Nokea
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.
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A 14-year-old boy presents with cough, shortness of breath, and difficulty lying down. His face and neck swell when his arms are raised. Chest x-ray reveals a large mediastinal mass. A tissue diagnosis is desired. A biopsy is performed with local anesthesia because the anesthesiologist thinks that the patient has a very high general anesthesia risk. Which of the following findings does not make general anesthesia unsafe?
- A. Tumor diameter greater than 45% of transthoracic diameter
- B. Tracheal cross-sectional area less than 50% of predicted
- C. Peak expiratory flow rate less than 50% of predicted
- D. A malignancy of hematopoietic origin
Correct Answer: D
Rationale: The correct answer is D. A malignancy of hematopoietic origin does not inherently make general anesthesia unsafe. This is because anesthesia risk is typically influenced by factors such as airway patency, respiratory function, and cardiac status. Choices A, B, and C all indicate potential complications that could make general anesthesia unsafe, such as airway obstruction due to a large mediastinal mass (A), compromised tracheal cross-sectional area (B), and impaired respiratory function (C). These factors would necessitate careful consideration and potential modifications in the anesthesia plan to ensure patient safety.
Dohle bodies are patches of dilated endoplasmic reticulum that appear as cerulean blue cytoplasmic puddles. These findings are mostly seen in
- A. Chronic myeloid leukemia
- B. Leukemoid reaction
- C. Chediak-Higashi syndrome
- D. Infectious mononucleosis
Correct Answer: D
Rationale: The correct answer is D: Infectious mononucleosis. Dohle bodies are seen in infectious mononucleosis due to the accumulation of rough endoplasmic reticulum in neutrophils. This is a result of the viral infection causing stress on the neutrophils. In chronic myeloid leukemia (A), leukemoid reaction (B), and Chediak-Higashi syndrome (C), Dohle bodies are not typically observed. In chronic myeloid leukemia, the characteristic finding is the Philadelphia chromosome. Leukemoid reaction is a reactive increase in white blood cells due to infection or inflammation. Chediak-Higashi syndrome is a rare autosomal recessive disorder characterized by defective phagolysosome formation.
Bone marrow responds to iron therapy by increasing erythropoietic activity. Which of the following in bone marrow would most likely indicate erythropoiesis?
- A. Myelocytes
- B. Reticulocytes
- C. Ring sideroblasts
- D. Target cells
Correct Answer: B
Rationale: The correct answer is B: Reticulocytes. Reticulocytes are immature red blood cells released by the bone marrow into the bloodstream in response to increased erythropoietic activity. They indicate ongoing erythropoiesis as they mature into fully functional red blood cells. Myelocytes (A) are immature granulocytic precursors, not involved in erythropoiesis. Ring sideroblasts (C) are seen in conditions like sideroblastic anemia and indicate abnormal iron metabolism. Target cells (D) are red blood cells with a central bull's eye appearance and are associated with conditions like liver disease and thalassemias, not specifically erythropoiesis.
An older client asks the nurse why 'people my age' have weaker immune systems than younger people. What responses by the nurse are best? (Select all that apply.)
- A. Bone marrow produces more blood cells as you age.'
- B. You may have decreased levels of circulating platelets.'
- C. You have lower levels of plasma proteins in the blood.'
- D. Lymphocytes become more reactive to antigens.'
Correct Answer: C
Rationale: Rationale:
- As we age, there is a decrease in the production of plasma proteins, which are essential for immune function.
- Lower levels of plasma proteins can lead to a weaker immune response.
- This decline in plasma proteins can make older individuals more susceptible to infections.
- Choices A, B, and D are incorrect as they do not directly address the impact of aging on immune system function.
You are discussing prognosis with the mother of a patient with stage 3, group III rhabdomyosarcoma. Which of the following is the most unfavorable primary site?
- A. Extremity
- B. Prostate
- C. Infratemporal fossa
- D. Neck
Correct Answer: A
Rationale: The correct answer is A: Extremity. Rhabdomyosarcoma has a better prognosis when located in the extremities compared to other sites due to easier surgical resection and less risk of metastasis. Prostate (B) is less common in children and has a poorer prognosis. Infratemporal fossa (C) and neck (D) sites have a higher risk of local invasion and metastasis, leading to a worse prognosis compared to extremity sites.