MSN Exam for Hodgkin’s Disease

EXPLANATION

 

✔Correct answer:

Night sweats. Night sweats are a classic symptom associated with Hodgkin's disease, particularly in its early stages. Hodgkin's disease, a type of lymphoma, often presents with what are known as "B symptoms," which include fever, night sweats, and unexplained weight loss. These symptoms reflect systemic involvement, and night sweats can be particularly troublesome and indicative. The presence of night sweats, especially when severe and causing the patient to change bedclothes, can be a hallmark symptom prompting further investigation into possible Hodgkin's disease.

Think of the body's lymphatic system like a neighborhood's waste management system. Normally, it works quietly and efficiently, clearing away the body's waste and unwanted materials. Hodgkin's disease, however, is like a strike of the waste management workers—it disrupts this system, leading to the accumulation of waste (in this case, abnormal cells) and systemic symptoms like night sweats, fever, and weight loss, as the body tries to fight off these abnormal cells and restore normal function.

Hodgkin's disease is characterized by the presence of Reed-Sternberg cells, abnormal cells in the lymphatic system. The disease can lead to the enlargement of lymph nodes and the manifestation of systemic symptoms as the immune system reacts to these abnormal cells. Night sweats are thought to be a symptom of the body's immune response, possibly related to cytokines (chemical messengers) released by the body in an attempt to fight the disease.

 

✘Incorrect answer options:

Splenomegaly. While splenomegaly, or enlargement of the spleen, can be associated with Hodgkin's disease, it's more characteristic of advanced disease or other lymphoproliferative disorders, not typically a presenting feature of stage 1 Hodgkin's disease.

Pericarditis. Pericarditis, or inflammation of the lining around the heart, is not a common symptom of early-stage Hodgkin's disease. It's more likely to be associated with other conditions, such as autoimmune diseases or infections.

Persistent hypothermia. Persistent hypothermia is not a recognized symptom of Hodgkin's disease. Fever, rather than hypothermia, is commonly associated with Hodgkin's disease and other lymphomas, as part of the B symptoms.

 

References

• Rubin, E., & Reisner, H. M. (2018). Essentials of Rubin's Pathology. Wolters Kluwer Health.
• Schrier, S. L. (2021). Diagnosis and treatment of Hodgkin lymphoma: UpToDate. Retrieved from [UpToDate website](https://www.uptodate.com/contents/diagnosis-and-treatment-of-hodgkin-lymphoma)

EXPLANATION

 

✔Correct answer:

False. The statement Nurse Emma made is not accurate. While chemotherapy is a common and effective treatment for Hodgkin lymphoma and can lead to remission or cure in many cases, it is not without its risks. One of the significant risks associated with certain chemotherapy regimens, especially those that include alkylating agents or topoisomerase II inhibitors, is the development of secondary cancers. Secondary acute nonlymphocytic leukemia (ANLL), also known as therapy-related myeloid neoplasm, is a well-documented complication that can arise after chemotherapy treatment for Hodgkin lymphoma. The risk of developing secondary ANLL increases with the cumulative dose of the chemotherapeutic agents and is not negligible even within 10 years post-treatment.

Imagine painting a wooden house to protect it from termites. The paint (similar to chemotherapy) effectively keeps termites away (treats Hodgkin lymphoma), ensuring the house remains strong and sturdy (patient goes into remission or is cured). However, the paint might contain a chemical that could gradually weaken the wood's structure over time (akin to the risk of developing secondary ANLL). Just like how the benefit of termite protection comes with the risk of long-term wood damage, chemotherapy's effectiveness against Hodgkin lymphoma comes with the potential risk of secondary cancers.

Chemotherapy agents used in treating Hodgkin lymphoma, particularly alkylating agents, are known to be mutagenic. They work by binding to DNA, thereby preventing the cancer cells from dividing and growing. However, these agents do not exclusively target cancer cells; they can also affect normal, healthy cells, including the hematopoietic stem cells in the bone marrow. The damage to DNA in these cells can lead to mutations and, over time, may result in the development of secondary cancers, such as acute nonlymphocytic leukemia (ANLL). The risk is dose-dependent and also influenced by the specific agents used, the duration of therapy, and individual patient factors.

