Anatomy of Hematologic System

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A 12-year-old patient has been referred to you following complete resection with clean margins of a high-grade malignant peripheral nerve sheath tumor of the shoulder region. The tumor measured approximately 4 cm in greatest dimension. A CT scan of the chest and a bone scan were within normal limits. The patient does not have evidence of neurofibromatosis type 1 (NF1). Which of the following treatment approaches would you recommend?

  • A. Chemotherapy with doxorubicin and ifosfamide
  • B. Radiotherapy
  • C. Chemotherapy with doxorubicin and ifosfamide plus radiotherapy
  • D. Observation
Correct Answer: D

Rationale: The correct answer is D: Observation. In this case, the patient has undergone complete resection of the tumor with clean margins and there is no evidence of metastasis or neurofibromatosis type 1. Given these factors, observation is the most appropriate approach as there is no indication for adjuvant chemotherapy or radiotherapy. Chemotherapy with doxorubicin and ifosfamide (Choice A) is typically reserved for cases with high-risk features such as incomplete resection or metastasis. Radiotherapy (Choice B) may be considered in certain cases, but in this scenario where surgery was curative and there is no evidence of spread, it is not necessary. Chemotherapy plus radiotherapy (Choice C) may be overly aggressive and carry unnecessary risks for a patient who has already had successful surgery. Thus, observation is the most appropriate approach in this situation.

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A client is having a bone marrow biopsy today. What action by the nurse takes priority?

  • A. Administer pain medication first.
  • B. Ensure valid consent is on the chart.
  • C. Have the client shower in the morning.
  • D. Premedicate the client with sedatives.
Correct Answer: B

Rationale: The correct answer is B: Ensure valid consent is on the chart. This is the priority because obtaining informed consent is crucial before any invasive procedure like a bone marrow biopsy. Without valid consent, the procedure cannot proceed legally or ethically. Administering pain medication (choice A) and premedicating with sedatives (choice D) are important for client comfort but are not the priority. Having the client shower in the morning (choice C) is not directly related to the immediate safety or success of the biopsy.

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.

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 patient with non-Hodgkin's lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurse's best response?

  • A. Everyone should do these things because they're health promotion activities that apply to everyone.
  • B. You don't want to develop a second cancer, do you?
  • C. You need to do this just to be on the safe side.
  • D. It's important to reduce other factors that increase the risk of second cancers.
Correct Answer: D

Rationale: The correct answer is D because reducing factors that increase the risk of second cancers is crucial for a patient with non-Hodgkin's lymphoma. Alcohol, smoking, and sun exposure are known risk factors for developing secondary cancers. By avoiding these behaviors, the patient can lower the chances of developing another cancer. Choice A is incorrect as it does not specifically address the patient's situation. Choice B uses fear tactics and may not be the most effective way to educate the patient. Choice C is vague and does not provide a clear rationale. Overall, choice D is the best response as it directly addresses the patient's concern and provides a logical explanation for the importance of changing these behaviors.

The nurse is assessing a client experiencing anemia. Which laboratory findings will the nurse expect for this client? (Select all that apply.)

  • A. Increased hematocrit
  • B. Decreased red blood cell count
  • C. Decreased serum iron
  • D. Decreased hemoglobin
Correct Answer: b

Rationale: The correct answer is B: Decreased red blood cell count. Anemia is characterized by a decrease in the number of red blood cells, leading to a lower than normal red blood cell count. In anemia, the body cannot transport enough oxygen to tissues, leading to symptoms such as fatigue and shortness of breath. Increased hematocrit (A) and decreased hemoglobin (D) are related to anemia but not specific enough to be conclusive. Decreased serum iron (C) may be seen in iron-deficiency anemia but is not always present in all types of anemia.

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