Nokea
You have been asked to see a 15-year-old girl who is being referred for evaluation of an ovarian mass. Her history is also significant for secondary amenorrhea, and physical examination shows signs of virilization. As you review her family history, what syndrome will you consider?
- A. Li-Fraumeni syndrome
- B. DICER-1 syndrome
- C. Turner syndrome
- D. Beckwith-Wiedemann syndrome
Correct Answer: B
Rationale: The correct answer is B: DICER-1 syndrome. This syndrome is associated with ovarian tumors, secondary amenorrhea, and signs of virilization. DICER-1 gene mutations can lead to the development of Sertoli-Leydig cell tumors, which can present with these symptoms in adolescent girls. Li-Fraumeni syndrome (A) is characterized by a predisposition to various cancers but not specifically ovarian tumors. Turner syndrome (C) is associated with ovarian dysgenesis leading to primary amenorrhea, not secondary amenorrhea and virilization. Beckwith-Wiedemann syndrome (D) is a genetic overgrowth syndrome with a risk of embryonal tumors but not typically ovarian masses with virilization.
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Incorrect about pernicious an:
- A. hyperchlorhydria
- B. premature graying of hair
- C. anti intrinsic factor antibody in 60% of pts.
- D. gastric polyp may occur
Correct Answer: A
Rationale: The correct answer is A, hyperchlorhydria. Pernicious anemia is characterized by vitamin B12 deficiency due to lack of intrinsic factor. Hyperchlorhydria refers to high stomach acid production, not a symptom of pernicious anemia. Premature graying of hair and gastric polyp are potential features of pernicious anemia. Anti intrinsic factor antibody presence in 60% of patients is a characteristic finding in pernicious anemia.
A 50-year-old male who had frequent infections of his upper respiratory tract manifested with subcutaneous petechiae over his arms and legs. Investigations revealed low hemoglobin and a dry tap marrow. The most likely condition the patient is suffering from
- A. Iron deficiency anemia
- B. Megaloblastic anemia
- C. Hemolytic anemia
- D. Aplastic anemia
Correct Answer: D
Rationale: The correct answer is D: Aplastic anemia. Aplastic anemia is characterized by pancytopenia, which includes low hemoglobin levels leading to anemia. The dry tap marrow indicates bone marrow failure, which is a hallmark of aplastic anemia. The subcutaneous petechiae are due to thrombocytopenia, another feature of this condition. Iron deficiency anemia (A) typically presents with microcytic hypochromic red blood cells and is not associated with bone marrow failure. Megaloblastic anemia (B) is characterized by macrocytic red blood cells and is usually due to deficiencies in vitamin B12 or folate. Hemolytic anemia (C) involves the premature destruction of red blood cells and is not typically associated with bone marrow failure.
A nurse is caring for a patient who is being treated for leukemia in the hospital. The patient was able to maintain her nutritional status for the first few weeks following her diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement what intervention?
- A. Arrange for total parenteral nutrition (TPN).
- B. Facilitate placement of a percutaneous endoscopic gastrostomy (PEG) tube.
- C. Provide the patient with several small, soft-textured meals each day.
- D. Assign responsibility for the patient's nutrition to the patient's friends and family.
Correct Answer: C
Rationale: The correct answer is C: Provide the patient with several small, soft-textured meals each day. This intervention is appropriate for the patient showing early signs of malnutrition as it aims to increase the patient's nutrient intake in a manageable way. Small, soft-textured meals are easier for the patient to consume and digest, promoting better absorption of nutrients. This approach also aligns with the principle of promoting oral intake whenever possible before resorting to more invasive measures like TPN or PEG tube placement.
Incorrect choices:
A: Total parenteral nutrition (TPN) is typically reserved for patients who cannot tolerate oral feeding at all or have significant malabsorption issues.
B: Percutaneous endoscopic gastrostomy (PEG) tube placement is usually considered if the patient cannot meet their nutritional needs orally in the long term.
D: Assigning responsibility for the patient's nutrition to friends and family is not a sustainable or appropriate solution for addressing malnutrition in a hospitalized patient.
A nurse is caring for a patient who is being treated for leukemia in the hospital. The patient was able to maintain her nutritional status for the first few weeks following her diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement what intervention?
- A. Arrange for total parenteral nutrition (TPN).
- B. Facilitate placement of a percutaneous endoscopic gastrostomy (PEG) tube.
- C. Provide the patient with several small, soft-textured meals each day.
- D. Assign responsibility for the patient's nutrition to the patient's friends and family.
Correct Answer: C
Rationale: The correct answer is C: Provide the patient with several small, soft-textured meals each day. This intervention is appropriate because it focuses on improving the patient's nutritional intake through easily digestible meals, which can help address early signs of malnutrition. Small, soft-textured meals are easier for the patient to eat, especially if they are experiencing symptoms like mouth sores or difficulty swallowing. This approach also promotes regular intake of nutrients throughout the day, which can be more beneficial than relying solely on one large meal.
Incorrect answers:
A: Total parenteral nutrition (TPN) is typically reserved for patients who cannot tolerate oral or enteral nutrition. It is not the first-line intervention for early signs of malnutrition.
B: Percutaneous endoscopic gastrostomy (PEG) tube placement is usually considered for patients who are unable to eat orally in the long term. It is not indicated for early signs of malnutrition.
D: Assigning responsibility for the patient's nutrition to friends and
A patient is being prepared to receive a prescribed blood transfusion. What is the best way that the LPN can assist the health team to prevent a transfusion reaction?
- A. Monitor vital signs every 15 minutes.
- B. Warm blood to 98.6°F (37°C) before infusion.
- C. Administer diphenhydramine (Benadryl) before the infusion.
- D. Assist the registered nurse (RN) to identify correctly the patient and the blood product.
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. Identifying the patient and blood product is crucial to prevent transfusion reactions.
2. Matching the patient's identity with the blood product minimizes risk of incompatibility.
3. This step ensures the right blood type and product are administered, preventing serious reactions.
4. LPNs play a key role in assisting the RN in verifying and confirming patient and blood product identity.
Summary:
A: Monitoring vital signs is important but doesn't directly prevent transfusion reactions.
B: Warming blood can improve patient comfort but does not prevent reactions.
C: Administering Benadryl addresses possible allergic reactions but doesn't prevent incompatibility issues.