Nokea
A 9-year-old boy is being treated for standard-risk acute lymphoblastic leukemia. His treatment protocol calls for administration of intravenous methotrexate and intramuscular L-asparaginase during interim maintenance chemotherapy. What is the most appropriate sequence of drug administration?
- A. Administer L-asparaginase during the methotrexate infusion.
- B. Administer L-asparaginase immediately after the methotrexate infusion.
- C. Administer both drugs at the same time to maximize synergistic activity.
- D. Administer methotrexate 24 hours after the asparaginase.
Correct Answer: B
Rationale: The correct answer is B: Administer L-asparaginase immediately after the methotrexate infusion. This sequence is appropriate because methotrexate can interfere with the activity of L-asparaginase if given concurrently, affecting the efficacy of both drugs. Administering L-asparaginase immediately after the methotrexate infusion allows for optimal therapeutic effects of both medications without compromising their individual actions.
Choice A (Administer L-asparaginase during the methotrexate infusion) is incorrect because it may lead to drug interactions and reduced effectiveness of both drugs. Choice C (Administer both drugs at the same time) is incorrect for the same reason as choice A. Choice D (Administer methotrexate 24 hours after the asparaginase) is incorrect as it does not follow the optimal timing for these medications during treatment.
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A leukemia investigator plans to obtain bone marrow under general anesthesia to measure minimal residual disease (MRD) and to see if this time point can predict early relapse. The specimen will be obtained at a time point when otherwise no bone marrow would be sampled. The results are not shared with the treating oncologist, and no therapeutic interventions are decided or based on the results. Which of the following statements is most accurate about this intervention?
- A. It constitutes a minimal-risk procedure because bone marrow assessments are considered routine for patients diagnosed with acute lymphoblastic leukemia.
- B. It constitutes a minimal-risk procedure because it is a single additional procedure being performed during the course of treatment.
- C. It constitutes a greater than minimal-risk procedure because it is being done under general anesthesia.
- D. It is justifiable because future patients may benefit from knowledge gained by the research.
Correct Answer: C
Rationale: The correct answer is C because obtaining bone marrow under general anesthesia carries inherent risks that make it greater than minimal-risk. Here's a step-by-step rationale:
1. General anesthesia poses risks such as allergic reactions, breathing problems, and potential complications, making the procedure more than minimal-risk.
2. Even though bone marrow assessments are routine for leukemia patients, the use of general anesthesia elevates the risk level.
3. The fact that the results are not shared with the treating oncologist and no therapeutic interventions are based on them indicates that the procedure is solely for research purposes, emphasizing the risk-benefit analysis.
4. Choice A is incorrect because the use of general anesthesia increases the procedure's risk level beyond routine.
5. Choice B is incorrect as the focus should be on the inherent risks of general anesthesia, not just the number of procedures performed.
6. Choice D is irrelevant to the risk assessment of the specific procedure and does not address the immediate safety concerns associated with general anesthesia.
An oncology nurse is providing health education for a patient who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia?
- A. The different leukemias all involve unregulated proliferation of WBC
- B. The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function.
- C. The different leukemias all result in a decrease in the production of white blood cells.
- D. The different leukemias all involve the development of cancer in the lymphatic system.
Correct Answer: A
Rationale: The correct answer is A: The different leukemias all involve unregulated proliferation of WBC. Leukemia is a type of cancer that affects the blood and bone marrow, leading to the uncontrolled growth of white blood cells. This abnormal proliferation of white blood cells is a common feature across all subtypes of leukemia.
Explanation:
1. Leukemia is a cancer of the blood and bone marrow.
2. In leukemia, there is uncontrolled proliferation of white blood cells.
3. Different subtypes of leukemia may have specific characteristics, but they all involve the abnormal growth of white blood cells.
Summary:
Choice B is incorrect because leukemias do not involve unregulated proliferation of red blood cells. Choice C is incorrect because leukemias do not always result in a decrease in white blood cell production. Choice D is incorrect because leukemia is not specifically related to the lymphatic system; it affects the blood and bone marrow.
A study is designed to investigate the rates of central line–associated blood stream infections among pediatric hematology/oncology patients. Three common central line types (totally implanted catheter [port], peripherally inserted central catheter [PICC], and tunneled externalized catheter [TEC]) were included in the study. What data structure is central line type?
- A. Continuous
- B. Dichotomous
- C. Nominal
- D. Ordinal
Correct Answer: C
Rationale: The correct answer is C: Nominal. The central line type is a categorical variable with no inherent order or ranking. Each type is distinct and cannot be quantitatively ordered or measured. It is not continuous (A), as it is not on a scale. It is not dichotomous (B) as there are more than two categories. It is not ordinal (D) because the types do not have a clear order or ranking. Therefore, central line type is best represented by a nominal data structure.
A nurse is caring for a client who has hemophilia A and is about to begin taking desmopressin to prevent bleeding. The nurse should monitor the client for which of the following adverse reactions?
- A. Weight loss
- B. Edema
- C. Polyuria
- D. Bradycardia
Correct Answer: B
Rationale: The correct answer is B: Edema. Desmopressin is a synthetic form of vasopressin that can cause fluid retention, leading to edema. This is a common adverse reaction associated with desmopressin use. Weight loss (choice A) is not a typical adverse reaction of desmopressin. Polyuria (choice C) is actually a desired effect of desmopressin, as it helps to concentrate urine. Bradycardia (choice D) is not directly associated with desmopressin use. Monitoring for edema is important to ensure the client's safety and adjust treatment as needed.
A nurse is caring for a patient who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the patient's sacral area and petechiae in her forearms. In addition to informing the patient's primary care provider, the nurse should perform what action?
- A. Initiate measures to prevent venous thromboembolism (VTE).
- B. Check the patient's most recent platelet level.
- C. Place the patient on protective isolation.
- D. Ambulate the patient to promote circulatory function.
Correct Answer: B
Rationale: Rationale:
1. Ecchymoses and petechiae indicate potential thrombocytopenia in leukemia.
2. Checking platelet levels will confirm if thrombocytopenia is present.
3. Low platelet levels increase bleeding risk, warranting intervention.
4. Initiating VTE prevention, isolation, or ambulation are not directly related to managing thrombocytopenia in leukemia.
Summary:
- A: VTE measures are not indicated with the given symptoms.
- C: Protective isolation is unnecessary for thrombocytopenia.
- D: Ambulation does not directly address thrombocytopenia.