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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 concern for potential serious underlying conditions such as malignancy. Referring the patient for medical assessment allows for proper evaluation, diagnosis, and timely intervention if needed. Calling 911 (choice A) is not necessary as the patient is not in immediate life-threatening danger. Facilitating a radiograph (choice C) may not provide sufficient information for a definitive diagnosis. Encouraging the patient to track the size and wait a week (choice D) can delay necessary medical evaluation and potentially worsen the condition if it is indeed concerning.
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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.
A 4-year-old girl with a history of relapsed pre-B-cell acute lymphoblastic leukemia is being admitted for unrelated donor bone marrow transplantation with cyclophosphamide and total body irradiation conditioning. Pretransplant workup shows the following: Recipient: CMV IgG: negative, CMV IgM: negative, HSV I/II antibody: negative, Varicella IgG: positive (vaccinated), Hepatitis B surface antigen: negative, Hepatitis B surface antibody: positive (vaccinated), Hepatitis B core antibody: negative, Hepatitis C antibody: negative. Donor: CMV IgG: negative, CMV IgM: negative, HSV I/II antibody: positive, Varicella IgG: positive, Hepatitis B surface antigen: negative, Hepatitis B core antibody: negative, Hepatitis C antibody: negative. How should the patient be managed during the admission with respect to infection prophylaxis?
- A. Acyclovir IV for herpes simplex virus (HSV) suppression
- B. Weekly screening by polymerase chain reaction (PCR) for cytomegalovirus (CMV) in blood
- C. Antifungal prophylaxis
- D. Valganciclovir PO for CMV suppression
Correct Answer: C
Rationale: The correct answer is C: Antifungal prophylaxis. This patient is at high risk for fungal infections post-bone marrow transplantation due to the conditioning regimen with cyclophosphamide and total body irradiation. CMV and HSV prophylaxis are not indicated as the patient and donor are negative for CMV IgG and IgM and the donor is positive for HSV antibodies. Weekly CMV PCR screening is not necessary in the absence of CMV seropositivity. Valganciclovir for CMV suppression is also not required in this case. Fungal prophylaxis is essential to prevent invasive fungal infections in high-risk patients like this 4-year-old with leukemia.
You examine a 10-year-old boy with severe aplastic anemia. He has no dysmorphic features and is at the 50th percentile for height and weight. Family history includes a sister with aplastic anemia unresponsive to anti-human thymocyte globulin (ATG) and cyclosporine who died early in the course of an unrelated donor hematopoietic stem cell transplant complicated by severe mucositis and transplant-related organ toxicities. There are no other siblings. A cousin died of acute myeloid leukemia at age 5 years. A peripheral blood sample test for Fanconi anemia is negative with no increased chromosomal breaks in response to diepoxylbutane or mitomycin C. Which of the following is the most important next step in management?
- A. Administer ATG and cyclosporine.
- B. Search for a donor for matched unrelated transplant.
- C. Send a bone marrow aspirate for Fanconi anemia testing.
- D. Send a skin fibroblast culture for Fanconi anemia testing.
Correct Answer: D
Rationale: The correct answer is D: Send a skin fibroblast culture for Fanconi anemia testing. This is the most important next step in management because the patient's family history, particularly the sister's unresponsiveness to ATG and cyclosporine and the cousin's history of leukemia, raises suspicion for Fanconi anemia. Testing for Fanconi anemia is crucial as it is an inherited bone marrow failure syndrome that predisposes individuals to aplastic anemia and leukemia. Skin fibroblast culture is the preferred test for diagnosing Fanconi anemia as it can detect chromosomal abnormalities indicative of the disease. Options A and B are not appropriate as the patient's sister did not respond to ATG and cyclosporine, and searching for a donor for transplant without confirming the underlying cause of aplastic anemia could lead to transplant failure. Option C is also not the best choice as the peripheral blood sample test for Fanconi anemia was already negative, and a skin fib
Which of the following will be present in chronic bacterial infection?
- A. Neutrophilia
- B. Basophilia
- C. Lymphocytosis
- D. Monocytosis
Correct Answer: D
Rationale: The correct answer is D: Monocytosis. In chronic bacterial infections, monocytosis occurs due to the increased presence of monocytes in response to the persistent infection. Monocytes differentiate into macrophages to help eliminate the bacteria. Neutrophilia (A) is more common in acute bacterial infections. Basophilia (B) is associated with conditions like chronic myeloid leukemia, not bacterial infections. Lymphocytosis (C) is often seen in viral infections or chronic inflammatory conditions, not specifically in chronic bacterial infections.
Sickle cell an. Is not complicated by:
- A. papillary necrosis
- B. pancreatitis
- C. osteomyelitis
- D. CHF
Correct Answer: B
Rationale: Step-by-step rationale for choice B (pancreatitis) being correct:
1. Sickle cell anemia primarily affects red blood cells, leading to vaso-occlusive crises.
2. Pancreatitis is not a known complication of sickle cell anemia.
3. Complications of sickle cell anemia commonly involve organs affected by sickling, such as the bones (osteomyelitis), kidneys (papillary necrosis), and heart (CHF).
Summary:
A: Papillary necrosis - Correct, as it can affect the kidneys in sickle cell anemia.
B: Pancreatitis - Correct, as it is not a typical complication of sickle cell anemia.
C: Osteomyelitis - Incorrect, as it can affect the bones in sickle cell anemia.
D: CHF - Incorrect, as it can affect the heart in sickle cell anemia.