Oncology Nursing

Why D is correct

All-trans retinoic acid, a vitamin-A drug that makes these leukemia cells mature, is started as soon as this leukemia is suspected. The abnormal cells set off clotting and bleeding together, and the drug quickly calms this, controlling her bleeding.

Why the other options are wrong

• A — "Start a heparin infusion right away": Heparin, a blood thinner, is not used routinely here because it adds to her bleeding.
• B — "Start the all-trans retinoic acid once the genetic result returns": The genetic test is part of confirming the diagnosis, but waiting delays the drug while bleeding is the main early danger.
• C — "Start a tranexamic acid infusion right away": Tranexamic acid, which keeps clots from breaking down, is discouraged here outside research studies.

Why A is correct

A sentinel lymph node biopsy removes the first one or few nodes the tumor drains to. An axillary node dissection takes many nodes from the armpit. The risk of lymphedema, arm swelling from lymph fluid that cannot drain, rises as more nodes are removed.

Why the other options are wrong

• B — "Her friend's surgery left the arm's lymph drainage undisturbed": Some drainage is still disturbed, so the risk is lower, not gone. It is correct that less drainage is disturbed, but that is because fewer nodes are removed.
• C — "Her friend's underarm nodes were dyed and tested but not removed": The sentinel nodes are removed. A dye or tracer shows which nodes to take out and check.
• D — "Her friend's nodes were taken from the breast instead of the underarm": The sentinel nodes usually sit in the underarm; location does not explain the risk.

Why C is correct

Mesna protects the bladder from ifosfamide. When the body breaks ifosfamide down, some of the products pass into the urine and irritate the bladder lining. Mesna binds these products and blocks their effect on the bladder. Without that protection the bladder can bleed. This is hemorrhagic cystitis: a bleeding, irritated bladder lining caused by some cancer drugs.

Why the other options are wrong

• A — "It prevents nausea from the drug": Mesna does not act on nausea. Nausea is eased by separate anti-nausea medicines.
• B — "It raises his white cell count": Mesna does not act on the marrow. White cells are raised by a different injection that signals the marrow to make them.
• D — "It increases his urine output": Mesna works by binding the harmful products, not by adding urine. Good urine flow is part of protecting the bladder, but mesna itself does not add to the urine.

Why C is correct

Carcinoma in situ means abnormal cells that look like cancer cells are still inside the epithelium, the lining where they began. The basement membrane, the thin layer under the lining, is still intact, so nothing has invaded.

Why the other options are wrong

• A — "Mildly abnormal cells within the epithelium that have not yet become malignant": Calling it not yet cancer is correct in some sources, but its cells already look like cancer cells, not mildly abnormal ones.
• B — "Malignant cells that have grown through the basement membrane into the tissue below": Crossing the basement membrane makes the cancer invasive, so it is no longer in situ.
• D — "Malignant cells that have spread to nearby lymph nodes without evidence of distant metastasis": Cancer in the lymph nodes has already invaded and spread beyond the lining.

Why C is correct

Warm packs to the site and hyaluronidase help the leaked vincristine spread out. Vincristine is a vinca alkaloid, a cancer drug made from the periwinkle plant. Its label advises local hyaluronidase and moderate heat to the area of the leak, to help disperse the drug. Warmth widens the local vessels. Hyaluronidase, an enzyme, loosens the tissue. The drug then spreads out and is carried away instead of pooling in one spot.

Why the other options are wrong

• A — "Cold packs to the site and dexrazoxane": Dexrazoxane protects tissue after a leak of an anthracycline, the drug group that includes doxorubicin. Cold packs are not used for vinca alkaloids either.
• B — "Cold packs to the site and hyaluronidase": Cold packs are not used for a vinca alkaloid leak. Cold is appropriate for many vesicant leaks, but a review warns against cold packs for vinca alkaloids. A vesicant is a drug that can blister and destroy tissue if it leaks out of the vein. In animal studies, cold packs increased ulcers (open sores) after vinca alkaloid leaks.
• D — "Warm packs to the site and sodium thiosulfate": Sodium thiosulfate is the antidote named for mechlorethamine, a different cancer drug, not for a vinca alkaloid. The warm packs are correct, but the drug paired with them belongs to a different leak.