Nokea
A 60-year-old patient with chronic myeloid leukemia will be treated in the home setting and the nurse is preparing appropriate health education. What topic should the nurse emphasize?
- A. The importance of adhering to the prescribed drug regimen
- B. The need to ensure that vaccinations are up to date
- C. The importance of daily physical activity
- D. The need to avoid shellfish and raw foods
Correct Answer: A
Rationale: The correct answer is A: The importance of adhering to the prescribed drug regimen. This is crucial in managing chronic myeloid leukemia effectively. Medication adherence is essential to control the disease and prevent complications. Skipping doses can lead to treatment failure or drug resistance.
B: While vaccinations are important, they are not the top priority in managing chronic myeloid leukemia.
C: Daily physical activity is beneficial for overall health but is not the primary concern in this case.
D: Avoiding shellfish and raw foods is not a key aspect of managing chronic myeloid leukemia.
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A 2-year-old girl has a diagnosis of overall stage IV favorable histology Wilms' tumor with pulmonary metastases and local stage III disease due to finding positive lymph nodes. After she completes 6 weeks of vincristine/dactinomycin/doxorubicin (DD4A) chemotherapy, restaging shows complete resolution of some but not all lung nodules. Tumor genetic testing reveals combined loss of heterozygosity for 1p and 16q. Which of the following would be the most appropriate treatment plan?
- A. Continue chemotherapy with vincristine, doxorubicin, and dactinomycin to complete 25 weeks of therapy. Administer radiation to lungs and flank.
- B. Continue chemotherapy with vincristine, doxorubicin and dactinomycin to complete 25 weeks of therapy. Radiation to flank only. No lung radiation.
- C. Continue chemotherapy with vincristine, doxorubicin and dactinomycin, add cyclophosphamide and etoposide to complete 33 weeks of therapy. Radiation to flank only. No lung radiation.
- D. Continue chemotherapy with vincristine, doxorubicin and dactinomycin, add cyclophosphamide and etoposide to complete 33 weeks of therapy. Radiation to lungs and flank.
Correct Answer: D
Rationale: The correct answer is D because the addition of cyclophosphamide and etoposide to the chemotherapy regimen is indicated for patients with combined loss of heterozygosity for 1p and 16q in Wilms' tumor. This genetic abnormality is associated with a higher risk of relapse and poorer outcomes. The extended duration of chemotherapy (33 weeks) is necessary to target any remaining tumor cells and reduce the risk of recurrence. Additionally, the decision to administer radiation to both the lungs and flank is appropriate given the incomplete resolution of some lung nodules after initial chemotherapy. Lung radiation helps to target any remaining metastatic lesions, while flank radiation targets the primary tumor site and positive lymph nodes. This comprehensive treatment approach aims to maximize the chances of long-term disease control and survival for the patient.
Choice A is incorrect because it lacks the addition of cyclophosphamide and etoposide, which are needed for Wilms' tumor with the specific genetic abnormality mentioned.
The mean cell volume of the patient is 90 fl and the reticulocyte production index is low. Which of the following is the most possible cause of anemia in this patient?
- A. Thalassemia
- B. Vitamin B12 deficiency
- C. Aplastic anemia
- D. Sideroblastic anemia
Correct Answer: C
Rationale: The correct answer is C: Aplastic anemia. Aplastic anemia is characterized by a low reticulocyte production index due to bone marrow failure, leading to decreased red blood cell production and subsequently causing anemia. Thalassemia (choice A) is a genetic disorder resulting in abnormal hemoglobin production, not bone marrow failure. Vitamin B12 deficiency (choice B) can lead to macrocytic anemia, not a low reticulocyte production index. Sideroblastic anemia (choice D) is characterized by abnormal iron metabolism in the bone marrow, not bone marrow failure.
A 10-year-old girl is a long-term survivor of type II pleuropulmonary blastoma (PPB). You suspect she has a cancer predisposition syndrome and perform genetic testing, which confirms she has DICER1 syndrome. Which other cancer is she predisposed to?
- A. Papillary thyroid cancer
- B. Medullary thyroid cancer
- C. Pheochromocytoma
- D. Renal cell carcinoma
Correct Answer: A
Rationale: The correct answer is A: Papillary thyroid cancer. DICER1 syndrome is associated with an increased risk of developing various tumors, including papillary thyroid cancer. This is due to the role of DICER1 gene mutation in dysregulating cell growth and division. Other choices like B: Medullary thyroid cancer, C: Pheochromocytoma, and D: Renal cell carcinoma are not typically associated with DICER1 syndrome. Medullary thyroid cancer is more commonly linked to RET gene mutations, pheochromocytoma to RET or SDHB/C/D gene mutations, and renal cell carcinoma to VHL gene mutations. Therefore, based on the genetic mechanism and known associations, papillary thyroid cancer is the most likely cancer this patient is predisposed to.
A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding?
- A. Hematocrit of 35%
- B. Hemoglobin of 11.8 g/dL
- C. Platelet count of 400000/L
- D. White blood cell (WBC) count of 2800/L
Correct Answer: D
Rationale: The correct answer is D: White blood cell (WBC) count of 2800/L. A low WBC count (leukopenia) in an older patient can indicate an impaired immune system, making them vulnerable to infections. This is concerning as older adults have a weakened immune response. A: Hematocrit of 35% is within the normal range. B: Hemoglobin of 11.8 g/dL is slightly low but not a major concern as long as it's not significantly lower. C: Platelet count of 400000/L is within the normal range and not typically a cause for concern.
The nurse is reviewing the results of a patient's arterial blood gas analysis. What should the nurse recognize as being a normal blood pH?
- A. 7.29
- B. 7.31
- C. 7.38
- D. 7.48
Correct Answer: C
Rationale: The normal blood pH range is 7.35-7.45. Choice C (7.38) falls within this range, indicating a normal pH level. Choices A (7.29) and D (7.48) are outside the normal range, indicating acidosis and alkalosis, respectively. Choice B (7.31) is slightly below the normal range, indicating mild acidosis. Therefore, the correct answer is C as it represents a normal blood pH level within the appropriate range.