Nokea
The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?
- A. Aspirin
- B. Heparin
- C. Warfarin
- D. Erythropoietin
Correct Answer: B
Rationale: The correct answer is B: Heparin. An aPTT level of 28 seconds is below the therapeutic range for heparin, indicating a subtherapeutic dose. The nurse should notify the healthcare provider to adjust the heparin dosage to achieve the desired anticoagulant effect. Aspirin (choice A) does not affect aPTT levels. Warfarin (choice C) affects PT/INR, not aPTT. Erythropoietin (choice D) is not related to aPTT levels.
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Which of the following characteristics are similar with respect to Factor VIII and von Willebrand factor (vWF)?
- A. Both are made in endothelial cells and megakaryocytes.
- B. Both are activated by thrombin.
- C. They are present in normal to high relative amounts in newborns.
- D. They are stored in Weibel-Palade bodies in endothelial cells.
Correct Answer: C
Rationale: Step-by-step rationale:
1. Factor VIII and vWF are present in normal to high relative amounts in newborns due to the physiological adaptation to the low levels at birth.
2. Both Factor VIII and vWF play crucial roles in the coagulation cascade, but their levels decrease after birth.
3. The other choices are incorrect because:
- A: Factor VIII is primarily made in endothelial cells and vWF is made in endothelial cells and platelets, not megakaryocytes.
- B: Thrombin activates Factor VIII but not vWF, which is activated by shear stress.
- D: Factor VIII is stored in Weibel-Palade bodies, but vWF is stored in platelets and endothelial cells, not in the Weibel-Palade bodies.
Your patient with relapsed high-risk neuroblastoma returns to your care after travelling to an outside institution for [131]I-MIBG therapy. In the weeks following [131]I-MIBG therapy, what adverse events directly attributable to this therapy will the patient most likely encounter?
- A. Myelosuppression requiring growth factor and blood product support
- B. Severe mucositis
- C. Hemorrhagic cystitis
- D. Symptomatic hypothyroidism
Correct Answer: A
Rationale: Rationale for Correct Answer (A): Myelosuppression requiring growth factor and blood product support is the most likely adverse event following [131]I-MIBG therapy due to its impact on bone marrow. The therapy targets neuroblastoma cells, but can also affect normal bone marrow function, leading to myelosuppression. Growth factors and blood products are often needed to support hematopoiesis.
Summary of Incorrect Answers:
B: Severe mucositis: Not a common adverse event associated with [131]I-MIBG therapy, as it primarily affects the bone marrow.
C: Hemorrhagic cystitis: Not directly related to [131]I-MIBG therapy, which does not typically cause bladder toxicity.
D: Symptomatic hypothyroidism: While [131]I-MIBG therapy can affect thyroid function, symptomatic hypothyroidism is not the most likely adverse event following this therapy.
You are treating a patient with localized osteosarcoma of the distal femur with methotrexate, doxorubicin, and cisplatin (MAP) chemotherapy. At week 10 of treatment, the patient undergoes complete resection of the tumor. Pathology demonstrates 40% necrosis. Which of the following represents the most appropriate further therapy?
- A. Ifosfamide and etoposide (IE)
- B. MAP plus ifosfamide and etoposide (MAPIE)
- C. Gemcitabine docetaxel
- D. MAP
Correct Answer: D
Rationale: The correct answer is D: MAP. In localized osteosarcoma, the response to preoperative chemotherapy is evaluated based on the percentage of tumor necrosis. A necrosis of 40% is considered a good response. The standard of care after surgery is to continue with the same chemotherapy regimen to complete the course. Continuing with MAP in this case is important to ensure that any remaining cancer cells are effectively treated. Option A (IE) and option B (MAPIE) are not indicated as they are different regimens and not the standard of care for this scenario. Option C (Gemcitabine docetaxel) is also not the appropriate choice as it is not the standard treatment protocol for localized osteosarcoma.
A 72-year-old male with enlargement of superficial lymph nodes and mild hepatosplenomegaly is diagnosed as having chronic lymphatic leukemia (CLL). The most important criteria for diagnosis of this disease is the
- A. Presence of hypogammaglobulinemia
- B. Absolute lymphocytes
- C. Male predominance
- D. Presence of enlarged lymph nodes
Correct Answer: B
Rationale: The correct answer is B: Absolute lymphocytes. In CLL, the most important diagnostic criterion is an absolute lymphocyte count of more than 5,000 cells per microliter in the peripheral blood. This is a key feature of CLL and distinguishes it from other conditions. Hypogammaglobulinemia (choice A) may occur in CLL but is not as specific for diagnosis. Male predominance (choice C) is a general characteristic of CLL but is not a diagnostic criterion. Presence of enlarged lymph nodes (choice D) is a common manifestation of CLL but not the most important criteria for diagnosis.
Oral iron supplements are given for iron deficiency anemia. Which of the statement is true regarding the absorption of oral iron supplements?
- A. Absorption occurs in the large intestine
- B. Intrinsic factor is necessary for the iron absorption
- C. Ascorbic acids reduces iron absorption
- D. Absorption is increased in hereditary hemochromatosis
Correct Answer: A
Rationale: Rationale:
A: Correct - Iron absorption primarily occurs in the duodenum and upper small intestine, not the large intestine.
B: Incorrect - Intrinsic factor is necessary for Vitamin B12 absorption, not iron.
C: Incorrect - Ascorbic acid (Vitamin C) actually enhances iron absorption.
D: Incorrect - Absorption is decreased in hereditary hemochromatosis, a condition of iron overload.