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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Correct Answer is C

Explanation

A) Increased preload that results in generalized peripheral edema:

This statement is incorrect. Decreased blood volume due to hemorrhage leads to decreased preload, not increased preload. Generalized peripheral edema is more commonly associated with conditions such as heart failure or kidney disease, where fluid retention leads to increased preload.

B) The lowered blood pressure results in a reduction of the heart rate:

While it's true that a decrease in blood pressure can trigger compensatory mechanisms such as an increase in heart rate (tachycardia), the specific response mentioned in this option is not entirely accurate. The primary compensatory response to hemorrhage-induced hypotension is typically an increase in heart rate, not a reduction.

C) Decreased preload that can lead to decreased cardiac output:

Correct. With decreased blood volume (preload), there is less blood returning to the heart during diastole. This leads to decreased ventricular filling and subsequently decreased stroke volume and cardiac output. Decreased cardiac output can contribute to hypotension and inadequate tissue perfusion.

D) Increased peripheral resistance resulting from poor renal perfusion:

While poor renal perfusion can trigger mechanisms to increase peripheral resistance (such as activation of the renin-angiotensin-aldosterone system), this option does not directly address the primary effect of decreased preload on cardiac output. Increased peripheral resistance alone does not adequately compensate for decreased preload to maintain cardiac output.

A. Fatigue and weakness. B. Cardiac dysrhythmias. C. Fever and infection. D. Decreased clotting time.

Correct Answer is A

Explanation

A) Fatigue and weakness:

Correct. The client's hemoglobin and hematocrit levels are below the reference ranges, indicating mild anemia. Anemia, characterized by low red blood cell count or hemoglobin levels, can lead to symptoms such as fatigue, weakness, and shortness of breath, as the body's oxygen-carrying capacity is reduced. Fatigue and weakness are common manifestations of anemia and are indicative of tissue hypoxia due to decreased oxygen delivery.

B) Cardiac dysrhythmias:

While severe anemia can lead to cardiac complications, such as dysrhythmias, the client's hemoglobin and hematocrit levels are only slightly below the reference ranges, indicating mild anemia. Cardiac dysrhythmias are more commonly associated with severe anemia or acute changes in hemoglobin levels rather than the mild anemia indicated in this scenario.

C) Fever and infection:

Anemia is not typically associated with fever and infection. While anemia may occur secondary to chronic inflammatory conditions or certain infections, the client's symptoms of fatigue and weakness are more directly related to the decreased oxygen-carrying capacity of the blood due to mild anemia.

D) Decreased clotting time:

Anemia is not directly associated with changes in clotting time. While severe anemia can lead to alterations in platelet function and clotting factors, the client's hemoglobin and hematocrit levels are only slightly below the reference ranges, indicating mild anemia. Decreased clotting time is not a typical manifestation of mild anemia.

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Naxlex Comprehensive Predictor Exams

Following 2 motor vehicle collision, an adult client is brought to the emergency department with a blood pressure of 72/50 mm Hg and a blood volume loss of approximately 40%. The nurse should plan care for this client based on which expected response to hemorrhaging?

Correct Answer is C

Explanation

Correct Answer is A

Explanation

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