Chapter 11: Disorders of White Blood Cells and Lymphoid Tissues
A nurse is assessing a client presenting with symptoms of fatigue, fever, severe joint pain, and headache. Laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour. The client asks what the blood test results mean. What is the most appropriate explanation for the nurse to provide? "The ESR tests for the presence of inflammation in the body." "Your ESR is high; this means you have an inflammatory disease." "The ESR tests for the presence of white blood cells in your body, which can indicate an infection." "I will ask your doctor to explain to you what the ESR test is used for."
"The ESR tests for the presence of inflammation in the body."
A child has been home from camp for 2 weeks and reports a 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, "How did my child acquire this type of infection?" Which is the best response by the nurse? "The infection is acquired primarily through contacted with infected blood." "The child may have acquired the infection when bitten by a mosquito." "The infection is acquired primarily through contact with infected oral secretions." "The only way to acquire this infection is if the child was kissing another person."
"The infection is acquired primarily through contact with infected oral secretions."
Which statement about natural killer (NK) cells is the best explanation of their function when reviewing laboratory work for a 10-year-old child? "Natural killer cells form antibody-producing plasma cells when there is an infection in the body." "The natural killer (NK) cells are located primarily in the thymus." "The primary job of natural killer (NK) cells is to hunt down and destroy foreign cells in the body." "Natural killer cell values will be high if you are having an allergy attack."
"The primary job of natural killer (NK) cells is to hunt down and destroy foreign cells in the body."
A mother brings her child to the pediatric clinic because of irritability, loss of appetite, low-grade fever, pallor, and leg pain. Blood tests reveal anemia, thrombocytopenia, and an elevated leukocyte count with atypical lymphocytes. A diagnosis of acute lymphocytic leukemia (ALL) is confirmed with bone marrow studies. The child undergoes aggressive, high-dose chemotherapy with plans for a possible stem cell transplant. Which question is most appropriate for the nurse to ask the mother? "Is there any history of stem cell disease in your family?" "Would you be willing to donate your stem cells to transplant to your child?" "When your child was born, did you save the umbilical cord blood in a blood bank?" "This procedure is very expensive; will your insurance cover the cost?"
"When your child was born, did you save the umbilical cord blood in a blood bank?"
A mother brings her child to the pediatric clinic because of irritability, loss of appetite, low-grade fever, pallor, and leg pain. Blood tests reveal anemia, thrombocytopenia, and an elevated leukocyte count with atypical lymphocytes. A diagnosis of acute lymphocytic leukemia (ALL) is confirmed with bone marrow studies. The child undergoes aggressive, high-dose chemotherapy with plans for a possible stem cell transplant. Which question is most appropriate for the nurse to ask the mother? "When your child was born, did you save the umbilical cord blood in a blood bank?" "Would you be willing to donate your stem cells to transplant to your child?" "Is there any history of stem cell disease in your family?" "This procedure is very expensive; will your insurance cover the cost?"
"When your child was born, did you save the umbilical cord blood in a blood bank?"
A client is diagnosed with infectious mononucleosis. When was this client most likely infected with the Epstein-Barr virus (EBV)? 2 to 3 months earlier 2 to 4 days earlier 4 to 8 weeks earlier 1 to 2 weeks earlier
4 to 8 weeks earlier
The nurse is reviewing the client's laboratory report. Select the report that represents a normal value for leukocytes. 12,000 cells/mL (12.0 ×109/L) 2000 cells/mL (2.0 ×109/L) 6500 cells/mL (6.5 ×109/L) 13,500 cells/mL (13.5 ×109/L)
6500 cells/mL (6.5 ×109/L)
Which person should the charge nurse assign as a roommate for a client diagnosed with aplastic anemia? A client with viral meningitis A client with bacterial pneumonia A client in traction with a broken femur A client with impetigo
A client in traction with a broken femur
A client 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 Congenital, cyclic neutropenia Acquired, drug-related neutropenia Congenital, alloimmune neonatal neutropenia
Acquired, autoimmune secondary neutropenia
Which types of leukemias originate from the B cells? Select all that apply. Chronic myelogenous leukemia Acute myelogenous leukemia Acute lymphocytic leukemia Chronic lymphocytic leukemia
Acute lymphocytic leukemia Chronic lymphocytic leukemia
A client 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. What is the most likely cause of the symptoms? Bacterial infection Viral infection Allergic reaction Fungal infection
Allergic reaction
The nurse is reviewing the laboratory results of a newborn. The infant has anemia, thrombocytopenia, and granulocytopenia (pancytopenia). Based on these results, the nurse anticipates the diagnosis of which type of anemia? Aplastic anemia Iron deficiency anemia Sickle cell anemia Hemolytic anemia
Aplastic anemia
Which statement most accurately conveys an aspect of lymphatic system activity? Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system. B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures. B cells and macrophages are released from the bone marrow in their completed state. Stem cells in the lymph nodes initiate and regulate the process of white cell synthesis.
