Nokea
The patient is a 2-month-old boy who presented with a skin abscess and is febrile. On exam, he is noted to have silvery hair and hypopigmented skin. A CBC shows a leukocyte count of 3.4 K/mcL with 10% neutrophils. What does the abnormality on the peripheral smear suggest?
- A. Abnormal lysosomal biogenesis
- B. Abnormal ribosome function
- C. Abnormal phagocytosis of opsonized particles
- D. Abnormal mitochondrial activity
Correct Answer: A
Rationale: The correct answer is A: Abnormal lysosomal biogenesis. In this case, the clinical presentation of silvery hair and hypopigmented skin suggests a diagnosis of Chediak-Higashi syndrome, a rare autosomal recessive disorder affecting lysosomal function. The abnormal leukocyte count and neutrophil percentage indicate impaired immune function due to defective lysosomal biogenesis. The other choices, B: Abnormal ribosome function, C: Abnormal phagocytosis of opsonized particles, and D: Abnormal mitochondrial activity, do not align with the clinical presentation and laboratory findings of this specific case.
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A patient reports severe abdominal cramping and diarrhea. Assessment reveals a temperature of 102°F (38.8°C) and pulse of 82 beats/min. Results of a complete blood count reveal lower than normal segmented and banded neutrophils and higher than normal lymphocytes. Which type of infection does the nurse suspect this patient is most likely experiencing?
- A. Viral
- B. Fungal
- C. Parasitic
- D. Bacterial
Correct Answer: A
Rationale: The correct answer is A: Viral. The patient's symptoms (abdominal cramping, diarrhea, fever) are consistent with a viral infection, such as gastroenteritis. The lower segmented and banded neutrophils indicate a viral infection, as viruses often target lymphocytes. The higher lymphocyte count is a characteristic response to viral infections. Other choices are incorrect as fungal, parasitic, and bacterial infections typically present with different symptoms and laboratory findings.
Which of the following is the most suitable anti malarial drug for pregnant women?
- A. Atovaquone and proguanil
- B. Quinine and doxycycline
- C. Quinine and clindamycin
- D. Primaquine
Correct Answer: C
Rationale: The correct answer is C: Quinine and clindamycin. Quinine is recommended for pregnant women due to its safety profile in pregnancy. Clindamycin is often used in combination with quinine to treat malaria during pregnancy.
A: Atovaquone and proguanil are not recommended for pregnant women due to limited safety data.
B: Quinine and doxycycline should be avoided in pregnancy as doxycycline can harm the fetus.
D: Primaquine is not recommended during pregnancy due to potential risks to the fetus.
In summary, the combination of quinine and clindamycin is the most suitable anti-malarial drug for pregnant women due to their safety profiles and efficacy in treating malaria without harming the fetus.
A hospitalized client has a platelet count of 58,000/mm3 (58 × 109/L). What action by the nurse is most appropriate?
- A. Encourage high-protein foods.
- B. Institute neutropenic precautions.
- C. Limit visitors to healthy adults.
- D. Place the client on safety precautions.
Correct Answer: D
Rationale: The correct answer is D: Place the client on safety precautions. A platelet count of 58,000/mm3 is considered low (normal range is 150,000-450,000/mm3). This places the client at risk for bleeding. Safety precautions involve preventing injuries that could lead to bleeding, such as falls, bumps, or cuts. This is crucial to prevent complications like spontaneous bleeding. Encouraging high-protein foods (choice A) is important for overall health but not directly related to managing low platelet count. Neutropenic precautions (choice B) are for clients with low white blood cell counts, not low platelet counts. Limiting visitors (choice C) to healthy adults is important for infection control but not directly related to preventing bleeding in a client with low platelet count.
A 19-year old male patient with a history of acute lymphoblastic leukemia, currently 13 years from completion of therapy, presents for a fertility consultation. He is interested in his risk for infertility. Which of the following statements is true?
- A. A semen analysis at this point would provide accurate information about future fertility.
- B. Males can maintain gonadal function at higher cumulative alkylator dosages compared with females.
- C. He should have been offered sperm cryopreservation at diagnosis.
- D. His risk for testosterone deficiency is greater than his risk for infertility.
Correct Answer: A
Rationale: The correct answer is A. A semen analysis at this point would provide accurate information about future fertility because it assesses sperm count, motility, and morphology, which are crucial indicators of fertility potential. This is important for the patient to understand his current fertility status and make informed decisions about future fertility preservation options.
Choice B is incorrect because males are also susceptible to gonadal toxicity from alkylating agents, and there is no evidence to suggest that they can maintain gonadal function at higher dosages compared to females.
Choice C is incorrect because sperm cryopreservation should ideally have been offered at the time of leukemia diagnosis, but it is not too late to assess current fertility status with a semen analysis.
Choice D is incorrect as the patient's primary concern is infertility, not testosterone deficiency, which is a different issue altogether.
A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects?
- A. Dusky nail beds
- B. Petechiae
- C. Enlarged spleen
- D. Swollen calf
Correct Answer: C
Rationale: Step-by-step rationale for why choice C is correct:
1. Filgrastim stimulates the production of neutrophils.
2. An enlarged spleen can indicate an increase in neutrophils.
3. Therefore, assessing the client for an enlarged spleen is crucial to monitor the drug's effectiveness and potential adverse effects.
Summary of why other choices are incorrect:
A: Dusky nail beds - Not directly related to filgrastim or neutropenia.
B: Petechiae - Typically associated with low platelet count, not neutrophil increase.
D: Swollen calf - Unlikely to be a direct adverse effect of filgrastim for neutropenia.