 

✘Incorrect answer options:

True. This statement is misleading and oversimplifies the risks associated with chemotherapy in the treatment of Hodgkin lymphoma. While chemotherapy can be highly effective, suggesting that it carries "almost no risk" of secondary cancers, particularly secondary ANLL within 10 years, is not supported by clinical evidence and does not accurately represent the potential long-term complications of chemotherapy treatment.

 

References

• DeVita, V. T., Lawrence, T. S., & Rosenberg, S. A. (2019). DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology (11th ed.). Wolters Kluwer Health.
• Linch, D. C., Winfield, D., Goldstone, A. H., Moir, D., Hancock, B., McMillan, A., Chopra, R., Milligan, D., & Hudson, G. V. (1993). Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. The Lancet, 341(8852), 1051-1054.

EXPLANATION

 

✔Correct answer:

Gently wash the targeted skin daily using a mild soap. Nurse Michelle's delegation to the nursing assistant should be an activity that falls within the assistant's scope of practice and competency level. Nursing assistants are trained in basic patient care techniques, including personal hygiene tasks such as bathing or washing skin.

Gently washing the targeted skin daily with a mild soap is an appropriate task to delegate. It's a fundamental aspect of patient hygiene and doesn't require the nursing judgment or skill level needed for assessment or patient education. The nursing assistant should be instructed on the specific needs of a patient undergoing radiation therapy, such as the necessity for gentleness and avoidance of irritation in the affected area.

Think of the healthcare team as a gardening team taking care of a delicate plant. The nurse is like the lead gardener, knowing all the specifics about the plant's needs and how to address any signs of disease. The nursing assistant is like the helper who waters the plant and keeps the soil clean under the guidance of the lead gardener. Just as watering is essential but doesn't require the detailed knowledge of plant diseases, washing the skin is essential for patient care but doesn't require the detailed medical knowledge that the nurse has.

 

✘Incorrect answer options:

Apply alcohol-free lotion to the affected area after cleansing. This task involves understanding the specifics of skin care post-radiation therapy, which can be quite sensitive. The application of lotions might have specific instructions or require assessment skills to ensure no adverse reaction occurs, making it more appropriate for a nurse.

Educate the client and family members on proper skin care. Education is a complex task requiring deep understanding, the ability to tailor information to the patient's understanding level, and assessment of the patient's comprehension. This task should be performed by the nurse, who has the training and scope of practice to educate patients and their families.

Examine the skin for early signs of redness or peeling. Examining the skin for early signs of redness or peeling is an assessment task. Assessment requires critical thinking and clinical judgment to detect subtle changes and potential complications, which are responsibilities of the nurse and should not be delegated to a nursing assistant.

 

References

• Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2021). Fundamentals of Nursing (10th ed.). Elsevier.
• Yarbro, C. H., Wujcik, D., & Gobel, B. H. (2018). Cancer Nursing: Principles and Practice (8th ed.). Jones & Bartlett Learning.

EXPLANATION

 

✔Correct answer:

False. Nurse Michelle's statement is not entirely accurate. Both gender and race/ethnicity are considered risk factors for non-Hodgkin lymphoma (NHL), although the degree to which they influence risk can vary.

1. Gender as a Risk Factor: Statistics show that non-Hodgkin lymphoma is more common in men than in women. This difference suggests that gender is indeed a risk factor for developing NHL. The reasons for this disparity are not entirely clear but may involve differences in exposure to certain risk factors, hormonal factors, or immune system differences between men and women.
2. Race/Ethnicity as a Risk Factor: Race and ethnicity can also play a role in the risk of developing NHL. The incidence of NHL varies among different racial and ethnic groups. For example, in the United States, whites have a higher incidence of non-Hodgkin lymphoma compared to African Americans and Asian/Pacific Islanders. Additionally, certain types of NHL are more common in specific ethnic or racial groups, which may be related to genetic factors, environmental exposures, or lifestyle factors specific to those groups.

Think of developing NHL like a complex puzzle where each piece represents a different risk factor, such as gender, race, environmental exposure, genetic predisposition, etc. Just as every puzzle piece contributes to completing the picture, each risk factor adds to the overall risk profile for NHL. Gender and race are like individual pieces of this puzzle, each playing a role in the bigger picture of NHL risk.

