Ch 11 Course Point Patho taken from http://thepoint.lww.com/Book/Show

A 9-year-old child has been home from summer camp for 2 weeks and complains of sore throat, low-grade fever, and enlarged cervical lymph nodes. After testing, it is determined the child has Epstein-Barr virus (EBV)-associated infectious mononucleosis. The parent asks the nurse how the child acquired this type of infection. Which of the following is the nurse's best response? a) "The only way to acquire this infection is if the child was kissing another person." b) "The child may have acquired the infection when bitten by a mosquito." c) "The infection is acquired primarily through contact with infected oral secretions." d) "The infection is acquired primarily through contacted with infected blood."

"The infection is acquired primarily through contact with infected oral secretions." EBV spreads from person to person primarily through contact with infected oral secretions. Transmission requires close contact with infected people. Thus, the virus spreads readily among young children in crowded conditions, where there is considerable sharing of oral secretions

A female client with a diagnosis of psoriatic arthritis is presently taking a course of prednisone for the control of symptoms related to inflammation. Which erythrocyte sedimentation rate (ESR) would indicate that the medication course has decreased the inflammation within normal limits? a) 60 mm/hr b) 30 mm/hr c) 90 mm/hr d) 10 mm/hr

10 mm/hr Increased sedimentation rate indicates inflammation and is used as a baseline and trend indicator in managing, for example, psoriatic arthritis. An individual who is diagnosed with psoriatic arthritis will have an initial ESR drawn. If the ESR is > 60 the person is diagnosed with a more severe condition than if the person had an elevated ESR of 40. Generally, the person is prescribed prednisone, and then at follow-up visits, the dose of prednisone will be gradually decreased, depending on the ESR and the person's symptoms.

The nurse evaluating a client's bloodwork determines that a client has an increased risk for infection based on which of the following lab results? a) Absoulute neutrophil count of 800/uL b) Absolute neutrophil count of 1200/uL c) Absoulute neutrophil count of 1000/uL d) Absolute neutrophil count of 1100/uL

Absoulute neutrophil count of 800/uL The absolute neutrophil count is supposed to be 1000/uL and neutropenia or a low neutrophil count is less than 1000/uL, placing the client at risk for infection, as nuetrophils play a critical role in fighting infection.

A patient diagnosed with systemic lupus erythematosus (SLE) has been experiencing a low neutrophil count. How would this type of neutropenia be classified? a) Acquired, drug-related neutropenia b) Acquired, autoimmune secondary neutropenia c) Congenital, cyclic neutropenia d) Congenital, alloimmune neonatal neutropenia

Acquired, autoimmune secondary neutropenia A person with SLE (an autoimmune disease) with neutropenia would be considered to have acquired (not born with), autoimmune secondary neutropenia. Chronic refers to long-term conditions

A patient diagnosed with systemic lupus erythematosus (SLE) has been experiencing a low neutrophil count. How would this type of neutropenia be classified? a) Congenital, alloimmune neonatal neutropenia b) Acquired, autoimmune secondary neutropenia c) Acquired, drug-related neutropenia d) Congenital, cyclic neutropenia

Acquired, autoimmune secondary neutropenia A person with SLE (an autoimmune disease) with neutropenia would be considered to have acquired (not born with), autoimmune secondary neutropenia. Chronic refers to long-term conditions.

A patient comes to the clinic with a runny nose and scratchy throat. The nurse is evaluating the white blood cell count, which shows an elevated number of white blood cells and an increased percentage of eosinophils. Which of the following is the most likely cause of the symptoms? a) Fungal infection b) Bacterial infection c) Viral infection d) Allergic reaction

Allergic reaction Eosinophils increase in number during allergic reactions and parasitic infections.

The cloning of the genes for most of the hematopoietic growth factors has been accomplished. The recombinant proteins that are produced are used in a wide range of clinical problems. What diseases have these proteins been used to fight? a) Anemia of cancer and Parkinson disease b) Aplastic anemia and the anemia of Huntington disease c) AIDS and autoimmune disorders d) Aplastic anemia and the anemia of kidney failure

Aplastic anemia and the anemia of kidney failure The genes for most hematopoietic growth factors have been cloned, and their recombinant proteins have been generated for use in a wide range of clinical problems. They are used to treat bone marrow failure caused by chemotherapy or aplastic anemia, the anemia of kidney failure and cancer, hematopoietic neoplasms, infectious diseases such as AIDS, and congenital and myeloproliferative disorders. Autoimmune disorders, Parkinson disease, and Huntington disease are not anemic disorders, so the recombinant proteins have not been used in the treatment of these diseases.

