NR574 UPDATED QUESTIONS AND SOLUTIONS
GUARANTEE A+
✔✔Stage II: HL - ✔✔Stage II: Two or more lymph node regions on the same side of the
diaphragm
✔✔Stage III: HL - ✔✔Stage III: Two or more lymph node regions above and below the
diaphragm
✔✔Stage IV: HL - ✔✔Stage IV: Widespread disease; multiple organs, with or without
lymph node involvement
✔✔how is HL differentiated from non-hodgkin's lymphoma? - ✔✔Lack of Reed-
Sternberg cells distinguishes NHL from HL as well as the differences in biological and
clinical characteristics
✔✔What is Non-Hodgkin's Lymphoma (NHL)? - ✔✔NHL is a malignancy of mature B,
T, and natural killer (NK) cells that arise in lymph nodes and lymphatic tissue found in
organs, or in some cases, bone marrow and blood.
✔✔Ira is a 40-year-old male who was admitted to the hospital for a decreased appetite,
bone pain, fatigue, fever, chills, night sweats, and unintentional weight loss (>20%) in
the last month. He has no family history of malignancy and no personal history of
cancer or autoimmune disease. He reports having mononucleosis in his late 20's.
Physical exam reveals nontender, mobile, cervical lymphadenopathy as well as
supraclavicular lymphadenopathy and splenomegaly. Vital signs are unremarkable
except a low-grade fever of 100.6° Fahrenheit (F) (38.1° C). CBC reveals
lymphocytosis, thrombocytopenia, and anemia. Subsequently, an excisional cervical
lymph node biopsy was per- formed for suspicion of lymphoma. The pathology report
reveals no presence of Reed-Sternberg cells. Which type of lymphoma is this, HL or
NHL? - ✔✔NHL
✔✔Venita was recently diagnosed with Hodgkin's lymphoma. A comprehen- sive
workup revealed that the disease is localized in three lymph node regions located above
the diaphragm (cervical and axillary regions). Venita exhibits which stage of HL? -
✔✔Stage II
✔✔Leukemia - ✔✔Leukemia is a broad term referring to cancers of the blood or bone
marrow that primarily affect the leukocytes, or white blood cells (WBCs).
✔✔what are the 4 types of Leukemias? - ✔✔acute myeloid leukemia (AML), chronic
myeloid leukemia (CML),acute lymphocytic leukemia (ALL), chronic lymphocytic
leukemia (CLL).
,✔✔objective clinical findings in AML - ✔✔fever infection acute hemorrhage
lymphadenopathy petechiae/purpura papilledema/retinal infiltrates hepatosplenomegaly
gingival hypertrophy
✔✔subjective clinical findings in AML - ✔✔The medical history should include poten- tial
risks including chemical exposures, radiation, previous cancer, chemotherapy
treatment, and family history of cancer.ROS: clients with AML are typically related to
thrombocytopenia, anemia, leukocy- tosis, and/or leukopenia. Common symptoms,
which may have developed gradually (over weeks to months) or abruptly, include but
are not limited to:
anorexia weight loss fatiguefever (with or without identified infection)
easy bruising or bleeding bone pain cough headache
✔✔Flow cytometry - ✔✔flow cytometry, a technique used to detect and measure
physical and chemical characteristics of a population of cells, must be performed to
distinguish AML from ALL and to identify the AML subtype.
✔✔diagnostic criteria for ALL - ✔✔ALL is diagnosed by the presence of greater than or
equal to 20% bone marrow lymphoblasts after cytogenetic, immunologic, and molecular
testing of bone marrow aspirate.