 

✘Incorrect answer options:

True. This statement is incorrect because it acknowledges gender as a risk factor but inaccurately dismisses race/ethnicity as a risk factor. Both gender and race/ethnicity are indeed relevant when considering the risk profile for non-Hodgkin lymphoma.

 

References

• Morton, L. M., Wang, S. S., Devesa, S. S., Hartge, P., Weisenburger, D. D., & Linet, M. S. (2006). Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood, 107(1), 265-276.
• Chiu, B. C., & Weisenburger, D. D. (2003). An update of the epidemiology of non-Hodgkin's lymphoma. Clinics in lymphoma, 4(3), 161-168.

EXPLANATION

 

✔Correct answer:

Young adults between the ages of 21-40 years. Hodgkin's disease, also known as Hodgkin's lymphoma, is most commonly diagnosed in two distinct age groups: young adults (specifically in their 20s and 30s) and older adults (over the age of 55). The incidence among young adults between the ages of 21-40 years makes this age group a key demographic for the occurrence of Hodgkin's disease. The disease is characterized by the presence of Reed-Sternberg cells in lymphatic tissue and typically presents with a painless, swollen lymph node, often in the neck or above the collarbone.

Hodgkin's disease arises from a mutation in the DNA of a lymphocyte (a type of white blood cell), which causes the cell to multiply uncontrollably. This leads to the characteristic swelling of the lymph nodes. The reason for the bimodal age distribution is not entirely clear but is thought to involve a combination of genetic predisposition and environmental factors, including the Epstein-Barr virus.

 

✘Incorrect answer options:

Children between the ages of 6-12 years. While children can develop Hodgkin's disease, it's less common in this age group compared to young adults and older adults.

Teenagers between the ages of 13-20 years. Teenagers do get Hodgkin's disease, and it's somewhat more common than in younger children, but the incidence is still lower compared to the peak incidence in young adults and older adults.

Older adults between the ages of 41-50 years. While the incidence of Hodgkin's disease does increase with age, the peak incidence in older adults is typically in those over the age of 55, not between the ages of 41-50.

 

References

• DeVita, V. T., Lawrence, T. S., & Rosenberg, S. A. (2018). DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology (11th ed.). Wolters Kluwer.
• Swerdlow, S. H., Campo, E., Harris, N. L., et al. (Eds.). (2017). WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (Revised 4th edition). International Agency for Research on Cancer.

EXPLANATION

 

✔Correct answer:

True. Nurse Robert's statement is correct. Individuals with HIV (Human Immunodeficiency Virus) are indeed at a higher risk of developing lymphatic diseases, including various types of lymphoma. This increased risk is primarily due to the weakened immune system caused by HIV, which makes it more difficult for the body to control the growth of abnormal cells and to fight off infections that may contribute to lymphoma development.

1. Non-Hodgkin Lymphoma (NHL): People with HIV are significantly more likely to develop certain types of non-Hodgkin lymphoma, especially aggressive forms like diffuse large B-cell lymphoma, primary central nervous system lymphoma, and Burkitt lymphoma. These are sometimes referred to as AIDS-related lymphomas because they are more common and tend to be more aggressive in individuals with AIDS, the advanced stage of HIV infection.
2. Hodgkin Lymphoma (HL): The risk of Hodgkin lymphoma is also increased in individuals with HIV compared to the general population. The incidence of HL in HIV-positive individuals has not declined significantly since the introduction of antiretroviral therapy, which is the standard treatment for HIV.

The underlying cause of this increased risk is not entirely clear but is thought to be related to immune dysfunction, chronic B-cell stimulation, and co-infection with oncogenic viruses like Epstein-Barr virus (EBV), which is associated with several types of lymphoma.

Imagine a city's police force (the immune system) is significantly understaffed due to an ongoing crisis (HIV infection). With fewer officers on duty, the city becomes more vulnerable to crimes (lymphatic diseases). Similarly, when the immune system is weakened by HIV, the body is less capable of controlling abnormal cell growth and responding to infections that might lead to lymphatic diseases.

