Nokea
The nurse is documenting findings after completing data collection with a patient. What term should the nurse use to document a large area of discoloration from hemorrhage under the skin?
- A. Pallor
- B. Rubor
- C. Petechiae
- D. Ecchymosis
Correct Answer: D
Rationale: The correct term to document a large area of discoloration from hemorrhage under the skin is ecchymosis. Ecchymosis refers to a bruise caused by the extravasation of blood into the subcutaneous tissues. Pallor (A) is paleness, rubor (B) is redness, and petechiae (C) are tiny, pinpoint-sized red or purple spots on the skin due to bleeding. Ecchymosis is the most appropriate term for describing a large area of discoloration from hemorrhage under the skin as it specifically denotes a bruise resulting from blood leakage into tissues.
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A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer?
- A. Alteplase
- B. Aspirin
- C. Clopidogrel
- D. Heparin
Correct Answer: A
Rationale: The correct answer is A: Alteplase. Alteplase is a thrombolytic medication used to dissolve blood clots and is crucial in treating acute ischemic cerebrovascular events caused by thrombus. It helps restore blood flow to the affected area of the brain. Aspirin (B) and Clopidogrel (C) are antiplatelet medications that prevent clot formation but do not dissolve existing clots. Heparin (D) is an anticoagulant that does not directly dissolve clots like Alteplase. Administering Alteplase promptly is essential to minimize brain damage in such emergencies.
A patient with non-Hodgkin's lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurse's best response?
- A. Everyone should do these things because they're health promotion activities that apply to everyone.
- B. You don't want to develop a second cancer, do you?
- C. You need to do this just to be on the safe side.
- D. It's important to reduce other factors that increase the risk of second cancers.
Correct Answer: D
Rationale: The correct answer is D because reducing factors that increase the risk of second cancers is crucial for a patient with non-Hodgkin's lymphoma due to the potential for developing secondary cancers. Alcohol, smoking, and sun exposure are known risk factors for various cancers, including secondary cancers. By avoiding these behaviors, the patient can decrease the likelihood of developing another cancer.
Choice A is incorrect because while health promotion activities are beneficial, the specific reason for a patient with non-Hodgkin's lymphoma to stop drinking, smoking, and avoiding sun exposure is to reduce the risk of second cancers, not just for general health.
Choice B is incorrect because it uses fear tactics and does not provide a clear rationale for why the patient should make these lifestyle changes.
Choice C is incorrect because it lacks a specific explanation for the importance of avoiding alcohol, smoking, and sun exposure in relation to reducing the risk of second cancers.
A 13-year-old boy presents to the emergency department with complaints of headache and visual changes. History reveals progressive dyspnea on exertion, generalized fatigue, and increased bruising. His labs are significant for a WBC of 350,000/mcL, of which 80% are reported to be blasts and appear to be myeloblasts without the presence of Auer rods. His hemoglobin is 7.2 g/dL, and his platelets are 18,000/mcL. A CT scan of the head shows a small intracerebral hemorrhage. His coags are normal. Which of the following is the most appropriate therapy?
- A. Start induction chemotherapy.
- B. Perform emergent leukapheresis followed the next day by induction chemotherapy.
- C. Perform emergent leukapheresis plus hydroxyurea.
- D. Provide emergent cranial radiation plus hydroxyurea followed the next day by induction chemotherapy.
Correct Answer: C
Rationale: The most appropriate therapy in this scenario is emergent leukapheresis plus hydroxyurea (Choice C). Leukapheresis is needed to rapidly reduce the high white blood cell count, preventing further complications such as leukostasis and hyperviscosity syndrome. Hydroxyurea can help further control the rapid proliferation of blasts. Induction chemotherapy (Choice A) may lead to tumor lysis syndrome due to the high tumor burden. Performing leukapheresis alone without a subsequent therapy (Choice B) may not adequately address the underlying disease. Providing cranial radiation (Choice D) is not the initial management for acute myeloid leukemia.
A 14-year-old male patient is diagnosed with very high risk acute lymphoblastic leukemia and is likely going to require an allogeneic hematopoietic stem cell transplant to cure his leukemia. Prior to going to transplant, he is likely to require multiple blood transfusions. Which of the following products or component modifications is the best way to prevent him from developing alloimmunization due to anti-HLA antibodies prior to transplant?
- A. Frozen RBCs
- B. Volume-reduced blood products
- C. Irradiation of all blood products
- D. Leukoreduced blood products
Correct Answer: D
Rationale: The correct answer is D, Leukoreduced blood products. Leukoreduction removes white blood cells from the blood product, reducing the risk of alloimmunization due to anti-HLA antibodies. White blood cells are a major source of HLA antigens that can stimulate the immune system to produce antibodies. This process helps prevent the development of alloimmunization, which is crucial for patients undergoing stem cell transplant.
A: Frozen RBCs - Freezing does not affect the risk of alloimmunization.
B: Volume-reduced blood products - Volume reduction does not specifically target white blood cells or HLA antigens.
C: Irradiation of all blood products - Irradiation is used to prevent graft-versus-host disease, not specifically to prevent alloimmunization.
An infant is born with a 7 cm × 6 cm lesion over the upper extremity from the elbow to the shoulder. The lesion is indurated and purpuric, with some petechiae around the edges. No other areas of petechiae are noted on the skin. The infant is doing well without other systemic problems. i were 9 and 9. You are called by the pediatric nurse practitioner to the NICU. What is the most appropriate next step?
- A. Do nothing because the infant is doing well and had good Apgars.
- B. Obtain an ultrasound for more information about the lesion.
- C. Obtain an MRI to assess the extent of the lesion.
- D. Obtain labs, including a CBC with platelet count and fibrinogen.
Correct Answer: D
Rationale: The correct next step is D: Obtain labs, including a CBC with platelet count and fibrinogen. This is the most appropriate action because the infant presents with an indurated and purpuric lesion with petechiae, suggesting a possible coagulation disorder. Labs can help assess for any underlying hematologic abnormalities.
Choice A is incorrect because it is important to investigate further given the concerning presentation.
Choice B is not the best next step as an ultrasound would not provide information on the hematologic status.
Choice C is also not the best option as an MRI is not typically used to assess coagulation disorders.