B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.
Which type of lymphocyte is involved with humoral-mediated immunity? T lymphocytes Natural killer cells (NKC) Helper T cells B lymphocytes
B lymphocytes
When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant? Neutrophils. Lymphocytes. Basophils. Eosinophils.
Basophils
A client is suspected of having acute leukemia. Which diagnostic test does the nurse prepare for to verify that diagnosis? Magnetic resonance imaging White blood cell count with differential Bone marrow biopsy Blood cultures
Bone marrow biopsy
The nurse caring for a client in the early stage of multiple myeloma would anticipate the client to report which symptom? Pathologic fractures Kidney failure Bone pain Hypercalcemia
Bone pain
What is the first symptom of multiple myeloma that a client typically presents with on a visit to the primary care provider? Hypercalcemia Bone pain Pathologic fractures Kidney failure
Bone pain
What is the first symptom of multiple myeloma that a client typically presents with on a visit to the primary care provider? Kidney failure Hypercalcemia Pathologic fractures Bone pain
Bone pain
A 16-year-old female has been brought to her primary care physician by her mother due to the girl's persistent sore throat and malaise. Which fact revealed in the girl's history and examination would lead the physician to rule out infectious mononucleosis? The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes. Blood work reveals an increased white blood cell count. Chest auscultation reveals crackles in her lower lung fields bilaterally. Her liver and spleen are both enlarged.
Chest auscultation reveals crackles in her lower lung fields bilaterally.
A client's laboratory report shows the presence of the Philadelphia chromosome. Which diagnosis should the nurse suspect the client has developed? Hairy cell leukemia Chronic lymphocytic leukemia (CLL) Chronic myelogenous leukemia (CML) Non-Hodgkin lymphoma
Chronic myelogenous leukemia (CML)
A nurse working in an emergency department is assigned to triage the following clients. Which client should the nurse evaluate first? Client with a history of anemia who has had nausea and diarrhea for 24 hours Client with a clotting deficiency who has ankle swelling after twisting an ankle Client with thrombocytopenia who has oozing after having a tooth extracted Client who has chemotherapy-induced neutropenia (decrease in neutrophil levels) and a temperature of 101.2°F (38.4°C)
Client who has chemotherapy-induced neutropenia (decrease in neutrophil levels) and a temperature of 101.2°F (38.4°C)
The nurse is caring for a client who has a low level of T lymphocytes. The nurse plans care for a client with: Infection Decreased immune response Decreased hematocrit Anemia
Decreased immune response
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: Decreased hematocrit Decreased leukocytes Anemia Leukemia
Decreased leukocytes
A nurse is caring for a newborn that has developed a low platelet count. What could be the cause? Decreased thrombopoietin (TPO) Decreased spleen function Increased pluripotent stem cell division Increased megakaryocytes
Decreased thrombopoietin (TPO)
The nurse is conducting a staff in-service program on non-Hodgkin lymphomas. The nurse should include that essentially all people with Burkitt lymphoma have evidence of infection with: EBV HIV HTLV-1 Helicobacter pylori
EBV
The client has been diagnosed with an acute leukemia. Which signs and symptoms would the practitioner expect to assess in this client? Select all that apply. Ecchymosis High-grade fevers Fatigue Weight gain Epistaxis
Ecchymosis Epistaxis Fatigue
