Nokea
A patient with chronic kidney disease is prescribed erythropoietin-stimulating agents (ESAs) to manage anemia. Which laboratory parameter should be monitored closely during ESA therapy?
- A. Serum potassium
- B. Serum creatinine
- C. Hemoglobin
- D. Platelet count
Correct Answer: C
Rationale: Erythropoietin-stimulating agents (ESAs) are prescribed to manage anemia in patients with chronic kidney disease. Monitoring the hemoglobin level closely during ESA therapy is crucial to ensure that the treatment is effective in increasing red blood cell production without causing excessive elevation. Hemoglobin levels should be checked regularly to adjust the ESA dosage accordingly and prevent risks associated with high hematocrit levels, such as increasing blood viscosity and cardiovascular events. Monitoring serum potassium, creatinine, and platelet count are important in the management of chronic kidney disease for different reasons, but for ESA therapy, monitoring hemoglobin is the most essential parameter.
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Which of the following mechanisms is responsible for the phenomenon of immunological memory, wherein the immune system mounts a faster and more robust response upon re-exposure to a previously encountered pathogen?
- A. Clonal expansion of memory B cells
- B. Differentiation of na(cid:239)ve T cells into effector T cells
- C. Production of antibodies by plasma cells
- D. Activation of the complement system
Correct Answer: A
Rationale: Immunological memory is primarily maintained by the clonal expansion of memory B cells. Memory B cells are a type of long-lived immune cell that originates from previously activated B cells during an immune response to a pathogen. When the immune system encounters the same pathogen again, memory B cells can quickly recognize and respond to it by undergoing rapid clonal expansion and differentiation into plasma cells that produce specific antibodies. This quick and robust response leads to the more efficient elimination of the pathogen during secondary exposure, resulting in the faster and stronger immune response characteristic of immunological memory.
A patient presents with a painless, gradually enlarging mass in the left neck, anterior to the sternocleidomastoid muscle. Fine-needle aspiration cytology reveals thyroid follicular cells. Which of the following conditions is most likely responsible for this presentation?
- A. Thyroglossal duct cyst
- B. Lymphadenopathy
- C. Thyroid adenoma
- D. Thyroid carcinoma
Correct Answer: C
Rationale: The presentation described is most consistent with a thyroid adenoma. Thyroid adenomas are benign neoplasms of the thyroid gland and can present as painless, gradually enlarging masses in the neck. Fine-needle aspiration cytology revealing thyroid follicular cells further supports the diagnosis of a thyroid adenoma. Thyroglossal duct cysts typically present as midline neck masses that move with swallowing, while lymphadenopathy presents as enlarged lymph nodes and may be associated with infection or malignancy. Thyroid carcinoma may also present as a neck mass but is more likely to be associated with other features such as vocal cord paralysis, hoarseness, or enlarged cervical lymph nodes.
This endocrine disorder is a severe form of hypothyroidism characterized by an accumulation of mucopolysaccharide in subcutaneous and other interstitial tissues
- A. Myxedema
- B. Cushing`s syndrome
- C. Thyrotoxicosis
- D. Hashimoto`s disease
Correct Answer: A
Rationale: Myxedema is a severe form of hypothyroidism that is characterized by the accumulation of mucopolysaccharides in subcutaneous and other interstitial tissues. This condition leads to puffiness, swelling, and thickening of the skin, giving it a waxy appearance. Other symptoms of myxedema include fatigue, weight gain, cold intolerance, and hair loss. It is important to recognize and treat myxedema promptly as it can lead to serious complications such as myxedema coma, which is a life-threatening condition requiring immediate medical attention.
A patient receiving palliative care for end-stage chronic obstructive pulmonary disease (COPD) expresses a desire to discuss advance care planning. What action should the palliative nurse take?
- A. Dismiss the patient's request and focus on symptom management.
- B. Initiate a conversation about advance directives and future care preferences.
- C. Encourage the patient to postpone discussions about advance care planning.
- D. Refer the patient to a social worker for assistance with advance care planning.
Correct Answer: B
Rationale: When a patient receiving palliative care for end-stage COPD expresses a desire to discuss advance care planning, the palliative nurse should initiate a conversation about advance directives and future care preferences. Advance care planning involves discussing and documenting a patient's preferences regarding future medical care, particularly in situations where the patient may no longer be able to make decisions. This discussion helps ensure that the patient's wishes are respected and followed in the event they are unable to communicate their preferences. By engaging in advance care planning discussions, the nurse can help the patient feel empowered, supported, and in control of their medical care decisions. It also allows healthcare providers to align care with the patient's values and goals, ultimately improving quality of life and ensuring dignity at the end of life.
While preparing the surgical site, the nurse notices that the skin preparation solution has expired. What should the nurse do?
- A. Use the expired solution as it is still effective
- B. Document the expiration date in the patient's chart
- C. Discard the expired solution and obtain a new one
- D. Dilute the solution with sterile water to extend its shelf life
Correct Answer: C
Rationale: Using an expired skin preparation solution can compromise the safety and effectiveness of the surgical site cleansing. Expired solutions may have reduced efficacy or could cause adverse reactions due to chemical breakdown over time. Therefore, it is essential for the nurse to discard the expired solution and obtain a new one to ensure proper sanitation and reduce the risk of complications during the surgical procedure. It is important to adhere to proper protocols and guidelines in healthcare settings to maintain patient safety and optimal outcomes.