 

✘Incorrect answer options:

False. This statement would be incorrect. Individuals with HIV are indeed at a higher risk of developing lymphatic diseases, including various types of lymphoma, due to the impact of HIV on the immune system.

 

References

• Shiels, M. S., Pfeiffer, R. M., Gail, M. H., Hall, H. I., Li, J., Chaturvedi, A. K., ... & Engels, E. A. (2011). Cancer burden in the HIV-infected population in the United States. Journal of the National Cancer Institute, 103(9), 753-762.
• Besson, C., Lancar, R., Prevot, S., Brice, P., Meyohas, M. C., Marchou, B., ... & Costagliola, D. (2015). High risk of non-Hodgkin lymphoma in HIV-positive patients. Journal of acquired immune deficiency syndromes (1999), 69(3), 291.

EXPLANATION

 

✔Correct answer:

Emily, a 20-year-old who has just been transferred to the medical unit for evaluation of suspected acute myelogenous leukemia. In prioritizing patient care, Nurse Olivia should assess and attend to the patients with the most urgent and potentially unstable conditions first. Acute myelogenous leukemia (AML) can be a life-threatening condition, and patients with suspected AML require immediate and thorough evaluation to confirm the diagnosis and initiate treatment as quickly as possible. The potential for rapid disease progression and the severe complications associated with AML (like infections, bleeding, and organ damage due to leukostasis) make it imperative that Emily is assessed promptly.

Think of this situation like a triage system in an emergency room. If four people come in with different issues - one with a teaching need, one with a request for help with compression stockings, one refusing treatment, and one with a potentially life-threatening condition that needs immediate assessment - the person with the potentially life-threatening condition would be attended to first, just like in a real emergency scenario.

Acute myelogenous leukemia is a type of cancer that rapidly progresses and affects the white blood cells, impairing the body's ability to fight infections and disrupting normal blood cell production. This can lead to a range of acute complications, making immediate medical intervention critical.

 

✘Incorrect answer options:

Robert, a 38-year-old with aplastic anemia who needs education on how to minimize infection risk as he is scheduled for discharge soon. While patient education is important, it is not as immediately life-threatening as suspected acute myelogenous leukemia.

John, a 60-year-old diagnosed with non-Hodgkin’s lymphoma who is currently refusing to undergo the ordered chemotherapy treatment. While it's crucial to address John's concerns and obtain his consent for treatment, it doesn't take precedence over the immediate assessment and potential stabilization needed for suspected acute leukemia.

Linda, a 40-year-old with lymphedema who is requesting assistance with putting on her compression stockings before getting out of bed. Assistance with compression stockings is a necessary and routine part of care for lymphedema, but it is not as urgent as assessing a patient with suspected acute leukemia.

 

References

• Estey, E. H. (2013). Acute myeloid leukemia: 2013 update on risk stratification and management. American Journal of Hematology, 88(4), 318-327.
• Juliusson, G., & Hough, R. (2016). Leukemia. Prognostic factors and treatment strategies for older patients with acute myeloid leukemia. Haematologica, 101(7), 792-800.

EXPLANATION

 

✔Correct answer:

True. Nurse Jennifer's statement is correct. Non-Hodgkin lymphoma (NHL) is known for its potential to spread to almost any part of the body. Unlike Hodgkin lymphoma, which follows a more predictable pattern of spread, NHL can involve multiple organs and tissues outside of the lymphatic system. Common sites of extranodal (outside of the lymph nodes) involvement include the liver, bone marrow, and spleen, but NHL can also involve the gastrointestinal tract, central nervous system, and other organs.

The spread of NHL to these areas can affect the staging of the disease and has implications for treatment and prognosis. For instance, involvement of the bone marrow or having more than one extranodal site affected usually indicates a more advanced stage of the disease.

Think of the lymphatic system as a public transportation system that connects different parts of a city (the body). Just as people (lymphoma cells) can get off at various stops and spread throughout the city, lymphoma cells can exit the lymphatic system and spread to various parts of the body, such as the liver, bone marrow, and spleen. Just as it's harder to manage or control the movement of people once they spread out across the city, it's more challenging to treat lymphoma and predict its outcome when it has spread to multiple parts of the body.