Infectious mononucleosis is a lymphoproliferative disorder caused by the Epstein-Barr virus (EBV) that is usually self-limiting and nonlethal. Which complication can arise during this mostly benign disease? Peripheral nerve palsies Rupture of the lymph nodes Severe bacterial infections Enlarged spleen
Enlarged spleen
Endemic Burkitt lymphoma occurs in regions of Africa where what other infections are common? Herpes zoster and Epstein-Barr Malaria and streptococcal Herpes zoster and streptococcal Epstein-Barr and malaria
Epstein-Barr and malaria
Aplastic anemia is the result of which condition? Failure of multipotent stem cells to grow Hypercellular bone marrow production Abnormal proliferation of white blood cells Overproduction of red blood cells
Failure of multipotent stem cells to grow
During science class, a student asks, "What is the difference between plasma and serum in the blood?" The nurse responds that the primary difference between plasma and serum is that plasma contains: Heparin White blood cells Fibrinogen Hydrogen ions
Fibrinogen
The nurse's plan of care for a client with multiple myeloma should include interventions to prevent: GI bleed Fractures Urinary tract infections Diarrhea
Fractures
The nurse's plan of care for a client with multiple myeloma should include interventions to prevent: Urinary tract infections GI bleed Fractures Diarrhea
Fractures
A client who has received chemotherapy has a steadily decreasing white blood cell count. To increase the neutrophil count, the nurse anticipates administering: Thrombopoietin Erythropoietin Granulocyte colony-stimulating factor Macrophage colony-stimulating factor
Granulocyte colony-stimulating factor
Which glycoprotein is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? T lymphocytes and natural killer cells. Growth factors and cytokines. Natural killer cells and granulocytes. Neutrophils and eosinophils.
Growth factors and cytokines.
Which topic should the nurse include in the discharge teaching plan for a client with Felty syndrome? Avoid shaving High protein diet Handwashing Vitamin K
Handwashing
Which assessment and laboratory findings would be most closely associated with acute leukemia? Increased blood urea nitrogen and bone pain High blast cell counts and fever Decreased oxygen partial pressure and weight loss Increased serum potassium and sodium levels
High blast cell counts and fever
The nurse assessing a client diagnosed with multiple myeloma should assess for which clinical manifestation associated with this diagnosis? Hyperparathyroidism Hepatomegaly Hypercalcemia Low vitamin D levels
Hypercalcemia
A client with leukemia is receiving rasburicase prophylactically prior to receiving chemotherapy. The nurse teaches the client that the medication is given to prevent which complication? Hyperuricemia Leukopenia Thrombocytopenia Neutropenia
Hyperuricemia
Which function is the main job of lymphocytes? Apoptosis Phagocytosis Immune reaction Degranulation
Immune reaction
A client is admitted to the emergency department with a diagnosis of polycythemia. The nurse plans to assess for symptoms related to which problem? Decreased ability to carry oxygen to the cells Increased risk of infection Inability to form blood clots Increased blood viscosity
Increased blood viscosity
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? Ischemia Clot formation Infection Bleeding
Infection
A 44-year-old hospitalized 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? Insufficient levels of neutrophils make him particularly susceptible to infections. His antibody-mediated immunity is compromised by his low production of neutrophils. Neutropenia limits the ability of his CD4+ helper cells to present antigens. Cyclic neutropenia limits his body's ability to fight various infections.
Insufficient levels of neutrophils make him particularly susceptible to infections.
