Nokea
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: Step-by-step rationale:
1. Subcutaneous injection of heparin is avoided due to the risk of hematoma formation at the injection site.
2. This statement is false because heparin is commonly administered subcutaneously for prophylaxis of thromboembolic events.
3. The preferred route for heparin administration is subcutaneous or intravenous.
4. Therefore, choice A is the false statement.
Summary:
- Choice A is incorrect as heparin is commonly given subcutaneously.
- Choice B is incorrect as heparin is not stored in mast cells but in specialized granules in mast cells.
- Choice C is correct as heparin binds to plasma antithrombin III to inhibit thrombin.
- Choice D is correct as protamine sulfate can reverse heparin's anticoagulant effects in case of overdose.
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A 16-year-old patient with a left-side pelvic osteosarcoma is taking extended release oxycodone twice daily as well as immediate release oxycodone for breakthrough pain approximately 2 or 3 times per day. She describes her pain as burning, tingling, and shooting in her left leg. Her pain worsens with hot showers. Her most recent EKG has a QTc of 495. What would be the best strategy to manage her pain?
- A. Switch from long-acting oxycodone to methadone.
- B. Recommend more frequent use of her immediate release oxycodone.
- C. Add amitriptyline daily. Start low and titrate upward on dosage.
- D. Add gabapentin three times daily. Start low and titrate upward on dose.
Correct Answer: D
Rationale: Step 1: The patient's pain is described as burning, tingling, and shooting in her left leg, which suggests neuropathic pain.
Step 2: The pain worsens with hot showers, indicating sensitivity to temperature changes, a common feature of neuropathic pain.
Step 3: Gabapentin is a first-line medication for neuropathic pain, as it stabilizes nerve cells and reduces abnormal pain signaling.
Step 4: Starting low and titrating upward on gabapentin dose helps minimize side effects and optimize pain relief.
Step 5: Methadone (Choice A) is not the best option for neuropathic pain. Increasing immediate release oxycodone (Choice B) may lead to opioid tolerance. Amitriptyline (Choice C) may help neuropathic pain but is not as specific as gabapentin.
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 72-year-old male with enlargement of superficial lymph nodes and mild hepatosplenomegaly is diagnosed as having chronic lymphatic leukemia (CLL). The most important criteria for diagnosis of this disease is the
- A. Presence of hypogammaglobulinemia
- B. Absolute lymphocytes
- C. Male predominance
- D. Presence of enlarged lymph nodes
Correct Answer: B
Rationale: The correct answer is B: Absolute lymphocytes. In CLL, the most important diagnostic criteria is an absolute lymphocyte count greater than 5,000/microliter. This is crucial for distinguishing CLL from other lymphoproliferative disorders. The presence of hypogammaglobulinemia (choice A) is not specific to CLL and can be seen in other conditions. Male predominance (choice C) is an epidemiological feature and not a diagnostic criterion. Enlarged lymph nodes (choice D) are a common clinical finding but do not solely confirm the diagnosis of CLL.
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 of abdominal cramping, diarrhea, fever, and altered white blood cell count with low neutrophils and high lymphocytes suggest a viral infection. Viral infections often present with these symptoms and characteristic lab findings. Other choices are incorrect because fungal infections typically do not cause acute abdominal symptoms, parasitic infections usually present with different symptoms and lab findings, and bacterial infections are more likely to have elevated neutrophils and different clinical presentation.
A 12-year-old patient with localized osteosarcoma is being treated with cisplatin, doxorubicin, and high-dose methotrexate. The pain at his primary site rapidly resolves after initiation of chemotherapy. After tumor resection, pathology reveals the tumor was greater than 95% necrotic. You want to continue cisplatin, doxorubicin, and high-dose methotrexate. Which of the following is the best answer regarding the evaluations that should be performed to monitor for toxicity in patients receiving cisplatin, doxorubicin, and high-dose methotrexate?
- A. Complete blood count, creatinine, liver function tests
- B. Complete blood count, serum electrolytes (sodium, potassium, BUN, chloride), and EKG to monitor for prolonged QTc
- C. Complete blood count, creatinine, serum magnesium, audiogram, and echocardiogram
- D. Complete blood count, creatinine, serum magnesium, chest x-ray
Correct Answer: C
Rationale: The correct answer is C: Complete blood count, creatinine, serum magnesium, audiogram, and echocardiogram. This choice includes essential monitoring tests for potential toxicities associated with cisplatin, doxorubicin, and high-dose methotrexate. Here's the rationale:
1. Complete blood count: To monitor for hematologic toxicities such as anemia, neutropenia, and thrombocytopenia.
2. Creatinine: To assess renal function, as cisplatin can cause nephrotoxicity.
3. Serum magnesium: Methotrexate can cause hypomagnesemia, necessitating monitoring.
4. Audiogram: Doxorubicin can lead to hearing loss, thus an audiogram is needed for early detection.
5. Echocardiogram: Doxorubicin can cause cardiotoxicity, so an echocardiogram helps in monitoring cardiac function.
Each of the other choices lacks one or more essential monitoring tests