Anatomy of Hematologic System

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A patient with non-Hodgkin's lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurse's best response?

  • A. Everyone should do these things because they're health promotion activities that apply to everyone.
  • B. You don't want to develop a second cancer, do you?
  • C. You need to do this just to be on the safe side.
  • D. It's important to reduce other factors that increase the risk of second cancers.
Correct Answer: D

Rationale: The correct answer is D because reducing factors that increase the risk of second cancers is crucial for a patient with non-Hodgkin's lymphoma due to the potential for developing secondary cancers. Alcohol, smoking, and sun exposure are known risk factors for various cancers, including secondary cancers. By avoiding these behaviors, the patient can decrease the likelihood of developing another cancer.

Choice A is incorrect because while health promotion activities are beneficial, the specific reason for a patient with non-Hodgkin's lymphoma to stop drinking, smoking, and avoiding sun exposure is to reduce the risk of second cancers, not just for general health.

Choice B is incorrect because it uses fear tactics and does not provide a clear rationale for why the patient should make these lifestyle changes.

Choice C is incorrect because it lacks a specific explanation for the importance of avoiding alcohol, smoking, and sun exposure in relation to reducing the risk of second cancers.

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A 14-year-old male patient is diagnosed with very high risk acute lymphoblastic leukemia and is likely going to require an allogeneic hematopoietic stem cell transplant to cure his leukemia. Prior to going to transplant, he is likely to require multiple blood transfusions. Which of the following products or component modifications is the best way to prevent him from developing alloimmunization due to anti-HLA antibodies prior to transplant?

  • A. Frozen RBCs
  • B. Volume-reduced blood products
  • C. Irradiation of all blood products
  • D. Leukoreduced blood products
Correct Answer: D

Rationale: The correct answer is D, Leukoreduced blood products. Leukoreduction removes white blood cells from the blood product, reducing the risk of alloimmunization due to anti-HLA antibodies. White blood cells are a major source of HLA antigens that can stimulate the immune system to produce antibodies. This process helps prevent the development of alloimmunization, which is crucial for patients undergoing stem cell transplant.

A: Frozen RBCs - Freezing does not affect the risk of alloimmunization.
B: Volume-reduced blood products - Volume reduction does not specifically target white blood cells or HLA antigens.
C: Irradiation of all blood products - Irradiation is used to prevent graft-versus-host disease, not specifically to prevent alloimmunization.

The nurse is reviewing the results of a patient's arterial blood gas analysis. What should the nurse recognize as being a normal blood pH?

  • A. 7.29
  • B. 7.31
  • C. 7.38
  • D. 7.48
Correct Answer: C

Rationale: The correct answer is C: 7.38. Normal blood pH ranges from 7.35 to 7.45. A pH of 7.38 falls within this range, indicating a slightly alkaline (basic) pH, which is considered normal. Choices A, B, and D are all outside the normal range, indicating acidosis (A and B) or alkalosis (D). Therefore, C is the correct answer as it falls within the normal blood pH range.

Which statement is correct regarding lymphocyte counts in infants versus adults?

  • A. NK-cell numbers are lowest at birth and increase with age.
  • B. B-cell numbers are highest at birth and decline with age.
  • C. T-cell numbers in infants are higher than in adults.
  • D. Infants have low lymphocyte counts that increase with age.
Correct Answer: C

Rationale: The correct answer is C because T-cell numbers in infants are indeed higher than in adults. This is due to the active development of the immune system in infants, leading to a higher proportion of T-cells.

A is incorrect because NK-cell numbers in infants are actually higher at birth and decrease with age.
B is incorrect because B-cell numbers are lower at birth and increase with age.
D is incorrect because infants do not have low lymphocyte counts; their immune system is actively developing, leading to higher lymphocyte counts compared to adults.

A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects?

  • A. Phlebitis
  • B. Dark
  • C. orange-colored stools
  • D. Constipation
Correct Answer: D

Rationale: The correct answer is D: Constipation. Ferrous sulfate is an iron supplement commonly associated with gastrointestinal side effects, including constipation. Iron can cause constipation by slowing down bowel movements. Phlebitis (A) is inflammation of a vein and is not a common adverse effect of ferrous sulfate. Dark (B) or orange-colored stools (C) are expected side effects of iron supplements due to the change in color caused by the iron, but they are not harmful. Constipation (D) is the most concerning adverse effect to monitor for as it can lead to discomfort and potential complications if left untreated.

Waldeyer's ring does not include:

  • A. faucal tonsils
  • B. submandibular glands
  • C. adenoids
  • D. lingual tonsils
Correct Answer: B

Rationale: The correct answer is B: submandibular glands. Waldeyer's ring consists of a ring of lymphoid tissue in the pharynx, including the palatine tonsils (faucal tonsils), adenoids, and lingual tonsils. Submandibular glands are salivary glands located beneath the mandible and are not part of Waldeyer's ring. Therefore, B is the correct answer. Choices A, C, and D are incorrect because they are all components of Waldeyer's ring.

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