Nokea
A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia?
- A. Monitoring for infection
- B. Monitoring nutritional status
- C. Monitor electrolyte levels
- D. Monitoring liver function
Correct Answer: A
Rationale: The correct answer is A: Monitoring for infection. Acute leukemia patients are at high risk for infections due to compromised immune function. Infection is the most common cause of death among leukemia patients. Regular monitoring for signs of infection, such as fever and abnormal white blood cell counts, is crucial for early detection and treatment. Option B, monitoring nutritional status, is important but not the most direct cause of death in leukemia patients. Option C, monitoring electrolyte levels, is important but not as directly related to the cause of death in leukemia patients. Option D, monitoring liver function, is not the most common cause of death in leukemia patients and is not directly related to leukemia complications.
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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.
A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects?
- A. Phlebitis
- B. Dark
- C. orange-colored stools
- D. Constipation
Correct Answer: D
Rationale: The correct answer is D: Constipation. Ferrous sulfate, an iron supplement, commonly causes constipation due to its effects on the digestive system. Iron slows down bowel movements, leading to constipation. Monitoring for constipation is crucial to ensure the client's comfort and prevent complications.
Phlebitis (choice A) is not a common adverse effect of ferrous sulfate administration. Dark, tarry stools (choice B) can indicate gastrointestinal bleeding but are not directly related to iron supplementation. Orange-colored stools (choice C) are not a typical side effect of ferrous sulfate and are more commonly associated with certain foods or medications.
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 patient has residual lung nodules after initial chemotherapy, indicating a need for intensified treatment. Adding cyclophosphamide and etoposide to the chemotherapy regimen can improve outcomes in patients with combined loss of heterozygosity for 1p and 16q. Radiation to both the lungs and flank targets all remaining disease sites effectively.
Choice A is incorrect because it does not address the need for intensified treatment with additional agents or radiation to the lungs, where residual disease remains.
Choice B is incorrect as it only includes radiation to the flank and not the lungs, which are still harboring disease.
Choice C is incorrect because although it adds cyclophosphamide and etoposide, it does not include radiation to the lungs, which is necessary for comprehensive disease control.
A young child with consanguineous parents has developmental delay and a history of multiple recurrent bacterial infections and short stature. He presents to the emergency department following trauma and requires a blood transfusion. Blood work identifies leukocytosis, neutrophilia, and the Bombay blood group (absent H antigen as well as absent A and B antigens). What is this patient's diagnosis?
- A. Chediak-Higashi syndrome
- B. Leukocyte adhesion deficiency (LAD) Type II
- C. CD18 deficiency
- D. Griscelli syndrome
Correct Answer: B
Rationale: The correct answer is B: Leukocyte adhesion deficiency (LAD) Type II. This patient's symptoms of recurrent bacterial infections, leukocytosis, neutrophilia, short stature, and Bombay blood group (lack of H antigen) are characteristic of LAD Type II. In LAD Type II, there is a defect in fucose metabolism, leading to impaired leukocyte adhesion and migration, causing immune dysfunction. Chediak-Higashi syndrome (A) presents with oculocutaneous albinism, recurrent infections, and giant granules in leukocytes. CD18 deficiency (C) is a type of LAD characterized by mutations in the CD18 gene causing impaired integrin function. Griscelli syndrome (D) presents with silvery hair, immunodeficiency, and neurological deficits, not matching this patient's symptoms.
A peripheral blood smear showing increase in numbers of neutrophils, band cells, basophils, eosinophils, and platelets is most suggestive
- A. Acute myeloid leukemia
- B. Acute lymphoid leukemia
- C. Chronic myelocytic leukemia
- D. Chronic lymphocytic leukemia
Correct Answer: C
Rationale: Rationale: A peripheral blood smear showing an increase in neutrophils, basophils, eosinophils, and platelets is indicative of Chronic Myelocytic Leukemia (CML). Neutrophils, basophils, and eosinophils are myeloid lineage cells typically elevated in CML. The presence of increased platelets is also common in CML due to the overproduction of cells in the bone marrow.
Summary of other choices:
A: Acute myeloid leukemia - Typically presents with a predominance of immature myeloid cells like blasts, rather than an increase in mature myeloid cells.
B: Acute lymphoid leukemia - Primarily involves lymphoid lineage cells, not myeloid cells as seen in the blood smear.
D: Chronic lymphocytic leukemia - Characterized by an increase in mature lymphocytes, not myeloid cells like neutrophils, basophils, and eosinophils.