Nokea
A nursing student wants to know why clients with chronic obstructive pulmonary disease tend to be polycythemic. What response by the nurse instructor is best?
- A. It is due to side effects of medications for bronchodilation.
- B. It is from overactive bone marrow in response to chronic disease.
- C. It combats the anemia caused by an increased metabolic rate.
- D. It compensates for tissue hypoxia caused by lung disease.
Correct Answer: D
Rationale: The correct answer is D because in chronic obstructive pulmonary disease (COPD), the lungs are unable to efficiently oxygenate the blood, leading to tissue hypoxia. Polycythemia is the body's compensatory mechanism to increase red blood cell production in an attempt to improve oxygen-carrying capacity to tissues. Choices A, B, and C are incorrect as polycythemia in COPD is primarily a response to tissue hypoxia rather than medication side effects, overactive bone marrow, or combating anemia related to increased metabolic rate.
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A 14-year-old Syrian male with beta thalassemia major has relocated to your community as a refugee. He has been receiving chronic transfusion therapy in Turkey for the past 3 years. On his first visit, you notice that his height is below the fifth percentile. He has skin discoloration and hepatosplenomegaly. His mother reports they have not had regular access to chelation therapy. Laboratory testing shows a serum ferritin of 6,200 ng/mL. A cardiac MRI shows grossly normal cardiac function but a T2* value of 9 ms. What is the most likely cause of his short stature?
- A. Lack of regular blood transfusion causing growth failure
- B. Cirrhosis and liver failure
- C. Ineffective erythropoiesis and chronic anemia
- D. Growth hormone deficiency due to iron deposition in the pituitary
Correct Answer: D
Rationale: The correct answer is D: Growth hormone deficiency due to iron deposition in the pituitary. Iron overload in patients with beta thalassemia major can lead to iron deposition in various organs, including the pituitary gland, impairing its function. This can result in growth hormone deficiency, leading to short stature. In this case, the patient's history of chronic transfusions and high serum ferritin level indicate iron overload, which can affect the pituitary gland. Choices A, B, and C are incorrect because growth failure in beta thalassemia major is primarily attributed to endocrine complications such as growth hormone deficiency, rather than lack of transfusions, cirrhosis, or ineffective erythropoiesis.
Sickle cell an. Is not complicated by:
- A. papillary necrosis
- B. pancreatitis
- C. osteomyelitis
- D. CHF
Correct Answer: B
Rationale: Step-by-step rationale for choice B (pancreatitis) being correct:
1. Sickle cell anemia primarily affects red blood cells, leading to vaso-occlusive crises.
2. Pancreatitis is not a known complication of sickle cell anemia.
3. Complications of sickle cell anemia commonly involve organs affected by sickling, such as the bones (osteomyelitis), kidneys (papillary necrosis), and heart (CHF).
Summary:
A: Papillary necrosis - Correct, as it can affect the kidneys in sickle cell anemia.
B: Pancreatitis - Correct, as it is not a typical complication of sickle cell anemia.
C: Osteomyelitis - Incorrect, as it can affect the bones in sickle cell anemia.
D: CHF - Incorrect, as it can affect the heart in sickle cell anemia.
The following pathological features is true regarding non-Hodgkin lymphoma (NHL)
- A. Classical Reed-Sternberg (RS) cells are neoplastic cells
- B. B cell phenotype is more common
- C. Contiguous group of lymph nodes are affected
- D. It is not associated with leukemic phase of disease
Correct Answer: B
Rationale: The correct answer is B because B cell phenotype is more common in non-Hodgkin lymphoma (NHL). This is supported by the fact that the majority of NHL cases arise from B cells in the lymphoid tissue. Choice A is incorrect as RS cells are characteristic of Hodgkin lymphoma, not NHL. Choice C is incorrect because NHL can involve non-contiguous lymph nodes. Choice D is incorrect because NHL can have a leukemic phase known as leukemic lymphoma.
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.
A 13-year-old Hispanic girl is found to have a WBC count of 6,500/mm3 with 40% Auer rod–containing granular blasts that, by flow cytometry, express very bright CD33 but are negative for human leukocyte antigen–DR isotype (HLA-DR). She is oozing blood around her peripheral IV site. Coagulation studies reveal an international normalized ratio (INR) of 3.4, a fibrinogen of 170, and a markedly elevated D-dimer. Marrow aspirate shows nearly 90% blasts with a similar morphology. You send the marrow to the fluorescence in situ hybridization (FISH) lab and request STAT testing for the most likely recurrent genetic abnormality based on the clinical presentation. How do you plan to initiate therapy?
- A. Perform a lumbar puncture to determine leukemic involvement, then proceed with induction chemotherapy.
- B. Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support.
- C. Start dexamethasone and hydroxyurea immediately while aggressively managing coagulopathy with blood product support.
- D. Start induction chemotherapy, obtain HLA typing, and start a donor search because of the poor prognosis associated with this leukemic phenotype.
Correct Answer: B
Rationale: The correct answer is B: Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support. In this scenario, the patient presents with acute promyelocytic leukemia (APL), characterized by the presence of Auer rod-containing blasts expressing CD33 and negative for HLA-DR. The presence of coagulopathy with elevated INR, D-dimer, and oozing blood suggests disseminated intravascular coagulation (DIC), a common complication in APL. Immediate treatment with ATRA is crucial to differentiate and mitigate the risk of DIC worsening. ATRA induces differentiation of APL blasts, resolving the coagulopathy. Aggressive management of coagulopathy with blood product support is essential to prevent bleeding complications. Lumbar puncture (choice A), dexamethasone and hydroxyurea (choice C), and starting a donor search (choice D) are not indicated as the