Nokea
Which of the following will be present in chronic bacterial infection?
- A. Neutrophilia
- B. Basophilia
- C. Lymphocytosis
- D. Monocytosis
Correct Answer: D
Rationale: The correct answer is D: Monocytosis. In chronic bacterial infections, monocytosis occurs due to the increased presence of monocytes in response to the persistent infection. Monocytes differentiate into macrophages to help eliminate the bacteria. Neutrophilia (A) is more common in acute bacterial infections. Basophilia (B) is associated with conditions like chronic myeloid leukemia, not bacterial infections. Lymphocytosis (C) is often seen in viral infections or chronic inflammatory conditions, not specifically in chronic bacterial infections.
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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 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.
The following pathological features is true regarding non-Hodgkin lymphoma (NHL)
- A. Classical Reed-Sternberg (RS) cells are neoplastic cells
- B. B cell phenotype is more common
- C. Contiguous group of lymph nodes are affected
- D. It is not associated with leukemic phase of disease
Correct Answer: B
Rationale: The correct answer is B because B cell phenotype is more common in non-Hodgkin lymphoma (NHL). This is supported by the fact that the majority of NHL cases arise from B cells in the lymphoid tissue. Choice A is incorrect as RS cells are characteristic of Hodgkin lymphoma, not NHL. Choice C is incorrect because NHL can involve non-contiguous lymph nodes. Choice D is incorrect because NHL can have a leukemic phase known as leukemic lymphoma.
A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage?
- A. Rapid pulse
- B. Yellowing of the sclera
- C. Elevated blood pressure
- D. Pale-colored stools
Correct Answer: A
Rationale: The correct answer is A: Rapid pulse. Hemorrhage is a potential complication of anticoagulant therapy with heparin due to the increased risk of bleeding. A rapid pulse can indicate hypovolemia from blood loss, a common sign of hemorrhage. Yellowing of the sclera (choice B) is a sign of jaundice, not directly related to hemorrhage. Elevated blood pressure (choice C) is not typically associated with hemorrhage. Pale-colored stools (choice D) can be indicative of liver or gallbladder issues, but not specifically hemorrhage. Overall, a rapid pulse is the most relevant finding to indicate possible hemorrhage in a client on heparin 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's red cell findings of ovalocytes and polikilocytosis are consistent with hereditary elliptocytosis, which is caused by mutations in genes encoding spectrin. In this scenario, the inheritance pattern aligns with the infant receiving an alpha-spectrin mutation from both parents, leading to the observed erythrocyte abnormalities. This condition may improve over time due to compensatory mechanisms.
Choice A (autosomal dominant ankyrin mutation causing hereditary spherocytosis) is incorrect because the clinical presentation and red cell morphology do not support a diagnosis of hereditary spherocytosis.
Choice B (inherited band 3 variants and need for splenectomy) is incorrect as the infant's condition does not match the characteristics of hereditary spherocytosis requiring splenectomy.
Choice D (PKLR variant and pyruvate kinase deficiency) is incorrect as the infant's red cell morphology is not indicative
A patient with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the patient?
- A. Chew with care to avoid inadvertently biting the tongue.
- B. Use the oral anesthetic 1 hour prior to meal time.
- C. Brush teeth before and after eating.
- D. Swallow slowly and deliberately.
Correct Answer: A
Rationale: The correct answer is A: Chew with care to avoid inadvertently biting the tongue. Stomatitis causes inflammation in the mouth, making it painful to eat. By chewing carefully, the patient can prevent accidentally biting the tongue or cheek, which can worsen the pain. Using the oral anesthetic before meals (choice B) may provide some relief, but the key is to prevent further injury. Brushing teeth before and after eating (choice C) and swallowing slowly (choice D) do not directly address the issue of preventing accidental bites and are not as essential for managing stomatitis.