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 D

Explanation

Hemodialysis is a renal replacement therapy used to remove waste products and excess fluid from the blood when the kidneys are unable to perform this function adequately. The physiological processes involved in hemodialysis include:

A) Solute movement toward a solution with a higher concentration:

While solute movement occurs during hemodialysis, it is typically from a solution with a higher concentration to one with a lower concentration, rather than the opposite. This movement facilitates the removal of waste products and excess solutes from the bloodstream.

B) Water movement toward a solution with a lower solute concentration:

Correct. Osmosis is the movement of water across a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration. In hemodialysis, water moves out of the bloodstream, across the semipermeable membrane of the dialyzer, and into the dialysate solution, which has a lower solute concentration. This process helps remove excess fluid from the body.

C) Blood cells and protein movement through the semipermeable membrane:

Blood cells and proteins are too large to pass through the pores of the semipermeable membrane in the dialyzer during hemodialysis. Therefore, the primary exchange occurs between smaller molecules such as urea, creatinine, electrolytes, and water.

D) Osmosis of water movement and diffusion of solute movement:

Correct. Hemodialysis involves both osmosis and diffusion. Osmosis refers to the movement of water across a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration. Diffusion is the movement of solutes from an area of higher concentration to an area of lower concentration. Together, these processes facilitate the removal of waste products and excess fluid from the bloodstream during hemodialysis.

A. Myocardial infarction. B. Unstable angina. C. Stable angina. D. Prinz metal angina.

Correct Answer is C

Explanation

A. Myocardial infarction:

Myocardial infarction (MI) typically presents with severe and prolonged chest pain or discomfort that is not relieved by rest or nitroglycerin. MI is characterized by myocardial necrosis due to prolonged ischemia, often resulting from the occlusion of a coronary artery by a thrombus or plaque rupture. While chest pressure and breathlessness are symptoms commonly associated with MI, the transient nature of the symptoms described by the client, as well as their relief after rest, is more indicative of stable angina rather than MI.

B. Unstable angina:

Unstable angina is characterized by new-onset angina, increasing frequency, or worsening intensity of angina symptoms. It is considered a medical emergency as it may precede a myocardial infarction. However, unstable angina typically presents with symptoms at rest or with minimal exertion and is not usually relieved by rest or nitroglycerin. The client's symptoms, which are relieved by rest, are more consistent with stable angina.

C. Stable angina:

Stable angina is characterized by predictable chest pain or discomfort that occurs with exertion or stress and is relieved by rest or nitroglycerin. The symptoms described by the client, including chest pressure and breathlessness that improve with rest, are consistent with stable angina. Stable angina occurs due to transient myocardial ischemia caused by an imbalance between myocardial oxygen supply and demand, often related to coronary artery disease.

D. Prinzmetal angina:

Prinzmetal angina, also known as variant angina, is characterized by chest pain or discomfort that occurs at rest, often in the early morning hours, and is typically caused by coronary artery spasm rather than fixed atherosclerotic lesions. While Prinzmetal angina can present with transient symptoms similar to those described by the client, it is less common than stable angina and is often associated with transient ST-segment elevation on electrocardiogram (ECG), which is not mentioned in the scenario.

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Naxlex Comprehensive Predictor Exams

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

Correct Answer is D

Explanation

Correct Answer is C

Explanation

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