NR574 ACUTE CARE PRACTICUM
CERTIFICATION SCRIPT 2026 TESTED
QUESTIONS AND FULL SOLUTION
◉ what are the characteristics of Stage 3: Blast phase of CML
Answer: 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 Answer: 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? Answer: greater
than 90% of clients at the time of CML diagnosis.
◉ what will the peripheral blood smear show in CML? Answer: 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?
Answer: 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: Answer: -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? Answer: 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: Answer: imitanib,
bosutinib, nilotinib, ponatinib, and dasatinib.
◉ Splenic irradiation or splenectomy may be required for those in
what stage of CML? Answer: -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?
Answer: clients who fail to achieve remission with or those who fail
imatinib and second-generation TKIs.
◉ what complications are associated with CLL? Answer: -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?
Answer: 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? Answer: 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? Answer: 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? Answer: 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 Answer:
platelet disorders, NOT coagulation disorders such as hemophilia.
◉ Hemarthrosis Answer: 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 Answer: -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 Answer: -Clients with
CERTIFICATION SCRIPT 2026 TESTED
QUESTIONS AND FULL SOLUTION
◉ what are the characteristics of Stage 3: Blast phase of CML
Answer: 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 Answer: 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? Answer: greater
than 90% of clients at the time of CML diagnosis.
◉ what will the peripheral blood smear show in CML? Answer: 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?
Answer: 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: Answer: -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? Answer: 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: Answer: imitanib,
bosutinib, nilotinib, ponatinib, and dasatinib.
◉ Splenic irradiation or splenectomy may be required for those in
what stage of CML? Answer: -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?
Answer: clients who fail to achieve remission with or those who fail
imatinib and second-generation TKIs.
◉ what complications are associated with CLL? Answer: -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?
Answer: 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? Answer: 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? Answer: 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? Answer: 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 Answer:
platelet disorders, NOT coagulation disorders such as hemophilia.
◉ Hemarthrosis Answer: 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 Answer: -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 Answer: -Clients with