Which of the following types of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions? a) Granulocytes b) Basophils c) Neutrophils d) B lymphocytes

Basophils The basophil is related to connective tissue mast cell because they contain similar granules and are believed to be involved in allergic and hypersensitivity reactions. Neutrophils, granulocytes, and B lymphocytes are not identified as being similar to mast cells

Select the option that best describes the production of T lymphocytes. a) Bone marrow - plasma cells - lymph nodes b) Plasma cells - lymph nodes - arteries c) Bone marrow - thymus - lymph nodes d) Myocardial tissue - bone marrow - lymph nodes

Bone marrow - thymus - lymph nodes T lymphocytes leave the bone marrow as precursor T lymphocytes and travel to the thymus, where they differentiate into CD4 helper T cells and CD8 cytotoxic T cells. T lymphocytes also travel to the lymph nodes. The first option describes the production of B lymphocytes. The other options do not describe B- or T-lymphocyte production.

Which of the following is the first symptom of multiple myeloma that a patient typically presents with on a visit to the primary care provider? a) Bone pain b) Hypercalcemia c) Pathological fractures d) Kidney failure

Bone pain Multiple myeloma presents primarily in the bones and bone marrow, and the first symptom is typically bone pain. Other symptoms include bone destruction, easy bruising, and fatigue. The other options are not generally seen as being the initial symptom of multiple myeloma.

A client is ordered the recumbent granulocyte CSF filgrastim. The nurse evaluates the effectiveness by monitoring which of the following? a) INR b) CBC/diff c) PT/PTT d) H/H

CBC/diff The nurse would evaluate the effectiveness of the recumbent granulocyte CSF by monitoring the client's CBC/diff, as the intended effect is to stimulate granulocyte maturation and increase neutrophil counts.

The nurse is caring for a client who has a low levels of T lymphocytes. The nurse plans care for a client with which of the following? a) Infection b) Decreased hematocrit c) Decreased immune response d) Anemia

Decreased immune response T lymphocytes differentiate to form CD4+ helper T cells which serve to orchestrate the immune response. A client with low levels of T lymphocytes will have decreased immune response, which the nurse should consider when planning the client's care. (

The nurse is caring for a client who has a low levels of T lymphocytes. The nurse plans care for a client with which of the following? a) Decreased immune response b) Infection c) Anemia d) Decreased hematocrit

Decreased immune response T lymphocytes differentiate to form CD4+ helper T cells which serve to orchestrate the immune response. A client with low levels of T lymphocytes will have decreased immune response, which the nurse should consider when planning the client's care.

The nurse reading a client's history and physical notes that the client has a history of leukopenia. The nurse interprets this to mean that the client has which of the following? a) Anemia b) Leukemia c) Decreased hematocrit d) Decreased leukocytes

Decreased leukocytes Leukopena is a dificiency in leukocytes, a disorder of the white blood cells.

A nurse is caring for a newborn that has developed a low platelet count. Which of the following could be the cause? a) Decreased spleen function b) Increased megakaryocytes c) Increased pluripotent stem cell division d) Decreased thrombopoietin (TPO)

Decreased thrombopoietin (TPO) TPO stimulates the differentiation of platelets.

The nurse is conducting a staff in-service program on non-Hodgkin's lymphomas. The nurse should include that essentially all people with Burkitt lymphoma have evidence of infection with which of the following? a) Helicobacter pylori b) EBV c) HIV d) HTLV-1

EBV The nurse should include that nearly all people with Burkitt lymphoma have evidence of infection with the EBV virus.

