent finding related to hemorrhage in this context.