The nurse is caring for a school-aged child with Burkitt lymphoma. A review of the child's laboratory results reveal serum calcium 8.1 mg/dL (1.9 mmol/L), serum potassium 6.1 mEq/L (6.1 mmol/L), and serum phosphorus 5.9 mg/dL (3.6 mmol/L). Which pathophysiological process is associated with the child's laboratory results?

Reference range:

Total Calcium [8.8 to 10.8 mg/dL (2.2 to 2.7 mmol/L)]

Potassium [3.4 to 4.7 mEq/L (3.4 to 4.7 mmol/L)]

Total Phosphorus [4.5 to 6.5 mg/dL (1.45 to 2.1 mmol/L)]

Wilm's tumor.

Tumor lysis syndrome.

Superior vena cava syndrome.

Hyperleukocytosis

Answer and Explanation

The Correct Answer is B

Tumor lysis syndrome (TLS) is a potentially life-threatening oncologic emergency characterized by the rapid release of intracellular contents into the bloodstream following the destruction of cancer cells. This release can lead to metabolic disturbances, including hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Here's how the child's laboratory results are indicative of tumor lysis syndrome:

A) Wilm's tumor:

Wilms tumor is a type of kidney cancer that primarily affects children. However, it typically does not cause the metabolic disturbances seen in tumor lysis syndrome. Laboratory abnormalities in Wilms tumor are generally related to renal dysfunction and may include hematuria and proteinuria.

B) Tumor lysis syndrome:

Correct. Tumor lysis syndrome occurs when chemotherapy or radiation therapy causes a rapid breakdown of cancer cells, leading to the release of intracellular contents such as potassium, phosphorus, and uric acid into the bloodstream. The elevated potassium and phosphorus levels seen in the child's laboratory results are consistent with tumor lysis syndrome. Hyperkalemia (elevated potassium) and hyperphosphatemia (elevated phosphorus) are common metabolic disturbances in tumor lysis syndrome.

C) Superior vena cava syndrome:

Superior vena cava syndrome occurs when the superior vena cava, a major vein that carries blood from the upper body to the heart, becomes partially or completely obstructed. This obstruction can lead to symptoms such as facial swelling, dyspnea, and dilated neck veins. While superior vena cava syndrome may occur in cancer patients, it does not typically cause the metabolic disturbances seen in the child's laboratory results.

D) Hyperleukocytosis:

Hyperleukocytosis refers to an extremely high white blood cell count, which can occur in leukemia. While leukemia can lead to metabolic abnormalities, the child's laboratory results, particularly the elevated potassium and phosphorus levels, are more indicative of tumor lysis syndrome than hyperleukocytosis.

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Free Nursing Study Resources

Correct Answer is D

Explanation

A) The drug may be needed to treat a sudden systemic allergic reaction:

While cortisol may play a role in managing allergic reactions by suppressing inflammation, the primary reason for carrying a cortisol kit in Addison's disease is not typically related to managing allergic reactions.

B) Hypertensive crisis requires immediate treatment to prevent a stroke:

Hypertensive crisis may occur in some individuals with Addison's disease due to adrenal insufficiency, but the immediate treatment for this would typically involve fluids and intravenous hydrocortisone rather than carrying a cortisol kit for self-administration.

C) Hyperglycemia may require cortisol to lower the blood glucose level:

Cortisol can indeed influence blood glucose levels, but the need to carry a cortisol kit is primarily related to the management of adrenal insufficiency rather than hyperglycemia alone.

D) Stress increases the body's need for additional replacement hormone:

Correct. Individuals with Addison's disease have insufficient production of cortisol and often also lack aldosterone. During times of stress, such as illness, trauma, or surgery, the body's demand for cortisol increases to help cope with the stress. Inadequate cortisol production during stress can lead to adrenal crisis, a life-threatening condition. Therefore, carrying a cortisol kit allows the individual to promptly administer additional replacement hormone (usually hydrocortisone) during times of stress to prevent adrenal crisis.

A. Histamine-mediated vascular permeability leading to fluid transudation. B. Bradykinin cascade resulting in the accumulation of substance P. C. Thromboxane A activation of chemical mediators. D. Neutrophil migration secondary to chemotaxis.

Correct Answer is A

Explanation

A) Histamine-mediated vascular permeability leading to fluid transudation:

Correct. Ankle edema following an ankle sprain is often due to inflammation and increased vascular permeability. Histamine, released from mast cells and basophils during the inflammatory response, causes vasodilation and increases vascular permeability. This leads to the leakage of fluid from the blood vessels into the surrounding tissues, resulting in edema.

B) Bradykinin cascade resulting in the accumulation of substance P:

While bradykinin is involved in the inflammatory response and can contribute to pain and vasodilation, it does not directly cause fluid transudation leading to edema in the context of an ankle sprain.

C) Thromboxane A activation of chemical mediators:

Thromboxane A is involved in platelet aggregation and vasoconstriction rather than increasing vascular permeability and edema formation.

D) Neutrophil migration secondary to chemotaxis:

Neutrophil migration is part of the inflammatory response and can contribute to tissue damage and inflammation, but it is not the primary mechanism responsible for the development of edema following an ankle sprain.

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Naxlex Comprehensive Predictor Exams

The nurse is preparing a female client with Addison's disease for self-care afi.4 discharge. Which is the pathophysiological basis to support the need for the client to carry a cortisol kit at all times?

Correct Answer is D

Explanation

A client's ankle is edematous after an ankle sprain. Which physiological mechanism is responsible for the swelling?

Correct Answer is A

Explanation

The nurse is caring for a client who experienced multiple invasive trauma from a motor vehicle collision and has developed systemic inflammatory response syndrome (SIRS). Which pathophysiological process is most likely associated with the development of SIRS in this client?

The nurse is providing care for a client with a diagnosis of otosclerosis due to previous ear surgeries. Which type of pathological hearing loss supports the client's clinical history?

A client with chronic osteoarthritis is troubled by knee pain. Which pathophysiological process is contributing to the pain?

The nurse is assessing a client with a gunshot wound to the abdomen who is admitted to the intensive care unit (ICU) following a 3-hour surgical procedure. Which elevated laboratory value indicates pancreatic damage?

Which physiological process supports the exchange of blood concentrations across a semipermeable membrane in the hemodialysis?

A client with diabetes mellitus develops an ulcer on the bottom of the foot. Which pathology is the primary contributing factor to the ability of the ulcer to heal?