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When should autologous hematopoietic stem cell transplantation be used, and what are the common cancers it is used for?
- A. It should be used when high dose therapy is needed to maximize response. Most common cancers it is used for include lymphoma, late relapse of acute lymphoblastic leukemia, neuroblastoma, and Ewing sarcoma.
- B. It should be used any time this approach can provide a meaningful survival benefit over chemotherapy. Most common cancers it is used for include neuroblastoma, responsive brain tumors in young children to avoid/minimize early radiation therapy, and relapsed lymphoma.
- C. It should be used for tumors in which a graft-versus-tumor effect does not occur. Most common cancers include neuroblastoma, lymphoma, selected brain tumors, rhabdomyosarcoma, and Ewing sarcoma with lung metastases.
- D. It should be used to avoid extensive treatment with chemotherapy and to shorten treatment. Most common cancers include neuroblastoma, relapsed Wilms' tumor, and selected brain tumors.
Correct Answer: B
Rationale: Correct Answer: B
Rationale:
1. Autologous hematopoietic stem cell transplantation should be used when it can provide a meaningful survival benefit over chemotherapy.
2. The most common cancers it is used for include neuroblastoma, responsive brain tumors in young children to avoid/minimize early radiation therapy, and relapsed lymphoma.
3. This choice aligns with the current guidelines and evidence-based practice in utilizing autologous stem cell transplantation for specific cancer types to improve outcomes.
Summary of Other Choices:
A: Incorrect. It is not necessary to use autologous stem cell transplantation solely for high-dose therapy. The listed cancers are not the most common indications for this procedure.
C: Incorrect. The statement about the graft-versus-tumor effect is misleading, and the listed cancers are not the most common ones treated with autologous stem cell transplantation.
D: Incorrect. Autologous stem cell transplantation is not used to shorten treatment or avoid extensive chemotherapy. The listed cancers
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Plummer Vinson syndrome is not associated with:
- A. angular stomatitis
- B. splenomegaly
- C. clubbing
- D. post cricoid web
Correct Answer: C
Rationale: The correct answer is C: clubbing. Plummer Vinson syndrome is characterized by the triad of dysphagia, iron deficiency anemia, and esophageal webs. Clubbing is not a typical feature of this syndrome. Angular stomatitis (A), splenomegaly (B), and post cricoid web (D) are all associated with Plummer Vinson syndrome. Angular stomatitis is due to iron deficiency anemia, splenomegaly can be present due to chronic anemia, and post cricoid web is a characteristic finding in the esophagus of patients with this syndrome.
A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects?
- A. Phlebitis
- B. Dark
- C. orange-colored stools
- D. Constipation
Correct Answer: D
Rationale: The correct answer is D: Constipation. Ferrous sulfate, an iron supplement, commonly causes constipation due to its effects on the digestive system. Iron slows down bowel movements, leading to constipation. Monitoring for constipation is crucial to ensure the client's comfort and prevent complications.
Phlebitis (choice A) is not a common adverse effect of ferrous sulfate administration. Dark, tarry stools (choice B) can indicate gastrointestinal bleeding but are not directly related to iron supplementation. Orange-colored stools (choice C) are not a typical side effect of ferrous sulfate and are more commonly associated with certain foods or medications.
A 17-year-old patient is referred to you for a platelet count of 1,200,000/mm3. On history, she notes that she often has numbness and tingling in her hands and feet and has frequent epistaxis. She is otherwise well-appearing and has no recent infections. On her exam, you note splenomegaly. What do you expect to see on further evaluation?
- A. Elevated C-reactive protein
- B. Low ferritin
- C. A hypocellular bone marrow
- D. Low von Willebrand factor activity
Correct Answer: D
Rationale: The correct answer is D: Low von Willebrand factor activity. A platelet count of 1,200,000/mm3 suggests thrombocytosis, which can be seen in conditions like essential thrombocythemia. This condition is associated with low von Willebrand factor activity, leading to increased bleeding tendency despite high platelet counts. Numbness, tingling, epistaxis, and splenomegaly are common features of essential thrombocythemia. Elevated C-reactive protein is not typically associated with this condition. Low ferritin is more indicative of iron deficiency anemia, not thrombocytosis. A hypocellular bone marrow is not expected in essential thrombocythemia, as it is characterized by increased platelet production.
What are the six dimensions of quality care according to the Institute of Medicine?
- A. Safe, timely, effective, efficient, equitable, and person-centered
- B. Safe, transparent, effective, efficient, equitable, and person-centered
- C. Safe, timely, effective, low-cost, equitable, and person-centered
- D. Safe, timely, effective, efficient, cutting-edge, and person-centered
Correct Answer: A
Rationale: The correct answer is A: Safe, timely, effective, efficient, equitable, and person-centered. This aligns with the six dimensions of quality care outlined by the Institute of Medicine. Safety ensures patient well-being, timeliness reduces delays, effectiveness means providing evidence-based care, efficiency minimizes waste, equity ensures fair access, and person-centered care considers individual preferences.
Choice B is incorrect because transparency is not included in the Institute of Medicine's six dimensions. Choice C is incorrect as "low-cost" is not a recognized dimension of quality care. Choice D is incorrect because "cutting-edge" is not part of the established dimensions of quality care.
A 14-year-old male patient is diagnosed with very high risk acute lymphoblastic leukemia and is likely going to require an allogeneic hematopoietic stem cell transplant to cure his leukemia. Prior to going to transplant, he is likely to require multiple blood transfusions. Which of the following products or component modifications is the best way to prevent him from developing alloimmunization due to anti-HLA antibodies prior to transplant?
- A. Frozen RBCs
- B. Volume-reduced blood products
- C. Irradiation of all blood products
- D. Leukoreduced blood products
Correct Answer: D
Rationale: The correct answer is D, Leukoreduced blood products. Leukoreduction removes white blood cells from the blood product, reducing the risk of alloimmunization due to anti-HLA antibodies. White blood cells are a major source of HLA antigens that can stimulate the immune system to produce antibodies. This process helps prevent the development of alloimmunization, which is crucial for patients undergoing stem cell transplant.
A: Frozen RBCs - Freezing does not affect the risk of alloimmunization.
B: Volume-reduced blood products - Volume reduction does not specifically target white blood cells or HLA antigens.
C: Irradiation of all blood products - Irradiation is used to prevent graft-versus-host disease, not specifically to prevent alloimmunization.