Which type of macrophages are found in the liver? Monocytes Histiocytes Microglial cells Kupffer cells
Kupffer cells
The pediatrician knows that the most common cause of cancer in children is: Infectious mononucleosis Non-Hodgkin lymphomas Multiple myeloma Leukemia
Leukemia
A client with severe anemia asks, "What happens if my bone marrow cannot produce sufficient numbers of red blood cells due to my bleeding?" Which response(s) by the nurse correctly identifies the organs that can resume hematopoiesis? Select all that apply. Pancreas Gall bladder Kidneys Liver Spleen
Liver Spleen
A young adult client presents with an enlarged, firm cervical lymph node on the right side of the neck. Palpation of the node is painless. The nurse should document this assessment finding and anticipate preparing the client for which diagnostic procedure to confirm diagnosis? Lymph node biopsy Watchful waiting and close monitoring of the node over the following weeks Radioactive isotope insertion Bone marrow transplant (BMT)
Lymph node biopsy
A physician is explaining to a 40-year-old male client the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which phenomenon would underlie the physician's explanation? Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas. Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens. Tissue destruction results from neutrophil deactivation.
Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas
A 30 year-old male's blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man's most likely diagnosis? Multiple myeloma Acute lymphocytic leukemia Hodgkin lymphoma Acute myelogenous leukemia
Multiple myeloma
An adult client's blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man's most likely diagnosis? Acute lymphocytic leukemia Acute myelogenous leukemia Hodgkin lymphoma Multiple myeloma
Multiple myeloma
The physician reviews a client's lab results and notes that the neutrophil count is 900/μL (0.90 x 109/L). This is known as: Aplastic anemia Neutropenia Agranulocytosis Leukopenia
Neutropenia
A nurse sends a blood sample to the lab for analysis. Assuming the sample is normal, the nurse anticipates which white blood cells (WBCs) will account for the highest percentage? Neutrophils Monocytes Lymphocytes Eosinophils
Neutrophils
Which is the most common leukocyte in normal blood? Lymphocyte Platelet Neutrophils Monocyte
Neutrophils
Which is the most common leukocyte in normal blood? Neutrophils Lymphocyte Platelet Monocyte
Neutrophils
The nurse is evaluating a client's blood work results. Which lab result should the nurse recognize as outside of the normal limits? Leukocytes 4600 cells/μL (4.60 x 109/L) Neutrophils 1600 cells/μL (1.60 x 109/L) Neutrophils 950/μL (0.95 x 109/L) Leukocytes 8200 cells/μL (8.20 x 109/L)
Neutrophils 950/μL (0.95 x 109/L)
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.
The nurse is caring for a client with leukemia who 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? Whole blood Platelets Albumin Ringer's lactate solution
Platelets
Progenitor cells, or parent cells, for the production of myeloid and lymphoid cells are derived from: Multipotential progenitor cells Unipotent cells Myeloproliferative cells Pluripotent stem cells
Pluripotent stem cells
Progenitor cells, or parent cells, for the production of myeloid and lymphoid cells are derived from: Unipotent cells Myeloproliferative cells Multipotential progenitor cells Pluripotent stem cells
Pluripotent stem cells
The entire hematopoietic system, including the precursor erythroids, myelocytes, lymphocytes, and megakaryocytes are derived from a small population of cells. These cells are known as: Lymphoid stem cells Progenitor cells Pluripotent stem cells Unipotent cells
Pluripotent stem cells
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: Fever Secondary infection Renal disease Urinary tract infection
Renal disease
Kostmann syndrome is a severe congenital neutropenia. Which disorder/infection is characteristic of this condition? Autoimmune disorders Severe bacterial infections Severe viral infections Bone marrow disorders
Severe bacterial infections
A client's history and physical documents the presence of an indolent lymphoma. The nurse plans care for which type of lymphoma? Encapsulated Diffuse Slow-growing Aggressive
Slow-growing
Chronic lymphocytic leukemia (CLL) commonly causes hypogammaglobulinemia. This makes clients with CLL more susceptible to infection. What is the most common infectious organism that attacks clients with CLL? Escherichia coli Pseudomonas aeruginosa Mycobacterium tuberculosis Staphylococcus aureus
Staphylococcus aureus
A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which treatment that can correct bone marrow deficiencies? Bone marrow biopsy Complete blood count (CBC) Stem cell transplant Whole blood transfusion
Stem cell transplant
A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which treatment that can correct bone marrow deficiencies? Bone marrow biopsy Stem cell transplant Complete blood count (CBC) Whole blood transfusion
Stem cell transplant
The nurse practitioner determines that the client receiving chemotherapy has mild neutropenia. Which signs and symptoms would the practitioner expect to see in this client? Select all that apply. Weight gain Diaphoresis Painless swollen lymph nodes Diarrhea Stomatitis
Stomatitis Diarrhea
What is the reason why bed rest and analgesics are expected treatments for infectious mononucleosis? To increase the white blood count To eliminate the causative organism To decrease the risk of neutropenia To relieve fever, headache, and sore throat
To relieve fever, headache, and sore throat
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 clinical manifestation of Felty syndrome? Select all that apply. Upper left quadrant pain on palpation. An area of diminished breath sounds related to pneumonia. Intermittent pain that radiates from the flank to the groin. Headache that worsens with exposure to bright lights. Abdominal cramping following intake of a high-fat meal.
