EAQ- Lewis Med Surg CH.31, Nursing Management: Hematologic Problems- Leukemia

Which leukemia is most commonly seen in children? 1. Acute lymphocytic leukemia 2. Acute myelogenous leukemia 3. Chronic lymphocytic leukemia 4. Chronic myelogenous leukemia

1. Acute lymphocytic leukemia Acute lymphocytic leukemia is most commonly seen in children. Acute myelogenous leukemia, chronic lymphocytic leukemia, and chronic myelogenous leukemia are commonly seen in older adults.

The white blood cell count of a patient with leukemia is 120,000 cells/µL. Which emergency treatment would be most beneficial for the patient? 1. Leukapheresis 2. Antitumor antibiotic 3. Monoclonal antibodies 4. Hematopoietic stem cell transplantation

1. Leukapheresis Certain leukemia patients may develop a high white blood cell count with more than 100,000 cells/µL. These patients may require initial emergency treatment with leukapheresis. This procedure involves removal of the white blood cells from the blood. Antitumor antibiotics are given in combination with other chemotherapeutic agents during different stages of chemotherapy but may not be used for emergency treatment. Monoclonal antibodies, like rituximab, are used to treat chronic lymphocytic leukemia, but may not be effective for emergency treatment. Hematopoietic stem cell transplantation is used to eliminate leukemic cells from the body, but may not be effective for emergency treatment.

A patient diagnosed with leukemia is given the initial treatment. During a follow-up visit, the primary health care provider identifies that there are no symptoms, and the peripheral blood smear is normal, but there is evidence of disease in the bone marrow. In which stage of disease control does the nurse anticipate the patient to be? 1. Partial remission 2. Complete remission 3. Molecular remission 4. Minimal residual disease

1. Partial remission After the diagnosis of leukemia, the first stage of therapy, which is the induction therapy, is given to achieve remission. In partial remission, there will be a lack of symptoms, and the peripheral blood smear will appear to be normal; however, evidence of disease in the bone marrow can be observed. In complete remission, there will be a lack of symptoms and no evidence of disease in the bone marrow. In molecular remission, all molecular studies are negative for residual leukemia. In minimal residual disease, tumor cells are not detected by morphologic examination but can be identified by molecular testing.

A patient with leukemia, who is on induction therapy, shows absence of any symptoms of the disease. The peripheral blood smear of the patient is normal, but the bone marrow shows evidence of the disease. Which term is used to refer to the patient's condition? 1. Partial remission 2. Complete remission 3. Molecular remission 4. Minimal residual disease

1. Partial remission Partial remission is a condition in which there is a lack of symptoms of the disease and a normal peripheral blood smear, but evidence of the disease in the bone marrow. Complete remission refers to the condition in which the bone marrow and the peripheral blood appear normal. Molecular remission is the condition in which all molecular studies are negative for residual leukemia. Minimal residual disease refers to the tumor cells that cannot be detected by morphologic examination, but can be detected by molecular testing.

Patient A: African Americans Patient B: Mediterranean origin Patient C: Ashkenazi Jews Patient D: Scandinavians The nurse is assessing four patients. Which patient does the nurse anticipate to be in need of cranial radiation therapy? 1. Patient A 2. Patient B 3. Patient C 4. Patient D

1. Patient A Cranial radiation therapy is given to a patient when the leukemia involves the central nervous system (CNS). This is commonly observed in patients with acute lymphocytic leukemia. Therefore, Patient A is in need of cranial radiation therapy. Acute myelogenous leukemia, chronic lymphocytic leukemia, and chronic myelogenous leukemia are not commonly associated with CNS leukemia, and therefore, cranial radiation therapy is not required, so Patients B, C, and D do not require cranial radiation therapy.

What is the correct order in which the various stages of chemotherapy for leukemia are administered? 1. Maintenance therapy 2. Induction therapy 3. Intensification therapy 4. Consolidation therapy

2. Induction therapy 3. Intensification therapy 4. Consolidation therapy 1. Maintenance therapy The first stage of chemotherapy is induction therapy, which involves treatment with high doses of drugs to attain remission. The second stage of chemotherapy is intensification therapy. This involves an increase in the dose of drugs given during the induction phase. The next stage of chemotherapy is consolidation, aimed at removing the tumor cells, which are clinically and pathologically nonevident. The final stage of chemotherapy is maintenance therapy, which involves treatment with low doses of drugs every three to four weeks for a prolonged period.

