Nokea
When reviewing the chemistry panel of a newly diagnosed patient with acute lymphoblastic leukemia who is lethargic, complaining of flank pain, and experiencing nausea and vomiting, which of the following would you expect to see?
- A. Potassium 4.5 mmol/L, phosphorus 8 mg/dL, uric acid 7 mg/dL, calcium 9.0 mg/dL, BUN 12 mg/dL
- B. Potassium 6.5 mmol/L, phosphorus 8 mg/dL, uric acid 9 mg/dL, calcium 10 mg/dL, BUN 14 mg/dL
- C. Potassium 4 mmol/L, phosphorus 9 mg/dL, uric acid 10 mg/dL, calcium 10 mg/dL, BUN 10 mg/dL
- D. Potassium 7 mmol/L, phosphorus 12 mg/dL, uric acid 10 mg/dL, calcium 7 mg/dL, BUN 25 mg/dL
Correct Answer: D
Rationale: Step-by-step rationale:
1. Lethargy, flank pain, nausea, vomiting in leukemia can suggest tumor lysis syndrome (TLS).
2. TLS can cause hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, and elevated BUN.
3. Choice D has the highest potassium, phosphorus, uric acid, and BUN levels, and the lowest calcium level.
4. Therefore, choice D is the most consistent with the expected lab findings in tumor lysis syndrome.
Summary:
- Choice A has normal potassium, phosphorus, uric acid, calcium levels, and lower BUN.
- Choice B has high potassium but normal phosphorus, uric acid, calcium, and slightly elevated BUN.
- Choice C has low potassium, normal phosphorus, and elevated uric acid, calcium, and BUN.
- Choice D aligns most closely with the expected lab findings in tumor lysis syndrome due to the pattern of
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A 14-year-old Syrian male with beta thalassemia major has relocated to your community as a refugee. He has been receiving chronic transfusion therapy in Turkey for the past 3 years. On his first visit, you notice that his height is below the fifth percentile. He has skin discoloration and hepatosplenomegaly. His mother reports they have not had regular access to chelation therapy. Laboratory testing shows a serum ferritin of 6,200 ng/mL. A cardiac MRI shows grossly normal cardiac function but a T2* value of 9 ms. What is the most likely cause of his short stature?
- A. Lack of regular blood transfusion causing growth failure
- B. Cirrhosis and liver failure
- C. Ineffective erythropoiesis and chronic anemia
- D. Growth hormone deficiency due to iron deposition in the pituitary
Correct Answer: D
Rationale: The correct answer is D: Growth hormone deficiency due to iron deposition in the pituitary. Iron overload in patients with beta thalassemia major can lead to iron deposition in various organs, including the pituitary gland, impairing its function. This can result in growth hormone deficiency, leading to short stature. In this case, the patient's history of chronic transfusions and high serum ferritin level indicate iron overload, which can affect the pituitary gland. Choices A, B, and C are incorrect because growth failure in beta thalassemia major is primarily attributed to endocrine complications such as growth hormone deficiency, rather than lack of transfusions, cirrhosis, or ineffective erythropoiesis.
Which of the following anemia is associated with splenomegaly:
- A. chronic renal failure
- B. aplastic anemia
- C. hereditary spherocytosis
- D. sickle cell anaemia
Correct Answer: C
Rationale: Rationale: Hereditary spherocytosis is associated with splenomegaly due to the spleen's increased destruction of abnormal red blood cells. In this condition, red blood cells have a spherical shape, making them more prone to destruction by the spleen. Chronic renal failure (A) is not typically associated with splenomegaly. Aplastic anemia (B) is characterized by bone marrow failure and does not directly involve the spleen. Sickle cell anemia (D) leads to splenomegaly in children but not in adults due to splenic sequestration crises, making it less likely to be the correct choice.
The nurse is assessing a patient with chronic lung disease. Which finding indicates long-term hypoxia?
- A. Pallor
- B. Dyspnea
- C. Clubbed fingertips
- D. Pulmonary crackles
Correct Answer: C
Rationale: The correct answer is C: Clubbed fingertips. Clubbing is a sign of prolonged hypoxia due to chronic lung disease. It is characterized by enlargement and rounding of the fingertips. This occurs as a result of chronic hypoxia causing tissue changes in the fingers. Pallor (A) is a pale skin color often indicating decreased blood flow. Dyspnea (B) is difficulty breathing and can be an acute symptom of hypoxia. Pulmonary crackles (D) are abnormal lung sounds indicating fluid accumulation and are not specific to long-term hypoxia.
A 14-year-old Syrian male with beta thalassemia major has relocated to your community as a refugee. He has been receiving chronic transfusion therapy in Turkey for the past 3 years. On his first visit, you notice that his height is below the fifth percentile. He has skin discoloration and hepatosplenomegaly. His mother reports they have not had regular access to chelation therapy. Laboratory testing shows a serum ferritin of 6,200 ng/mL. A cardiac MRI shows grossly normal cardiac function but a T2* value of 9 ms. What is the most likely cause of his short stature?
- A. Lack of regular blood transfusion causing growth failure
- B. Cirrhosis and liver failure
- C. Ineffective erythropoiesis and chronic anemia
- D. Growth hormone deficiency due to iron deposition in the pituitary
Correct Answer: D
Rationale: The correct answer is D: Growth hormone deficiency due to iron deposition in the pituitary. Iron deposition in the pituitary gland can lead to impaired production and secretion of growth hormone, resulting in short stature. This is a known complication of beta thalassemia major. The patient's elevated serum ferritin levels and T2* value of 9 ms indicate iron overload, which can cause damage to organs including the pituitary gland. Choices A, B, and C are incorrect because the patient's growth failure is primarily due to the impact of iron deposition on the pituitary gland rather than lack of transfusion, cirrhosis, or ineffective erythropoiesis. Regular chelation therapy is essential to prevent iron overload and its complications in patients with beta thalassemia major.
An adult patient has presented to the health clinic with a complaint of a firm, painless cervical lymph node. The patient denies any recent infectious diseases. What is the nurse's most appropriate response to the patient's complaint?
- A. Call 911.
- B. Promptly refer the patient for medical assessment.
- C. Facilitate a radiograph of the patient's neck and have the results forwarded to the patient's primary care provider.
- D. Encourage the patient to track the size of the lymph node and seek care in 1 week.
Correct Answer: B
Rationale: The correct answer is B: Promptly refer the patient for medical assessment. A firm, painless cervical lymph node in an adult without recent infectious diseases raises concerns for potential underlying serious conditions such as malignancy. Referring the patient for medical assessment allows for further evaluation, including physical examination, laboratory tests, and imaging studies if necessary, to determine the cause of the lymphadenopathy. This prompt referral is crucial for timely diagnosis and appropriate management.
Summary:
A: Calling 911 is not warranted as the patient is stable and does not have an emergency medical condition.
C: Facilitating a radiograph may not provide sufficient information for evaluating the lymph node and delays definitive assessment.
D: Encouraging the patient to wait and track the lymph node size can lead to delayed diagnosis and potentially worsening of the underlying condition.