NSG 555 - Nurse Practitioners in Primary Care II
Exam 3
Question:
A patient has type 1 Von Willebrand disease (vWD). What treatment is generally effective to prevent and treat bleeding episodes in this patient?Coagulation factor Desmopressin Heparin Vitamin K
Answer:
ANS: B
Desmopressin may be useful in patients with type 1 vWD. Coagulation factor is used in most patients with hemophilia. Heparin is an anticoagulant.Vitamin K is used to counter warfarin overdose.
Question:
A child has a recent history of leg pain, unexplained bruising, and nosebleeds. The provider notes petechiae and diffuse lymphadenopathy. A complete blood count reveals a white blood cell (WBC) of 30,000 cells/mm3 1 / 4
and near normal red blood cell (RBC) and platelet counts. What will the provider do next to manage this patient?Order coagulation studies to evaluate for coagulopathies Perform biochemical studies to look for hyperuricemia Refer to a specialist for a bone marrow aspirate and biopsy Repeat the complete blood count in 2 weeks
Answer:
ANS: C
Patients with acute lymphocytic leukemia (ALL) may have normal blood counts even when the marrow has been replaced with leukemic cells, so a bone marrow aspirate and biopsy is required for the definitive diagnosis.Coagulation and biochemical studies may be performed after the diagnosis is known to evaluate for complications. Waiting and repeating the CBC in 2 weeks is not recommended since the definitive diagnosis is made by bone marrow biopsy.
Question:
A patient is suspected of having leukemia and the provider orders biochemical studies and a bone marrow aspirate and biopsy. The results include white blood cells (WBCs) greater than 200,000 cells/mm3 normal red blood cells (RBCs), hyperplastic myeloid cells, and the absence of serum leukocyte alkaline phosphatase. Which test will the provider order to confirm a diagnosis in this patient?Chest radiograph Coagulation studies Philadelphia chromosome test Serum protein electrophoresis 2 / 4
Answer:
ANS: C
The findings from the complete blood count (CBC) and bone marrow biopsy, along with a positive Philadelphia chromosome test, confirm the diagnosis of chronic myelogenous leukemia. A chest radiograph and serum protein electrophoresis may be performed to evaluate for associated symptoms.Coagulation studies are usually performed as part of the diagnostic workup for acute lymphocytic leukemia (ALL).
Question:
A patient with acute myelogenous leukemia (AML) who has a high white blood cell count and diffuse lymphadenopathy is hospitalized during the induction phase of chemotherapy. What monitoring and interventions are critical to assess for complications during this phase of care for this patient?(Select all that apply.) Administration of sodium bicarbonate and allopurinol Assessment for bruising and petechiae Close monitoring of absolute neutrophil counts Daily renal function and chemistry values Meticulous assessment of hydration status
Answer:
ANS: A, D, E
This patient has a high WBC load and diffuse lymphadenopathy, so is at increased risk for acute tumor lysis syndrome (ATLS). Close monitoring of renal function, serum renal chemistry values, and hydration status is essential. Adding sodium bicarbonate and allopurinol help to minimize risk.Thrombocytopenia causing bruising and petechiae, along with neutropenia, 3 / 4
are common complications of chemotherapy but these symptoms generally occur 7 to 10 days after initiation of therapy.
Question:
A patient reports a neck mass that has been present intermittently for 5 or 6 weeks which varies in size. The provider palpates a lymph node measuring 1.25 cm. Which test will provide proper histologic diagnosis for this patient?Bone marrow aspirate Computed tomography (CT) scan with intravenous (IV) contrast Lymph node biopsy Positron emission tomography (PET) scan
Answer:
ANS: C
The lymph node biopsy is used to provide proper histologic diagnosis and precise classification. Bone marrow aspirate identifies the presence of dysplastic cells. PET and CT scans will identify the presence of other lesions.
Question:
A 30-year-old male patient is diagnosed with Hodgkin lymphoma. Initial lab work reveals a WBC of 20 109/L, hemoglobin of 10.1 gm/dL, a serum albumin of 3 g/dL, and lymphopenia of 0.5 109/L. Staging studies identify stage III disease. What is this patient's prognostic score?
- 2
- 3
- 4
- / 4