✔✔what diagnostic testing should be done for suspected ALL - ✔✔CBC with differential
peripheral smearbone marrow aspirate with biopsy. A coagulation panel serum
electrolytes liver profile panel BUN/creatinine LDH uric acid levels*Direct smears of the
bone marrow are essential to confirm the diagnosis of ALL as well as to differentiate
ALL from AML.*
✔✔What is CML (chronic myeloid leukemia)? - ✔✔CML is a myeloproliferative
neoplasm that results in the uncontrolled production of multiple cell lines including
eosinophils, basophils, and mature (or maturing) granulocytes.CML is generally slow-
growing cancer but if untreated can become acute leukemia that is difficult to treat
✔✔What are the stages of CML - ✔✔1.Chronic phase 2.Accelerated phase 3.Blast
phase
✔✔what are the characteristics of Stage 1: Chronic phase of CML - ✔✔This phase is
characterized by < 10% blasts (immature WBCs) in the blood and bone marrow. AML
clients may be asymptomatic.The majority of cases are diagnosed during this stage.
✔✔what are the characteristics of Stage 2: Accelerated phase of CML - ✔✔This phase
is characterized by 10-19% blasts in the blood and bone marrow or >20% basophils in
the peripheral blood.
Additional deoxyribonucleic acid (DNA) damage and CML cell mutations occur during
this stage.
,✔✔what are the characteristics of Stage 3: Blast phase of CML - ✔✔This phase is
characterized by > 20% blasts in the blood and bone marrow.WBCs become difficult to
control (leukocytosis).Fever, splenomegaly, weight loss, and general malaise are
common symptoms in this stage.
✔✔Diagnostic criteria of CML - ✔✔A CML diagnosis is definitively made by identification
of the Philadelphia chromosome, the BCR-ABL1 fusion mRNA, or BCR-ABL1 fusion
gene in peripheral blood or bone marrow cells.
✔✔The Philadelphia chromosome in the bone marrow aspirate needs to be what
precent at time of diagnosis for CML? - ✔✔greater than 90% of clients at the time of
CML diagnosis.
✔✔what will the peripheral blood smear show in CML? - ✔✔early myeloid cells such as
nucleated red blood cells, metamyelocytes, myelocytes, and myeloblasts
✔✔what will the liver panel show in CML at time of diagnosis? - ✔✔The liver profile
panel will often demonstrate hyperbilirubinemia which results from increased bone
marrow turnover.Uric acid and vitamin B12 levels are also often elevated.
✔✔Management of CML includes: - ✔✔-managed by oncology specialty teams-
Treatment options vary and are also individualized based upon the client's performance
status, co-morbidities, and CML phase.-Med: Tyrosine kinase inhibitors (TKIs) first line-
supportive care
✔✔What is the first line medication class used for the treatment of CML? - ✔✔Tyrosine
kinase inhibitors (TKIs) are typically the drug of choice for clients who present in the
chronic phase. (stage 1)-TKIs typically have very mild side effects and are well
tolerated.
✔✔The most commonly used TKIs for CML include: - ✔✔imitanib, bosutinib, nilotinib,
ponatinib, and dasatinib.
✔✔Splenic irradiation or splenectomy may be required for those in what stage of CML?
- ✔✔-Late stage-who develop significant pain secondary to splenomegaly or
leukapheresis -may be performed for clients with WBC > 300,000 μL.
✔✔Stem cell transplantation is reserved for which CML patients? - ✔✔clients who fail to
achieve remission with or those who fail imatinib and second-generation TKIs.
✔✔what complications are associated with CLL? - ✔✔-infections,-autoimmune
complications including cytopenias, vasculitis, neuropathies, thrombo-
cytopenia, glomerulonephritis-secondary malignancies: skin, prostate, and breast
cancers. -transformation into lymphomas
, ✔✔what is Richter's transformation in terms of CLL complications? - ✔✔occurs when
CLL transforms into aggressive diffuse large B-cell lymphoma which has a median
survival rate of only 6 to 16 months.
✔✔What is hemophilia? - ✔✔Hemophilia is a disorder of blood clotting caused by anX-
linked recessive defect (spontaneous or hereditary).-Most hemophilia cases are
inherited, and the disease commonly affects males more than females.-Hemophilia
results from impaired secondary hemostasis due to a defect in the coagulation cascade.
