Anatomy of Hematologic System

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After receiving a diagnosis of acute lymphocytic leukemia, a patient is visibly distraught, stating, 'I have no idea where to go from here.' How should the nurse prepare to meet this patient's psychosocial needs?

  • A. Assess the patient's previous experience with the health care system.
  • B. Reassure the patient that treatment will be challenging but successful.
  • C. Assess the patient's specific needs for education and support.
  • D. Identify the patient's plan of medical care.
Correct Answer: C

Rationale: Rationale for Choice C (Correct Answer): Assessing the patient's specific needs for education and support is crucial in meeting the psychosocial needs of a patient diagnosed with acute lymphocytic leukemia. By understanding the patient's informational and emotional needs, the nurse can provide tailored support and resources, enhancing the patient's coping abilities and overall well-being. This approach fosters a therapeutic relationship and promotes patient-centered care.

Summary of Other Choices:
A: Assessing the patient's previous experience with the health care system is important but may not directly address the immediate psychosocial needs related to the new diagnosis.
B: Reassuring the patient about treatment success is premature and may invalidate the patient's feelings of distress and uncertainty.
D: Identifying the patient's plan of medical care is essential but focuses more on the medical aspect rather than the psychosocial aspect of care.

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You are seeing a 13-year-old boy with fatigue, weight loss, night sweats, and splenomegaly. Peripheral blood shows anemia, thrombocytosis, and leukocytosis (300,000/mm3). What is this patient's most likely diagnosis?

  • A. Leukemoid reaction
  • B. Acute lymphoblastic leukemia (ALL)
  • C. Chronic myeloid leukemia (CML)
  • D. Juvenile myelomonocytic leukemia (JMML)
Correct Answer: C

Rationale: The correct answer is C: Chronic myeloid leukemia (CML). This is a likely diagnosis due to the presence of fatigue, weight loss, night sweats, splenomegaly, anemia, thrombocytosis, and leukocytosis with an elevated white blood cell count. CML is characterized by the Philadelphia chromosome, resulting in the BCR-ABL fusion gene. This gene leads to uncontrolled proliferation of myeloid cells, causing the symptoms seen in this patient. Leukemoid reaction (A) is a reactive increase in white blood cells, usually in response to an infection. Acute lymphoblastic leukemia (B) typically presents with symptoms in children but is more commonly associated with lymphoblasts in the peripheral blood. JMML (D) is a rare myelodysplastic disorder in children characterized by monocytosis and a specific genetic mutation.

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 because T-cell numbers in infants are indeed higher than in adults. This is due to the active development of the immune system in infants, leading to a higher proportion of T-cells.

A is incorrect because NK-cell numbers in infants are actually higher at birth and decrease with age.
B is incorrect because B-cell numbers are lower at birth and increase with age.
D is incorrect because infants do not have low lymphocyte counts; their immune system is actively developing, leading to higher lymphocyte counts compared to adults.

A 4-year-old girl with a history of recurrent epistaxis and easy bruising is referred to you for evaluation. She is found to have a prolonged PTT and a factor VIII level that is less than 1%. Both parents have a history of excessive bleeding. She is admitted with a severe episode of epistaxis, and your colleague orders 40 IU/kg of recombinant factor VIII. Her epistaxis resolves initially but within an hour starts again at the same severity as before. What is the best next step?

  • A. Infuse a von Willebrand factor concentrate.
  • B. Give another dose of recombinant factor VIII concentrate.
  • C. Call otorhinolaryngology to pack her nose.
  • D. Check for a factor VIII inhibitor.
Correct Answer: A

Rationale: The correct answer is A: Infuse a von Willebrand factor concentrate. In this case, the 4-year-old girl with a factor VIII deficiency did not respond to recombinant factor VIII, suggesting a possible von Willebrand disease (vWD) as well. Infusing von Willebrand factor concentrate can help address the underlying vWD component, which is necessary for adequate hemostasis. Option B is incorrect because giving another dose of recombinant factor VIII won't address the potential vWD deficiency. Option C is not the best next step as packing the nose does not address the underlying bleeding disorder. Option D is not the immediate next step as checking for a factor VIII inhibitor is important but can be done after addressing the acute bleeding episode with appropriate therapy.

Waldeyer's ring does not include:

  • A. faucal tonsils
  • B. submandibular glands
  • C. adenoids
  • D. lingual tonsils
Correct Answer: B

Rationale: The correct answer is B: submandibular glands. Waldeyer's ring consists of a ring of lymphoid tissue in the pharynx, including the palatine tonsils (faucal tonsils), adenoids, and lingual tonsils. Submandibular glands are salivary glands located beneath the mandible and are not part of Waldeyer's ring. Therefore, B is the correct answer. Choices A, C, and D are incorrect because they are all components of Waldeyer's ring.

A 10-year-old girl is a long-term survivor of type II pleuropulmonary blastoma (PPB). You suspect she has a cancer predisposition syndrome and perform genetic testing, which confirms she has DICER1 syndrome. Which other cancer is she predisposed to?

  • A. Papillary thyroid cancer
  • B. Medullary thyroid cancer
  • C. Pheochromocytoma
  • D. Renal cell carcinoma
Correct Answer: A

Rationale: The correct answer is A: Papillary thyroid cancer. Individuals with DICER1 syndrome are at increased risk for developing various tumors, including papillary thyroid cancer. This is due to the role of DICER1 gene in regulating cell growth and division. The other choices, B (medullary thyroid cancer), C (pheochromocytoma), and D (renal cell carcinoma), are not typically associated with DICER1 syndrome. Medullary thyroid cancer is commonly linked to RET gene mutations, pheochromocytoma to genes such as SDHB, SDHD, and VHL, and renal cell carcinoma to mutations in genes like VHL and MET.

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