A 12-year-old patient with localized osteosarcoma is being treated with cisplatin, doxorubicin, and high-dose methotrexate. The pain at his primary site rapidly resolves after initiation of chemotherapy. After tumor resection, pathology reveals the tumor was greater than 95% necrotic. You want to continue cisplatin, doxorubicin, and high-dose methotrexate. Which of the following is the best answer regarding the evaluations that should be performed to monitor for toxicity in patients receiving cisplatin, doxorubicin, and high-dose methotrexate?

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ATI Hematologic System Quizlet Questions

Question 1 of 5

A 12-year-old patient with localized osteosarcoma is being treated with cisplatin, doxorubicin, and high-dose methotrexate. The pain at his primary site rapidly resolves after initiation of chemotherapy. After tumor resection, pathology reveals the tumor was greater than 95% necrotic. You want to continue cisplatin, doxorubicin, and high-dose methotrexate. Which of the following is the best answer regarding the evaluations that should be performed to monitor for toxicity in patients receiving cisplatin, doxorubicin, and high-dose methotrexate?

Correct Answer: C

Rationale: The correct answer is C: Complete blood count, creatinine, serum magnesium, audiogram, and echocardiogram. This choice includes essential monitoring tests for potential toxicities associated with cisplatin, doxorubicin, and high-dose methotrexate. Here's the rationale: 1. Complete blood count: To monitor for hematologic toxicities such as anemia, neutropenia, and thrombocytopenia. 2. Creatinine: To assess renal function, as cisplatin can cause nephrotoxicity. 3. Serum magnesium: Methotrexate can cause hypomagnesemia, necessitating monitoring. 4. Audiogram: Doxorubicin can lead to hearing loss, thus an audiogram is needed for early detection. 5. Echocardiogram: Doxorubicin can cause cardiotoxicity, so an echocardiogram helps in monitoring cardiac function. Each of the other choices lacks one or more essential monitoring tests

Question 2 of 5

A 10-year-old patient with aplastic anemia, who is blood type B negative, is receiving a red blood cell transfusion. About 10 minutes after the transfusion starts, the patient develops anxiety and lower back pain. The transfusion continues for another 5 minutes until it is stopped when he develops a temperature of 40 °C with chills and rigors. A transfusion reaction work-up is most likely to reveal what findings?

Correct Answer: D

Rationale: The correct answer is D: DAT positive for C3. This finding suggests complement-mediated hemolysis, which is consistent with a transfusion reaction known as transfusion-related acute lung injury (TRALI). TRALI presents with respiratory distress, fever, and chills due to immune complexes activating the complement system. A: Spherocytes indicate hemolysis, which is not specific to TRALI. B: Gram-negative Bacillus suggests bacterial contamination, leading to sepsis, not TRALI. C: Bilateral pulmonary infiltrates are seen in transfusion-associated circulatory overload (TACO), not TRALI.

Question 3 of 5

The pathophysiology of venous thrombosis is often explained by Virchow's triad, which includes hypercoagulability, endothelial injury, and venous stasis. Based on Virchow's triad and your knowledge of risk factors for thrombosis, which of the following pediatric patients has the greatest risk of hospital-acquired venous thromboembolism?

Correct Answer: C

Rationale: The correct answer is C because the ex-28 week premature infant requiring NICU-level care for necrotizing enterocolitis has the greatest risk of hospital-acquired venous thromboembolism. Premature infants have inherent hypercoagulability due to immature coagulation factors and increased risk of endothelial injury from central lines or catheters. Necrotizing enterocolitis further increases the risk of venous stasis due to decreased gut perfusion. Choice A: The 3-day-old full-term infant admitted for hyperbilirubinemia is less likely to have significant risk factors for thrombosis compared to a premature infant with necrotizing enterocolitis. Choice B: The 6-month-old male admitted for respiratory syncytial virus is less likely to have prolonged immobilization or other significant risk factors compared to a premature infant in the NICU. Choice D: The 7-year-old male with acute lymphoblastic leukemia has a higher risk of thromb

Question 4 of 5

You are treating a patient with localized osteosarcoma of the distal femur with methotrexate, doxorubicin, and cisplatin (MAP) chemotherapy. At week 10 of treatment, the patient undergoes complete resection of the tumor. Pathology demonstrates 40% necrosis. Which of the following represents the most appropriate further therapy?

Correct Answer: D

Rationale: The correct answer is D: MAP. In localized osteosarcoma, the response to preoperative chemotherapy is evaluated based on the percentage of tumor necrosis. A necrosis of 40% is considered a good response. The standard of care after surgery is to continue with the same chemotherapy regimen to complete the course. Continuing with MAP in this case is important to ensure that any remaining cancer cells are effectively treated. Option A (IE) and option B (MAPIE) are not indicated as they are different regimens and not the standard of care for this scenario. Option C (Gemcitabine docetaxel) is also not the appropriate choice as it is not the standard treatment protocol for localized osteosarcoma.

Question 5 of 5

A hospitalized client has a platelet count of 58,000/mm3 (58 × 109/L). What action by the nurse is most appropriate?

Correct Answer: D

Rationale: The correct answer is D: Place the client on safety precautions. A platelet count of 58,000/mm3 is considered low (normal range is 150,000-450,000/mm3). This places the client at risk for bleeding. Safety precautions involve preventing injuries that could lead to bleeding, such as falls, bumps, or cuts. This is crucial to prevent complications like spontaneous bleeding. Encouraging high-protein foods (choice A) is important for overall health but not directly related to managing low platelet count. Neutropenic precautions (choice B) are for clients with low white blood cell counts, not low platelet counts. Limiting visitors (choice C) to healthy adults is important for infection control but not directly related to preventing bleeding in a client with low platelet count.

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