✔✔Hemophilia is classified by identifying the deficient clotting factor: what are the 3
clotting factors? - ✔✔hemophilia A (factor VIII) ~ 80 % of cases hemophilia B (factor IX)
~ 20% of cases hemophilia C (factor XI) ~ very rare < 1%
✔✔what things should you ask a patient with suspected hemophilia in regards to
bleeding? - ✔✔Clients with suspected or diagnosed hemophilia should be assessed for
-prior bleeding episodes;-abnormal bleeding with menstrual cycles,-dental procedures,
or surgical intervention;
-family history of bleeding disorders;-family history of work-up for bleeding disorders.
✔✔Clinical Tip: Petechial bleeding is a common sign of - ✔✔platelet disorders, NOT
coagulation disorders such as hemophilia.
✔✔Hemarthrosis - ✔✔Hemarthrosis is a condition of articular bleeding, that is into the
joint cavity. This can occur after an injury or, more commonly, in bleeding disorders
such as hemophilia. Patients will typically present with pain, swelling and a decreased
range of motion of the involved joint.
✔✔management of hemarthrosis - ✔✔-receive factor concentrate infusion within 2
hours of presentation with joint bleeding.-The goal of factor concentrate infusion for
hemarthrosis is an activity level of approximately 50 percent.Clients with hemophilia B
should receive 50 to 60 units/kg of factor IX.
✔✔If a patient has Hemophilia A and presents with hemarthrosis, what med- ication
should they receive - ✔✔-Clients with hemophilia A should receive 25 units/kg of factor
VIII. -within 2 hours of presentation with joint bleeding
-If bleeding does not resolve, a higher dose may be required. Clients with joint bleeding
as a result of trauma often require a higher target factor activity level.
✔✔If a patient has Hemophilia B and presents with hemarthrosis, what med- ication
should they receive - ✔✔Clients with hemophilia B should receive 50 to 60 units/kg of
factor IX-within 2 hours of presentation with joint bleeding-If bleeding does not resolve,
a higher dose may be required. Clients with joint bleeding as a result of trauma often
require a higher target factor activity level.
GUARANTEE A+
✔✔Stage II: HL - ✔✔Stage II: Two or more lymph node regions on the same side of the
diaphragm
✔✔Stage III: HL - ✔✔Stage III: Two or more lymph node regions above and below the
diaphragm
✔✔Stage IV: HL - ✔✔Stage IV: Widespread disease; multiple organs, with or without
lymph node involvement
✔✔how is HL differentiated from non-hodgkin's lymphoma? - ✔✔Lack of Reed-
Sternberg cells distinguishes NHL from HL as well as the differences in biological and
clinical characteristics
✔✔What is Non-Hodgkin's Lymphoma (NHL)? - ✔✔NHL is a malignancy of mature B,
T, and natural killer (NK) cells that arise in lymph nodes and lymphatic tissue found in
organs, or in some cases, bone marrow and blood.
✔✔Ira is a 40-year-old male who was admitted to the hospital for a decreased appetite,
bone pain, fatigue, fever, chills, night sweats, and unintentional weight loss (>20%) in
the last month. He has no family history of malignancy and no personal history of
cancer or autoimmune disease. He reports having mononucleosis in his late 20's.
Physical exam reveals nontender, mobile, cervical lymphadenopathy as well as
supraclavicular lymphadenopathy and splenomegaly. Vital signs are unremarkable
except a low-grade fever of 100.6° Fahrenheit (F) (38.1° C). CBC reveals
lymphocytosis, thrombocytopenia, and anemia. Subsequently, an excisional cervical
lymph node biopsy was per- formed for suspicion of lymphoma. The pathology report
reveals no presence of Reed-Sternberg cells. Which type of lymphoma is this, HL or
NHL? - ✔✔NHL
✔✔Venita was recently diagnosed with Hodgkin's lymphoma. A comprehen- sive
workup revealed that the disease is localized in three lymph node regions located above
the diaphragm (cervical and axillary regions). Venita exhibits which stage of HL? -
✔✔Stage II
✔✔Leukemia - ✔✔Leukemia is a broad term referring to cancers of the blood or bone
marrow that primarily affect the leukocytes, or white blood cells (WBCs).
