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You are seeing a 13-year-old boy with fatigue, weight loss, night sweats, and splenomegaly. Peripheral blood shows anemia, thrombocytosis, and leukocytosis (300,000/mm3). What is this patient's most likely diagnosis?
- A. Leukemoid reaction
- B. Acute lymphoblastic leukemia (ALL)
- C. Chronic myeloid leukemia (CML)
- D. Juvenile myelomonocytic leukemia (JMML)
Correct Answer: C
Rationale: The most likely diagnosis for this 13-year-old boy presenting with fatigue, weight loss, night sweats, splenomegaly, anemia, thrombocytosis, leukocytosis (300,000/mm3) is Chronic Myeloid Leukemia (CML).
1. Presence of anemia, thrombocytosis, and leukocytosis is characteristic of CML.
2. CML typically presents with splenomegaly.
3. Age of onset (13 years) is within the typical range for CML.
4. The Philadelphia chromosome (t(9;22)) is present in most cases of CML, aiding in diagnosis.
5. Leukemoid reaction (A) is a reactive increase in white blood cells, not a primary neoplastic disorder.
6. Acute lymphoblastic leukemia (ALL) (B) typically presents with bone pain, lymphadenopathy, and CNS symptoms in children.
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What are the six dimensions of quality care according to the Institute of Medicine?
- A. Safe, timely, effective, efficient, equitable, and person-centered
- B. Safe, transparent, effective, efficient, equitable, and person-centered
- C. Safe, timely, effective, low-cost, equitable, and person-centered
- D. Safe, timely, effective, efficient, cutting-edge, and person-centered
Correct Answer: A
Rationale: The correct answer is A: Safe, timely, effective, efficient, equitable, and person-centered. According to the Institute of Medicine, these six dimensions encompass quality care. Safety is essential to avoid harm. Timeliness ensures care is provided promptly. Effectiveness means care should be evidence-based and achieve desired outcomes. Efficiency aims to minimize waste. Equitability ensures fair and non-discriminatory care. Lastly, being person-centered emphasizes individual preferences and needs.
Summary:
Choice B is incorrect because transparency is not included in the six dimensions. Choice C is incorrect as low-cost is not a primary dimension of quality care. Choice D is incorrect as it includes cutting-edge, which is not one of the six dimensions outlined by the Institute of Medicine.
A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase?
- A. Protamine
- B. Desmopressin
- C. Ferrous sulfate
- D. Heparin
Correct Answer: D
Rationale: The correct answer is D: Heparin. Following an acute MI, a client receiving alteplase may also be prescribed heparin to prevent re-thrombosis and further clot formation. Alteplase is a thrombolytic agent that works by breaking down clots, while heparin is an anticoagulant that helps prevent new clots from forming. Protamine (choice A) is used to reverse the effects of heparin, not typically administered alongside alteplase. Desmopressin (choice B) is used for conditions like diabetes insipidus, unrelated to MI treatment. Ferrous sulfate (choice C) is an iron supplement, not indicated in this scenario.
What is the nurse's priority when caring for a client who just completed a bone marrow aspiration and biopsy?
- A. Teach the client to avoid activity for 24 to 48 hours to prevent infection.
- B. Administer a nonsteroidal anti-inflammatory drug (NSAID) to promote comfort.
- C. Check the pressure dressing frequently for signs of excessive or active bleeding.
- D. Report the laboratory results to the primary health care provider.
Correct Answer: C
Rationale: The correct answer is C: Check the pressure dressing frequently for signs of excessive or active bleeding. This is the priority because post bone marrow aspiration and biopsy, there is a risk of bleeding due to the procedure. By checking the dressing, the nurse can assess for any signs of excessive bleeding or hematoma formation, which are crucial to prevent complications.
A: Teaching the client to avoid activity is important but not the priority immediately post-procedure.
B: Administering NSAIDs may not be appropriate as they can increase the risk of bleeding.
D: Reporting the lab results is important but not the priority over ensuring immediate post-procedure safety.
A nurse is teaching a client about taking ferrous sulfate to treat iron deficiency anemia. Which of the following instructions should the nurse include? (Select All)
- A. Eat iron-enriched foods.
- B. Spread the dosage across each day.
- C. Take the drug on an empty stomach.
- D. Report dark green or black stools.
Correct Answer: A
Rationale: The correct answer is A: Eat iron-enriched foods. Iron-enriched foods help increase iron levels in the body, aiding in treating iron deficiency anemia. Consuming these foods along with ferrous sulfate can enhance the effectiveness of the treatment.
B: Spreading the dosage across each day is important to maintain consistent iron levels but is not the most crucial aspect of treatment.
C: Taking the drug on an empty stomach may enhance absorption but can also lead to stomach upset, so it is not necessary for all clients.
D: Reporting dark green or black stools is important to monitor for gastrointestinal bleeding, but it is not an instruction related to taking ferrous sulfate.
A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects?
- A. Phlebitis
- B. Dark
- C. orange-colored stools
- D. Constipation
Correct Answer: D
Rationale: The correct answer is D: Constipation. Ferrous sulfate, an iron supplement, commonly causes constipation due to its effects on the digestive system. Iron slows down bowel movements, leading to constipation. Monitoring for constipation is crucial to ensure the client's comfort and prevent complications.
Phlebitis (choice A) is not a common adverse effect of ferrous sulfate administration. Dark, tarry stools (choice B) can indicate gastrointestinal bleeding but are not directly related to iron supplementation. Orange-colored stools (choice C) are not a typical side effect of ferrous sulfate and are more commonly associated with certain foods or medications.