A nurse is evaluating laboratory results of a patient diagnosed with a parasitic infection. The tests reveal a large group of cells that are membrane bound with granules in their cytoplasm that are aiding in the destruction of the parasite. Which of the following cells is the nurse evaluating? a) Lymphocyte b) Monocyte c) Macrophage d) Eosinophil

Eosinophil People who have helminthic parasites will have an increase in eosinophils in their complete blood count. The specific cytoplasmic granules of the eosinophils stain red with the acidic dye eosin. In parasitic infections, the eosinophils use surface markers to attach themselves to the parasite and then release hydrolytic enzymes that kill it.

Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to help with their chronic anemia? a) Thrombopoietin (TPO). b) Interleukin. c) Erythropoietin (EPO). d) Neupogen.

Erythropoietin (EPO) The CSFs that act on committed progenitor cells include erythropoietin (EPO) which stimulates RBC production. TPO stimulates platelets. Neupogen is for white blood cell production. Interleukin is a cytokine utilized as a immune response agent.

Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to help with their chronic anemia? a) Neupogen. b) Erythropoietin (EPO). c) Interleukin. d) Thrombopoietin (TPO).

Erythropoietin (EPO). The CSFs that act on committed progenitor cells include erythropoietin (EPO) which stimulates RBC production. TPO stimulates platelets. Neupogen is for white blood cell production. Interleukin is a cytokine utilized as a immune response agent

The nurse's plan of care for a client with multiple myeloma should include interventions to prevent which of the following? a) Urinary tract infections b) Fractures c) Diarhhea d) GI bleed

Fractures In multiple myeloma there is abnormal proliferation of marrow plasma cells, which leads to bone resorption and destruction, predisposing the person to fractures.

A lymph node biopsy pathology report notes the presence of Reed-Sternberg cells on a patient suspected of having a lymphoma. The nurse interprets the report as indicating which of the following? a) Multiple myeloma b) Leukemia c) Hodgkin's lymphoma d) Non-Hodgkin's lymphoma

Hodgkin's lymphoma Hodgkin's lymphoma is a specialized form of lymphoma that features the presence of an abnormal cell called a Reed-Sternberg cell. Therefore the nurse should interpret the pathology report as indicating Hodgkin's lymphoma.

A client with acute leukemia has developed gout. The nurse is aware that this results from: a) Diet b) Alcohol c) Hyperuricemia d) Anorexia

Hyperuricemia Hyperuricemia occurs as the result of increased proliferation or increased breakdown of purine nucleotides secondary to leukemic cell death that results from chemotherapy. It may increase before and during treatment. Prophylactic therapy with allopurinol, a drug that inhibits uric acid synthesis, is routinely administered. Diet will contribute to gout.

Which of the following is the main job of lymphocytes? a) Degranulation b) Immune reaction c) Apoptosis d) Phagocytosis

Immune reaction Immune reaction is the main job of lymphocytes.

Which of the following is the main job of lymphocytes? a) Immune reaction b) Degranulation c) Phagocytosis d) Apoptosis

Immune reaction Immune reaction is the main job of lymphocytes.

A patient is admitted to the emergency department with a diagnosis of polycythemia. The nurse plans to assess for symptoms related to which of the following problems? a) Increased risk of infection b) Increased blood viscosity c) Decreased ability to carry oxygen to the cells d) Inability to form blood clots

Increased blood viscosity Unregulated overproduction of the red cell mass is termed polycythemia, which causes a thickening of the blood and an increased risk of blood clots.

A 44 year-old male hospital client with a diagnosis of end-stage acquired immunodeficiency syndrome (AIDS) has been placed on neutropenic precautions that limit his interaction with visitors, staff and other clients. What is the underlying rationale for these precautions? a) His antibody-mediated immunity is compromised by his low production of neutrophils. b) Neutropenia limits the ability of his CD4 helper cells to present antigens. c) Insufficient levels of neutrophils make him particularly susceptible to infections. d) Cyclic neutropenia limits his body's ability to fight various infections.

Insufficient levels of neutrophils make him particularly susceptible to infections. A decrease in the number of neutrophils places an individual at risk for infection. Neutrophils are not directly involved in the antibody-mediated immune process and his neutropenia is infection-related, not cyclic.