 

✘Incorrect answer options:

False. This statement would be incorrect. Non-Hodgkin lymphoma is indeed known for its ability to spread to various parts of the body, including but not limited to the liver, bone marrow, and spleen.

 

References

• Swerdlow, S. H., Campo, E., Pileri, S. A., Harris, N. L., Stein, H., Siebert, R., Advani, R., Ghielmini, M., Salles, G. A., Zelenetz, A. D., & Jaffe, E. S. (2016). The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood, 127(20), 2375-2390.
• Armitage, J. O., Gascoyne, R. D., Lunning, M. A., & Cavalli, F. (2017). Non-Hodgkin lymphoma. Lancet, 390(10091), 298-310.

EXPLANATION

 

✔Correct answer:

False. The statement made by Nurse Allison contains a factual error regarding the nationality and the date associated with Thomas Hodgkin. Thomas Hodgkin was not an American physician; he was actually a British physician. He first described the disease that would later carry his name in 1832, so the date is correct, but his nationality is not.

Thomas Hodgkin made significant contributions to medicine and is best known for his discovery of Hodgkin lymphoma, which he initially described in a paper titled "On Some Morbid Appearances of the Absorbent Glands and Spleen." This work was presented to the Medical and Chirurgical Society of London. However, it was only much later, after further study and recognition of his work, that the disease was named Hodgkin's disease, now commonly known as Hodgkin lymphoma.

Imagine a historical figure who wrote a famous book. Over time, the book becomes synonymous with the author's name, much like a brand becoming synonymous with its product. Just as it's important to remember the correct author of the book, it's crucial to remember the correct details about Thomas Hodgkin, acknowledging his British nationality and the groundbreaking work he did in describing Hodgkin lymphoma.

 

✘Incorrect answer options:

True. This statement is incorrect because it inaccurately describes Thomas Hodgkin as an American physician. He was, in fact, a British physician who made significant contributions to the medical field, including the characterization of Hodgkin lymphoma.

 

References

• Kaplan, H. S. (1980). Hodgkin's Disease. Harvard University Press.
• Rich, R. R., Fleisher, T. A., Shearer, W. T., Schroeder, H. W., Frew, A. J., & Weyand, C. M. (2019). Clinical Immunology (5th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

True. Nurse Sarah's statement is accurate. One of the common symptoms of lymphatic diseases, including various types of lymphoma and infections, is the swelling or enlargement of lymph nodes, medically known as lymphadenopathy. Often, this swelling is not accompanied by pain, especially in the early stages or in certain diseases, which can lead to the symptom being overlooked or dismissed by individuals.

Lymph nodes are small, bean-shaped structures that are part of the body's immune system. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid. When there is an infection or disease, lymph nodes may become enlarged as they work to filter out the offending organisms or cells.

While lymph node swelling can occur in response to benign conditions, such as infections (like the common cold), it can also be a sign of more serious conditions, including lymphomas or other malignancies. The painless nature of the swelling is particularly characteristic of certain types of lymphomas, as the enlarged nodes are typically not tender unless they become inflamed or if there is an associated infection.

Think of lymph nodes as security checkpoints in a large building. Under normal circumstances, they operate quietly and efficiently, often unnoticed. However, when there's a disturbance (such as an infection or disease), these checkpoints may increase in size due to the increased activity, similar to how security measures ramp up in a building during a high-alert scenario. Just as the increased security presence isn't inherently painful or discomforting to the people in the building, the enlargement of lymph nodes isn't usually painful, even though it signifies that something unusual is happening in the body.

 

✘Incorrect answer options:

False. This statement would be incorrect. Lymph node enlargement without pain is indeed a common symptom of various lymphatic diseases and can often go unnoticed because the swelling does not necessarily cause discomfort.

 

References

• Harris, N. L., Jaffe, E. S., Diebold, J., Flandrin, G., Muller-Hermelink, H. K., Vardiman, J., ... & Stein, H. (1999). The World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. Annals of Oncology, 10(12), 1419-1432.
• Swerdlow, S. H., Campo, E., Pileri, S. A., Harris, N. L., Stein, H., Siebert, R., ... & Jaffe, E. S. (2016). The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood, 127(20), 2375-2390.

