Nokea
A patient has an altered level of T and B cells. The nurse realizes that these cells are members of which cell type?
- A. Platelets
- B. Eosinophils
- C. Lymphocytes
- D. Red blood cells
Correct Answer: C
Rationale: The correct answer is C: Lymphocytes. T and B cells are types of lymphocytes, a crucial component of the immune system responsible for fighting infections. T cells regulate immune responses, while B cells produce antibodies. Platelets (A), eosinophils (B), and red blood cells (D) are not involved in immune responses and do not possess the functions of T and B cells. Platelets are involved in blood clotting, eosinophils are a type of white blood cell involved in allergic reactions, and red blood cells are responsible for oxygen transport.
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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 16-year-old female presents to the emergency room with a new complaint of chest pain. When performing a review of systems and physical examination, which of the following would substantially decrease your suspicion for a diagnosis of pulmonary embolism?
- A. Cough
- B. Fever
- C. Rib tenderness
- D. Shortness of breath
Correct Answer: C
Rationale: The correct answer is C: Rib tenderness. Rib tenderness would decrease suspicion for pulmonary embolism because it suggests a musculoskeletal origin of chest pain rather than a vascular one. Pulmonary embolism typically presents with symptoms such as shortness of breath, pleuritic chest pain, and sometimes cough, but rib tenderness is not a common finding in this condition. Fever is non-specific and can be present in various conditions, including pulmonary embolism. Shortness of breath is a key symptom of pulmonary embolism and would increase suspicion for this diagnosis.
A 50-year-old male who had frequent infections of his upper respiratory tract manifested with subcutaneous petechiae over his arms and legs. Investigations revealed low hemoglobin and a dry tap marrow. The most likely condition the patient is suffering from
- A. Iron deficiency anemia
- B. Megaloblastic anemia
- C. Hemolytic anemia
- D. Aplastic anemia
Correct Answer: D
Rationale: The correct answer is D: Aplastic anemia. This condition is characterized by pancytopenia, which includes low hemoglobin (anemia), low platelets (manifested as petechiae), and low white blood cells (frequent infections). Dry tap marrow is a classic finding in aplastic anemia due to bone marrow failure. Iron deficiency anemia (choice A) typically presents with microcytic hypochromic anemia without pancytopenia. Megaloblastic anemia (choice B) is characterized by macrocytic anemia with hypersegmented neutrophils and is usually caused by deficiencies in vitamin B12 or folate. Hemolytic anemia (choice C) presents with anemia due to increased destruction of red blood cells, which does not explain the low platelets and white blood cells seen in this patient.
A client is having a radioisotopic imaging scan. What action by the nurse is most important?
- A. Assess the client for shellfish allergies.
- B. Place the client on radiation precautions.
- C. Sedate the client before the scan.
- D. Teach the client about the procedure.
Correct Answer: D
Rationale: The correct answer is D because educating the client about the procedure is crucial for informed consent, cooperation, and reducing anxiety. This empowers the client to participate actively in their care. Assessing for shellfish allergies (A) is irrelevant unless a specific contrast agent is used. Placing the client on radiation precautions (B) is unnecessary for radioisotopic imaging. Sedating the client (C) may not be indicated and should be avoided if possible. Teaching the client about the procedure (D) addresses the immediate need and supports client safety and understanding.
Several gene mutations have been associated with juvenile myelomonocytic leukemia (JMML), and they may or may not have prognostic implications. A gene expression–based classification system has been found to be an independent predictor of clinical outcome in these patients. What is the disease signature that predicts a poor outcome?
- A. Tyrosine kinase inhibitors
- B. Acute myeloid leukemia–like
- C. Chronic myeloid leukemia-like
- D. BRAF pathway abnormalities
Correct Answer: B
Rationale: The correct answer is B: Acute myeloid leukemia-like. This is because JMML shares similarities with acute myeloid leukemia in terms of aggressive progression and poor outcomes. Children with JMML who exhibit an acute myeloid leukemia-like gene expression signature have been shown to have a worse prognosis compared to those with other gene expression profiles. The other choices (A, C, D) are incorrect because tyrosine kinase inhibitors are not directly related to predicting clinical outcomes in JMML, chronic myeloid leukemia-like gene expression profile does not necessarily predict poor outcomes in JMML, and BRAF pathway abnormalities are not specifically associated with predicting poor outcomes in JMML.