Which type of macrophages are found in the liver? a) Microglial cells b) Histiocytes c) Kupffer cells d) Monocytes

Kupffer cells Rationale: Macrophages found in the liver are known as Kupffer cells. Histiocytes are macrophages found loose in connective tissue, and microglial cells are brain macrophages. Monocytes are referred to macrophages when they enter the tissues.

A client's bone marrow study report reveals the findings of blast cells in the bone marrow. What does the nurse interpret this as indicating? a) Luekemia b) Neutropenia c) Hodgkin's disease d) Non-Hodgkin's disease

Luekemia The finding of blast cells in the bone marrow is indicative of leukemia.

The nurse is conducting patient education for a client who is scheduled to undergo diagnostic testing for non-Hodgkin's lymphoma (NHL). The nurse includes information on which of the following? a) Lymph node biopsy b) Blood cultures c) White blood cell counts d) Diagnostic X-ray

Lymph node biopsy Diagnostic testing for NHL includes a lymph node biopsy and immunophenotyping to determine the lineage and clonality.

When collecting a client's history the client states that he is receiving treatment to maintain remission from leukemia. What does the nurse document that the client is receiving? a) Intesification therapy b) Maintenance therapy c) Lysis therapy d) Induction therapy

Maintenance therapy When a client receives therapy to maintain remission, it is documented and referred to as maintenance therapy.

A nurse sends a blood sample to the lab for analysis. Assuming the sample is normal, the nurse anticipates which of the following white blood cells (WBCs) will account for the highest percentage? a) Eosinophils b) Neutrophils c) Lymphocytes d) Monocytes

Neutrophils Neutrophils constitute 55-65% of the total WBCs.

Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the: a) Erythrocytes. b) Albumin. c) Neutrophils. d) Basophils.

Neutrophils. Neutrophils are very mobile and are the first cells to go to an area of tissue damage. Erythrocytes (RBCs) contain O2-carrying protein that functions in the transport of oxygen. Albumin, a plasma protein does not pass through the pores in the capillary wall to enter the interstitial fluid and therefore contributes to the plasma osmotic pressure and maintenance of blood volume. Basophil granules contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation.

A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered: a) PSA. b) Philadelphia. c) BRCA-1. d) Interleukin cells.

Philadelphia. One of the more studied translocations is the Philadelphia chromosome, which was the first chromosomal abnormality identified in cancer. Cytokines or chemical messengers, such as interleukin (IL)-1, IL-4, IL-6, and interferon, act synergistically to support the functions of the growth factors. BRCA is a genetic test for breast cancer testing. BRCA mutations place the female at risk for developing cancers of the breast and ovary; PSA stands for prostate-specific antigen. It is a protein produced by prostate cells and is utilized to screen for prostate cancer.

A nurse is reviewing a client's complete blood count (CBC) which indicates thrombocytopenia. Based on this result which action should the nurse include in the plan of care? a) Place the client on bleeding precautions. b) Encourage increased oral fluids. c) Place the client on contact isolation. d) Increase intake of iron-rich foods.

Place the client on bleeding precautions. Thrombocytopenia is a decreased number of platelets, which places the patient at high risk for bleeding.

The nurse is caring for a client with leukemia that is having difficulty with blood clotting after having several transfusions with packed red blood cells. What does the nurse anticipate infusing for this client to assist with controlling the bleeding? a) Albumin b) Whole blood c) Platelets d) Ringers Lactate solution

Platelets Thrombocytes, or platelets, are circulating cell fragments of the large megakaryocytes that are derived from the myeloid stem cell. They function to form the platelet plug to help control bleeding after injury to a vessel wall. Their cytoplasmic granules release mediators required for the blood coagulation process. Thrombocytes have a membrane but no nucleus, cannot replicate, and, if not used, last approximately 10 days in the circulation before the phagocytic cells of the spleen remove them.