EXPLANATION

 

✔Correct answer:

Levels of hemoglobin and hematocrit. Chemotherapy, a common treatment for Hodgkin's Disease, can significantly affect the bone marrow's ability to produce blood cells, leading to conditions such as anemia (a decrease in red blood cells), thrombocytopenia (a decrease in platelets), and leukopenia (a decrease in white blood cells). Monitoring the levels of hemoglobin and hematocrit is essential as they are key indicators of anemia. Hemoglobin is the protein in red blood cells that carries oxygen throughout the body, and hematocrit is the proportion of blood volume that is made up of red blood cells. A decrease in these levels can indicate a diminished capacity of the blood to carry oxygen, resulting in fatigue, weakness, and other related symptoms. Therefore, frequent monitoring is crucial to manage potential anemia and ensure the patient's safety during chemotherapy.

Think of the blood as a delivery service like a mail carrier. Hemoglobin and hematocrit levels are like the number of trucks and drivers available. If there are fewer trucks (red blood cells) or drivers (hemoglobin), the delivery service can't operate efficiently, leading to delays or problems in delivering oxygen (packages) to different parts of the body. Regularly checking these levels is like ensuring there are enough trucks and drivers to maintain a smooth delivery service.

 

✘Incorrect answer options:

Liver function tests. While liver function tests are important and chemotherapy can affect liver function, these tests are not typically the highest priority unless the patient has a pre-existing liver condition or is receiving specific chemotherapy drugs known to affect the liver significantly.

Blood glucose levels. Monitoring blood glucose is crucial for patients with diabetes or those receiving treatments known to affect blood sugar levels. However, it's not routinely the highest priority in chemotherapy for Hodgkin's Disease unless there's a specific indication.

Levels of creatinine and BUN (Blood Urea Nitrogen). These tests assess kidney function and may be important for patients receiving certain chemotherapeutic agents that can affect the kidneys. While it's important to monitor renal function, the immediate risk of bone marrow suppression leading to anemia, leukopenia, or thrombocytopenia typically makes monitoring hemoglobin and hematocrit levels a higher priority.

 

References

• Yarbro, C. H., Wujcik, D., & Gobel, B. H. (2018). Cancer Nursing: Principles and Practice (8th ed.). Jones & Bartlett Learning.
• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2020). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed.). Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

Reed-Sternberg cells. Hodgkin's disease, also known as Hodgkin's lymphoma, is characterized by the presence of Reed-Sternberg cells in lymphatic tissue. These cells are large, abnormal lymphocytes that can be multinucleated and are considered a hallmark of the disease. The presence of Reed-Sternberg cells in a biopsy of lymphatic tissue is a key diagnostic criterion for Hodgkin's disease. These cells are not found in other types of lymphoma or lymphoid leukemias, making their identification crucial for the definitive diagnosis of Hodgkin's disease.

Think of a garden where each plant represents a different type of cell in the lymphatic tissue. Just as a botanist can identify a specific plant by its unique flowers or leaves, a pathologist can identify Hodgkin's disease by the presence of the unique "Reed-Sternberg cells" in the lymph node sample, much like spotting a distinct flower in the garden.

In Hodgkin's disease, Reed-Sternberg cells are derived from B lymphocytes that have undergone genetic mutations. These cells are large and carry more than one nucleus or a nucleus that is much larger than normal. The presence of these cells leads to the characteristic symptoms of Hodgkin's disease, including the enlargement of lymph nodes and other related symptoms, by causing an inflammatory response in the affected tissues.

 

✘Incorrect answer options:

Rieder's cells. Rieder's cells are associated with certain types of leukemia and are not indicative of Hodgkin's disease.

Lymphoblastic cells. Lymphoblastic cells are immature cells that are found in acute lymphoblastic leukemia (ALL), not Hodgkin's disease.

Gaucher's cells. Gaucher's cells are macrophages that have ingested glucocerebroside and are characteristic of Gaucher's disease, a genetic metabolic disorder, not Hodgkin's disease.

