Chapter 11

46. Manifestations of Hodgkin lymphoma that distinguish it from non-Hodgkin lymphoma include:

pruritus and night fevers

41. Cytokines that affect hematopoiesis in bone marrow are called colony-stimulating factors (CSFs) based on their ability to:

regulate blood cells.

under normal conditions who controls the total mass of each type or blood circulation that makes it constant?

the Hormone- like- growth factor called CYTOKINES

*The nurse notes that the client has a decreased neutrophil count. The nurse recognizes that the client is at risk for which of the following?

Infection p. 246-247.

Which type of macrophages are found in the liver?

Kupffer cells Page 244

Agranulocytes

LET MONKEYS Lymphocytes B cells T cells Monocytes(macrophages)

A patient diagnosed with systemic lupus erythematosus (SLE) has been experiencing a low neutrophil count. How would this type of neutropenia be classified?

Acquired autoimmune secondary neutropenia Pg.247.

What is an infectious mononucleosis?

An acute, self-limiting viral infection of B lymphocytes. -its a virus who attack the lymphoproliferative disorder - pathogenesis and clinical course * caused by the B- cells

*A patient comes to the clinic following exposure to chicken pox. The patient states he had chicken pox as a child but was worried about getting sick again. Which of the following statements best explains humoral-mediated immunity to the patient?

B lymphocytes (B cells) in the body produce antibodies to fight infections. Once exposed, the cells retain memory and are able to quickly fight off pathogens during re-exposure and prevent the disease from reoccurring. p. 242-244.

*Select the option that best describes the production of T lymphocytes.

Bone marrow - thymus - lymph nodes Page 251

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?

Bone pain p. 251.

The nurse is planning a prevention program for infectious mononucleosis. The best target audience for the program is which of the following?

College students living in a dorm p. 248.

44. 16-year-old boy has enlarged lymph nodes and a sore throat. His girlfriend was recently diagnosed with infectious mononucleosis, which is caused by ________ and commonly transmitted in ________.

Epstein Barr virus; Saliva

*A teenage client has been diagnosed with infectious mononucleosis and asks the health care provider what caused the condition. Which response is most accurate for the nurse to share with this client?

Epstein-Barr virus (EBV) p. 248.

Which colony-stimulating factor (CSF) is given to clients with end-stage renal disease to help with chronic anemia?

Erythropoietin (EPO) p. 243.

The nurse's plan of care for a client with multiple myeloma should include interventions to prevent which of the following?

Fractures p. 257.

Erythocytes

Hemoglobin (Iron & Protein) produced in the bone marrow (adults) liver & spleen men 12-16/ 37-47% women 14-16 / 40-50%

Which of the following assessment and laboratory findings would be most closely associated with acute leukemia?

High blast cell counts and fever. P. 251-252.

The pathologist notes that the client has Reed-Sternberg cells. He knows that these cells are a diagnostic hallmark for which of the following disorders?

Hodgkin lymphoma p. 255-256.

A patient is suspected of having leukemia and is having diagnostic tests performed to determine the type of leukemia. Which of the following forms of leukemia does the nurse recognize has the classic symptoms of pruritus and intermittent fevers associated with night sweats?

Hodgkin's lymphoma (HL) p. 255.

A client with acute leukemia has developed gout. The nurse is aware that this results from:

Hyperuricemia p. 251.

A client with leukemia is receiving rasburicase (Elitek) prophylactically prior to receiving chemotherapy. The nurse teaches the client that the medication is given to prevent which complication?

Hyperuricemia p. 251.

hematopoietic growth factors

Increase peripheral stem cells for transplantation Accelerate cell proliferation after bone marrow engraftment - Erythropoietin (EPO) - Thrombopoietin (TPO) - Granulocyte Colony- Stimulating Factor (G-CSF) - Granulocyte Macrophage Colony- Stimulating Factor (GM-CSF)

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?

Increased blood viscosity p. 251.

What are some Signs and Symptoms of Neutropenia

Initially those of BACTERIA or FUNGAL infections -malainse -chills -fever -extreme weakness -fatigue reduced WBC count.

59. Which of the following patient complaints should prompt a clinician to order a diagnostic work-up for multiple myeloma?

Lately my bones just seem to ache so bad, and nothing seems to help

The pediatrician knows that the most common cause of cancer in children is which of the following?

Leukemia p. 249-250.

60. Which of the following abnormal blood work results is most closely associated with a diagnosis of multiple myeloma?

Low glomerular filtration rate and high calcium levels

*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?

Luekemia p. 249-251.

*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?

Lymph node biopsy p. 255.

57. A patient has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that most likely originated in which of the following sites?

Lymph nodes

51. Which of the following statements accurately describes a component of the hematopoietic system?

Lymphocytes lack cytoplasmic granules.

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?

