Nokea
An adult patient has presented to the health clinic with a complaint of a firm, painless cervical lymph node. The patient denies any recent infectious diseases. What is the nurse's most appropriate response to the patient's complaint?
- A. Call 911.
- B. Promptly refer the patient for medical assessment.
- C. Facilitate a radiograph of the patient's neck and have the results forwarded to the patient's primary care provider.
- D. Encourage the patient to track the size of the lymph node and seek care in 1 week.
Correct Answer: B
Rationale: The correct answer is B: Promptly refer the patient for medical assessment. A firm, painless cervical lymph node in an adult without recent infectious diseases raises concerns for potential underlying serious conditions such as malignancy. Referring the patient for medical assessment allows for further evaluation, including physical examination, laboratory tests, and imaging studies if necessary, to determine the cause of the lymphadenopathy. This prompt referral is crucial for timely diagnosis and appropriate management.
Summary:
A: Calling 911 is not warranted as the patient is stable and does not have an emergency medical condition.
C: Facilitating a radiograph may not provide sufficient information for evaluating the lymph node and delays definitive assessment.
D: Encouraging the patient to wait and track the lymph node size can lead to delayed diagnosis and potentially worsening of the underlying condition.
You may also like to solve these questions
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.
An older adult patient is receiving a transfusion of packed red blood cells after being injured in a car accident. On assessment, the nurse notes a new finding of bounding pulse, crackles, and increasing dyspnea. What should the nurse do first, after stopping the transfusion?
- A. Assess vital signs.
- B. Raise the head of the bed.
- C. Encourage the patient to deep breathe and cough.
- D. Administer pm diphenhydramine (Benadryl) as ordered.
Correct Answer: B
Rationale: The correct answer is B: Raise the head of the bed. This action is crucial in managing the potential complication of fluid overload in the patient receiving a blood transfusion. Elevating the head of the bed helps reduce venous return to the heart, decreasing preload and cardiac workload. This can alleviate symptoms like dyspnea and crackles associated with fluid overload. Assessing vital signs (choice A) is important but should follow positioning the patient appropriately. Encouraging deep breathing and coughing (choice C) may exacerbate the patient's respiratory distress. Administering diphenhydramine (choice D) is not indicated for the symptoms described.
A 14-year-old Syrian male with beta thalassemia major has relocated to your community as a refugee. He has been receiving chronic transfusion therapy in Turkey for the past 3 years. On his first visit, you notice that his height is below the fifth percentile. He has skin discoloration and hepatosplenomegaly. His mother reports they have not had regular access to chelation therapy. Laboratory testing shows a serum ferritin of 6,200 ng/mL. A cardiac MRI shows grossly normal cardiac function but a T2* value of 9 ms. What is the most likely cause of his short stature?
- A. Lack of regular blood transfusion causing growth failure
- B. Cirrhosis and liver failure
- C. Ineffective erythropoiesis and chronic anemia
- D. Growth hormone deficiency due to iron deposition in the pituitary
Correct Answer: D
Rationale: The correct answer is D: Growth hormone deficiency due to iron deposition in the pituitary. Iron deposition in the pituitary gland can lead to impaired production and secretion of growth hormone, resulting in short stature. This is a known complication of beta thalassemia major. The patient's elevated serum ferritin levels and T2* value of 9 ms indicate iron overload, which can cause damage to organs including the pituitary gland. Choices A, B, and C are incorrect because the patient's growth failure is primarily due to the impact of iron deposition on the pituitary gland rather than lack of transfusion, cirrhosis, or ineffective erythropoiesis. Regular chelation therapy is essential to prevent iron overload and its complications in patients with beta thalassemia major.
A patient is presented with weakness of legs, arms, trunk, tingling and numbness that progressively worsens. Peripheral blood smear shows macrocytic anemia. Which of the following is not the factor causing this condition?
- A. Chronic atrophic gastritis
- B. Ileal resection
- C. Tapeworm infestation
- D. Alcoholism
Correct Answer: C
Rationale: The correct answer is C: Tapeworm infestation. The symptoms described are consistent with vitamin B12 deficiency, which can result in macrocytic anemia and neurological symptoms. Chronic atrophic gastritis and ileal resection can impair absorption of vitamin B12, leading to deficiency. Alcoholism can also lead to malnutrition and vitamin deficiencies. Tapeworm infestation, on the other hand, does not directly affect vitamin B12 absorption. Therefore, tapeworm infestation is not a factor causing the condition described.
A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?
- A. Elevate the head of the bed to 45 degrees.
- B. Apply a sterile 2-inch gauze dressing to the site.
- C. Use a half-inch sterile gauze to pack the wound.
- D. Have the patient lie on the left side for 1 hour.
Correct Answer: D
Rationale: The correct answer is D: Have the patient lie on the left side for 1 hour. This position helps prevent bleeding by applying pressure to the site. Elevating the head of the bed (A) is not necessary for this procedure. Applying a 2-inch gauze dressing (B) may disrupt the site and increase the risk of bleeding. Using half-inch sterile gauze to pack the wound (C) is not recommended for bone marrow aspiration sites as it can lead to infection.