 

References

• Stein, H., Warnke, R. A., Chan, W. C., et al. (2008). Hodgkin Lymphoma. In: WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, IARC.
• Küppers, R. (2009). The biology of Hodgkin's lymphoma. Nature Reviews Cancer, 9(1), 15-27.

EXPLANATION

 

✔Correct answer:

True. Nurse Andrew's statement is correct. Lymphomas are a diverse group of blood cancers that develop in the lymphatic system. They are primarily classified into two main categories: Hodgkin lymphoma (HL) and non-Hodgkin lymphomas (NHL). This classification is based on the specific characteristics of the cancer cells, particularly the presence of Reed-Sternberg cells in Hodgkin lymphoma.

1. Hodgkin Lymphoma (HL): Hodgkin lymphoma is distinguished by the presence of Reed-Sternberg cells, a type of abnormal lymphocyte. The presence of these cells when examined under a microscope is crucial for the diagnosis of HL. Hodgkin lymphoma has subtypes based on the cellular makeup and the presence of these characteristic cells.
2. Non-Hodgkin Lymphomas (NHL): NHL represents a larger group of lymphomas that are diverse in their presentation, behavior, and histology. They do not have the Reed-Sternberg cells that are typical of Hodgkin lymphoma. NHL encompasses various subtypes, including but not limited to, follicular lymphoma, diffuse large B-cell lymphoma, and mantle cell lymphoma. The classification of NHL is complex and is based on the type of lymphocyte involved (B-cell, T-cell, or NK cell), the cellular morphology, and the genetic and molecular features.

Think of the lymphatic system as a garden with many different types of plants (cells). Lymphomas are like weeds in this garden. Hodgkin lymphoma is a specific type of weed with a unique marker (Reed-Sternberg cell), making it easy to identify. On the other hand, non-Hodgkin lymphomas represent all other types of weeds, each with its own distinct characteristics but without the unique marker that Hodgkin's has. Just as a gardener needs to know the type of weed to choose the right removal method, doctors need to distinguish between Hodgkin and non-Hodgkin lymphomas to provide the most effective treatment.

 

✘Incorrect answer options:

False. This statement would be incorrect. The two main categories of lymphoma are indeed Hodgkin lymphoma and non-Hodgkin lymphomas. This classification is well-established in medical literature and is a fundamental aspect of understanding and treating lymphatic cancers.

 

References

• Swerdlow, S. H., Campo, E., Pileri, S. A., Harris, N. L., Stein, H., Siebert, R., Advani, R., Ghielmini, M., Salles, G. A., Zelenetz, A. D., & Jaffe, E. S. (2016). The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood, 127(20), 2375-2390.
• American Cancer Society. (2021). What Is Lymphoma? Retrieved from [American Cancer Society website](https://www.cancer.org/cancer/lymphoma.html).

EXPLANATION

 

✔Correct answer:

Enlarged lymph nodes. Hodgkin's disease, a type of lymphoma, is primarily characterized by the enlargement of lymph nodes. These swollen nodes are usually painless and may be found in the neck, armpits, or groin areas. The enlargement is due to the accumulation of diseased lymphocytes in the lymphatic tissue. This is one of the most common and early signs of Hodgkin's disease, and it is what Nurse Andrew is most likely to note during a physical examination of Mark.

Imagine a security checkpoint in a building where the guards (lymph nodes) inspect what goes in and out. Now, if there's an increased workload or a problem at the checkpoint, you'd notice a buildup or congestion at that spot. Similarly, in Hodgkin's disease, the lymph nodes (the guards) are dealing with abnormal cells, causing them to swell as they try to manage the situation, much like congestion at a busy checkpoint.

Lymph nodes are part of the lymphatic system, which is integral to the body's immune response. In Hodgkin's disease, Reed-Sternberg cells (abnormal cells) accumulate in lymph nodes, causing them to enlarge. While the exact cause of Hodgkin's disease is not fully understood, the presence of these cells is believed to trigger an inflammatory response, leading to the enlargement of the lymph nodes.

 

✘Incorrect answer options:

Weight gain. Weight gain is not typically associated with Hodgkin's disease. In fact, unexplained weight loss is more common in individuals with this condition.

Weakness. While weakness can be a symptom of Hodgkin's disease, it is nonspecific and can be associated with many other conditions. It is not as indicative of Hodgkin's disease as enlarged lymph nodes.