Maintenance therapy p. 249-252.

plasma carries important substance (ME LA Pelan Hombres Guevones)

Medicine Electrolytes Lipids Amino Acids Pigments Hormones Glucose --In other words it transport -- gases, nutrients, hormones

Granulocytes

NEVER EAT BANANAS Neutrophils Eosinophils Basophils

The physician reviews a client's lab results and notes that the neutrophil count is 900/uL. This is known as which of the following?

Neutropenia p. 246-247.

*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?

Neutrophils Page 244

*A client is admitted with a suspected diagnosis of Hodgkin lymphoma (HL). Which diagnostic test would the nurse look for to confirm the diagnosis?

Presence of Reed-Sternberg cells p. 255.

58. A young adult is preparing to begin treatment for non-Hodgkin lymphoma (NHL), a disease that has disseminated widely. What is the most likely treatment regimen for this patient?

Radiation and chemotherapy

45. The patient is diagnosed with Hodgkin type of lymphoma based on the results of laboratory tests and study of the tumor cells. A distinct characteristic of Hodgkin lymphoma is the presence of:

Reed-Sternberg cells.

55. Which of the following factors differentiates chronic leukemias from acute leukemias?

The leukemic cells are more fully differentiated than in acute leukemias.

56. Following peripheral blood testing and a bone marrow biopsy, a patient has been diagnosed with chronic myelogenous leukemia. Which of the following is most likely to have preceded the patient's diagnosis?

The presence of a Philadelphia chromosome-a

52. Which of the following parts of the body are considered to be parts of the lymphatic system? Select all that apply.

Thymus & Spleen

25. A client with rheumatoid arthritis has been diagnosed with a secondary immune-associated neutropenia called Felty syndrome. The nurse should be assessing this client for which clllinical manifestations of Felty syndrome? Select all that apply.

Upper left quadrant pain on palpation. An area of diminished breath sounds related to pneumonia. p. 247.

53. A patient with a long-standing diagnosis of human immunodeficiency virus (HIV) has recently developed neutropenia and been admitted to a hospital. Which of the following measures should be prioritized by the nurses who are providing his care?

Vigilant infection control and handwashing

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?

White blood cell count p. 248-249.

*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?

White blood cells (WBCs) 18,500/µL p. 243.

50. Multiple myeloma is a malignancy of:

plasma cells.

Erythropoiesis

process of making blood

49. In contrast to acute leukemias, chronic leukemias are malignancies involving abnormal _________________ blood cells in the marrow.

proliferation of well-differentiated

What kind of people used ERYTHOPOIETING Where is it made?

with Hypoxia Renal Failure Chemotherapy for cancer made by the kidneys and liver to stimulate the Bone Marrow

When was a client diagnosed with infectious mononucleosis most likely infected with the Epstein-Barr virus (EBV)?

Four to eight weeks earlier p. 248.

*Which of the following is the main job of lymphocytes?

Immune reaction p. 244.

what are some disease of deficient blood cells production?

-Leukopenia deficiency {Agranulocytosis} No= l,m * neutrophiles * Granulocytopenia -Leukocytosis increase number of leukocytes proliferative disorder -Aplastic anemia * anemia * thrombocytopenia * agranulocytosis

what does Cytokines stimuli

-Proliferation -Differentiation -Functional Activation of the various blood cells

Thrombocytes

-circulating cell fragments of the large megakaryocytes -Function to form platelets plug to help control bleeding -8-9 days in circulation 150,000 - 4000,000 count

What are the disorders of white blood cells

-controlled by multiple hematopoietic growth factor or inducers -the life span of WBC is relatively short *constant renewal is necessary to maintain normal levels -conditions that decrease availability of stem cells or hematopoietic growth factors produce a decrease in WBC's

ways to obtain blood specimens

-skin puncture (capillary blood) (fingers) -venipuncture (veins like foarm ) -arterial puncture (artery radia, brachial, ect.) - bone marrow aspiration (like on, iliac spine bone)

Basophils

0.3- 0.5 % of the total leukocytes consist of HEPARIN ANTICOAGULANT HISTAMINE VASODILATOR MEDIATORS OF INFLAMMATION similar to mast cells involved in HYPERSENSITIVITY REACTION ALLERGIC

The Pluripotent stem cells (Hematopoietic) give rise to how many types?

1- Common Lymphoid Stem Cells - T-cells - B-cells - Natural Killer (NK) cells from 2- Common Myeloid Stem Cells - Erythrocytes(megakaryocytic) - Granulocyte- monocyte pathways Granulocyte(N E B) Monocytes(macrophages)

Eosinophils

1-3 % of the total number of WBC increase in number during --ALLERGIC REACTIONS --PARASITIC INFECTIONS: it uses surface markers to attach themselves to the parasite and then release HYDROLYTIC enzymes

LEUKOCYTES (WBC): (Never Let Monkeys Eat Bananas)

Neutrophils:7 hrs immune response (1st to arrived) Lymphocyte (for years) : memory cells Monocytes(3 days): immune surveillance Eosinophiles (8-12 days) : defense against parasites Basophiles (few hrs - few days) : Inflammatory response

54. A 16-year-old girl has been brought to her primary care provider by her mother due to the daughter's recent malaise and lethargy. Which of the following assessments should the clinician perform in an effort to confirm or rule out infectious mononucleosis?

