Nokea
A patient receiving blood begins complaining of severe chest pain and a feeling of warmth. What should the nurse do first?
- A. Call the physician.
- B. Administer diuretics as ordered.
- C. Discontinue the blood transfusion.
- D. Assess vital signs and cardiovascular status.
Correct Answer: C
Rationale: The correct first action is to discontinue the blood transfusion (Choice C). This is because the patient's symptoms of severe chest pain and warmth suggest a possible transfusion reaction, which can be life-threatening. By stopping the transfusion, the nurse can prevent further harm to the patient. Calling the physician (Choice A) can be done after stopping the transfusion. Administering diuretics (Choice B) without knowing the cause of symptoms can exacerbate the situation. Assessing vital signs and cardiovascular status (Choice D) is important but should come after stopping the transfusion to prioritize patient safety.
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After seven days of treatment with sulfonamides, a patient's hemoglobin had decreased from 14.7 gm/100ml to 10gm/100ml. The most likely cause of hemolysis in this patient is
- A. Sickle cell disease
- B. Thalassemia minor
- C. Hereditary spherocytosis
- D. Glucose 6-phosphate dehydrogenase deficiency (G6PD)
Correct Answer: D
Rationale: The correct answer is D: Glucose 6-phosphate dehydrogenase deficiency (G6PD). G6PD deficiency can cause hemolysis in response to oxidative stress, such as medications like sulfonamides. The decrease in hemoglobin levels after sulfonamide treatment indicates hemolysis, which is a common manifestation of G6PD deficiency. Sickle cell disease (A), thalassemia minor (B), and hereditary spherocytosis (C) do not typically present with hemolysis triggered by sulfonamides. G6PD deficiency is the most likely cause in this scenario due to the timing of hemolysis after the drug exposure and the characteristic response of G6PD-deficient red blood cells to oxidative stress.
The nurse is assessing a patient with chronic lung disease. Which finding indicates long-term hypoxia?
- A. Pallor
- B. Dyspnea
- C. Clubbed fingertips
- D. Pulmonary crackles
Correct Answer: C
Rationale: The correct answer is C: Clubbed fingertips. Clubbing is a sign of prolonged hypoxia due to chronic lung disease. It is characterized by enlargement and rounding of the fingertips. This occurs as a result of chronic hypoxia causing tissue changes in the fingers. Pallor (A) is a pale skin color often indicating decreased blood flow. Dyspnea (B) is difficulty breathing and can be an acute symptom of hypoxia. Pulmonary crackles (D) are abnormal lung sounds indicating fluid accumulation and are not specific to long-term hypoxia.
A 36-year-old woman presented with weakness, lassitude, and feeling easily tired. Her bone marrow aspirate showed 15% myeloblasts and reduced erythropoiesis. The most likely cause is
- A. Acute myeloid leukemia
- B. Acute lymphoid leukemia
- C. Myelofibrosis
- D. Myelodysplastic syndrome
Correct Answer: D
Rationale: The correct answer is D: Myelodysplastic syndrome. The patient's symptoms of weakness, lassitude, and reduced erythropoiesis along with increased myeloblasts in bone marrow are indicative of a myelodysplastic syndrome. This condition is characterized by ineffective hematopoiesis leading to cytopenias and an increased risk of progression to acute myeloid leukemia. Acute myeloid leukemia (choice A) typically presents with more aggressive symptoms and higher blast count. Acute lymphoid leukemia (choice B) primarily affects lymphoid cells, not myeloid cells. Myelofibrosis (choice C) is characterized by fibrosis in the bone marrow, leading to extramedullary hematopoiesis, which is not seen in this case.
A newborn infant develops jaundice on day of life 2. Labs are drawn, and she has a hemoglobin of 7.4 g/dL with a reticulocyte count of 8%. Upon peripheral blood smear review, she is found to have bizarre red cell forms with significant polkilocytosis. Although her parents have normal blood counts, on review of their peripheral blood smears, they both have a moderate number of ovalocytes. Which of the following is the most likely cause of the infant's red cell findings?
- A. She has an autosomal dominant ankyrin mutation from one of her parents causing hereditary spherocytosis.
- B. She has inherited band 3 variants from each parent and will likely need a splenectomy after she turns 5 years old.
- C. She has inherited an alpha-spectrin mutation from both of her parents and may experience an improvement in her anemia over time.
- D. She has inherited a PKLR variant from each parent, and enzyme testing will be consistent with her diagnosis of pyruvate kinase deficiency.
Correct Answer: C
Rationale: The correct answer is C because the infant likely has hereditary elliptocytosis, an autosomal dominant disorder caused by mutations in the alpha-spectrin gene. Ovalocytes and polkilocytosis are characteristic of this condition. Since both parents have ovalocytes, it is likely that the infant inherited mutations from each parent, resulting in a more severe presentation. Anemia in hereditary elliptocytosis can improve over time due to compensatory mechanisms. Choices A, B, and D are incorrect as they describe different genetic disorders (hereditary spherocytosis, hereditary stomatocytosis, and pyruvate kinase deficiency, respectively) and do not match the clinical and family history provided.
A female patient's hematocrit level is 50% and oxygen saturation is 98% on room air. What should the nurse suspect as being the cause for this patient's hematocrit level?
- A. Dehydration
- B. Chronic renal failure
- C. Bone marrow suppression
- D. Bleeding esophageal varices
Correct Answer: A
Rationale: The correct answer is A: Dehydration. Dehydration can lead to hemoconcentration, resulting in an elevated hematocrit level. When a person is dehydrated, the plasma volume decreases, causing an increase in the proportion of red blood cells in the blood, leading to a higher hematocrit level. In this case, the patient's high hematocrit level of 50% is likely due to dehydration rather than the other options. Oxygen saturation being 98% on room air indicates adequate oxygenation, ruling out chronic renal failure, bone marrow suppression, and bleeding esophageal varices as potential causes for the high hematocrit level in this patient.