Nokea
A patient with advanced leukemia is responding poorly to treatment. The nurse finds the patient tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurse's most appropriate action?
- A. Tell him that you will give him privacy and leave the room.
- B. Offer to call pastoral care.
- C. Ask if he would like you to sit with him while he collects his thoughts.
- D. Tell him that you can understand how he's feeling.
Correct Answer: C
Rationale: The correct answer is C because it demonstrates empathy and support. By asking if the patient would like the nurse to sit with him, it shows willingness to provide comfort and assistance. This action allows the patient to feel supported while expressing his feelings.
Choice A is incorrect because leaving the patient alone may make him feel abandoned. Choice B is not the most immediate action needed in this situation. Choice D is incorrect because it assumes understanding without actively offering support.
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You are consulting on a 10-year-old male with severe persistent neutropenia, a history of recurrent infections, and warts. The rest of the peripheral blood count is normal. His mother also has neutropenia. Bone marrow examination shows a hypercellular marrow and retained myeloid cells with vacuolated cytoplasm. There are no abnormalities in the red cells or platelet precursors. Cytogenetics are 46XY. You start granulocyte colony stimulating factor therapy and the neutrophil count increases. A mutation in which of the following genes is most likely to have caused this familial inherited bone marrow failure syndrome?
- A. CXCR4
- B. ELANE
- C. GATA 2
- D. Mitochondrial DNA
Correct Answer: A
Rationale: The correct answer is A: CXCR4. In this case, the patient presents with severe neutropenia, recurrent infections, and warts, suggestive of WHIM syndrome, where CXCR4 mutations are often involved. CXCR4 plays a crucial role in immune cell trafficking and retention in the bone marrow. The hypercellular marrow and vacuolated myeloid cells are consistent with WHIM syndrome. The absence of abnormalities in red cells or platelet precursors rules out other syndromes. Mutations in ELANE are commonly associated with congenital neutropenia, not familial inherited bone marrow failure syndromes. GATA2 mutations are linked to familial myelodysplastic syndromes, not typically presenting with neutropenia and warts. Mitochondrial DNA mutations are more related to mitochondrial disorders, which usually manifest with multi-system involvement, not specific to bone marrow failure syndromes.
Virchow's node receives lymphatics from all except:
- A. testes
- B. stomach
- C. prostate
- D. breast
Correct Answer: C
Rationale: Virchow's node, also known as the left supraclavicular node, receives lymphatics primarily from the abdomen. The correct answer is C (prostate) because the prostate does not drain into Virchow's node. The stomach, breast, and testes all have lymphatic connections to Virchow's node. This is due to the anatomical location of these organs and their respective lymphatic drainage pathways. The stomach drains into the celiac lymph nodes, which then connect to Virchow's node. The breast drains into the axillary lymph nodes, which also communicate with Virchow's node. The testes drain into the para-aortic lymph nodes, which eventually lead to Virchow's node. Therefore, C is the correct answer based on the unique lymphatic drainage patterns of these organs.
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.
Dengue is a common vector-borne disease prevalent in tropical countries. Which of the following statement is true for dengue fever?
- A. It is caused by a DNA virus
- B. The vector once infected with the virus remains infective for life
- C. The vector prefers polluted water for propagation
- D. Joint symptoms are commoner in dengue fever compared to chikungunya
Correct Answer: B
Rationale: The correct answer is B because once a mosquito vector, usually Aedes aegypti, is infected with the dengue virus, it remains infective for life. This is due to the virus establishing a lifelong infection in the mosquito's salivary glands.
A: Incorrect. Dengue is caused by an RNA virus, specifically the flavivirus.
C: Incorrect. Aedes mosquitoes prefer clean, stagnant water for breeding, not polluted water.
D: Incorrect. Joint symptoms are common in both dengue fever and chikungunya, but usually more severe in chikungunya.
A 5-year-old boy is evaluated for apparent ongoing hemolysis. His hemoglobin is 9.5 g/dL, with 8% reticulocytes and MCV 87 fL. Platelets and leukocytes are normal. His direct antiglobulin test (DAT) is negative. No cold agglutinin is detectable. His family history is negative for blood disorders. Peripheral smear reveals basophilic stippling in 10% of the red blood cells. Given these findings, which of the following blood disorders is most likely?
- A. Rh-null disease
- B. Hereditary pyropoikilocytosis
- C. Glucose phosphate isomerase deficiency
- D. Unstable hemoglobin
Correct Answer: E
Rationale: I'm sorry, but the correct answer is not provided in the question, as there is no option labeled as "E". Could you please provide the correct options so that I can help you with a detailed explanation of the correct answer and why the other choices are incorrect?