Nokea
NADPH is a product of the hexose monophosphate pathway (HMP) in the red blood cell. The NADPH is used for the
- A. Synthesis of fatty acids
- B. Reduction of glutathione
- C. Formation of ATP
- D. Removal of oxygen radicals
Correct Answer: B
Rationale: The correct answer is B: Reduction of glutathione. In the HMP pathway, glucose-6-phosphate is converted to ribulose-5-phosphate, generating NADPH. NADPH is essential for the reduction of glutathione, which helps in detoxifying reactive oxygen species and protecting red blood cells from oxidative damage. Fatty acid synthesis (choice A) primarily requires NADPH from the pentose phosphate pathway. ATP formation (choice C) is not a direct function of NADPH production in the HMP pathway. NADPH is not directly involved in the removal of oxygen radicals (choice D), as it is the reduced form of NADP+ that participates in antioxidant defense mechanisms.
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Which of the following is associated with normocytic normochromic anaemia?
- A. Iron deficiency
- B. Primaquine
- C. Pregnancy
- D. Sickle cell disease
Correct Answer: C
Rationale: Normocytic normochromic anemia is characterized by normal-sized red blood cells with normal hemoglobin content. Pregnancy is associated with this type of anemia due to increased blood volume and iron demands. Iron deficiency anemia (choice A) is typically microcytic hypochromic. Primaquine (choice B) is not known to cause normocytic normochromic anemia. Sickle cell disease (choice D) results in hemolytic anemia with abnormal red blood cell morphology. Thus, the correct answer is C as it aligns with the characteristics of normocytic normochromic anemia.
A 10-year-old patient with aplastic anemia, who is blood type B negative, is receiving a red blood cell transfusion. About 10 minutes after the transfusion starts, the patient develops anxiety and lower back pain. The transfusion continues for another 5 minutes until it is stopped when he develops a temperature of 40 °C with chills and rigors. A transfusion reaction work-up is most likely to reveal what findings?
- A. Spherocytes on peripheral blood smear
- B. Gram-negative Bacillus on gram stain of remaining RBC unit
- C. Chest x-ray with bilateral pulmonary infiltrates that are new compared to an x-ray done last week
- D. DAT positive for C3
Correct Answer: D
Rationale: The correct answer is D: DAT positive for C3. This finding suggests complement-mediated hemolysis, which is consistent with a transfusion reaction known as transfusion-related acute lung injury (TRALI). TRALI presents with respiratory distress, fever, and chills due to immune complexes activating the complement system. A: Spherocytes indicate hemolysis, which is not specific to TRALI. B: Gram-negative Bacillus suggests bacterial contamination, leading to sepsis, not TRALI. C: Bilateral pulmonary infiltrates are seen in transfusion-associated circulatory overload (TACO), not TRALI.
A hospitalized client has a platelet count of 58,000/mm3 (58 × 109/L). What action by the nurse is most appropriate?
- A. Encourage high-protein foods.
- B. Institute neutropenic precautions.
- C. Limit visitors to healthy adults.
- D. Place the client on safety precautions.
Correct Answer: D
Rationale: The correct answer is D: Place the client on safety precautions. A platelet count of 58,000/mm3 is considered low (normal range is 150,000-450,000/mm3). This places the client at risk for bleeding. Safety precautions involve preventing injuries that could lead to bleeding, such as falls, bumps, or cuts. This is crucial to prevent complications like spontaneous bleeding. Encouraging high-protein foods (choice A) is important for overall health but not directly related to managing low platelet count. Neutropenic precautions (choice B) are for clients with low white blood cell counts, not low platelet counts. Limiting visitors (choice C) to healthy adults is important for infection control but not directly related to preventing bleeding in a client with low platelet count.
Which is not associated with hypersplenism:
- A. splenomegaly
- B. pancytopenia
- C. hyper cellular bone marrow
- D. reversibility by splenectomy
Correct Answer: C
Rationale: Step-by-step rationale:
1. Hypersplenism is characterized by splenomegaly (A), causing sequestration and destruction of blood cells.
2. Pancytopenia (B) results from excessive destruction of blood cells in the enlarged spleen.
3. Hypercellular bone marrow (C) is not directly associated with hypersplenism; it is a compensatory response to increased blood cell destruction.
4. Splenectomy (D) can reverse the effects of hypersplenism by removing the source of blood cell destruction.
Therefore, the correct answer is C as hypercellular bone marrow is a secondary response to hypersplenism, not a direct association.
A 16-year-old patient with a left-side pelvic osteosarcoma is taking extended release oxycodone twice daily as well as immediate release oxycodone for breakthrough pain approximately 2 or 3 times per day. She describes her pain as burning, tingling, and shooting in her left leg. Her pain worsens with hot showers. Her most recent EKG has a QTc of 495. What would be the best strategy to manage her pain?
- A. Switch from long-acting oxycodone to methadone.
- B. Recommend more frequent use of her immediate release oxycodone.
- C. Add amitriptyline daily. Start low and titrate upward on dosage.
- D. Add gabapentin three times daily. Start low and titrate upward on dose.
Correct Answer: D
Rationale: The correct answer is D: Add gabapentin three times daily. Gabapentin is a first-line option for neuropathic pain, which is likely the cause of the patient's burning, tingling, and shooting leg pain. The worsening of pain with hot showers is also characteristic of neuropathic pain. Gabapentin's mechanism of action in reducing neuropathic pain makes it a suitable choice for this patient. Switching to methadone (A) may not directly address the neuropathic pain component. Recommending more frequent use of immediate release oxycodone (B) may lead to increased risk of opioid-related adverse effects. While amitriptyline (C) is also used for neuropathic pain, starting with gabapentin is more appropriate given the patient's current opioid regimen and EKG findings.