Nokea
An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem?
- A. Hodgkin disease
- B. Non-Hodgkin Lymphoma
- C. Multiple Myeloma
- D. Acute Thrombocytopenia
Correct Answer: C
Rationale: The correct answer is C: Multiple Myeloma. In this case, the patient's age, symptoms of fatigue, back, and rib pain without recent injuries are indicative of multiple myeloma. This condition is a type of cancer that affects plasma cells in the bone marrow, leading to bone pain and fatigue. Hodgkin disease and Non-Hodgkin Lymphoma typically present with lymph node enlargement rather than back and rib pain. Acute Thrombocytopenia would present with symptoms related to low platelet levels such as bleeding tendencies, not back and rib pain.
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The health care provider tells the nurse that a client is to be started on a platelet inhibitor. About what drug does the nurse plan to teach the client?
- A. Clopidogrel (Plavix)
- B. Enoxaparin (Lovenox)
- C. Reteplase (Retavase)
- D. Warfarin (Coumadin)
Correct Answer: A
Rationale: The correct answer is A: Clopidogrel (Plavix). Clopidogrel is a platelet inhibitor that helps prevent blood clots by inhibiting platelet aggregation. It is commonly used to reduce the risk of heart attack or stroke. Enoxaparin (Lovenox) is a low molecular weight heparin that works by preventing blood clots by inhibiting clotting factors. Reteplase (Retavase) is a thrombolytic agent used to dissolve blood clots in emergency situations. Warfarin (Coumadin) is an anticoagulant that works by inhibiting vitamin K-dependent clotting factors. Clopidogrel is the most appropriate choice for a platelet inhibitor in this scenario due to its mechanism of action and indication for preventing blood clots.
You are seeing a 12-year-old female who presented to the emergency department with the sudden onset of severe abdominal pain. Imaging that was obtained to rule out appendicitis revealed a mass adjacent to the bladder. The mass was surgically resected, and pathology demonstrated a paraganglioma. Which of the studies below would be most useful to determine disease stage for this patient?
- A. Bone Scan
- B. Lumbar puncture for cerebrospinal fluid cytology
- C. Bone marrow aspirate and biopsy
- D. Ga 68-DOTATATE PET/CT
Correct Answer: D
Rationale: The correct answer is D: Ga 68-DOTATATE PET/CT. Paragangliomas are neuroendocrine tumors that can secrete catecholamines and have a high expression of somatostatin receptors. Ga 68-DOTATATE PET/CT is the most appropriate imaging study to determine disease stage in patients with paragangliomas because it can detect the somatostatin receptor expression in these tumors, aiding in localization, staging, and treatment planning.
A: Bone scan is not the most useful study for determining disease stage in paraganglioma.
B: Lumbar puncture for cerebrospinal fluid cytology is not relevant for staging paraganglioma.
C: Bone marrow aspirate and biopsy are not the most appropriate studies for staging paraganglioma.
A patient has an altered level of T and B cells. The nurse realizes that these cells are members of which cell type?
- A. Platelets
- B. Eosinophils
- C. Lymphocytes
- D. Red blood cells
Correct Answer: C
Rationale: The correct answer is C: Lymphocytes. T and B cells are types of lymphocytes, a crucial component of the immune system responsible for fighting infections. T cells regulate immune responses, while B cells produce antibodies. Platelets (A), eosinophils (B), and red blood cells (D) are not involved in immune responses and do not possess the functions of T and B cells. Platelets are involved in blood clotting, eosinophils are a type of white blood cell involved in allergic reactions, and red blood cells are responsible for oxygen transport.
A 4-year-old child with acute lymphoblastic leukemia is receiving high-dose methotrexate during interim maintenance. He receives ondansetron and арrepitant during his stay, which control his nausea and vomiting well. These medications work by inhibiting signaling in which part of the brain?
- A. Vestibular system
- B. Cerebral cortex
- C. Hypothalamus
- D. Vomiting center
Correct Answer: E
Rationale: The correct answer is D: Vomiting center. Ondansetron and aprepitant are antiemetic drugs that work by targeting the vomiting center in the brainstem. The vomiting center coordinates the vomiting reflex in response to various stimuli, including chemotherapy drugs like methotrexate. By inhibiting signaling in the vomiting center, these medications effectively prevent nausea and vomiting. The other choices (A: Vestibular system, B: Cerebral cortex, C: Hypothalamus) are not directly involved in the control of nausea and vomiting in response to chemotherapy.
RBCs break into fragments, they are referred to as schistocytes. These type of cells are seen in
- A. Sickle cell trait
- B. Thalassemia
- C. Microangiopathic hemolytic anemia
- D. Idiopathic thrombocytopenic purpura
Correct Answer: C
Rationale: The correct answer is C, Microangiopathic hemolytic anemia. Schistocytes are fragmented red blood cells caused by mechanical damage as they pass through narrowed vessels. This occurs in conditions like thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, which are types of microangiopathic hemolytic anemia. Sickle cell trait (A) and Thalassemia (B) are genetic disorders affecting red blood cell structure and production, not causing mechanical fragmentation. Idiopathic thrombocytopenic purpura (D) is a disorder characterized by low platelet count, unrelated to RBC fragmentation.