A client is admitted with a suspected diagnosis of Hodgkin lymphoma (HL). Select the diagnostic manifestation that would confirm the diagnosis. a) H. pylori infection b) Positive Bence Jones proteins c) Epstein-Barr virus d) Presence of Reed-Sternberg cells

Presence of Reed-Sternberg cells HL has the presence of Reed-Sternberg cells and originates in a single node or chain of nodes (rather than extranodal sites). Bence Jones proteins are related to multiple myeloma; Epstein-Barr is related to mononucleosis and H. pylori with gastric ulcer disease

The nurse is caring for a client with multiple myeloma with Bence-Jones proteins. With this "light chain" form of the disease, it is important for the nurse to include assessment for which of the following? a) Renal disease b) Fever c) Urinary tract infection d) Secondary infection

Renal disease People with light chain form of multiple myeloma have Bence-Jones proteins present that are excreted in the urine and are toxic to the renal tubular structures that can lead to renal failure. Therefore, the nurse should include assessment for signs and symptoms of renal failure.

Kostmann syndrome is a severe congenital neutropenia. Which of the following is characteristic of this condition? a) Severe bacterial infections b) Bone marrow disorders c) Severe viral infections d) Autoimmune disorders

Severe bacterial infections Severe congenital neutropenia, or Kostmann syndrome, is characterized by an arrest in myeloid maturation at the promyelocyte stage of development resulting in an absolute neutrophil count of less than 200 cells/μL. The disorder is characterized by severe bacterial infections. Kostmann syndrome is not characterized by bone marrow disorders, viral infections, or autoimmune disorders.

When looking at a granulocyte under a microscope, the anatomy student would describe it as: a) Having no nuclei. b) Lacking granules. c) Having a kidney-shaped nucleus. d) Shaped like a sphere with multi-lobar nuclei.

Shaped like a sphere with multi-lobar nuclei. Granulocytes are spherical and have distinctive multi-lobar nuclei. They are all phagocytic cells that are identifiable because of their cytoplasmic granules. Answers A, B, and C are incorrect. Agranulocytes (lacking granular cytoplasm). Monocytes have a large amount of cytoplasm and a nucleus in the shape of a kidney. Erythrocytes lack a cell nucleus.

A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which of the following treatments that can correct bone marrow deficiencies? a) Whole blood transfusion b) Bone marrow biopsy c) Stem cell transplant d) Complete blood count (CBC)

Stem cell transplant Aplastic anemia develops when the multipotent stem cells fail to grow and provide cells for differentiation. The result is concomitant anemia, thrombocytopenia, and granulocytopenia (pancytopenia). Potential cures for these and many other disorders use hematopoietic stem cells as part of the treatment. Stem cell transplants focus on correcting bone marrow failure, immunodeficiencies, hematologic defects and malignancies, and inherited errors of metabolism.

A 6-year-old child is having a stem cell transplant using umbilical cord blood. What benefit does the nurse understand that this type of transplant will have for the child? a) There are no side effects to this type of transplant. b) This type of transplant does not require an inpatient stay in the hospital. c) This type of transplant creates less risk of graft-versus host disease d) The child will not have to take any form of chemotherapy.

This type of transplant creates less risk of graft-versus host disease Umbilical cord blood from HLA-matched donors is a transplant option for children and carries less risk of graft-versus-host disease. Stem cell transplants focus on correcting bone marrow failure, immunodeficiencies, hematologic defects and malignancies, and inherited errors of metabolism. Sources of the stem cells include bone marrow and umbilical cord blood, which replenish the recipient with a normal population of pluripotent stem cells. Stem cell transplants may be derived from the client (autologous) or from a histocompatible donor (allogeneic). Autologous transplants are often used to replenish stem cells after high-dose chemotherapy or irradiation

The nurse is providing a client with education on taking the medication clozapine. The nurse includes the importance of which of the following? a) Elimination of caffeine b) Daily weights c) Weekly bloodwork d) Decreased sodium diet

Weekly bloodwork The nurse should include the importance of weekly blood work for the first 6 months of therapy to monitor for agranulocytosis.

A high school teenager comes to the emergency room with symptoms that include the abrupt onset of severe pharyngitis and a high fever. The teenager reports that in the previous four days he has "just not felt well." The nurse anticipates orders to include which of the following? a) CT scan b) White blood cell count c) Chest X-ray d) Intravenous antibiotics

White blood cell count The nurse should anticipate orders that include white blood cell count as this teenager is experiencing symptoms of possible mononucleosis, including severe pharyngitis, a fever, and prodromal period that includes maliase. Typically, the peripheral blood of those with mononucleosis includes increase in number of leukocytees with a white blood cell count of 10,000 cells/uL, 30 percent of which are leukocytes.

