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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. In patients with acute leukemia, the most common cause of death is infection due to the suppression of the immune system by the disease and its treatment. By closely monitoring for signs of infection such as fever, chills, increased heart rate, and low white blood cell count, the nurse can promptly intervene and provide appropriate treatment to prevent complications and improve patient outcomes. The other choices are incorrect because while they are important aspects of care for patients with leukemia, monitoring for infection directly addresses the most critical risk factor leading to mortality in this patient population.
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A 13-year-old boy presents to the emergency department with complaints of headache and visual changes. History reveals progressive dyspnea on exertion, generalized fatigue, and increased bruising. His labs are significant for a WBC of 350,000/mcL, of which 80% are reported to be blasts and appear to be myeloblasts without the presence of Auer rods. His hemoglobin is 7.2 g/dL, and his platelets are 18,000/mcL. A CT scan of the head shows a small intracerebral hemorrhage. His coags are normal. Which of the following is the most appropriate therapy?
- A. Start induction chemotherapy.
- B. Perform emergent leukapheresis followed the next day by induction chemotherapy.
- C. Perform emergent leukapheresis plus hydroxyurea.
- D. Provide emergent cranial radiation plus hydroxyurea followed the next day by induction chemotherapy.
Correct Answer: C
Rationale: The most appropriate therapy in this scenario is emergent leukapheresis plus hydroxyurea (Choice C). Leukapheresis is needed to rapidly reduce the high white blood cell count, preventing further complications such as leukostasis and hyperviscosity syndrome. Hydroxyurea can help further control the rapid proliferation of blasts. Induction chemotherapy (Choice A) may lead to tumor lysis syndrome due to the high tumor burden. Performing leukapheresis alone without a subsequent therapy (Choice B) may not adequately address the underlying disease. Providing cranial radiation (Choice D) is not the initial management for acute myeloid leukemia.
Which statement is correct regarding lymphocyte counts in infants versus adults?
- A. NK-cell numbers are lowest at birth and increase with age.
- B. B-cell numbers are highest at birth and decline with age.
- C. T-cell numbers in infants are higher than in adults.
- D. Infants have low lymphocyte counts that increase with age.
Correct Answer: C
Rationale: The correct answer is C: T-cell numbers in infants are higher than in adults. This is because infants have a relatively higher proportion of T-cells compared to adults due to their underdeveloped immune system. T-cell numbers decrease with age as the immune system matures and adapts to the environment.
Rationale:
1. T-cells play a crucial role in the immune response, especially in infants who rely heavily on cellular immunity.
2. NK-cell numbers do not follow the pattern described in option A, as they are important in early immune responses.
3. B-cell numbers do not decline with age as stated in option B, as they are responsible for antibody production throughout life.
4. Option D is incorrect as infants actually have higher lymphocyte counts compared to adults due to their developing immune system.
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. Given the complete resection with clean margins, normal chest CT, bone scan, and absence of NF1, observation is appropriate. Chemotherapy or radiotherapy may be considered in the presence of residual disease, positive margins, or metastasis. Chemotherapy with doxorubicin and ifosfamide may cause unnecessary toxicity without clear benefit in this scenario. Radiotherapy may be reserved for cases with high-risk features. Combining chemotherapy and radiotherapy may lead to increased toxicity without proven benefit. Observation allows monitoring for disease recurrence while minimizing unnecessary treatment side effects.
The nurse is documenting findings after completing data collection with a patient. What term should the nurse use to document a large area of discoloration from hemorrhage under the skin?
- A. Pallor
- B. Rubor
- C. Petechiae
- D. Ecchymosis
Correct Answer: D
Rationale: The correct term for a large area of discoloration from hemorrhage under the skin is "Ecchymosis" (Choice D). Ecchymosis refers to the medical term for a bruise, which is characterized by a large area of skin discoloration caused by bleeding beneath the skin due to trauma or injury. Pallor (Choice A) refers to paleness of the skin due to decreased blood flow or anemia, not discoloration from hemorrhage. Rubor (Choice B) refers to redness of the skin due to increased blood flow, not discoloration from hemorrhage. Petechiae (Choice C) are tiny red or purple spots on the skin caused by broken capillaries, not a large area of discoloration from hemorrhage as described in the question.
Artemisinin and its derivatives are used in the treatment of severe forms of chloroquine-resistant falciparum because they have:
- A. Rapid gametocidal activity
- B. The ability to prevent further development of hypnozoites
- C. Rapid sporontocidal activity
- D. Rapid schizonticidal activity
Correct Answer: D
Rationale: The correct answer is D: Rapid schizonticidal activity. Artemisinin and its derivatives target the asexual stage of the malaria parasite's life cycle, specifically the schizont stage. By quickly destroying the schizonts, they effectively kill the parasites in the blood, leading to a rapid reduction in parasite load and alleviating symptoms. The other choices are incorrect because A (Rapid gametocidal activity) targets sexual stage parasites, B (Ability to prevent further development of hypnozoites) refers to relapse prevention in Plasmodium vivax and Plasmodium ovale infections, and C (Rapid sporontocidal activity) targets the mosquito stage of the parasite's life cycle.