Palpating the patient's lymph nodes

What are the conditions to respond to the used of Hematopoietic Growth Factor? EPO (erythropoietin) G-CSF (Granulocyte colony stimulating factor) GM-CSF(Granulocyte-monocyte colony-stimulating factor)

-Bone Marrow failure by chemo or aplastic anemia -Anemia of kidneys failure -Hematopoietic neoplasms -Infectious disease such as acquired immunodeficiency syndrome (AIDS) -Congenital and myeloproLIferative disorders -Some solid tumors

A high school soccer player has just been diagnosed with mononucleosis. He tells the nurse he feels "OK" and really needs to play in the championship game this weekend. The most important information for the nurse to provide would be:

"Avoidance of contact sports for a minimum of 3 weeks after diagnosis is recommended." p. 248.

Monocytes/Macrophages

3-8% of total WBC cells survive for months to years in the tissues important role in chronic inflammation involved in the immune response --activate lymphocytes -- present antigen to T cells

A client is ordered the recumbent granulocyte CSF filgrastim. The nurse evaluates the effectiveness by monitoring which of the following?

CBC/diff P. 257.

Lymphocytes

30% of total WBC function in the lymph nodes spleen to defend against microorganism through immune response 3- types B-cells T -cells NK- cells (natural killer cells)

Neutrophils

60-65% OF total WBC they survive in the tissues for appx 4-5 days -- Die in the tissue discharging phagocytic function or die of senescence immune response -infection -inflammation primary pathogen fighting cells 1ry responsible for maintaining normal host defenses against invading substances -- 1st cells to arrive at the site of INFECTION -- originates in the myeloblast found in the BM

17. Which person should the charge nurse assign as a roommate for a client diagnosed with aplastic anemia?

A client in traction with a broken femur p. 243.

*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?

Absolute neutrophil count of 800/uL p. 244.

24. When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant?

Basophils P. 243

The nurse caring for a client in the early stage of multiple myeloma would anticipate the client to complain of which symptom?

Bone Pain P. 251

What is are the causes of Neutropenia

Congenital *alloimmune neonatal neutropenia (maternal Ab) * cyclic neut * kostmann syndrome (severe congenital neutropenia) Acquired * autoimmune * systemic lupus erythematosus * felty syndrome (RA, Splenomegaly, leukopenia) Infection * viruses (Epstein-Barr Virus- Infectious mononucleosis) * Increased consumption of Neutrophils , Autoantibodies, BM suppression Drug- Induced Granulocytopenia * Immune mediated (PCN, PTU) * Accelerated apoptosis (clozapine) * Chemo * Hematologic malignancies involving bone marrow * Radiology therapy * Idiopathic neutropenia occurring in the absence of other disease or provoking influence

plasma also carries metabolic BYproducts

Creatine Lactic Acid Uric Acid

*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?

Decreased immune response p. 244.

A nurse is caring for a newborn that has developed a low platelet count. Which of the following could be the cause?

Decreased thrombopoietin (TPO) p. 243.

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?

EBV Page 253

42. Leukocytes consist of three categories of cells that have different roles in the inflammatory and immune responses. Which of the following leukocytes is correctly matched with its function?

Eosinophils allergic reactions

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?

Place the client on bleeding precautions. p. 246, 251

Platelets (1% )

activate by bleeding or during inflammatory response *( it can be inhibited by meds)

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:

aggressive. p. 252.

plasma functions

aids in body defenses prevents blood loss oncotic regulation

plasma (55%) made by

albumin (most abundant 54%) Fibrinogen Globulin Other proteins WAter

43. The patient has an abnormally low neutrophil count. Neutropenia is most commonly caused by:

drug reactions.

A 20-year-old client has presented for care because she has a cervical lymph node on the right side of her neck that is firm and enlarged, and has been so for several weeks. Palpation of the node is painless. The nurse should document this assessment finding and anticipate:

facilitating the client's lymph node biopsy. p. 255.

48. A child has Down syndrome and has recently experienced unexplained nose bleeds. His blood tests identify blast cells in the peripheral smear. In addition to nose bleeds, his acute leukemia will typically manifest all of the following EXCEPT:

hypogammaglobulinemia.

47. Leukemias are classified according to the predominant cell type. The myelogenous cell type of leukemia can:

interfere with thrombocyte cell maturation.

hematopoietic growth factors

is a PLURIPOTENT STEM CELL IN BONE MARROW blood cells -leukocytes or WBC -Thrombocytes or platelets - Erythrocytes or RBC - Plasma in which cells are suspended.

Hematopoietic

pertaining to the formation of blood or blood cells