Nokea
The nurse is staying with a patient who has been started on a blood transfusion. Which assessment should the nurse perform during a blood product infusion to detect a reaction?
- A. Vital signs
- B. Skin turgor
- C. Bowel sounds
- D. Pupil reactivity
Correct Answer: A
Rationale: Correct Answer: A (Vital signs)
Rationale: Monitoring vital signs during a blood transfusion is crucial to detect any adverse reactions promptly. Changes in blood pressure, pulse rate, temperature, and respiratory rate can indicate a potential reaction. By assessing vital signs, the nurse can intervene promptly if there is any sign of an adverse reaction, such as fever, hypotension, tachycardia, or shortness of breath.
Summary of Incorrect Choices:
B: Skin turgor is not directly related to detecting a reaction during a blood transfusion.
C: Bowel sounds are not indicative of a reaction during a blood transfusion.
D: Pupil reactivity is not relevant for monitoring during a blood transfusion.
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A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?
- A. Hypertension
- B. Muscle pain
- C. Edema
- D. Dry mouth
Correct Answer: A
Rationale: The correct answer is A: Hypertension. Epoetin stimulates red blood cell production, increasing blood volume and potentially leading to hypertension. This adverse effect is known as hypertensive crisis. Muscle pain (B), edema (C), and dry mouth (D) are not typically associated with epoetin therapy for renal failure. Thus, they are incorrect choices.
Splenectomy is curative in:
- A. G6PD def.
- B. ITP
- C. thalassemia
- D. hereditary spherocytosis
Correct Answer: D
Rationale: The correct answer is D: hereditary spherocytosis. Splenectomy is curative in hereditary spherocytosis because the spleen is responsible for the destruction of the abnormal spherocytes in this condition. Removing the spleen eliminates the primary site of red blood cell destruction, leading to an improvement in anemia and other symptoms.
Incorrect choices:
A: Splenectomy is contraindicated in G6PD deficiency as it can worsen hemolysis by increasing the workload on other organs.
B: Splenectomy can be beneficial in ITP to increase platelet counts but is not curative as the underlying autoimmune process persists.
C: Splenectomy is not curative in thalassemia as it does not address the underlying genetic defect causing abnormal hemoglobin synthesis.
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. The key features in the case are increased neutrophils with a left shift, presence of abnormal cells in blood and bone marrow, and flow cytometry showing TdT–, CD10+, CD19+, CD20+, sIg+. These findings are consistent with Burkitt leukemia/lymphoma, a highly aggressive B-cell neoplasm. The presence of CD10, CD19, and CD20, along with sIg positivity, points towards a B-cell origin. Additionally, the characteristic translocation t(8;14) involving c-Myc oncogene is commonly seen in Burkitt lymphoma. The absence of TdT expression rules out T-cell ALL (Choice C). Hematogones (Choice D) are normal precursor B-cells found in bone marrow, but they do not typically present with the clinical features described. B-cell ALL (Choice B) lacks the specific features seen in this case
You are seeing a 12-year-old boy in the survivorship program who presented at 2 years old with a desmoplastic nodular medulloblastoma. You note the child recently underwent germline genetic testing and was found to have nevoid basal cell carcinoma syndrome. In which gene is the child most likely to have a pathogenic variant?
- A. PTEN
- B. CDKN2A
- C. SUFU
- D. SMARCB1
Correct Answer: C
Rationale: Rationale: The correct answer is C: SUFU. Nevoid basal cell carcinoma syndrome, also known as Gorlin syndrome, is associated with pathogenic variants in the SUFU gene. SUFU is a tumor suppressor gene involved in the sonic hedgehog signaling pathway, which plays a role in medulloblastoma and basal cell carcinoma development. PTEN (A) is associated with Cowden syndrome, CDKN2A (B) with familial atypical multiple mole melanoma syndrome, and SMARCB1 (D) with rhabdoid tumor predisposition syndrome, but not specifically linked to nevoid basal cell carcinoma syndrome.
An 8-year-old boy undergoes a resection of a tumor in the right cerebrum next to the lateral ventricle (supratentorial). The pathologist feels the histology is most consistent with an ependymoma. The tumor is sent for advanced molecular and genetic testing. Which of the following findings would further support a diagnosis of ependymoma?
- A. BRAFKIAA1549 fusion
- B. BRAFV600E mutation
- C. RELA fusion
- D. H3K27M mutation
Correct Answer: C
Rationale: The correct answer is C: RELA fusion. Ependymomas are known to have specific genetic alterations, including RELA fusions. The fusion of RELA gene is a hallmark genetic abnormality observed in certain subtypes of ependymomas, aiding in the diagnosis. Conversely, choices A, B, and D are associated with other types of brain tumors such as pilocytic astrocytoma (A), melanoma (B), and diffuse intrinsic pontine glioma (D), respectively. These genetic alterations are not characteristic of ependymomas, making them incorrect choices in this context.