Which treatment option is used for patients with chronic lymphocytic leukemia? 1. α-interferons 2. Intrathecal methotrexate 3. Colony-stimulating factors 4. Autologous hematopoietic stem cell transplantation

3. Colony- stimulating factors A splenectomy and colony-stimulating factors are beneficial treatment options for chronic lymphocytic leukemia. α-interferons are mostly used for the treatment of chronic myelogenous leukemia. Intrathecal methotrexate is generally the preferred treatment option for patients with acute lymphocytic leukemia, because it is most commonly associated with CNS involvement. Autologous hematopoietic stem cell transplantation (HSCT) is used as a treatment option for patients with acute myelogenous leukemia. However, for patients with chronic lymphocytic leukemia, allogeneic HSCT is used.

Which diagnostic test is used to detect leukemic cells outside of the blood and bone marrow? 1. Bone marrow examination 2. Peripheral blood evaluation 3. Computed tomography (CT) scan 4. Morphologic and cytogenetic methods

3. Computed tomography (CT) scan A CT scan is used to detect leukemic cells outside of the blood and bone marrow. Bone marrow examination and peripheral blood evaluation are considered primary methods for diagnosing and classifying the type of leukemia. Morphologic and cytogenetic methods are used to detect cell type and stages of development.

Leukemia patients often suffer from infections and fever. In what order do the pathophysiologic events that cause fevers and infections occur in a leukemia patient? 1. Blast cells replace bone marrow 2. Suppression of immunity in the body 3. Leukemia causes increase in the number of blast cells 4. Decrease in the number of lymphocytes

3. Leukemia causes increase in the number of blast cells 1. Blast cells replace bone marrow 4. Decrease in the number of lymphocytes 2. Suppression of immunity in the body Leukemia is characterized by an increased number of immature white blood cells that are malignant, blast cells. These blast cells replace bone marrow, leading to bone marrow failure. This results in a decrease in the number of lymphocytes. Low lymphocyte count leads to immunosuppression, resulting in infections and fever.

Which information does the nurse include in the objective data while documenting the patient's data? 1. Impotence 2. Prolonged menses 3. Low platelet count 4. Klinefelter syndrome

3. Low platelet count The nurse includes information regarding the patient's diagnostic findings in the objective data. Therefore, the nurse documents low platelet count in the objective data. Information regarding sexuality or the reproductive system, such as impotence, is documented in the subjective data. Information regarding the menstrual cycle, like prolonged menses, is documented in the subjective data. The category called subjective data includes information about chromosome abnormalities such as Down's syndrome, Klinefelter's syndrome, and Fanconi's syndrome.

Which condition may occur due to infiltration of leukemic cells in a patient's body systems? 1. Anemia 2. Leukostasis 3. Thrombocytopenia 4. Meningeal irritation

4. Meningeal irritation Meningeal irritation may occur due to infiltration of leukemic cells in patient's body systems such as the central nervous system. Bone marrow failure may lead to replacement of bone marrow with blast cells thereby causing anemia. Leukostasis is thickening of the blood potentially blocking circulatory pathways, which is caused by a high leukemic white blood cell count in the peripheral blood. Bone marrow failure may impair the production of platelets leading to thrombocytopenia.

Arrange the steps involved in the pathophysiology of leukemia in chronologic order. 1. Replacement of bone marrow with blast cells 2. Reduction in RBC, WBC, and platelet count 3. Occurrence of anemia, pallor, and infection 4. Proliferation of immature white blood cells

4. Proliferation of immature white blood cells 1. Replacement of bone marrow with blast cells 2. Reduction in RBC, WBC, and platelet count 3. Occurrence of anemia, pallor, and infection In leukemia, immature white blood cells such as malignant and blast cells proliferate. Blast cells replace bone marrow resulting in bone marrow failure, which causes a decrease in RBC, WBC, and platelet count. Anemia and pallor occur due to reduction in RBC count. The decrease in WBC count leads to immunosuppression resulting in infection.