Leukemia

Brian asks the nurse if there are more than one type of leukemia. What should the nurse include as the types? Select all that apply. Acute myelogenous leukemia (AML) Chronic myelogenous leukemia (CML) Acute lymphoblastic leukemia (ALL) Chronic lymphocytic leukemia (CLL) Non-acute lymphoblastic leukemia (NALL)

Acute myelogenous leukemia (AML) Chronic myelogenous leukemia (CML) Acute lymphoblastic leukemia (ALL) Chronic lymphocytic leukemia (CLL) Leukemias include acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML), acute lymphoblastic leukemia (ALL), and chronic lymphocytic leukemia (CLL). Acute myelogenous leukemia and ALL have acute, sudden onsets; CML and CLL may be present for years. There is no such thing as NALL.

Which is true regarding the pathophysiology of leukemia? The uncontrollable production of white blood cells is called apoptosis. An unknown stimulus mutates a lymphoid stem cell. Programmed cell death is called leukocytosis. The cloning process of the leukemic cell is controllable.

An unknown stimulus mutates a lymphoid stem cell. Rationale: an unknown stimulus mutates the lymphoid stem cell. The mutated cell clones itself, producing an immature WBC or the leukemic cell.

Brian asks the nurse how they know he's neutropenic. Which lab result best indicates a neutropenic state? Low WBC count High WBC count Low ANC High ANC

Low ANC An absolute neutrophil count (ANC) less than 1,000 confirms neutropenic precautions are required.

A nurse is teaching about the epidemiology of leukemia. Which statements indicate a need for further teaching? Select all that apply. "Leukemia is prevalent in black women older than 50 years of age. " "Patients who have had several years of chemotherapy treatment are at a risk of developing leukemia." "Acute lymphoblastic leukemia is prevalent mainly in older adults." "Down syndrome is a risk factor for leukemia." "There are four major types of leukemia."

"Leukemia is prevalent in black women older than 50 years of age. " "Acute lymphoblastic leukemia is prevalent mainly in older adults." Rationale: leukemia is prevalent in white men older than the age of 60, not black women. Acute lymphoblastic leukemia is a prevalent form of leukemia and occurs during childhood, not old age.

The client is being prepared for a procedure that will give the healthcare team more information about the type of leukemia and extent of the malignancy. The nurse would provide pre-procedure teaching for which procedure? Bone scan Bone marrow transplant Bone marrow biopsy Magnetic resonance imaging

Bone marrow biopsy

The client with leukemia can possibly be treated with which medical management options? Select all that apply. Surgery Chemotherapy Radiation Stem-cell transplant Ketogenic diet

Chemotherapy Radiation Stem-cell transplant

A client the nurse is caring for has leukemia and says she has heard that there are multiple types, asking the nurse to list them. Which would you list as types of leukemia? Select all that apply. Chronic myelogenous leukemia Acute lymphoblastic leukemia Chronic lymphogenous leukemia Chronic lymphocytic leukemia Acute myelogenous leukemia

Chronic myelogenous leukemia Acute lymphoblastic leukemia Chronic lymphocytic leukemia Acute myelogenous leukemia

The nurse is caring for a client on neutropenic precautions secondary to chemotherapy and advanced liver cancer . Upon entering the room, the nurse sees that multiple family members are visiting. What action should the nurse take first? Place a mask on the client. Request that every leave. Give masks to each visitor. Only allow 1 visitor at a time

Give masks to each visitor. Rationale: this will prevent the spread of droplets and airborne illnesses.

The provider orders a regimen of antibiotics for Brian. What is the reason for this? It suppresses his immune system. He has an infection. It weakens the cancer cells. He is at risk for infection.

He is at risk for infection. A prophylactic regimen of antibiotics, antivirals, and antifungals is often initiated to provide added protection against infection when the neutrophil count is low.

Brian is diagnosed with acute myelogenous leukemia (AML) after the bone marrow biopsy. This type of leukemia directly impacts what type of cells? Lymphocyte and monocyte Lymphocyte and platelet Plasma and mast Monocyte and platelet

Monocyte and platelet Acute myelogenous leukemia (AML) evolves from the myeloid stem cell, which impacts the neutrophils, erythrocytes, monocytes, and platelets. Lymphoblastic leukemia, both acute and chronic, evolves from the lymphoid stem cell (lymphocytes).

