Nokea
Presence of an --jaundice --splenomegaly with increase MCH is seen in:
- A. liver cirrhosis
- B. th.major
- C. PNH
- D. herditary spherocytosis
Correct Answer: D
Rationale: The correct answer is D, hereditary spherocytosis. In this condition, the presence of jaundice and splenomegaly is due to the destruction of red blood cells by the spleen, leading to increased MCH. In liver cirrhosis (choice A), jaundice is due to impaired liver function. Thalassemia major (choice B) presents with severe anemia, not jaundice. Paroxysmal nocturnal hemoglobinuria (choice C) is characterized by hemolytic anemia and not typically associated with splenomegaly and jaundice. Therefore, the presence of jaundice, splenomegaly, and increased MCH points towards hereditary spherocytosis.
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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. Central line type is a nominal data structure because it represents categories without any inherent order or ranking. In this study, the central line types (port, PICC, TEC) are distinct categories with no numerical significance or order. They are simply different types of central lines used for medical purposes. Continuous (A) data involves numerical values with infinite possibilities, which is not the case here. Dichotomous (B) data consists of only two categories, while in this study there are three central line types. Ordinal (D) data involves categories with a specific order or ranking, which is not applicable to central line types as they do not have a natural order.
When reviewing the chemistry panel of a newly diagnosed patient with acute lymphoblastic leukemia who is lethargic, complaining of flank pain, and experiencing nausea and vomiting, which of the following would you expect to see?
- A. Potassium 4.5 mmol/L, phosphorus 8 mg/dL, uric acid 7 mg/dL, calcium 9.0 mg/dL, BUN 12 mg/dL
- B. Potassium 6.5 mmol/L, phosphorus 8 mg/dL, uric acid 9 mg/dL, calcium 10 mg/dL, BUN 14 mg/dL
- C. Potassium 4 mmol/L, phosphorus 9 mg/dL, uric acid 10 mg/dL, calcium 10 mg/dL, BUN 10 mg/dL
- D. Potassium 7 mmol/L, phosphorus 12 mg/dL, uric acid 10 mg/dL, calcium 7 mg/dL, BUN 25 mg/dL
Correct Answer: D
Rationale: Step-by-step rationale:
1. Lethargy, flank pain, nausea, vomiting in leukemia can suggest tumor lysis syndrome (TLS).
2. TLS can cause hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, and elevated BUN.
3. Choice D has the highest potassium, phosphorus, uric acid, and BUN levels, and the lowest calcium level.
4. Therefore, choice D is the most consistent with the expected lab findings in tumor lysis syndrome.
Summary:
- Choice A has normal potassium, phosphorus, uric acid, calcium levels, and lower BUN.
- Choice B has high potassium but normal phosphorus, uric acid, calcium, and slightly elevated BUN.
- Choice C has low potassium, normal phosphorus, and elevated uric acid, calcium, and BUN.
- Choice D aligns most closely with the expected lab findings in tumor lysis syndrome due to the pattern of
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 because a prothrombin time (PT) of 28 seconds indicates potential issues with blood clotting and can be a sign of bleeding disorders or liver dysfunction, requiring immediate assessment and intervention to prevent complications.
Choice A (INR of 2.8) is within the therapeutic range for clients on anticoagulant therapy, so it's not an immediate concern. Choice B (platelet count of 128,000/mm3) is low but not critically low, so it doesn't require immediate assessment. Choice D (red blood cell count of 5.1 million/mcl) is within the normal range and doesn't indicate urgent issues.
In summary, the nurse should assess the client with a PT of 28 seconds first due to the potential risk of bleeding or clotting disorders, while the other choices are not as urgent.
When reviewing the chemistry panel of a newly diagnosed patient with acute lymphoblastic leukemia who is lethargic, complaining of flank pain, and experiencing nausea and vomiting, which of the following would you expect to see?
- A. Potassium 4.5 mmol/L, phosphorus 8 mg/dL, uric acid 7 mg/dL, calcium 9.0 mg/dL, BUN 12 mg/dL
- B. Potassium 6.5 mmol/L, phosphorus 8 mg/dL, uric acid 9 mg/dL, calcium 10 mg/dL, BUN 14 mg/dL
- C. Potassium 4 mmol/L, phosphorus 9 mg/dL, uric acid 10 mg/dL, calcium 10 mg/dL, BUN 10 mg/dL
- D. Potassium 7 mmol/L, phosphorus 12 mg/dL, uric acid 10 mg/dL, calcium 7 mg/dL, BUN 25 mg/dL
Correct Answer: D
Rationale: The correct answer is D because the patient with acute lymphoblastic leukemia and symptoms of lethargy, flank pain, nausea, and vomiting is likely experiencing tumor lysis syndrome. This syndrome can lead to hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, and elevated BUN levels. In option D, the potassium, phosphorus, and BUN levels are elevated, while the calcium level is decreased, which aligns with the expected findings in tumor lysis syndrome. The other choices do not reflect the characteristic electrolyte imbalances seen in tumor lysis syndrome.
The nurse is assessing a patient with chronic lung disease. Which finding indicates long-term hypoxia?
- A. Pallor
- B. Dyspnea
- C. Clubbed fingertips
- D. Pulmonary crackles
Correct Answer: C
Rationale: The correct answer is C: Clubbed fingertips. Clubbing of the fingertips is a sign of long-term hypoxia due to chronic lung disease, causing changes in the nail bed angle and soft tissue around the nails. Pallor (A) is a paleness of the skin and not specific to hypoxia. Dyspnea (B) is difficulty breathing, which can occur in acute or chronic conditions. Pulmonary crackles (D) are abnormal lung sounds indicating fluid in the lungs, commonly seen in conditions like pneumonia. Clubbed fingertips specifically point towards long-term hypoxia in chronic lung disease.