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 increased breakdown of red blood cells leading to excessive production of bilirubin causing jaundice. Viral hepatitis B and C do not directly cause jaundice in thalassemia. Iron deposition in the liver is seen in iron overload conditions like hemochromatosis, not thalassemia. Haemolysis in thalassemia is the primary reason for jaundice.
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The nurse is caring for a patient who has a white blood cell (WBC) count of 8000/mm³. What concern should the nurse have about this finding?
- A. The patient has an infection.
- B. The patient is at risk for infection.
- C. The patient has a hematological disorder.
- D. There is no concern; this is a normal finding.
Correct Answer: D
Rationale: The correct answer is D because a WBC count of 8000/mm³ falls within the normal reference range of 4000-11000/mm³. Therefore, there is no immediate concern regarding infection or hematological disorder. Choice A is incorrect because a normal WBC count does not indicate infection. Choice B is incorrect as the count is within the normal range, not indicating increased infection risk. Choice C is incorrect as a normal WBC count does not suggest a hematological disorder.
A nurse is preparing to assist with a bone marrow biopsy. Which anatomical site should the nurse anticipate will be used to obtain the specimen?
- A. Ribs
- B. Humerus
- C. Posterior iliac crest
- D. Long bones in the legs
Correct Answer: C
Rationale: The correct answer is C: Posterior iliac crest. This site is commonly used for bone marrow biopsies due to its accessibility and abundance of red bone marrow. The iliac crest is a flat bone, making it easier to access for the procedure compared to the round shape of other bones listed. Ribs (A) are not commonly used due to the risk of pneumothorax. The humerus (B) is not an ideal site as it contains mostly yellow bone marrow. Long bones in the legs (D) are not typically used for bone marrow biopsies due to the difficulty in accessing and the higher risk of complications.
An oncology nurse recognizes a patient's risk for fluid imbalance while the patient is undergoing treatment for leukemia. What relevant assessments should the nurse include in the patient's plan of care? Select all that apply.
- A. Monitoring the patient's electrolyte levels
- B. Monitoring the patient's hepatic function
- C. Measuring the patient's weight on a daily basis
- D. Measuring and recording the patient's intake and output
Correct Answer: B
Rationale: The correct answer is B: Monitoring the patient's hepatic function. In leukemia treatment, chemotherapy drugs can affect liver function, leading to fluid imbalance. By monitoring hepatic function, the nurse can assess the liver's ability to regulate fluid balance.
A: Monitoring electrolyte levels is important but not directly related to fluid imbalance in leukemia treatment.
C: Measuring weight daily is important for fluid status assessment but does not target hepatic function specifically.
D: Measuring and recording intake and output is crucial for fluid balance monitoring but does not focus on hepatic function assessment.
Basophilic stippling is classically seen in:
- A. CML
- B. myelosclerosis
- C. chronic lead poisoning
- D. iron def anemia
Correct Answer: C
Rationale: Basophilic stippling refers to the presence of blue-staining granules in red blood cells, which is a classic finding in chronic lead poisoning due to the inhibition of heme synthesis. In CML, the primary feature is the presence of the Philadelphia chromosome. Myelosclerosis is characterized by bone marrow fibrosis, not basophilic stippling. Iron deficiency anemia typically presents with microcytic hypochromic red blood cells, not basophilic stippling. Therefore, the correct answer is C: chronic lead poisoning.
A 7-year-old boy presents with recent onset of vomiting and lethargy. Blood smear shows increased neutrophils with a left shift and 8% abnormal cells. Bone marrow contains 60% of the same cells. Flow cytometry shows that the cells are TdT–, CD10+, CD19+, CD20+, sIg+. What is the most likely diagnosis?
- A. Burkitt leukemia/lymphoma
- B. B-cell acute lymphoblastic leukemia (ALL)
- C. T-cell ALL
- D. Hematogones
Correct Answer: A
Rationale: The correct answer is A: Burkitt leukemia/lymphoma. This diagnosis is supported by the presence of abnormal cells that are CD10+, CD19+, CD20+, sIg+, which are characteristic of Burkitt lymphoma. The absence of TdT– indicates that it is not T-cell ALL. B-cell ALL would typically show TdT positivity. Hematogones are immature B-cell precursors commonly seen in the bone marrow of healthy children and do not typically present with the described clinical picture. The high percentage of abnormal cells in both blood and bone marrow, along with the specific immunophenotype, point towards Burkitt leukemia/lymphoma.