The nurse is assisting with the collection of data from a patient with a hematologic disorder. On which body system should the nurse expect to focus when collecting this data?
- A. Respiratory
- B. Genitourinary
- C. Cardiovascular
- D. All body systems
Correct Answer: D
Rationale: The correct answer is D because hematologic disorders affect all body systems due to their impact on blood production, clotting, and oxygen transport. The nurse needs to assess respiratory system for oxygenation, genitourinary system for kidney function, cardiovascular system for circulation, and other systems for secondary effects. Choices A, B, and C are incorrect as they focus on specific systems, while hematologic disorders can impact multiple systems. It is important to consider the interconnectedness of the body and assess all systems comprehensively.
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Platelet aggregation is an important event in hemostasis. Which of the following statement is true for platelet aggregation in vascular injury?
- A. There will be initial vasodilation
- B. Clotting factors play no role in its formation
- C. Platelets change their shape during the process
- D. Serotonin stimulates platelet aggregation
Correct Answer: C
Rationale: Platelets change their shape during platelet aggregation to form a plug at the site of vascular injury. This process involves platelets adhering to the injured blood vessel wall, becoming activated, and then changing shape to form a clot. Vasodilation is not an initial response, as vasoconstriction occurs to reduce blood loss. Clotting factors are essential for clot formation and play a significant role. Serotonin is released from platelets during aggregation but does not directly stimulate aggregation. The correct choice, C, directly correlates with the physiological process of platelet aggregation in response to vascular injury.
A 4-year-old child with acute lymphoblastic leukemia is receiving high-dose methotrexate during interim maintenance. He receives ondansetron and арrepitant during his stay, which control his nausea and vomiting well. These medications work by inhibiting signaling in which part of the brain?
- A. Vestibular system
- B. Cerebral cortex
- C. Hypothalamus
- D. Vomiting center
Correct Answer: E
Rationale: The correct answer is D: Vomiting center. Ondansetron and aprepitant are antiemetic medications that work by inhibiting signaling in the vomiting center of the brain. The vomiting center is located in the medulla oblongata in the brainstem, which plays a crucial role in triggering the reflexes that lead to nausea and vomiting. By blocking signals in the vomiting center, these medications effectively prevent and control nausea and vomiting.
Incorrect choices:
A: The vestibular system is responsible for balance and spatial orientation, not for controlling nausea and vomiting.
B: The cerebral cortex is involved in higher brain functions such as thinking and decision-making, not in regulating nausea and vomiting.
C: The hypothalamus regulates various physiological processes like temperature regulation and hormone release, but it is not directly involved in controlling nausea and vomiting.
You are consulting on a 10-year-old male with severe persistent neutropenia, a history of recurrent infections, and warts. The rest of the peripheral blood count is normal. His mother also has neutropenia. Bone marrow examination shows a hypercellular marrow and retained myeloid cells with vacuolated cytoplasm. There are no abnormalities in the red cells or platelet precursors. Cytogenetics are 46XY. You start granulocyte colony stimulating factor therapy and the neutrophil count increases. A mutation in which of the following genes is most likely to have caused this familial inherited bone marrow failure syndrome?
- A. CXCR4
- B. ELANE
- C. GATA 2
- D. Mitochondrial DNA
Correct Answer: A
Rationale: The correct answer is A: CXCR4. In this case, the familial inherited bone marrow failure syndrome with severe neutropenia, recurrent infections, and warts suggests WHIM syndrome. WHIM syndrome is caused by a gain-of-function mutation in the CXCR4 gene, leading to impaired neutrophil trafficking. The symptoms and bone marrow findings in this patient align with WHIM syndrome. Choice B (ELANE) is associated with cyclic neutropenia, not WHIM syndrome. Choice C (GATA 2) is linked to familial myelodysplastic syndromes and acute myeloid leukemia, not WHIM syndrome. Choice D (Mitochondrial DNA) is not associated with WHIM syndrome. Therefore, the mutation in CXCR4 is the most likely cause of the familial inherited bone marrow failure syndrome in this patient.
A patient is being prepared to receive a prescribed blood transfusion. What is the best way that the LPN can assist the health team to prevent a transfusion reaction?
- A. Monitor vital signs every 15 minutes.
- B. Warm blood to 98.6°F (37°C) before infusion.
- C. Administer diphenhydramine (Benadryl) before the infusion.
- D. Assist the registered nurse (RN) to identify correctly the patient and the blood product.
Correct Answer: D
Rationale: The correct answer is D: Assist the registered nurse (RN) to identify correctly the patient and the blood product. This is crucial to prevent transfusion reactions as it ensures the right blood is given to the right patient. Misidentification can lead to severe complications. Monitoring vital signs (A) is important but doesn't directly prevent transfusion reactions. Warming blood (B) may improve patient comfort but doesn't prevent reactions. Administering diphenhydramine (C) is not a standard pre-transfusion medication and should not be given without specific orders. Identifying the patient and blood product correctly is the best way to prevent transfusion reactions.
A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take?
- A. Shake the vial before using.
- B. Administer via IV bolus over 1 to 3 min.
- C. Dilute the drug first with D5W.
- D. Save the used vial for the next dose.
Correct Answer: B
Rationale: The correct answer is B: Administer via IV bolus over 1 to 3 min. This is the correct action because epoetin is typically administered intravenously over a specified time frame to prevent adverse reactions such as rapid changes in blood pressure or heart rate. Shaking the vial before using (option A) is unnecessary and may lead to frothing. Diluting the drug with D5W (option C) is not recommended for administration as an IV bolus. Saving the used vial for the next dose (option D) is incorrect and violates medication safety protocols. Administering via IV bolus over 1 to 3 min ensures safe and effective delivery of the medication.