Nokea
The commonest cause of jaundice in thalassemia is:
- A. viral hepatitis c
- B. iron deposition in liver
- C. viral hepatitis B
- D. haemolysis
Correct Answer: D
Rationale: The correct answer is D: haemolysis. In thalassemia, there is an abnormality in hemoglobin production leading to the destruction of red blood cells, causing hemolysis. This results in the release of bilirubin, leading to jaundice. Iron deposition in the liver (choice B) is seen in conditions like hemochromatosis, not thalassemia. Viral hepatitis B and C (choices A and C) can cause jaundice, but they are not the commonest cause in thalassemia patients, as hemolysis is the primary mechanism in this population.
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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 essential before any invasive procedure like a bone marrow aspiration and biopsy. It ensures that the client understands the procedure, risks, benefits, and alternatives. Administering pain medication (A), having the client shower (C), and premedicating with sedatives (D) are important aspects of care but obtaining valid consent is crucial for legal and ethical reasons before proceeding with the procedure.
A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?
- A. Hypertension
- B. Muscle pain
- C. Edema
- D. Dry mouth
Correct Answer: A
Rationale: The correct answer is A: Hypertension. Epoetin stimulates red blood cell production, increasing blood volume and potentially leading to hypertension. This adverse effect is known as hypertensive crisis. Muscle pain (B), edema (C), and dry mouth (D) are not typically associated with epoetin therapy for renal failure. Thus, they are incorrect choices.
A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?
- A. Uncontrolled bleeding
- B. Myocardial infarction
- C. Respiratory depression
- D. Decreased renal perfusion
Correct Answer: A
Rationale: The correct answer is A: Uncontrolled bleeding. Aspirin is an antiplatelet medication that inhibits platelet aggregation, leading to decreased clotting ability. This places the client at risk for uncontrolled bleeding during and after surgery. Myocardial infarction (B) is not directly associated with aspirin use. Respiratory depression (C) is not a common complication of aspirin. Decreased renal perfusion (D) is not a typical complication of aspirin use.
A patient is scheduled for upcoming surgery. He is on nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. You are being asked what to do with his medications for the surgery. What is the mechanism of action of NSAIDS?
- A. Irreversible inhibition of cyclooxygenase 1
- B. Irreversible inhibition of cyclooxygenase 2
- C. Reversible inhibition of cyclooxygenase 1
- D. Reversible inhibition of cyclooxygenase 2
Correct Answer: C
Rationale: The correct answer is C: Reversible inhibition of cyclooxygenase 1. NSAIDs work by reversibly inhibiting cyclooxygenase enzymes, particularly COX-1 and COX-2, which are involved in the synthesis of prostaglandins. In this case, reversible inhibition is crucial because it allows for the temporary suppression of prostaglandin production, leading to pain relief and anti-inflammatory effects.
Explanation of other choices:
A: Irreversible inhibition of cyclooxygenase 1 - This is incorrect because NSAIDs typically do not irreversibly inhibit COX-1.
B: Irreversible inhibition of cyclooxygenase 2 - This is incorrect because NSAIDs do not irreversibly inhibit COX-2.
D: Reversible inhibition of cyclooxygenase 2 - This is incorrect because while NSAIDs can inhibit COX-2, the primary target is COX-1 for their therapeutic effects.
You receive a phone call from a community pediatrician who is caring for a 2-year-old toddler with a cancer predisposition syndrome. The pediatrician describes a child at the 95th percentile for height and weight with a history of corrective oral surgery to reduce a large tongue and a history of an omphalocele in infancy. The pediatrician is currently performing ultrasound of the abdomen and laboratory evaluation for this patient every 3 months. Which tumor is this patient most at risk of developing?
- A. Pleuropulmonary blastoma
- B. Hepatocellular carcinoma
- C. Cystic nephroma
- D. Nephroblastoma
Correct Answer: D
Rationale: The correct answer is D: Nephroblastoma. This patient most likely has Beckwith-Wiedemann Syndrome (BWS) due to the large tongue (macroglossia) and omphalocele. BWS is associated with an increased risk of nephroblastoma (Wilms tumor). The 95th percentile for height and weight is also a characteristic feature of BWS. Ultrasound and laboratory evaluation are appropriate monitoring tools for nephroblastoma in this patient due to the increased risk associated with BWS.
A: Pleuropulmonary blastoma is more commonly associated with DICER1 syndrome, not BWS.
B: Hepatocellular carcinoma is not commonly associated with BWS.
C: Cystic nephroma is not typically associated with BWS, and nephroblastoma is a more common tumor in this context.