Nokea
Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult patient who is otherwise healthy. The patient and the care team have collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient for which of the following?
- A. Daily treatment with targeted treatment medications
- B. Radiation therapy on a daily basis
- C. Hematopoietic stem cell transplantation
- D. An aggressive course of chemotherapy
Correct Answer: D
Rationale: The correct answer is D: An aggressive course of chemotherapy. For AML, induction therapy typically involves aggressive chemotherapy to achieve remission. This approach aims to rapidly reduce the number of leukemia cells in the body. Targeted treatment medications are not the standard first-line therapy for AML. Radiation therapy is not commonly used as a primary treatment for AML. Hematopoietic stem cell transplantation is usually considered after achieving remission with chemotherapy as a consolidation therapy. Therefore, preparing the patient for an aggressive course of chemotherapy aligns with the standard treatment approach for AML.
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A 50-year-old male who had frequent infections of his upper respiratory tract manifested with subcutaneous petechiae over his arms and legs. Investigations revealed low hemoglobin and a dry tap marrow. The most likely condition the patient is suffering from
- A. Iron deficiency anemia
- B. Megaloblastic anemia
- C. Hemolytic anemia
- D. Aplastic anemia
Correct Answer: D
Rationale: The correct answer is D: Aplastic anemia. Aplastic anemia is characterized by pancytopenia, which includes low hemoglobin levels leading to anemia. The dry tap marrow indicates bone marrow failure, which is a hallmark of aplastic anemia. The subcutaneous petechiae are due to thrombocytopenia, another feature of this condition. Iron deficiency anemia (A) typically presents with microcytic hypochromic red blood cells and is not associated with bone marrow failure. Megaloblastic anemia (B) is characterized by macrocytic red blood cells and is usually due to deficiencies in vitamin B12 or folate. Hemolytic anemia (C) involves the premature destruction of red blood cells and is not typically associated with bone marrow failure.
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.
RBCs break into fragments, they are referred to as schistocytes. These type of cells are seen in
- A. Sickle cell trait
- B. Thalassemia
- C. Microangiopathic hemolytic anemia
- D. Idiopathic thrombocytopenic purpura
Correct Answer: C
Rationale: The correct answer is C, Microangiopathic hemolytic anemia. Schistocytes are fragmented red blood cells caused by mechanical damage as they pass through narrowed vessels. This occurs in conditions like thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, which are types of microangiopathic hemolytic anemia. Sickle cell trait (A) and Thalassemia (B) are genetic disorders affecting red blood cell structure and production, not causing mechanical fragmentation. Idiopathic thrombocytopenic purpura (D) is a disorder characterized by low platelet count, unrelated to RBC fragmentation.
A nurse is caring for a client who has chronic stable angina. The nurse should identify that which of the following drugs inhibits the action of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction?
- A. Clopidogrel
- B. Heparin
- C. Warfarin
- D. Alteplase
Correct Answer: A
Rationale: Clopidogrel is the correct answer because it inhibits the action of ADP receptors on platelets, reducing platelet aggregation and the risk of myocardial infarction. Heparin works by inhibiting clotting factors, Warfarin interferes with vitamin K-dependent clotting factors, and Alteplase is a thrombolytic drug that dissolves blood clots. None of these drugs target ADP receptors specifically like Clopidogrel does.
A 4-year-old boy is pale with intermittent jaundice and splenomegaly. Laboratory results are as follows: RBC 4.85 M/mcL (N); Hgb 8.6 g/dL (L); Hct 25.8% (L); MCV 81.6 (N); MCHC 38% (H); RDW 20% (H); Retic 7% (H). What are the two best tests to distinguish autoimmune hemolytic anemia from hereditary spherocytosis?
- A. Free erythrocyte protoporphyrin and IgG levels
- B. Hemoglobin electrophoresis and direct antiglobulin test (DAT)
- C. Lactate dehydrogenase (LDH) and modified Russell viper venom test
- D. Red cell distribution width (RDW) and mean corpuscular hemoglobin concentration (MCHC)
Correct Answer: E
Rationale: I'm sorry, but the correct answer is not provided in the question. Could you please provide the correct answer or clarify the question so that I can give you a detailed explanation based on the correct information?