Nokea
When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered?
- A. Platelet count
- B. Neutrophil count
- C. White blood cell count
- D. Hemoglobin (Hgb) level
Correct Answer: D
Rationale: The correct answer is D: Hemoglobin (Hgb) level. Pallor of the skin and nail beds indicates possible anemia, which is a decrease in red blood cells or hemoglobin. Checking the hemoglobin level will confirm if the patient is anemic. Platelet count (A) assesses for clotting ability, not anemia. Neutrophil count (B) and White blood cell count (C) are indicators of infection or inflammation, not anemia. Therefore, ensuring the hemoglobin level has been ordered is crucial for assessing the patient's pallor.
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Mr XY was found to be anemic. During history taking, he informed his doctor that he was a strict vegetarian who did not consume any meat, fish or milk products.
- A. Iron deficiency
- B. Vitamin B12 deficiency
- C. Defects in erythropoietin production
- D. Calcium-deficiency
Correct Answer: B
Rationale: The correct answer is B: Vitamin B12 deficiency. As a strict vegetarian who does not consume any meat, fish, or milk products, Mr XY is at risk for Vitamin B12 deficiency. Vitamin B12 is primarily found in animal products and is essential for red blood cell production. Anemia can result from Vitamin B12 deficiency, leading to symptoms such as fatigue and weakness. Iron deficiency (A) is also common in vegetarians, but in this case, the focus is on Vitamin B12 due to the exclusion of all animal products. Defects in erythropoietin production (C) are not related to Mr XY's dietary choices. Calcium-deficiency (D) is not directly related to anemia in this scenario.
A 9-year-old boy is being treated for standard-risk acute lymphoblastic leukemia. His treatment protocol calls for administration of intravenous methotrexate and intramuscular L-asparaginase during interim maintenance chemotherapy. What is the most appropriate sequence of drug administration?
- A. Administer L-asparaginase during the methotrexate infusion.
- B. Administer L-asparaginase immediately after the methotrexate infusion.
- C. Administer both drugs at the same time to maximize synergistic activity.
- D. Administer methotrexate 24 hours after the asparaginase.
Correct Answer: B
Rationale: The correct answer is B: Administer L-asparaginase immediately after the methotrexate infusion. This sequence is appropriate because methotrexate can interfere with the activity of L-asparaginase if given concurrently, affecting the efficacy of both drugs. Administering L-asparaginase immediately after the methotrexate infusion allows for optimal therapeutic effects of both medications without compromising their individual actions.
Choice A (Administer L-asparaginase during the methotrexate infusion) is incorrect because it may lead to drug interactions and reduced effectiveness of both drugs. Choice C (Administer both drugs at the same time) is incorrect for the same reason as choice A. Choice D (Administer methotrexate 24 hours after the asparaginase) is incorrect as it does not follow the optimal timing for these medications during treatment.
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.
The typical Reed-Sternberg cells are either infrequent or absent. Instead, lymphocytic and histiocytic cells or 'popcorn cells' are seen within a background of inflammatory cells, which are predominantly benign lymphocytes. Which type of Hodgkin's lymphoma best suit the description?
- A. Nodular sclerosis
- B. Mixed cellularity
- C. Lymphocyte depleted
- D. Lymphocyte predominance
Correct Answer: D
Rationale: The correct answer is D: Lymphocyte predominance. In this type of Hodgkin's lymphoma, the typical Reed-Sternberg cells are absent or rare. Instead, popcorn cells (lymphocytic and histiocytic cells) are seen among benign lymphocytes. This is characteristic of lymphocyte predominance subtype.
A: Nodular sclerosis - characterized by lacunar Reed-Sternberg cells in a background of collagen bands.
B: Mixed cellularity - characterized by numerous Reed-Sternberg cells, eosinophils, plasma cells, and histiocytes in a background of mixed inflammatory cells.
C: Lymphocyte depleted - characterized by few Reed-Sternberg cells in a background of fibrosis and few inflammatory cells.
Therefore, based on the description provided, choice D is the most appropriate answer.
Which of the following alters the function of thrombin from a procoagulant protein to one that downregulates the formation of fibrinogen?
- A. Protein C
- B. Protein S
- C. Antithrombin
- D. Thrombomodulin
Correct Answer: D
Rationale: The correct answer is D: Thrombomodulin. Thrombomodulin binds to thrombin and changes its function from procoagulant to anticoagulant by activating protein C. This leads to the downregulation of fibrinogen formation. Protein C (choice A) and its cofactor Protein S (choice B) are involved in the anticoagulant pathway but do not directly alter thrombin's function. Antithrombin (choice C) inhibits thrombin and other coagulation factors, but it doesn't specifically change thrombin's function from procoagulant to anticoagulant.