Nokea
A patient has a bone marrow aspiration from the posterior iliac crest. Before the procedure, the patient's vital signs were: blood pressure 132/82 mm Hg and pulse 88 beats/min. One hour after the procedure, the blood pressure is 108/70 mm Hg and pulse is 96 beats/min. Which assessment is the least important for the patient at this time?
- A. Observe the puncture site.
- B. Check the patient's most recent complete blood count report.
- C. Ask the patient about feelings of lightheadedness or dizziness.
- D. Determine if the patient had any medications before the procedure.
Correct Answer: B
Rationale: The correct answer is B because the patient's vital signs have changed post-procedure, indicating a potential complication. Checking the complete blood count report is the least important at this time as it does not immediately impact the patient's current condition.
A: Observing the puncture site is important to assess for bleeding or infection.
C: Asking about lightheadedness or dizziness is crucial to monitor for signs of hypovolemia or shock.
D: Determining medications taken before the procedure is essential to identify any potential interactions or adverse effects.
In summary, monitoring vital signs, assessing the puncture site, and checking for symptoms of hypovolemia or shock are more critical post-procedure than reviewing the complete blood count report.
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A patient who is infected with hookworms produces signs and symptoms of anemia. Which of the following can be seen in the peripheral blood smear of the patient?
- A. Howell-Jolly bodies
- B. Basophilic stippling
- C. Target cells
- D. Spherocytes
Correct Answer: B
Rationale: The correct answer is B: Basophilic stippling. Basophilic stippling is a common finding in the peripheral blood smear of patients infected with hookworms due to lead poisoning, which can occur as a result of hookworm infection. Basophilic stippling is seen as the presence of small, dark blue granules within red blood cells and is indicative of impaired heme synthesis. Howell-Jolly bodies (A) are remnants of nuclear material in red blood cells and are typically seen in patients with functional asplenia. Target cells (C) are seen in conditions such as liver disease and hemoglobinopathies. Spherocytes (D) are seen in conditions like hereditary spherocytosis or autoimmune hemolytic anemia, but not specifically in hookworm infection.
A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?
- A. Have you had a recent weight loss?
- B. Do you have any history of lung disease?
- C. Have you noticed any dark or bloody stools?
- D. What is your dietary intake of meats and protein?
Correct Answer: B
Rationale: The correct answer is B: Do you have any history of lung disease? A high hemoglobin and hematocrit can be indicative of chronic hypoxia, often seen in lung diseases like COPD. The nurse should ask about lung disease to explore the possibility of chronic hypoxia as the underlying cause. Choices A, C, and D are incorrect as they do not directly relate to the potential cause of elevated hemoglobin and hematocrit levels in this scenario.
According to the FAB classification, the L2 stage is characterized by:
- A. Large heterogenous blasts with prominent nucleoli
- B. Small homogenous blasts with scanty nucleoli and higher nucleus to cytoplasm ratio
- C. Large homogenous blasts with scanty nucleoli and higher nucleus to cytoplasm ratio
- D. Large blasts with basophilic vacuolated cytoplasm
Correct Answer: C
Rationale: The correct answer is C because according to the FAB classification, the L2 stage is characterized by large homogenous blasts with scanty nucleoli and a higher nucleus to cytoplasm ratio. This stage represents acute lymphoblastic leukemia with a high risk of relapse. Choice A is incorrect as it describes the L1 stage. Choice B is incorrect as it describes the L3 stage. Choice D is incorrect as it does not accurately describe the characteristics of the L2 stage.
An 18-year old male patient presents with bruising, fatigue, and diffuse extremity pain. He is noted to be tachypneic and hypoxic and has a diffuse interstitial infiltrate on chest x-ray. CBC reveals a WBC count of 285,000/mm3 (85% myeloblasts, with monocytic morphology), hemoglobin of 7.9 g/dL, and platelet count of 36,000/mm3. What is the most likely cause of the infiltrate and respiratory symptoms and the most appropriate initial treatment?
- A. Hyperleukocytosis; initiation of induction chemotherapy
- B. Hyperleukocytosis; leukapheresis or manual exchange transfusion and initiation of induction chemotherapy
- C. COVID-19 infection; convalescent plasma and prednisone
- D. Pneumococcal pneumonia; vancomycin
Correct Answer: B
Rationale: The correct answer is B: Hyperleukocytosis; leukapheresis or manual exchange transfusion and initiation of induction chemotherapy. In this scenario, the patient's symptoms and lab findings are consistent with acute myeloid leukemia (AML) with leukostasis, causing hypoxia and interstitial infiltrates. Leukapheresis or manual exchange transfusion is crucial to rapidly reduce the high white blood cell count, which can help alleviate symptoms and prevent complications like tissue hypoxia. Initiation of induction chemotherapy is also essential for long-term management of AML.
Rationale for why other choices are incorrect:
A: Hyperleukocytosis alone without leukostasis does not typically require immediate leukoreduction, as in this case. Induction chemotherapy should be initiated promptly to address the underlying AML.
C: COVID-19 infection would not typically present with such profound leukocytosis and monocytic morphology. Convalescent plasma and prednisone are not
An 18-year old male patient with acute lymphoblastic leukemia recently started maintenance therapy and is complaining of increased hip pain. The pain increases during weight-bearing activity; however, it occasionally hurts at night as well. His CBCd is normal. Which of the following risk factors is most commonly associated with this process?
- A. Younger age at diagnosis
- B. Non-White race
- C. Low body-mass index
- D. Dexamethasone exposure
Correct Answer: D
Rationale: The correct answer is D: Dexamethasone exposure. Dexamethasone is a corticosteroid commonly used in the treatment of acute lymphoblastic leukemia. It can lead to avascular necrosis of the hip, causing hip pain during weight-bearing activities. This is due to its negative impact on bone health and blood supply to the hip joint. Other choices are incorrect because younger age at diagnosis is not a risk factor for avascular necrosis, non-White race and low body-mass index are not directly associated with this process.