Nokea
The nurse is reviewing the parts of the complete blood count and differential with a patient. Where should the nurse state that neutrophils, eosinophils, and basophils are produced?
- A. Spleen
- B. Thymus
- C. Lymph nodes
- D. Red bone marrow
Correct Answer: D
Rationale: The correct answer is D: Red bone marrow. Neutrophils, eosinophils, and basophils are all types of white blood cells that are produced in the red bone marrow through a process called hematopoiesis. The red bone marrow is a primary site for the production of blood cells, including these specific types of white blood cells. Neutrophils are important for fighting bacterial infections, eosinophils are involved in allergic reactions and parasitic infections, and basophils play a role in allergic responses. Therefore, it is crucial for the nurse to inform the patient that these cells are produced in the red bone marrow. The other choices (A: Spleen, B: Thymus, C: Lymph nodes) are incorrect as these organs do not play a primary role in the production of these specific types of white blood cells.
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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 addition of cyclophosphamide and etoposide to the chemotherapy regimen is indicated for patients with combined loss of heterozygosity for 1p and 16q in Wilms' tumor. This genetic abnormality is associated with a higher risk of relapse and poorer outcomes. The extended duration of chemotherapy (33 weeks) is necessary to target any remaining tumor cells and reduce the risk of recurrence. Additionally, the decision to administer radiation to both the lungs and flank is appropriate given the incomplete resolution of some lung nodules after initial chemotherapy. Lung radiation helps to target any remaining metastatic lesions, while flank radiation targets the primary tumor site and positive lymph nodes. This comprehensive treatment approach aims to maximize the chances of long-term disease control and survival for the patient.
Choice A is incorrect because it lacks the addition of cyclophosphamide and etoposide, which are needed for Wilms' tumor with the specific genetic abnormality mentioned.
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.
Hepato-splenomegaly with lymphadenopathy occur in all except:
- A. ALL
- B. lymphoma
- C. CML
- D. dissiminated TB
Correct Answer: C
Rationale: Step-by-step rationale:
1. Chronic Myeloid Leukemia (CML) primarily involves the bone marrow and blood, not the liver, spleen, or lymph nodes.
2. Hepato-splenomegaly with lymphadenopathy are commonly seen in Acute Lymphoblastic Leukemia (ALL) and lymphoma.
3. Disseminated TB can cause hepato-splenomegaly but typically does not present with lymphadenopathy.
Therefore, C (CML) is the correct answer as it does not typically present with the described findings.
The nurse is assessing a client experiencing anemia. Which laboratory findings will the nurse expect for this client? (Select all that apply.)
- A. Increased hematocrit
- B. Decreased red blood cell count
- C. Decreased serum iron
- D. Decreased hemoglobin
Correct Answer: b
Rationale: The correct answer is B: Decreased red blood cell count. Anemia is characterized by a decrease in the number of red blood cells, leading to a lower than normal red blood cell count. In anemia, the body cannot transport enough oxygen to tissues, leading to symptoms such as fatigue and shortness of breath. Increased hematocrit (A) and decreased hemoglobin (D) are related to anemia but not specific enough to be conclusive. Decreased serum iron (C) may be seen in iron-deficiency anemia but is not always present in all types of anemia.
An infant is born with a 7 cm × 6 cm lesion over the upper extremity from the elbow to the shoulder. The lesion is indurated and purpuric, with some petechiae around the edges. No other areas of petechiae are noted on the skin. The infant is doing well without other systemic problems. i were 9 and 9. You are called by the pediatric nurse practitioner to the NICU. What is the most appropriate next step?
- A. Do nothing because the infant is doing well and had good Apgars.
- B. Obtain an ultrasound for more information about the lesion.
- C. Obtain an MRI to assess the extent of the lesion.
- D. Obtain labs, including a CBC with platelet count and fibrinogen.
Correct Answer: D
Rationale: The correct answer is D: Obtain labs, including a CBC with platelet count and fibrinogen. This is the most appropriate next step because the infant's presentation with an indurated and purpuric lesion raises concern for a possible bleeding disorder or coagulopathy. By obtaining labs, including a CBC with platelet count and fibrinogen, we can assess the infant's hemostatic profile and rule out any underlying hematologic abnormalities. This step is crucial in ensuring the infant's well-being and guiding further management if any abnormalities are detected.
Why the other choices are incorrect:
A: Doing nothing is not appropriate as the presentation warrants further investigation.
B: An ultrasound may not provide useful information in this scenario as the lesion is concerning for a systemic issue.
C: An MRI is not the initial diagnostic test of choice for evaluating a possible bleeding disorder or coagulopathy.