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Which of the following is not the criteria in the international prognostic index for non Hodgkin's lymphoma?
- A. Number of extranodal sites
- B. LDH level
- C. Lymphocyte count
- D. Performance status
Correct Answer: C
Rationale: The correct answer is C: Lymphocyte count. In the International Prognostic Index for Non Hodgkin's Lymphoma, the criteria are based on the number of extranodal sites, LDH level, and performance status. Lymphocyte count is not included in the IPI criteria because it does not play a significant role in predicting the prognosis of Non Hodgkin's Lymphoma. Lymphocyte count is not a commonly used parameter in prognostic scoring systems for this type of cancer. Therefore, the absence of lymphocyte count as a criteria in the IPI is justified.
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A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take?
- A. Shake the vial before using.
- B. Administer via IV bolus over 1 to 3 min.
- C. Dilute the drug first with D5W.
- D. Save the used vial for the next dose.
Correct Answer: B
Rationale: The correct answer is B: Administer via IV bolus over 1 to 3 min. This route and method of administration is appropriate for epoetin to ensure proper absorption and effect. Shaking the vial (A) can denature the drug. Diluting with D5W (C) is not recommended as it may alter the drug's effectiveness. Saving the used vial for the next dose (D) is unsafe and violates infection control practices.
A 19-year-old freshman in college presents with 'lumps' on the right side of his neck and in the right axilla. He had a fever to 39 °C 1 day in the past week. On physical exam, there are firm anterior cervical and axillary nodes, all greater than 2 cm in diameter. A chest x-ray shows a large mediastinal mass. A biopsy of the axillary node reveals classic Hodgkin lymphoma. Which of the following symptoms revealed during the history is a B symptom?
- A. Fever to 39 °C
- B. 10% weight loss in past 6 months
- C. Fatigue
- D. Alcohol-induced pain
Correct Answer: B
Rationale: The correct answer is B. In Hodgkin lymphoma, B symptoms are systemic symptoms associated with poor prognosis. Weight loss of ≥10% in the past 6 months is a B symptom. This indicates a more aggressive disease. Fever (choice A) is a general symptom. Fatigue (choice C) is common but nonspecific. Alcohol-induced pain (choice D) is not a recognized B symptom in Hodgkin lymphoma. Weight loss is a key indicator of disease severity and is classified as a B symptom.
An 18-year old male patient presents with bruising, fatigue, and diffuse extremity pain. He is noted to be tachypneic and hypoxic and has a diffuse interstitial infiltrate on chest x-ray. CBC reveals a WBC count of 285,000/mm3 (85% myeloblasts, with monocytic morphology), hemoglobin of 7.9 g/dL, and platelet count of 36,000/mm3. What is the most likely cause of the infiltrate and respiratory symptoms and the most appropriate initial treatment?
- A. Hyperleukocytosis; initiation of induction chemotherapy
- B. Hyperleukocytosis; leukapheresis or manual exchange transfusion and initiation of induction chemotherapy
- C. COVID-19 infection; convalescent plasma and prednisone
- D. Pneumococcal pneumonia; vancomycin
Correct Answer: B
Rationale: The correct answer is B: Hyperleukocytosis; leukapheresis or manual exchange transfusion and initiation of induction chemotherapy. In this scenario, the patient's symptoms and lab findings are consistent with acute myeloid leukemia (AML) with leukostasis, causing hypoxia and interstitial infiltrates. Leukapheresis or manual exchange transfusion is crucial to rapidly reduce the high white blood cell count, which can help alleviate symptoms and prevent complications like tissue hypoxia. Initiation of induction chemotherapy is also essential for long-term management of AML.
Rationale for why other choices are incorrect:
A: Hyperleukocytosis alone without leukostasis does not typically require immediate leukoreduction, as in this case. Induction chemotherapy should be initiated promptly to address the underlying AML.
C: COVID-19 infection would not typically present with such profound leukocytosis and monocytic morphology. Convalescent plasma and prednisone are not
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. In the treatment of AML, induction therapy typically involves a combination of chemotherapy drugs to achieve remission. Chemotherapy targets rapidly dividing cancer cells in the bone marrow. This approach aims to eradicate leukemic cells and allow normal blood cell production to resume. Daily treatment with targeted medications (choice A) is not typically the first-line approach for AML. Radiation therapy (choice B) is not commonly used in the induction phase of AML treatment. Hematopoietic stem cell transplantation (choice C) is a treatment option for certain cases of AML but is usually considered after achieving remission with chemotherapy. Therefore, the most appropriate preparation for the patient in this scenario is to expect an aggressive course of chemotherapy to begin induction therapy.
A 16-year-old female patient with severe factor XI deficiency presents with acute appendicitis and requires urgent surgery. You are called by the surgeon, who wants to know what, if any, blood products or treatments are required to reduce the risk of perioperative bleeding. The patient weighs 62 kg. What should you tell him to administer?
- A. Cryoprecipitate (five units), which will likely raise her factor XI level to 20%
- B. Factor XI concentrate (20 units/kg), which will raise her factor XI level to 20%
- C. Fresh frozen plasma (20 mL/kg), which will raise her factor XI level to 20%
- D. Prothrombin complex concentrate (40 units/kg), which will raise her factor XI level to 20%
Correct Answer: C
Rationale: The correct answer is C: Fresh frozen plasma (20 mL/kg), which will raise her factor XI level to 20%. Fresh frozen plasma contains various clotting factors, including factor XI. In a patient with severe factor XI deficiency, administering fresh frozen plasma can increase factor XI levels and help reduce the risk of perioperative bleeding. The dose of 20 mL/kg is appropriate for this patient's weight of 62 kg. Cryoprecipitate (choice A) may contain factor XI but is not the optimal choice for raising factor XI levels specifically. Factor XI concentrate (choice B) would be ideal but is not commonly available, making fresh frozen plasma a more practical option. Prothrombin complex concentrate (choice D) primarily contains factors II, VII, IX, and X, but not factor XI, so it would not effectively raise factor XI levels in this patient.