✔✔what are the 4 types of Leukemias? - ✔✔acute myeloid leukemia (AML), chronic
myeloid leukemia (CML),acute lymphocytic leukemia (ALL), chronic lymphocytic
leukemia (CLL).
,✔✔objective clinical findings in AML - ✔✔fever infection acute hemorrhage
lymphadenopathy petechiae/purpura papilledema/retinal infiltrates hepatosplenomegaly
gingival hypertrophy
✔✔subjective clinical findings in AML - ✔✔The medical history should include poten- tial
risks including chemical exposures, radiation, previous cancer, chemotherapy
treatment, and family history of cancer.ROS: clients with AML are typically related to
thrombocytopenia, anemia, leukocy- tosis, and/or leukopenia. Common symptoms,
which may have developed gradually (over weeks to months) or abruptly, include but
are not limited to:
anorexia weight loss fatiguefever (with or without identified infection)
easy bruising or bleeding bone pain cough headache
✔✔Flow cytometry - ✔✔flow cytometry, a technique used to detect and measure
physical and chemical characteristics of a population of cells, must be performed to
distinguish AML from ALL and to identify the AML subtype.
✔✔diagnostic criteria for ALL - ✔✔ALL is diagnosed by the presence of greater than or
equal to 20% bone marrow lymphoblasts after cytogenetic, immunologic, and molecular
testing of bone marrow aspirate.
✔✔what diagnostic testing should be done for suspected ALL - ✔✔CBC with differential
peripheral smearbone marrow aspirate with biopsy. A coagulation panel serum
electrolytes liver profile panel BUN/creatinine LDH uric acid levels*Direct smears of the
bone marrow are essential to confirm the diagnosis of ALL as well as to differentiate
ALL from AML.*
✔✔What is CML (chronic myeloid leukemia)? - ✔✔CML is a myeloproliferative
neoplasm that results in the uncontrolled production of multiple cell lines including
eosinophils, basophils, and mature (or maturing) granulocytes.CML is generally slow-
growing cancer but if untreated can become acute leukemia that is difficult to treat
✔✔What are the stages of CML - ✔✔1.Chronic phase 2.Accelerated phase 3.Blast
phase
✔✔what are the characteristics of Stage 1: Chronic phase of CML - ✔✔This phase is
characterized by < 10% blasts (immature WBCs) in the blood and bone marrow. AML
clients may be asymptomatic.The majority of cases are diagnosed during this stage.
✔✔what are the characteristics of Stage 2: Accelerated phase of CML - ✔✔This phase
is characterized by 10-19% blasts in the blood and bone marrow or >20% basophils in
the peripheral blood.
Additional deoxyribonucleic acid (DNA) damage and CML cell mutations occur during
this stage.
,✔✔what are the characteristics of Stage 3: Blast phase of CML - ✔✔This phase is
characterized by > 20% blasts in the blood and bone marrow.WBCs become difficult to
control (leukocytosis).Fever, splenomegaly, weight loss, and general malaise are
common symptoms in this stage.
✔✔Diagnostic criteria of CML - ✔✔A CML diagnosis is definitively made by identification
of the Philadelphia chromosome, the BCR-ABL1 fusion mRNA, or BCR-ABL1 fusion
gene in peripheral blood or bone marrow cells.
✔✔The Philadelphia chromosome in the bone marrow aspirate needs to be what
precent at time of diagnosis for CML? - ✔✔greater than 90% of clients at the time of
CML diagnosis.
✔✔what will the peripheral blood smear show in CML? - ✔✔early myeloid cells such as
nucleated red blood cells, metamyelocytes, myelocytes, and myeloblasts
✔✔what will the liver panel show in CML at time of diagnosis? - ✔✔The liver profile
panel will often demonstrate hyperbilirubinemia which results from increased bone
marrow turnover.Uric acid and vitamin B12 levels are also often elevated.