The nurse is reviewing the complete blood count (CBC) and white blood cell (WBC) differential of a client admitted with lower right abdominal pain. Which laboratory results are the most important for the nurse to communicate to the health care provider? a) White blood cells (WBCs) 18,500/µL b) Platelet count 168,000/µL c) Monocytes 4% d) Basophils 2/µL

White blood cells (WBCs) 18,500/µL Leukocytes are crucial to our defense against disease. The high WBC count in this would indicate that the patient has an inflammatory or infectious process ongoing, which may be the cause of the patient's pain, and that further diagnostic testing is needed.

A patient being treated for polymyalgia rheumatica (PMR) comes to the clinic for a follow-up visit. The current erythrocyte sedimentation rate (ESR) rate has decreased from 60 mm/hour to 30 mm/hour and the patient is afebrile, denies any headaches, and reports a decrease in joint pain and fatigue. Based on these findings, the nurse anticipates which of the following changes to the treatment plan? a) Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks. b) The patient is cured, and no further treatment is necessary. c) Discontinue the current prednisone prescription and start an anti-inflammatory drug such as naproxen. Repeat ESR in 2weeks. d) No change of treatment; continue to monitor the patient with a follow-up visit in 1 month.

a) Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks. The ESR is a screening test for monitoring the fluctuations in the clinical course of a disease such as PMR. Symptoms of this inflammatory disorder include fatigue, fever, pain, and headache, which are all a result of the systemic effects of cytokine release. An individual who is diagnosed with PMR will have an initial ESR drawn. If the ESR is >60, the person is diagnosed with a severe PMR. Generally, the person is prescribed prednisone, and then at follow-up visits, the dose of prednisone will be gradually decreased depending on the ESR and the person's symptoms.

The nursing caring for a 62-year-old client with diffuse large B-cell lymphoma plans care based on the knowledge that this client's lymphoma is: a) indolent. b) encapsulated. c) aggressive. d) rare.

aggressive. Diffuse large B-cell lymphomas are a heterogenous group of aggressive germinal or postgeminal center noeplasms. They evolve rapidly, are multifocal, nodal and extranodal. They are rapidly fatal if left untreated

The nurse is planning a prevention program for infectious mononucleosis. The best target audience for the program is which of the following? a) Parents of preschool children b) College students living in a dorm c) Older adults living in a senior apartment building d) Employees of a large factory

b) College students living in a dorm The best target audience for the program is college students living in a dorm because in developed countries, infectious mononucleosis principally occurs in adolescents and young adults. And it spreads from person to person primarily through contact with infected oral secretions, making it spread easily in crowded conditions where there is considerable sharing of oral secretions.

The pediatrician knows that the most common cause of cancer in children is which of the following? a) Multiple myeloma b) Leukemia c) Infectious mononucleosis d) Non-Hodgkin lymphomas

b) Leukemia Leukemia is the most common cause of cancer in children and adolescents. Multiple myeloma occurs most frequently in people older than 60 years of age. Children are not as likely as adults to be diagnosed with non-Hodgkin lymphomas. Infectious mononucleosis does not cause cancer in children.

Following a bone marrow biopsy, which of the following assessments would indicate the patient is experiencing a complication as a result of this diagnostic procedure? a) BP 90/60, heart rate 132, excess bleeding and hematoma noted at insertion site. b) Respiratory rate 24, complaining of pain at insertion site. c) BP 130/80, oxygen saturation 95%, crackles heard on inspiration. d) Heart rate regular 64 bpm, Temperature 99.6 orally.

b) Respiratory rate 24, BP 90/60, heart rate 132, excess bleeding and hematoma noted at insertion site. The major hazard of a bone marrow biopsy is the risk of hemorrhage. This is usually seen by a decrease in BP, tachycardia, edema from blood pooling in the tissues, etc. All of the other answers contain s/s other than shock. Crackles in the lungs correlate with fluid/secretions in the lungs. A bone marrow aspiration is usually performed on the posterior iliac crest and should not cause an elevated respiratory rate. A low-grade fever is not considered a complication.