Fatigue. Fatigue is a common symptom in many conditions, including Hodgkin's disease, but it is not specific and is less indicative of the disease compared to enlarged lymph nodes.

 

References

• Küppers, R. (2009). The biology of Hodgkin's lymphoma. Nature Reviews Cancer, 9(1), 15-27.
• Stein, H., Warnke, R. A., Chan, W. C., et al. (2008). Hodgkin Lymphoma. In: WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, IARC.

EXPLANATION

 

✔Correct answer:

"Would you like to talk more about your fears of not making it?" This response is therapeutic and patient-centered, demonstrating empathy and opening up a dialogue that allows Sarah to express her feelings more deeply. By asking this question, Nurse Olivia shows that she is listening, validates Sarah's feelings, and offers her the opportunity to talk about her fears, which can be an important part of the emotional healing process. It's essential in nursing to create a safe space for patients to express their emotions and fears, as this can lead to better understanding and support for the patient.

Imagine someone is carrying a heavy backpack (their fears and emotional burden). Offering to let them open the backpack and show you what's inside (discuss their fears) doesn't lighten the load right away, but it allows them to sort through what they're carrying and possibly share the load with someone who cares.

Acknowledging and discussing fears can help reduce feelings of isolation and anxiety. It's crucial for patients to feel heard and understood, and open communication can foster a sense of trust and safety between the patient and the nurse. This can be especially important in oncology settings, where patients often face not only physical challenges but also significant emotional and psychological stress.

 

✘Incorrect answer options:

"Maybe you should discuss medication options with your doctor." This response shifts the focus from Sarah's emotional well-being to medical treatment and does not address her immediate emotional need. While discussing medication options might be a part of comprehensive care, it does not validate her feelings or encourage her to express her emotions.

"The majority of people with stage I Hodgkin's disease have a good prognosis." Although this statement is factually correct and might be meant to reassure Sarah, it can be perceived as dismissive of her feelings. It doesn't acknowledge her individual experience or fears, and it might make her feel like her concerns are not valid or important.

"It's not uncommon for people with your diagnosis to experience similar fears." While this response is meant to normalize Sarah's feelings and let her know she's not alone, it doesn't invite her to share more about her personal experience or feelings. It may be perceived as brushing aside her individual concerns in favor of a more generalized statement about people with her condition.

 

EXPLANATION

 

✔Correct answer:

False. Nurse Patricia's statement is not entirely accurate. While Hodgkin lymphoma typically starts in a single group of lymph nodes, it can spread to contiguous (adjacent) lymph node groups. Moreover, it can also affect other parts of the lymphatic system, including the spleen, and in advanced stages, it can involve the bone marrow and other organs outside the lymphatic system.

Hodgkin lymphoma is known for its predictable pattern of spread, which is generally from one lymph node group to an adjacent group (orderly spread). However, this does not mean it's confined only to a group of lymph nodes without the potential to affect individual nodes or other parts of the body. The statement may oversimplify the nature of Hodgkin lymphoma's progression and spread.

Think of Hodgkin lymphoma as a weed in a garden that prefers to spread to neighboring plots of land (adjacent lymph node groups). While it typically moves in an orderly manner from one plot to the next, it's not entirely confined to just a few plots. Over time, if not managed, it can spread to distant parts of the garden (other parts of the lymphatic system like the spleen or even the bone marrow).

 

✘Incorrect answer options:

True. This statement would be incorrect because Hodgkin lymphoma, while typically starting in a single group of lymph nodes and spreading in an orderly fashion, can indeed affect individual lymph nodes and other parts of the lymphatic system, including the spleen and bone marrow, especially in more advanced stages.

 

References

• DeVita, V. T., Lawrence, T. S., & Rosenberg, S. A. (2019). DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology (11th ed.). Wolters Kluwer Health.
• Swerdlow, S. H., Campo, E., Pileri, S. A., Harris, N. L., Stein, H., Siebert, R., Advani, R., Ghielmini, M., Salles, G. A., Zelenetz, A. D., & Jaffe, E. S. (2016). The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood, 127(20), 2375-2390.