What symptoms must the nurse be aware the client may exhibit in relation to eating and nutrition after chemotherapy and radiation? Select all that apply. Nausea Vomiting Increase in appetite Constipation Ulceration of the mouth

Nausea Vomiting Ulceration of the mouth

Arrange the events in the order in which they occur, leading to leukemia. An unknown stimulus mutates a myeloid or lymphoid stem cell. Correct Position: 1 The single cell clones itself to produce an immature white blood cell. Correct Position: 2 The cloning process fills the bone marrow with leukemic cells. Correct Position: 3 The leukemic cells are pushed into circulation. Correct Position: 4 The leukemic cells infiltrate the body's mucous membranes and lungs. Correct Position: 5

Rationale: The process begins when an unknown stimulus mutates either a myeloid or lymphoid stem cell. This single cell clones itself, producing an immature white blood cell. This cell, also known as a leukemic cell or blast, does not mature or die as a result of the mutation. The cloning process becomes uncontrollable and fills the bone marrow with these leukemic cells. These cells are subsequently pushed into the circulation. The bone marrow, spleen, and lymph tissue become congested with the blasts, leading to lymphadenopathies, splenomegaly, and infiltration of the body's mucous membranes and lungs.

The nurse is explaining to the nursing student why neutropenic precautions are instituted for the client with leukemia. The nurse would include which fact in the explanation? The client has an extremely low neutrophil count. The client has an extremely low platelet count. The client has a bacterial infection. The client has a low red blood cell count.

The client has an extremely low neutrophil count.

The client has leukemia and is receiving chemotherapy in the outpatient setting. The nurse explains to the client to call the office if a low-grade fever is noted. The client asks why this could occur. What would be the best response? "The chemotherapy has increased the number of platelets in your body." "The chemotherapy has decreased the number of mature neutrophils that are available to fight infection in your body." "The chemotherapy has impacted the ability of your body to control your temperature." "The chemotherapy has decreased the number of red blood cells that are produced by your body."

"The chemotherapy has decreased the number of mature neutrophils that are available to fight infection in your body."

The nurse is caring for a patient with leukemia who is receiving chemotherapy and radiation. Which precautions should the nurse take for this patient? Select all that apply. Wash hands frequently or use alcohol-based hand sanitizer. Keep fresh cut flowers in the room. Instruct the patient to refrain from consuming blackberries and raspberries. Teach the patient to refrain from meeting very sick people or pets. Monitor the patient's rectal temperature.

Wash hands frequently or use alcohol-based hand sanitizer. Instruct the patient to refrain from consuming blackberries and raspberries. Teach the patient to refrain from meeting very sick people or pets.

The nurse is caring for a patient with leukemia in the postremission maintenance phase of care. Which is the most appropriate should the nurse teach the patient about this treatment? "The treatment involves high doses of chemotherapy." "The treatment begins with radiation therapy." "The treatment involves chemotherapy at low doses or less frequently." "The treatment involves transfusion of red blood cells and/or platelets."

"The treatment involves chemotherapy at low doses or less frequently." Rationale: the post remission maintenance is the second phase of treatment. The patient receives chemotherapy at lower doses and/or less frequently in order to suppress the formation of leukemic cells. This may continue for months or years.

The client is asking the nurse why chemotherapy must continue if the healthcare provider stated the leukemia is in remission. What would be the nurse's best response? "You need to ask the healthcare provider what was meant by this." "After remission is induced, post-remission maintenance chemotherapy is needed for a period of time to continue to suppress the formation of leukemia cells." "Granulocyte-colony stimulating factors must continue, and with this treatment you must continue chemotherapy." "You must have misunderstood; chemotherapy is not necessary if you are in remission."

"After remission is induced, post-remission maintenance chemotherapy is needed for a period of time to continue to suppress the formation of leukemia cells."

The nurse is aware that the client who had a bone marrow transplant is at risk for developing a complication known as graft-vs-host disease. The nurse could use which simple explanation to describe this complication? "The body's circulatory system cannot circulate the donor cells due to their growing size." "The body's immune system is attacked by the donor cells of the bone marrow transplant." "The body's liver stores the donor cells, not allowing them to circulate in the body." "The body's kidneys are damaged from filtering the donor cells."

"The body's immune system is attacked by the donor cells of the bone marrow transplant."

