Nokea
A parent of a child with Wilms tumor asks the nurse about surgery. Which statement concerning the type of surgery for Wilms tumor is most accurate?
- A. Surgery is only done if chemotherapy and radiation fail.
- B. Surgery is usually performed within 24 to 48 hours of admission.
- C. Surgery is the least favorable therapy for the treatment of Wilms tumor.
- D. Surgery will be delayed until the child's overall health status improves.
Correct Answer: B
Rationale: Wilms tumor, a kidney cancer in children, is primarily treated with surgical resection (nephrectomy) as the cornerstone of therapy, typically performed within 24 to 48 hours of diagnosis to remove the tumor before it spreads. This urgency stems from its responsiveness to surgery and the need to stage the cancer accurately, guiding subsequent chemotherapy or radiation. Delaying surgery until chemotherapy or radiation fails is incorrect surgery is the initial step, not a last resort. It's not the least favorable option; rather, it's the preferred first-line treatment due to high cure rates when combined with adjuvant therapies. Waiting for health improvement isn't standard unless the child is critically unstable, which isn't typical at diagnosis. The nurse's accurate explanation reassures parents and underscores surgery's role, aligning with pediatric oncology protocols to optimize outcomes in Wilms tumor management.
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The nurse knows that hemolytic to blood transfusions occur most often when the first milliliters of the infusion.
- A. 125
- B. 50
- C. 100
- D. 75
Correct Answer: B
Rationale: Hemolytic reactions strike early 50 mL often triggers as mismatched blood clashes, a rapid antigen-antibody storm. Later volumes (75-125) build on it; 100's common but not peak. Nurses watch those first drops, stopping at 50 mL's hint of fever or pain, a tight window in this transfusion trap.
Lymphoma is differentiated in stages to assisting classifications. Stage III is when there are
- A. Diffuse or disseminated involvement of one or more extra lymphatic organs
- B. Involvement limited to one side of the diaphragm with two or more lymph node regions
- C. Involvement of lymph node regions on both sides of the diaphragm
- D. Involvement of a single lymph node region or single extralymphatic organ or site
Correct Answer: C
Rationale: Lymphoma's Stage III nodes jump diaphragm's sides, not one-sided, organ-wide, or solo. Nurses stage this, a chronic spread mark.
Mr Yee, a 45-year-old, reports three recent gout attacks in the ankle or knee. You notice a small tophus over the left elbow. He says that two years ago he took allopurinol 100 mg for one month, then 200 mg OM for one month but stopped as it 'did not help his gout and there was no improvement'. When you probe, he states that he was not very adherent to allopurinol either then as it was some years ago, and he says he probably took it 'once or twice a week'. He states he did not experience any rashes or other side effects to it then. He does not drink alcohol except one glass of wine once or twice a year on special occasions. He has past history of renal stones and also underlying ischaemic cardiomyopathy for which he is still being followed up by the cardiologist. Two weeks ago, he was admitted to the hospital for a gout flare. He had a blood test done, with the following results: Uric acid 620 mmol/L, Creatinine 120 umol/L, eGFR 55 mL/min, BP 144/94 mmHg, he has Hypertension on HCTZ long-term. He is asking you to give him Arcoxia 120 mg OM standby as it usually works for his gout flare. Which is correct advice?
- A. Discuss HLA B5801 testing particularly as febuxostat is being prescribed for him
- B. Advise that he will need stepwise up-titration of allopurinol to reach the uric acid target. Regular blood tests will allow this to be done safely
- C. Advise that colchicine prophylaxis is helpful to prevent gout attacks and increase hydrochlorothiazide to optimise his BP control
- D. Offer to initiate probenecid immediately as allopurinol is ineffective
Correct Answer: B
Rationale: Tophus and frequent flares with uric acid 620 mmol/L indicate chronic gout needing ULT. Prior allopurinol failure' likely stems from non-adherence (once/twice weekly), not ineffectiveness. Stepwise up-titration of allopurinol, starting low (e.g., 100 mg) due to eGFR 55, with regular blood tests (uric acid, creatinine), targets <360 mmol/L safely, per ACR guidelines. HLA-B5801 testing is for high-risk groups (e.g., Han Chinese) before allopurinol, not febuxostat-specific here. Colchicine helps, but increasing HCTZ (urate-retaining) may worsen gout. Probenecid suits renal underexcretors, not proven here. This approach optimizes chronic gout control.
Which of the following cancer patients could potentially be placed together as roommates?
- A. A patient with a neutrophil count of 1000/mm³
- B. A patient who underwent debulking of a tumor to relieve pressure
- C. A patient receiving high-dose chemotherapy after a bone marrow harvest
- D. A patient who is post-op laminectomy for spinal cord compression
Correct Answer: B
Rationale: Roommate pairing hinges on infection risk and care needs. The debulking patient tumor reduced for symptom relief and post-laminectomy patient spinal decompression both underwent palliative surgeries, not inherently immunocompromised, making them compatible. A neutrophil count of 1000/mm³ signals moderate neutropenia, needing isolation to dodge infections. High-dose chemotherapy post-bone marrow harvest obliterates immunity, demanding strict protection. The surgical pair's stability, lacking acute immune suppression, allows safe cohabitation, a nurse's practical call to optimize space and reduce cross-infection risks in cancer care settings.
A client admitted for sickle cell crisis is distraught after learning her child also has the disease. What response by the nurse is best?
- A. Both you and the father are equally responsible for passing it on
- B. There are many good treatments for sickle cell disease these days
- C. It's not your fault; there is no way to know who will have this disease
- D. It's understandable that you are upset about this news. Would you like to talk about what you're feeling?
Correct Answer: D
Rationale: Sickle cell's genetic blow autosomal recessive hits emotionally. Acknowledging distress and offering to talk validates feelings, fostering coping over blame or facts alone. Blaming genetics risks guilt, while touting treatments sidesteps her pain. Denying fault misleads carriers are predictable via screening but misses empathy. Nurses prioritize therapeutic communication, opening dialogue to process this crisis, a compassionate bridge to support mother and child through sickle cell's lifelong challenges.