Nokea
Which is not associated with hypersplenism:
- A. splenomegaly
- B. pancytopenia
- C. hyper cellular bone marrow
- D. reversibility by splenectomy
Correct Answer: C
Rationale: Rationale:
C: Hypercellular bone marrow is not associated with hypersplenism. Hypersplenism is characterized by splenomegaly, pancytopenia, and reversible by splenectomy. Hypercellular bone marrow is a feature of bone marrow hyperplasia, not hypersplenism.
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While taking a client history, which factor(s) that place the client at risk for a hematologic health problem will the nurse document? (Select all that apply.)
- A. Family history of military excellence
- B. Diet low in iron and protein
- C. Excessive alcohol consumption
- D. Family history of allergies
Correct Answer: C
Rationale: The correct answer is C: Excessive alcohol consumption. Excessive alcohol intake can lead to hematologic health problems such as anemia and abnormal blood clotting. Alcohol interferes with the production of red blood cells and impairs the function of platelets. Therefore, documenting excessive alcohol consumption is crucial in assessing a client's risk for hematologic issues.
Explanation for why other choices are incorrect:
A: Family history of military excellence - This choice is irrelevant to hematologic health problems and does not pose a risk factor.
B: Diet low in iron and protein - While a poor diet can contribute to hematologic issues, this specific choice does not directly indicate a risk factor for hematologic problems.
D: Family history of allergies - Allergies are not directly related to hematologic health problems, so this choice is not relevant in this context.
A 3-year-old boy is referred to you for evaluation of right leukocoria. Funduscopic examination under anesthesia reveals a large amelanotic mass occupying more than two-thirds of the vitreous space in his right eye, with massive retinal detachment, consistent with group E retinoblastoma. The left eye is normal. An MRI confirms the funduscopic findings and shows no extraocular disease. What is the most appropriate next step in the management of this child's disease?
- A. Enucleation
- B. Systemic chemotherapy
- C. Brachytherapy
- D. Needle biopsy
Correct Answer: A
Rationale: The most appropriate next step in the management of the child's retinoblastoma is enucleation (choice A). Enucleation, the surgical removal of the affected eye, is indicated when there is a large intraocular tumor with extensive retinal detachment, as in this case. Enucleation can provide local control of the disease and prevent systemic spread. It is considered the standard treatment for advanced retinoblastoma to prevent metastasis.
Systemic chemotherapy (choice B) is not the first-line treatment for advanced retinoblastoma with massive intraocular involvement. Brachytherapy (choice C) involves the placement of a radioactive source near the tumor, which may not be effective in this case of extensive intraocular disease. Needle biopsy (choice D) is not recommended as the primary management strategy due to the risk of seeding tumor cells outside the eye. Therefore, enucleation is the most appropriate next step in this scenario.
Heparin is an anticoagulant produced by the basophils. The most likely mechanism heparin prevents blood clotting is by
- A. Inhibiting the formation of vitamin K-dependent clotting factors
- B. Preventing the activation of platelets
- C. Preventing the aggregation of platelets
- D. Binding to antithrombin III to inactivate thrombin
Correct Answer: D
Rationale: The correct answer is D because heparin binds to antithrombin III, enhancing its ability to inactivate thrombin. This prevents the conversion of fibrinogen to fibrin, thereby inhibiting blood clot formation. Choice A is incorrect because vitamin K-dependent clotting factors are not directly affected by heparin. Choice B is incorrect because heparin does not prevent the activation of platelets, rather it affects the coagulation cascade. Choice C is incorrect as heparin does not directly prevent platelet aggregation, which is more related to antiplatelet agents like aspirin.
Which of the following is false regarding heparin?
- A. Subcutaneous injection of heparin is avoided because of hematomas formation.
- B. Heparin is usually stored in the mast cells.
- C. Heparin binds to plasma anti thrombin III and inhibits activated thrombin.
- D. Protamine sulfate can be used to counteract heparin overdose.
Correct Answer: A
Rationale: The correct answer is A. Subcutaneous injection of heparin is avoided because it can lead to hematomas due to its anticoagulant properties. Heparin is not stored in mast cells (B), but it is synthesized in mast cells. Heparin binds to plasma antithrombin III and inhibits activated thrombin (C). Protamine sulfate can be used to counteract heparin overdose by binding to heparin and neutralizing its anticoagulant effects (D). Therefore, the statement that subcutaneous injection of heparin is avoided due to hematoma formation is the false statement among the options provided.
The pathophysiology of venous thrombosis is often explained by Virchow's triad, which includes hypercoagulability, endothelial injury, and venous stasis. Based on Virchow's triad and your knowledge of risk factors for thrombosis, which of the following pediatric patients has the greatest risk of hospital-acquired venous thromboembolism?
- A. 3-day-old full-term infant admitted to hospital pediatrics for hyperbilirubinemia
- B. 6-month-old male admitted to the infectious disease unit for respiratory syncytial virus
- C. Ex-28 week premature infant, requiring NICU-level care for necrotizing enterocolitis
- D. 7-year-old male with acute lymphoblastic leukemia receiving maintenance chemotherapy admitted to hematology/oncology unit for fever and neutropenia
Correct Answer: C
Rationale: The correct answer is C because the ex-28 week premature infant requiring NICU-level care for necrotizing enterocolitis has the greatest risk of hospital-acquired venous thromboembolism. Premature infants have inherent hypercoagulability due to immature coagulation factors and increased risk of endothelial injury from central lines or catheters. Necrotizing enterocolitis further increases the risk of venous stasis due to decreased gut perfusion.
Choice A: The 3-day-old full-term infant admitted for hyperbilirubinemia is less likely to have significant risk factors for thrombosis compared to a premature infant with necrotizing enterocolitis.
Choice B: The 6-month-old male admitted for respiratory syncytial virus is less likely to have prolonged immobilization or other significant risk factors compared to a premature infant in the NICU.
Choice D: The 7-year-old male with acute lymphoblastic leukemia has a higher risk of thromb