Upper left quadrant pain on palpation. An area of diminished breath sounds related to pneumonia.
A 14-year-old boy has been diagnosed with infectious mononucleosis. Which pathophysiologic phenomenon is most responsible for his symptoms? EBV inhibits the maturation of white cells within his peripheral lymph nodes. The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes. Viruses are killing some of his B cells and becoming incorporated into the genome of others. The Epstein-Barr virus (EBV) is lysing many of the boy's neutrophils.
Viruses are killing some of his B cells and becoming incorporated into the genome of others.
A client is scheduled for the last dose of chemotherapy on Tuesday. The nurse reviews the client's laboratory values, notes a steadily decreasing white blood cell count, and notifies the oncologist, who states, "We will use colony-stimulating factors (CSFs) to stimulate the production of white blood cells." When will the nurse anticipate administering the CSFs? Tuesday, while the client is still receiving chemotherapy Tuesday, immediately following chemotherapy Wednesday afternoon, 24 hours after the chemotherapy ends One week after chemotherapy ends
Wednesday afternoon, 24 hours after the chemotherapy ends
The nurse is providing a client with education on taking the medication clozapine. The nurse includes the importance of: Decreased sodium diet Daily weights Weekly blood work Elimination of caffeine
Weekly blood work
A nurse is reviewing laboratory data for an older adult client. Which laboratory value should the nurse be most concerned about? Hemoglobin 11.8 g/dL (118 g/L) Hematocrit 37% Platelets 400,000/mL (400,000 x 109/L) White blood cell (WBC) count 3500/mL
White blood cell (WBC) count 3500/mL
A nurse is reviewing laboratory data for an older adult client. Which laboratory value should the nurse be most concerned about? Hemoglobin 11.8 g/dL (118 g/L) White blood cell (WBC) count 3500/mL Platelets 400,000/mL (400,000 x 109/L) Hematocrit 37%
White blood cell (WBC) count 3500/mL
A nurse is reviewing the laboratory data for a hospitalized client. The nurse would be mostconcerned about which finding? Eosinophils 1.5/µL White blood cell (WBC) count of 2800/µL (2.80 x 109/L) Red blood cells 4.0/µL Platelet count of 200,000/µL (200,000 x 109/L)
White blood cell (WBC) count of 2800/µL (2.80 x 109/L)
A client has been experiencing anemia and thrombocytopenia. Subsequent diagnostic testing has revealed the presence of immature granulocyte types and the Philadelphia chromosome. This client is likely to experience: a high risk of pathologic bone fractures. hyperuricemia. a prolonged chronic phase of leukemia. a self-limiting infection with the Epstein-Barr virus.
a prolonged chronic phase of leukemia.
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: rare. aggressive. encapsulated. indolent.
aggressive.
A client is prescribed the recumbent granulocyte colony-stimulating factor (CSF) filgrastim. The nurse evaluates the effectiveness by monitoring which laboratory value? complete blood count (CBC)/differential Prothrombin time (PT)/partial thromboplastin time (PTT) international normalized ratio (INR) hemoglobulin and hematocrit (H&H)
complete blood count (CBC)/differential
A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which client would be most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered? An adult with: orthostatic hypotension and syncopal episodes. systemic lupus erythematosus. congestive heart failure. a diagnosis of Alzheimer disease and depression.
systemic lupus erythematosus.