✔✔Management of CML includes: - ✔✔-managed by oncology specialty teams-
Treatment options vary and are also individualized based upon the client's performance
status, co-morbidities, and CML phase.-Med: Tyrosine kinase inhibitors (TKIs) first line-
supportive care
✔✔What is the first line medication class used for the treatment of CML? - ✔✔Tyrosine
kinase inhibitors (TKIs) are typically the drug of choice for clients who present in the
chronic phase. (stage 1)-TKIs typically have very mild side effects and are well
tolerated.
✔✔The most commonly used TKIs for CML include: - ✔✔imitanib, bosutinib, nilotinib,
ponatinib, and dasatinib.
✔✔Splenic irradiation or splenectomy may be required for those in what stage of CML?
- ✔✔-Late stage-who develop significant pain secondary to splenomegaly or
leukapheresis -may be performed for clients with WBC > 300,000 μL.
✔✔Stem cell transplantation is reserved for which CML patients? - ✔✔clients who fail to
achieve remission with or those who fail imatinib and second-generation TKIs.
✔✔what complications are associated with CLL? - ✔✔-infections,-autoimmune
complications including cytopenias, vasculitis, neuropathies, thrombo-
cytopenia, glomerulonephritis-secondary malignancies: skin, prostate, and breast
cancers. -transformation into lymphomas
, ✔✔what is Richter's transformation in terms of CLL complications? - ✔✔occurs when
CLL transforms into aggressive diffuse large B-cell lymphoma which has a median
survival rate of only 6 to 16 months.
✔✔What is hemophilia? - ✔✔Hemophilia is a disorder of blood clotting caused by anX-
linked recessive defect (spontaneous or hereditary).-Most hemophilia cases are
inherited, and the disease commonly affects males more than females.-Hemophilia
results from impaired secondary hemostasis due to a defect in the coagulation cascade.
✔✔Hemophilia is classified by identifying the deficient clotting factor: what are the 3
clotting factors? - ✔✔hemophilia A (factor VIII) ~ 80 % of cases hemophilia B (factor IX)
~ 20% of cases hemophilia C (factor XI) ~ very rare < 1%
✔✔what things should you ask a patient with suspected hemophilia in regards to
bleeding? - ✔✔Clients with suspected or diagnosed hemophilia should be assessed for
-prior bleeding episodes;-abnormal bleeding with menstrual cycles,-dental procedures,
or surgical intervention;
-family history of bleeding disorders;-family history of work-up for bleeding disorders.
✔✔Clinical Tip: Petechial bleeding is a common sign of - ✔✔platelet disorders, NOT
coagulation disorders such as hemophilia.
✔✔Hemarthrosis - ✔✔Hemarthrosis is a condition of articular bleeding, that is into the
joint cavity. This can occur after an injury or, more commonly, in bleeding disorders
such as hemophilia. Patients will typically present with pain, swelling and a decreased
range of motion of the involved joint.
✔✔management of hemarthrosis - ✔✔-receive factor concentrate infusion within 2
hours of presentation with joint bleeding.-The goal of factor concentrate infusion for
hemarthrosis is an activity level of approximately 50 percent.Clients with hemophilia B
should receive 50 to 60 units/kg of factor IX.
✔✔If a patient has Hemophilia A and presents with hemarthrosis, what med- ication
should they receive - ✔✔-Clients with hemophilia A should receive 25 units/kg of factor
VIII. -within 2 hours of presentation with joint bleeding
-If bleeding does not resolve, a higher dose may be required. Clients with joint bleeding
as a result of trauma often require a higher target factor activity level.
✔✔If a patient has Hemophilia B and presents with hemarthrosis, what med- ication
should they receive - ✔✔Clients with hemophilia B should receive 50 to 60 units/kg of
factor IX-within 2 hours of presentation with joint bleeding-If bleeding does not resolve,
a higher dose may be required. Clients with joint bleeding as a result of trauma often
require a higher target factor activity level.
