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A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take?
- A. Shake the vial before using.
- B. Administer via IV bolus over 1 to 3 min.
- C. Dilute the drug first with D5W.
- D. Save the used vial for the next dose.
Correct Answer: B
Rationale: The correct answer is B: Administer via IV bolus over 1 to 3 min. This is the correct action because epoetin is typically administered intravenously over a specified time frame to prevent adverse reactions such as rapid changes in blood pressure or heart rate. Shaking the vial before using (option A) is unnecessary and may lead to frothing. Diluting the drug with D5W (option C) is not recommended for administration as an IV bolus. Saving the used vial for the next dose (option D) is incorrect and violates medication safety protocols. Administering via IV bolus over 1 to 3 min ensures safe and effective delivery of the medication.
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Several gene mutations have been associated with juvenile myelomonocytic leukemia (JMML), and they may or may not have prognostic implications. A gene expression–based classification system has been found to be an independent predictor of clinical outcome in these patients. What is the disease signature that predicts a poor outcome?
- A. Tyrosine kinase inhibitors
- B. Acute myeloid leukemia–like
- C. Chronic myeloid leukemia-like
- D. BRAF pathway abnormalities
Correct Answer: B
Rationale: The correct answer is B: Acute myeloid leukemia-like. In JMML, a disease signature resembling acute myeloid leukemia (AML) has been associated with a poor outcome. This signature includes features such as increased blasts, abnormal karyotypes, and mutations in genes like NRAS and KRAS. AML-like JMML cases often have aggressive disease progression and poorer response to treatment. Tyrosine kinase inhibitors (choice A) are not typically used in JMML treatment. Chronic myeloid leukemia-like (choice C) is not associated with a poor outcome in JMML. BRAF pathway abnormalities (choice D) may be present in some cases of JMML but are not the primary disease signature predicting poor outcomes.
A 16-year-old female patient with severe factor XI deficiency presents with acute appendicitis and requires urgent surgery. You are called by the surgeon, who wants to know what, if any, blood products or treatments are required to reduce the risk of perioperative bleeding. The patient weighs 62 kg. What should you tell him to administer?
- A. Cryoprecipitate (five units), which will likely raise her factor XI level to 20%
- B. Factor XI concentrate (20 units/kg), which will raise her factor XI level to 20%
- C. Fresh frozen plasma (20 mL/kg), which will raise her factor XI level to 20%
- D. Prothrombin complex concentrate (40 units/kg), which will raise her factor XI level to 20%
Correct Answer: C
Rationale: The correct answer is C: Fresh frozen plasma (20 mL/kg), which will raise her factor XI level to 20%. Fresh frozen plasma contains various clotting factors, including factor XI. In a patient with severe factor XI deficiency, administering fresh frozen plasma can increase factor XI levels and help reduce the risk of perioperative bleeding. The dose of 20 mL/kg is appropriate for this patient's weight of 62 kg. Cryoprecipitate (choice A) may contain factor XI but is not the optimal choice for raising factor XI levels specifically. Factor XI concentrate (choice B) would be ideal but is not commonly available, making fresh frozen plasma a more practical option. Prothrombin complex concentrate (choice D) primarily contains factors II, VII, IX, and X, but not factor XI, so it would not effectively raise factor XI levels in this patient.
An 8-year-old girl presents with National Cancer Institute (NCI) Standard Risk acute pre-B-cell acute lymphoblastic leukemia. Her family history is significant for her mother having been diagnosed with breast cancer at age 34 years and a maternal uncle who developed osteosarcoma as a teenager. What cytogenetic abnormality is most likely to be detected in this patient?
- A. t(1;19)
- B. CRLF2 rearrangement with a JAK2 mutation
- C. KMT24 rearrangement
- D. Hypodiploidy with a modal chromosome number of 34
Correct Answer: D
Rationale: The correct answer is D: Hypodiploidy with a modal chromosome number of 34. In pediatric pre-B-cell acute lymphoblastic leukemia, hypodiploidy (fewer than 44 chromosomes) is associated with poor prognosis. A modal chromosome number of 34 is specifically linked to high-risk disease.
A: t(1;19) is characteristic of pre-B-cell acute lymphoblastic leukemia but is associated with intermediate prognosis, not standard risk.
B: CRLF2 rearrangement with a JAK2 mutation is seen in a subset of high-risk acute lymphoblastic leukemia cases, not standard risk.
C: KMT24 rearrangement is not a known cytogenetic abnormality in acute lymphoblastic leukemia.
The nurse is assisting with the collection of data from a patient with a hematologic disorder. On which body system should the nurse expect to focus when collecting this data?
- A. Respiratory
- B. Genitourinary
- C. Cardiovascular
- D. All body systems
Correct Answer: D
Rationale: The correct answer is D because hematologic disorders affect all body systems due to their impact on blood production, clotting, and oxygen transport. The nurse needs to assess respiratory system for oxygenation, genitourinary system for kidney function, cardiovascular system for circulation, and other systems for secondary effects. Choices A, B, and C are incorrect as they focus on specific systems, while hematologic disorders can impact multiple systems. It is important to consider the interconnectedness of the body and assess all systems comprehensively.
The nurse is assisting with the collection of data from a patient with a hematologic disorder. On which body system should the nurse expect to focus when collecting this data?
- A. Respiratory
- B. Genitourinary
- C. Cardiovascular
- D. All body systems
Correct Answer: D
Rationale: The correct answer is D: All body systems. When assessing a patient with a hematologic disorder, the nurse needs to consider the impact on multiple body systems. Hematologic disorders can affect the cardiovascular system (such as anemia or clotting disorders), respiratory system (such as decreased oxygen-carrying capacity), genitourinary system (such as kidney dysfunction in conditions like hemolytic uremic syndrome), and other systems. By focusing on all body systems, the nurse ensures a comprehensive assessment to identify any potential complications or manifestations related to the hematologic disorder. Choices A, B, and C are incorrect because hematologic disorders can have implications beyond these specific systems, necessitating a more holistic approach to data collection.