Nokea
Mr XY was found to be anemic. During history taking, he informed his doctor that he was a strict vegetarian who did not consume any meat, fish or milk products.
- A. Iron deficiency
- B. Vitamin B12 deficiency
- C. Defects in erythropoietin production
- D. Calcium-deficiency
Correct Answer: B
Rationale: Correct Answer: B (Vitamin B12 deficiency)
Rationale:
1. Mr. XY is a strict vegetarian, avoiding meat, fish, and milk products.
2. Vitamin B12 is mainly found in animal products, crucial for red blood cell production.
3. Vegetarians at risk of B12 deficiency due to limited dietary sources.
4. Anemia can result from B12 deficiency, leading to decreased red blood cell production.
Summary:
A: Iron deficiency - Possible but less likely since vegetarian diets can still provide iron.
C: Defects in erythropoietin production - Unrelated to diet, more related to kidney function.
D: Calcium-deficiency - Not directly related to anemia; more associated with bone health.
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A nurse is caring for a patient who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the patient's sacral area and petechiae in her forearms. In addition to informing the patient's primary care provider, the nurse should perform what action?
- A. Initiate measures to prevent venous thromboembolism (VTE).
- B. Check the patient's most recent platelet level.
- C. Place the patient on protective isolation.
- D. Ambulate the patient to promote circulatory function.
Correct Answer: B
Rationale: Rationale:
1. Ecchymoses and petechiae indicate potential thrombocytopenia in leukemia.
2. Checking platelet levels will confirm if thrombocytopenia is present.
3. Low platelet levels increase bleeding risk, warranting intervention.
4. Initiating VTE prevention, isolation, or ambulation are not directly related to managing thrombocytopenia in leukemia.
Summary:
- A: VTE measures are not indicated with the given symptoms.
- C: Protective isolation is unnecessary for thrombocytopenia.
- D: Ambulation does not directly address thrombocytopenia.
The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?
- A. Do you take salicylates?
- B. Are you taking any oral contraceptives?
- C. Have you been prescribed antiseizure drugs?
- D. How long have you taken antihypertensive drugs?
Correct Answer: A
Rationale: Correct Answer: A: Do you take salicylates?
Rationale:
1. Petechiae are tiny red or purple spots caused by bleeding under the skin.
2. Salicylates (like aspirin) can cause bleeding issues leading to petechiae.
3. Asking about salicylate use helps identify a potential cause for the petechiae.
Summary of Incorrect Choices:
B: Oral contraceptives are not typically associated with petechiae.
C: Antiseizure drugs do not commonly cause petechiae.
D: Antihypertensive drugs are not known to be a common cause of petechiae.
A client is having a bone marrow aspiration and biopsy. What action by the nurse takes priority?
- A. Administer pain medication first.
- B. Ensure that valid consent is in the medical record.
- C. Have the client shower in the morning.
- D. Premedicate the client with sedatives.
Correct Answer: B
Rationale: The correct answer is B: Ensure that valid consent is in the medical record. This is the priority because obtaining informed consent is a legal and ethical requirement before any invasive procedure like a bone marrow aspiration and biopsy. Without valid consent, the procedure cannot proceed. Administering pain medication (A) can be important, but ensuring consent comes first. Having the client shower (C) is not a priority before the procedure. Premedicating with sedatives (D) may not be necessary for every client and should be based on individual assessment.
A leukemia investigator plans to obtain bone marrow under general anesthesia to measure minimal residual disease (MRD) and to see if this time point can predict early relapse. The specimen will be obtained at a time point when otherwise no bone marrow would be sampled. The results are not shared with the treating oncologist, and no therapeutic interventions are decided or based on the results. Which of the following statements is most accurate about this intervention?
- A. It constitutes a minimal-risk procedure because bone marrow assessments are considered routine for patients diagnosed with acute lymphoblastic leukemia.
- B. It constitutes a minimal-risk procedure because it is a single additional procedure being performed during the course of treatment.
- C. It constitutes a greater than minimal-risk procedure because it is being done under general anesthesia.
- D. It is justifiable because future patients may benefit from knowledge gained by the research.
Correct Answer: C
Rationale: Step 1: General anesthesia carries inherent risks, making the procedure more than minimal-risk.
Step 2: The absence of therapeutic interventions based on results does not make the procedure low-risk.
Step 3: Performing an additional procedure does not automatically make it minimal-risk.
Step 4: Not sharing results with the treating oncologist may raise ethical concerns.
Summary: Choice C is correct because the use of general anesthesia increases the risk level of the procedure, making it greater than minimal-risk. Choices A, B, and D are incorrect as they do not adequately address the specific risk associated with the use of general anesthesia in this scenario.
A 14-year-old boy presents with cough, shortness of breath, and difficulty lying down. His face and neck swell when his arms are raised. Chest x-ray reveals a large mediastinal mass. A tissue diagnosis is desired. A biopsy is performed with local anesthesia because the anesthesiologist thinks that the patient has a very high general anesthesia risk. Which of the following findings does not make general anesthesia unsafe?
- A. Tumor diameter greater than 45% of transthoracic diameter
- B. Tracheal cross-sectional area less than 50% of predicted
- C. Peak expiratory flow rate less than 50% of predicted
- D. A malignancy of hematopoietic origin
Correct Answer: D
Rationale: The correct answer is D because a malignancy of hematopoietic origin does not inherently increase the risk of general anesthesia. Hematopoietic malignancies such as leukemia or lymphoma do not directly impact the respiratory system or airway, unlike the other choices. A: Tumor size affecting transthoracic diameter can compress airways, leading to respiratory compromise. B: Tracheal cross-sectional area affects air flow and can be a concern during intubation. C: Peak expiratory flow rate indicates respiratory function; lower values suggest increased risk under general anesthesia. Therefore, D is the correct answer as it does not pose a direct risk to general anesthesia.