Which is a disorder related to white blood cells (WBCs)? Thrombocytopenia Sickle cell anemia Leukemia Polycythemia

Leukemia Rationale: leukemia is a disorder related to WBCs. Test taking tips: leukemia comes from the work leukocyte.

Which is most appropriate for the nurse to teach a patient with leukemia who has developed thrombocytopenia? Select all that apply. Use a soft-bristle toothbrush to clean the teeth. Use an electric razor for shaving. Refrain from using stool softeners. Apply direct pressure on a laceration for at least 5 minutes. Refrain from using sharp knives for cutting.

Use a soft-bristle toothbrush to clean the teeth. Use an electric razor for shaving. Apply direct pressure on a laceration for at least 5 minutes.

Due to the client's low platelet count, what priority teaching should you share with him? Check your feet weekly for blisters. Avoid the influenza immunization. Eat five small meals a day. Use an electric razor to shave.

Use an electric razor to shave. If the client's platelet count is low, cutting himself with a nonelectric razor could result in uncontrolled bleeding. He should be encouraged to receive the flu vaccine because of his compromised immune system.

The nurse is caring for a patient who is receiving chemotherapy for leukemia. Which treatment is likely to be initiated if the patient develops neutropenic fever? Radiation therapy Low-dose chemotherapy Transfusion of blood products Administration of IV antibiotics

Administration of IV antibiotics Rationale: neutropenic fever is a dangerous situation. The patient is treated with immediate administration of IV antibiotics for survival. Test taking tips: neutropenic fever occurs when the patients ANC is less than 1,000.

A client with leukemia presents to the healthcare provider's office with a low-grade fever and symptoms of general malaise. The healthcare provider orders a complete blood count (CBC) with differential. After reviewing the client's symptoms, the nurse would expect to find which result on the client's CBC report? Elevated platelet count Decreased neutrophil Decreased red blood cell count Increased hematocrit count

Decreased neutrophil

The nurse talks with Brian about his neutropenic status. What possible symptom related to the neutropenia should the client report to his primary health-care provider? Low-grade fever Decrease in ability to smell Insomnia Increased appetite

Low-grade fever The client should immediately call his healthcare provider if he is running a low-grade fever. This symptom is the body's response to an infection because of the decrease in mature neutrophils. Insomnia, increased appetite, and a decreased sense of smell could be reported to the primary healthcare provider but are not related to the client's neutropenic status.

The nurse is preparing to give the client a subcutaneous injection of granulocyte-colony-stimulating factor. The client asks the purpose of the subcutaneous injection. What would be the nurse's best response? "This injection helps to stimulate production of red blood cells in your body." "This injection helps your body to stimulate platelet production." "This injection is given to help your body produce antibodies to fight the leukemia." "This injection helps to stimulate your bone marrow to produce neutrophils."

"This injection helps your body to stimulate platelet production."

The healthcare provider explains to Brian that his physical exam and laboratory results indicate a potential diagnosis of leukemia. What diagnostic test or procedure would be performed to make a definitive diagnosis and determine the extent of the disease process? Bone marrow biopsy Lumbar puncture Liver biopsy MRI

Bone marrow biopsy The healthcare provider would explain to the client that a bone marrow biopsy must be performed to definitively diagnose the type of leukemia and the extent of the disease process. The bone marrow is the source of formation of blood components, including platelets, red blood cells, and white blood cells. If immature white blood cells were present in abnormal numbers in the bone marrow, a biopsy would confirm a diagnosis of leukemia. Diagnostic serum tests would not provide the detailed information that a bone marrow biopsy would provide.

Brian Andres is a 67-year-old male who scheduled a visit with his primary healthcare provider with symptoms of generalized fatigue and weakness, with some mild shortness of breath. He states that he is so tired that he has been going to bed by 7 p.m. He noticed that his gums have started to bleed when he brushes his teeth, and he has a nosebleed about twice a week. The provider performs a history and physical exam, along with ordering various laboratory tests.Brian's frequent nosebleeds and bleeding gums are related to what laboratory finding? Increased white blood cell count Decreased red blood cell count Decreased platelet count Increased hemoglobin

Decreased platelet count The client's frequent nosebleeds and bleeding gums are related to a decreased platelet count. Platelets help the body form blood clots. When the platelet count is low, spontaneous bleeding may occur. An increased white blood cell count could indicate infection. A decreased red blood cell count could indicate anemia. An increased hemoglobin count could indicate dehydration.