Nokea
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: The correct answer is C, hereditary spherocytosis. This condition is characterized by a defect in red blood cell membrane proteins, leading to their premature destruction in the spleen, causing splenomegaly. In contrast, chronic renal failure (A) does not typically present with splenomegaly. Aplastic anemia (B) is characterized by bone marrow failure, not splenomegaly. Sickle cell anemia (D) is associated with splenomegaly in early childhood due to sequestration of damaged red blood cells, but splenomegaly usually resolves in later life.
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A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness?
- A. Amylase level
- B. Reticulocyte count
- C. C-reactive protein
- D. Creatinine clearance
Correct Answer: B
Rationale: The correct answer is B: Reticulocyte count. Reticulocytes are immature red blood cells. In megaloblastic anemia, there is a decrease in red blood cell production due to a deficiency in folic acid. Monitoring reticulocyte count helps determine if the folic acid treatment is increasing red blood cell production.
A: Amylase level is not relevant to monitoring the effectiveness of folic acid in treating megaloblastic anemia.
C: C-reactive protein is a marker for inflammation and not specific to monitoring anemia treatment.
D: Creatinine clearance is used to assess kidney function, not the effectiveness of folic acid in treating anemia.
A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions?
- A. Myocardial infarction
- B. Peptic ulcer disease
- C. Pancreatitis
- D. Myasthenia gravis
Correct Answer: B
Rationale: Clopidogrel is contraindicated for clients with peptic ulcer disease due to its antiplatelet effect, which can increase the risk of gastrointestinal bleeding. Myocardial infarction, pancreatitis, and myasthenia gravis are not direct contraindications for clopidogrel. Myocardial infarction can actually be an indication for clopidogrel use to prevent further cardiovascular events. Pancreatitis and myasthenia gravis are not known to have specific contraindications with clopidogrel.
A 36-year-old woman presented with weakness, lassitude, and feeling easily tired. Her bone marrow aspirate showed 15% myeloblasts and reduced erythropoiesis. The most likely cause is
- A. Acute myeloid leukemia
- B. Acute lymphoid leukemia
- C. Myelofibrosis
- D. Myelodysplastic syndrome
Correct Answer: D
Rationale: The correct answer is D: Myelodysplastic syndrome. Given the patient's age, symptoms, and bone marrow findings of myeloblasts with reduced erythropoiesis, it aligns with the characteristics of myelodysplastic syndrome. This condition involves abnormal blood cell production leading to cytopenias and an increased risk of progression to acute myeloid leukemia. Acute myeloid leukemia (Choice A) typically presents with higher blast percentages and more aggressive symptoms. Acute lymphoid leukemia (Choice B) is less likely due to the presence of myeloblasts in the bone marrow. Myelofibrosis (Choice C) is characterized by fibrosis in the bone marrow, which is not indicated in this case.
A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?
- A. Vitamin K
- B. Aminocaproic acid
- C. Protamine
- D. Deferoxamine
Correct Answer: B
Rationale: Rationale: Aminocaproic acid is used to manage bleeding complications associated with thrombolytic therapy, like alteplase. In case of severe adverse reaction such as uncontrolled bleeding, aminocaproic acid can help by inhibiting fibrinolysis. Vitamin K (A) is not used for this purpose. Protamine (C) is used to reverse heparin anticoagulation, not for thrombolytic therapy. Deferoxamine (D) is used for iron toxicity, not related to thrombolytic therapy. Thus, having aminocaproic acid available is crucial for managing potential adverse reactions during alteplase therapy.
A newborn infant develops jaundice on day of life 2. Labs are drawn, and she has a hemoglobin of 7.4 g/dL with a reticulocyte count of 8%. Upon peripheral blood smear review, she is found to have bizarre red cell forms with significant polkilocytosis. Although her parents have normal blood counts, on review of their peripheral blood smears, they both have a moderate number of ovalocytes. Which of the following is the most likely cause of the infant's red cell findings?
- A. She has an autosomal dominant ankyrin mutation from one of her parents causing hereditary spherocytosis.
- B. She has inherited band 3 variants from each parent and will likely need a splenectomy after she turns 5 years old.
- C. She has inherited an alpha-spectrin mutation from both of her parents and may experience an improvement in her anemia over time.
- D. She has inherited a PKLR variant from each parent, and enzyme testing will be consistent with her diagnosis of pyruvate kinase deficiency.
Correct Answer: C
Rationale: The correct answer is C because the infant likely has hereditary elliptocytosis, an autosomal dominant disorder caused by mutations in the alpha-spectrin gene. Ovalocytes and polkilocytosis are characteristic of this condition. Since both parents have ovalocytes, it is likely that the infant inherited mutations from each parent, resulting in a more severe presentation. Anemia in hereditary elliptocytosis can improve over time due to compensatory mechanisms. Choices A, B, and D are incorrect as they describe different genetic disorders (hereditary spherocytosis, hereditary stomatocytosis, and pyruvate kinase deficiency, respectively) and do not match the clinical and family history provided.