A client is experiencing the early stage of multiple myeloma. The nurse would assess the client for: a) Hypercalcemia b) Pathologic fractures c) Bone pain d) Kidney failure

c) Bone pain Bone pain is one of the first symptoms to occur in approximately three fourths of all individuals diagnosed with multiple myeloma. Multiple myeloma presents primarily in the bones and bone marrow. The other choices are also signs and symptoms of the disease, however, not commonly the earliest

A client laboratory report indicates neutropenia. The nurse is aware the client is at greatest risk for development of infection. The most important area for the nurse to assess would be: a) Hair b) Nails c) Skin d) Eyes

c) Skin Neutrophils provide the first line of defense against organisms that inhabit the skin and gastrointestinal tract. Thus, skin infections and ulcerative necrotizing lesions of the mouth are common types of infection in neutropenia.

Which of the following statements most accurately conveys an aspect of lymphatic system activity? a) B cells and macrophages are released from the bone marrow in their completed state. b) Stem cells in the lymph nodes initiate and regulate the process of white cell synthesis. c) Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system. d) B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.

d) B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures. While both precursor B and T lymphocytes begin their development in the bone marrow, they migrate to peripheral lymphoid structures to complete the differentiation process. Stem cells are not located in the lymph nodes and circulation of white cells is not exclusive to the lymphatic circulatory system.

The nurse is caring for a client with multiple myeloma and communicates to the physician the possibility of hypercalcemia based on which of the following symptoms? Select all that apply. a) Frequent urination b) Lumbar pain c) Edema d) Extreme thirst

• Extreme thirst • Frequent urination The nurse should communicate to the physican the possibility of hypercalcemia based on the client's symptoms of extreme thirst and frequent urination. Other symptoms would include nausea and vomiting, loss of appetite, constipation, abdominal pain, muscle weakness, muscle and joint aches, confusion, lethargy, and fatigue.

The nurse is assessing a client newly diagnosed with Hodgkin's lymphoma. Where should the nurse anticipate finding enlarged lymph nodes? Select all that apply. a) Neck b) Groin c) Axilla d) Supraclavicular area

• Neck • Axilla • Supraclavicular area The nurse would anticipate finding enlarged lymph nodes above the level of the diaphragm (axilla, supraclavicular, neck, mediastinal) as this is where the initial lymph node involvement typically occurs

The nurse is speaking to a group of genetic students touring the hospital's laboratory. The nurse talks about the possibility of a genetic predisposition for the leukemias being suggested because of the increased incidence of the disease among a number of congenital disorders. Which congenital disorders are these? (Select all that apply.) a) Down syndrome b) Prader-Willi syndrome c) Cushing syndrome d) Neurofibromatosis e) Fanconi anemia

• Neurofibromatosis • Fanconi anemia • Down syndrome The existence of a genetic predisposition to develop acute leukemia is suggested by the increased leukemia incidence among a number of congenital disorders, including Down syndrome, neurofibromatosis, and Fanconi anemia. Cushing syndrome is not a genetic disorder, nor is Prader-Willi syndrome.

A client with chronic myelogenous leukemia (CML) has been diagnosed with terminal blast crisis. Which of the following clinical manifestations should the nurse focus the assessment on for this client? Select all that apply. a) Headache and lethargy b) Bleeding from the gums c) Low temperature of 96°F d) Increasing confusion e) Shortness of breath and progressive dyspnea

• Shortness of breath and progressive dyspnea • Headache and lethargy • Increasing confusion Explanation: The terminal blast crisis phase of CML represents evolution to acute leukemia and is characterized by an increasing number of myeloid precursors, especially blast cells, in the blood. With very high blast counts (>100,000 cells/μL), symptoms of leukostasis may occur. The high number of circulating leukemic blasts increases blood viscosity and predisposes to the development of leukoblastic emboli with obstruction of small blood vessels in the pulmonary and cerebral circulations. Occlusion of the pulmonary vessels leads to vessel rupture and infiltration of lung tissue, resulting in sudden shortness of breath and progressive dyspnea. Cerebral leukostasis leads to diffuse headache and lethargy, which can progress to confusion and coma.