Nokea
An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL?
- A. Increased numbers of blast cells
- B. Increased lymphocyte levels
- C. Intractable bone pain
- D. Thrombocytopenia with no evidence of bleeding
Correct Answer: B
Rationale: The correct answer is B: Increased lymphocyte levels. In CLL, there is an overproduction of mature lymphocytes, leading to increased lymphocyte levels in the blood. This is a hallmark feature of CLL.
A: Increased numbers of blast cells are typically seen in acute leukemias, not CLL.
C: Intractable bone pain is not a typical finding in CLL. It may indicate bone involvement in other types of leukemia.
D: Thrombocytopenia with no evidence of bleeding is not a specific finding in CLL. Thrombocytopenia may occur in CLL, but it is not a certain finding; bleeding manifestations are more common in acute leukemias.
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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.
Which of the following anemia is associated with splenomegaly:
- A. chronic renal failure
- B. aplastic anemia
- C. hereditary spherocytosis
- D. sickle cell anaemia
Correct Answer: C
Rationale: Rationale: Hereditary spherocytosis is associated with splenomegaly due to the spleen's increased destruction of abnormal red blood cells. In this condition, red blood cells have a spherical shape, making them more prone to destruction by the spleen. Chronic renal failure (A) is not typically associated with splenomegaly. Aplastic anemia (B) is characterized by bone marrow failure and does not directly involve the spleen. Sickle cell anemia (D) leads to splenomegaly in children but not in adults due to splenic sequestration crises, making it less likely to be the correct choice.
A study is designed to investigate the rates of central line–associated blood stream infections among pediatric hematology/oncology patients. Three common central line types (totally implanted catheter [port], peripherally inserted central catheter [PICC], and tunneled externalized catheter [TEC]) were included in the study. What data structure is central line type?
- A. Continuous
- B. Dichotomous
- C. Nominal
- D. Ordinal
Correct Answer: C
Rationale: The correct answer is C: Nominal. The central line types in this study (port, PICC, TEC) are categorical and do not have a natural order or ranking. They are simply names or labels representing different types of central lines. This makes them fall under the nominal data structure category. Continuous data (choice A) would involve measurements with infinite possible values. Dichotomous data (choice B) would have only two categories. Ordinal data (choice D) would imply a natural ranking or order among the categories, which is not applicable in this context.
A newborn infant develops jaundice on day of life 2. Labs are drawn, and she has a hemoglobin of 7.4 g/dL with a reticulocyte count of 8%. Upon peripheral blood smear review, she is found to have bizarre red cell forms with significant polkilocytosis. Although her parents have normal blood counts, on review of their peripheral blood smears, they both have a moderate number of ovalocytes. Which of the following is the most likely cause of the infant's red cell findings?
- A. She has an autosomal dominant ankyrin mutation from one of her parents causing hereditary spherocytosis.
- B. She has inherited band 3 variants from each parent and will likely need a splenectomy after she turns 5 years old.
- C. She has inherited an alpha-spectrin mutation from both of her parents and may experience an improvement in her anemia over time.
- D. She has inherited a PKLR variant from each parent, and enzyme testing will be consistent with her diagnosis of pyruvate kinase deficiency.
Correct Answer: C
Rationale: The correct answer is C because the infant likely has hereditary elliptocytosis, an autosomal dominant disorder caused by mutations in the alpha-spectrin gene. Ovalocytes and polkilocytosis are characteristic of this condition. Since both parents have ovalocytes, it is likely that the infant inherited mutations from each parent, resulting in a more severe presentation. Anemia in hereditary elliptocytosis can improve over time due to compensatory mechanisms. Choices A, B, and D are incorrect as they describe different genetic disorders (hereditary spherocytosis, hereditary stomatocytosis, and pyruvate kinase deficiency, respectively) and do not match the clinical and family history provided.
After seven days of treatment with sulfonamides, a patient's hemoglobin had decreased from 14.7 gm/100ml to 10gm/100ml. The most likely cause of hemolysis in this patient is
- A. Sickle cell disease
- B. Thalassemia minor
- C. Hereditary spherocytosis
- D. Glucose 6-phosphate dehydrogenase deficiency (G6PD)
Correct Answer: D
Rationale: The correct answer is D: Glucose 6-phosphate dehydrogenase deficiency (G6PD). G6PD deficiency can cause hemolysis in response to oxidative stress, such as medications like sulfonamides. The decrease in hemoglobin levels after sulfonamide treatment indicates hemolysis, which is a common manifestation of G6PD deficiency. Sickle cell disease (A), thalassemia minor (B), and hereditary spherocytosis (C) do not typically present with hemolysis triggered by sulfonamides. G6PD deficiency is the most likely cause in this scenario due to the timing of hemolysis after the drug exposure and the characteristic response of G6PD-deficient red blood cells to oxidative stress.