Nokea
Increase Fe & normal TIBC are found in:
- A. thalassemia major
- B. haemosidrosis
- C. rheumatoid arthritis
- D. dissiminated malignancy
Correct Answer: C
Rationale: The correct answer is C: rheumatoid arthritis. In rheumatoid arthritis, chronic inflammation can lead to anemia of chronic disease, causing increased levels of serum iron (Fe) due to decreased iron utilization and normal Total Iron Binding Capacity (TIBC). Thalassemia major (A) would show decreased TIBC due to iron overload. Haemosiderosis (B) would show increased Fe and TIBC due to iron overload. Disseminated malignancy (D) may show decreased Fe and TIBC due to anemia of chronic disease or other factors.
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The nurse is reviewing the results of a patient's arterial blood gas analysis. What should the nurse recognize as being a normal blood pH?
- A. 7.29
- B. 7.31
- C. 7.38
- D. 7.48
Correct Answer: C
Rationale: The correct answer is C: 7.38. Normal blood pH ranges from 7.35 to 7.45. A pH of 7.38 falls within this range, indicating a slightly alkaline (basic) pH, which is considered normal. Choices A, B, and D are all outside the normal range, indicating acidosis (A and B) or alkalosis (D). Therefore, C is the correct answer as it falls within the normal blood pH range.
A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia?
- A. Monitoring for infection
- B. Monitoring nutritional status
- C. Monitor electrolyte levels
- D. Monitoring liver function
Correct Answer: A
Rationale: The correct answer is A: Monitoring for infection. Acute leukemia patients are at high risk for infections due to compromised immune function. Infection is the most common cause of death among leukemia patients. Regular monitoring for signs of infection, such as fever and abnormal white blood cell counts, is crucial for early detection and treatment. Option B, monitoring nutritional status, is important but not the most direct cause of death in leukemia patients. Option C, monitoring electrolyte levels, is important but not as directly related to the cause of death in leukemia patients. Option D, monitoring liver function, is not the most common cause of death in leukemia patients and is not directly related to leukemia complications.
A young child with consanguineous parents has developmental delay and a history of multiple recurrent bacterial infections and short stature. He presents to the emergency department following trauma and requires a blood transfusion. Blood work identifies leukocytosis, neutrophilia, and the Bombay blood group (absent H antigen as well as absent A and B antigens). What is this patient's diagnosis?
- A. Chediak-Higashi syndrome
- B. Leukocyte adhesion deficiency (LAD) Type II
- C. CD18 deficiency
- D. Griscelli syndrome
Correct Answer: B
Rationale: The correct answer is B: Leukocyte adhesion deficiency (LAD) Type II. This diagnosis is supported by the patient's history of recurrent bacterial infections, leukocytosis, neutrophilia, and the Bombay blood group. LAD Type II is characterized by a defect in the CD18 integrin molecules, leading to impaired leukocyte adhesion and migration to sites of infection. The Bombay blood group is due to the absence of H antigen, which is also seen in LAD Type II.
A: Chediak-Higashi syndrome is characterized by recurrent infections, albinism, and peripheral neuropathy, not leukocyte adhesion deficiency.
C: CD18 deficiency is actually another term for LAD Type I, not LAD Type II.
D: Griscelli syndrome presents with silvery hair and immunodeficiency, but does not involve leukocyte adhesion deficiency.
A patient shows prolonged prothrombin time and activated partial thromboplastin time. Blood test otherwise is normal. Which of the following is the most probably diagnosis for this patient's condition?
- A. Hemophilia A
- B. Thrombocytopenia
- C. Von Willebrand factor disease
- D. Vitamin K deficiency
Correct Answer: D
Rationale: The correct answer is D: Vitamin K deficiency. Prolonged prothrombin time and activated partial thromboplastin time indicate impaired blood clotting, which is characteristic of vitamin K deficiency. Vitamin K is essential for synthesizing clotting factors II, VII, IX, and X. Hemophilia A (choice A) is a genetic disorder resulting in deficiency of clotting factor VIII, not vitamin K-dependent factors. Thrombocytopenia (choice B) is a condition characterized by low platelet count, not affecting clotting factor synthesis. Von Willebrand factor disease (choice C) involves a deficiency or dysfunction of von Willebrand factor, not related to vitamin K deficiency.
A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?
- A. Give two more courses of intensification chemotherapy.
- B. Perform an autologous hematopoietic stem cell transplant (HSCT).
- C. Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
- D. Give one more course of intensification chemotherapy and then 1 year of maintenance chemotherapy.
Correct Answer: C
Rationale: The correct answer is C: Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
Rationale:
1. The patient achieved morphologic remission and MRD-negative status after the second course of chemotherapy, indicating good response.
2. Given the high-risk AML with negative cytogenetics and molecular markers, HSCT from a matched unrelated donor offers the best chance for long-term remission.
3. HSCT provides a curative option by replacing the patient's diseased bone marrow with healthy donor cells, reducing the risk of relapse.
4. The presence of a large number of potential matched unrelated donors increases the likelihood of finding a suitable donor for the transplant.
Summary:
- Option A: Giving more courses of intensification chemotherapy may not address the high-risk nature of the disease and may not provide a curative outcome.
- Option B: Autologous HSCT uses the patient's own stem cells, which may carry the risk of relapse due