Nokea
An 18-month-old boy, whose parents are first cousins, is referred to you because of a significant episode of epistaxis. The parents report that the child had bleeding after circumcision and large hematomas with immunizations. Platelet aggregation studies show the following: This child's platelets are unable to interact with which of the following?
- A. ADP
- B. Fibrinogen
- C. von Willebrand factor
- D. Platelet factor 4
Correct Answer: B
Rationale: The correct answer is B: Fibrinogen. In this case, the child is likely suffering from Glanzmann thrombasthenia, a rare inherited platelet disorder where platelets lack the ability to bind to fibrinogen. This results in impaired platelet aggregation and clot formation, leading to bleeding tendencies. The other options (A, C, D) are not affected in Glanzmann thrombasthenia. Platelets interact normally with ADP (A), von Willebrand factor (C), and Platelet factor 4 (D) in this disorder.
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All produce microcytic anemia except:
- A. sideroblastic an.
- B. thalassemia
- C. pernicious anemia
- D. lead poisoning
Correct Answer: C
Rationale: The correct answer is C, pernicious anemia. Pernicious anemia is a macrocytic anemia caused by vitamin B12 deficiency affecting red blood cell production. Sideroblastic anemia (A), thalassemia (B), and lead poisoning (D) can all lead to microcytic anemia due to different mechanisms such as impaired hemoglobin synthesis or red blood cell destruction. Pernicious anemia, on the other hand, is not associated with microcytosis.
A home health nurse is caring for a patient with multiple myeloma. Which of the following interventions should the nurse prioritize when addressing the patient's severe bone pain?
- A. Implementing distraction techniques
- B. Educating the patient about the effective use of hot and cold packs
- C. Teaching the patient to use NSAIDs effectively
- D. Helping the patient manage the opioid analgesic regimen
Correct Answer: D
Rationale: The correct answer is D because severe bone pain in multiple myeloma often requires strong analgesics like opioids for effective pain management. Distraction techniques (A) may provide temporary relief but may not address the underlying pain. Hot and cold packs (B) are more suited for musculoskeletal injuries, not severe bone pain. NSAIDs (C) are usually not sufficient for managing severe bone pain in multiple myeloma. Therefore, helping the patient manage the opioid analgesic regimen (D) is the priority for effective pain control.
NADPH is a product of the hexose monophosphate pathway (HMP) in the red blood cell. The NADPH is used for the
- A. Synthesis of fatty acids
- B. Reduction of glutathione
- C. Formation of ATP
- D. Removal of oxygen radicals
Correct Answer: B
Rationale: The correct answer is B: Reduction of glutathione. In the hexose monophosphate pathway (HMP), NADPH is generated, which serves as a reducing agent. This NADPH is crucial for reducing oxidized glutathione back to its reduced form, maintaining cellular antioxidant defense. This process helps to protect cells from oxidative damage and maintain redox balance.
Now, let's summarize why the other choices are incorrect:
A: Synthesis of fatty acids - NADPH is indeed involved in fatty acid synthesis, but in the context of red blood cells, the primary role of NADPH is in reducing glutathione.
C: Formation of ATP - NADPH is not directly involved in ATP synthesis. ATP is primarily produced through processes like glycolysis and oxidative phosphorylation.
D: Removal of oxygen radicals - While NADPH indirectly contributes to the removal of oxygen radicals through its role in reducing glutathione, it is not the primary function of NAD
A 72-year-old male with enlargement of superficial lymph nodes and mild hepatosplenomegaly is diagnosed as having chronic lymphatic leukemia (CLL). The most important criteria for diagnosis of this disease is the
- A. Presence of hypogammaglobulinemia
- B. Absolute lymphocytes
- C. Male predominance
- D. Presence of enlarged lymph nodes
Correct Answer: B
Rationale: The correct answer is B: Absolute lymphocytes. In CLL, the most important diagnostic criteria is an absolute lymphocyte count greater than 5,000/microliter. This is crucial for distinguishing CLL from other lymphoproliferative disorders. The presence of hypogammaglobulinemia (choice A) is not specific to CLL and can be seen in other conditions. Male predominance (choice C) is an epidemiological feature and not a diagnostic criterion. Enlarged lymph nodes (choice D) are a common clinical finding but do not solely confirm the diagnosis of CLL.
A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patient's care plan?
- A. Protective isolation and vigilant use of standard precautions
- B. Provision of a high-calorie, low-texture diet and appropriate oral hygiene
- C. Including the family in planning the patient's activities of daily living
- D. Monitoring and treating the patient's pain
Correct Answer: A
Rationale: The correct answer is A: Protective isolation and vigilant use of standard precautions. This is the priority because patients with AML undergoing induction therapy are immunocompromised and at high risk for infection. Isolating the patient and using standard precautions help prevent exposure to pathogens.
B: Providing a high-calorie, low-texture diet and oral hygiene is important but not the priority as infection control takes precedence.
C: Including the family in planning activities of daily living is beneficial for holistic care but not the priority compared to infection prevention.
D: Monitoring and treating pain is essential, but in this case, infection prevention is the priority due to the patient's immunocompromised state.