Nokea
An oncology nurse is caring for a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood tests, the nurse should anticipate what imbalance?
- A. Hypercalcemia
- B. Hyperproteinemia
- C. Elevated serum viscosity
- D. Elevated RBC count
Correct Answer: A
Rationale: The correct answer is A: Hypercalcemia. In multiple myeloma, bone destruction releases calcium into the bloodstream, leading to hypercalcemia. Elevated serum viscosity (C) is not typically associated with multiple myeloma. Hyperproteinemia (B) may be present due to increased production of abnormal proteins, but it does not directly cause bone destruction. Elevated RBC count (D) is not a common finding in multiple myeloma and is not directly related to bone destruction.
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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 nurse is caring for four clients. After reviewing today's laboratory results, which client would the nurse assess first?
- A. Client with an international normalized ratio of 2.8
- B. Client with a platelet count of 128,000/mm3 (128 x 109/L).
- C. Client with a prothrombin time (PT) of 28 seconds
- D. Client with a red blood cell count of 5.1 million/mcl. (5.1 x 1012/L)
Correct Answer: C
Rationale: The correct answer is C: Client with a prothrombin time (PT) of 28 seconds. A PT measures the time it takes for blood to clot, indicating the client's clotting ability. A PT of 28 seconds is prolonged, suggesting a potential bleeding risk. This client should be assessed first to prevent any complications related to inadequate clotting.
A: Client with an international normalized ratio of 2.8 - Although an elevated INR indicates a risk of bleeding, it is not as time-sensitive as a prolonged PT.
B: Client with a platelet count of 128,000/mm3 - While low platelets can lead to bleeding, a prolonged PT is more critical for immediate assessment.
D: Client with a red blood cell count of 5.1 million/mcl - This value is within normal range and does not indicate an urgent issue related to clotting.
Assuming that adherence has been excellent, which of the following should have returned to normal 6 weeks following appropriate oral iron treatment for a child with severe dietary iron deficiency (hemoglobin [Hgb] 5.0 g/dL and mean corpuscular volume [MCV] 48 fL at the beginning of therapy)?
- A. Hgb concentration
- B. MCV
- C. Red cell distribution width
- D. Peripheral blood smear
Correct Answer: A
Rationale: Rationale:
1. Hemoglobin (Hgb) reflects the oxygen-carrying capacity of red blood cells.
2. Severe dietary iron deficiency causes low Hgb levels.
3. Adequate iron treatment should lead to increased Hgb levels.
4. MCV and other parameters may take longer to normalize.
Summary:
B, C, and D are incorrect because MCV and red cell distribution width may take longer to normalize, and peripheral blood smear changes may persist even after Hgb has returned to normal.
A patient with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the patient?
- A. Chew with care to avoid inadvertently biting the tongue.
- B. Use the oral anesthetic 1 hour prior to meal time.
- C. Brush teeth before and after eating.
- D. Swallow slowly and deliberately.
Correct Answer: A
Rationale: The correct answer is A: Chew with care to avoid inadvertently biting the tongue. Stomatitis causes mouth sores, making it crucial for the patient to be cautious while chewing to prevent accidental injury to the mouth. This helps in reducing pain and promoting healing.
Choice B is incorrect because using the oral anesthetic 1 hour prior to mealtime may not provide immediate relief during eating. Choice C is incorrect as brushing teeth before and after eating can irritate the mouth sores further. Choice D is incorrect as swallowing slowly and deliberately does not address the issue of preventing accidental biting of the tongue.
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: Step-by-step rationale:
1. CLL is characterized by the proliferation of abnormal lymphocytes.
2. Increased lymphocyte levels are a hallmark of CLL due to the accumulation of these abnormal cells.
3. Lymphocytosis is a key diagnostic feature in CLL.
4. Other choices are incorrect because blast cells are characteristic of acute leukemia, bone pain is more common in multiple myeloma, and thrombocytopenia with no bleeding is not a specific finding in CLL.
Summary: Increased lymphocyte levels are certain to be present in a patient with CLL due to the abnormal proliferation of lymphocytes. Other choices are incorrect as they do not align with the characteristic features of CLL.