Hematology

When obtaining subjective data from a patient with leukemia, which question should the nurse ask?

"Did you undergo chemotherapy and radiation therapy for cancer?": Subjective data is the category that includes information related to the surgery or other treatments received by the patient. Therefore the nurse may ask the patient about any chemotherapy and radiation therapy received. The objective data category includes the information about gingival bleeding and oral ulcerations. Neurologic manifestations like seizures, decreased coordination, and confusion are documented in the objective data section. Integumentary information like reddish brown to purple spots on the body is documented in the objective data section.

Which instruction is beneficial for the nurse to provide to a patient diagnosed with pernicious anemia?

"Undergo frequent gastrointestinal cancer screenings.": Pernicious anemia is characterized by decreased secretion of hydrochloric acid in the stomach due to autoimmune-mediated destruction of parietal cells and thereby causes an increased risk for gastric cancer. The patient with cobalamin deficiency can develop pernicious anemia, so the patient should consume foods such as red meat, fish, milk and dairy products. Patients with thalassemia may contract hepatitis C from blood transfusions.

A student nurse asks the nurse about the difference between lymphoma and leukemia. What explanation should the nurse give?

"With lymphoma, there are fewer circulating abnormal cells.": A patient with lymphoma is likely to have fewer circulating abnormal cells compared to a patient with leukemia. Peripheral lymphocytosis with bone marrow involvement, which is commonly associated with leukemia, may also be present in about 20 percent of adults with some types of non-Hodgkin's lymphoma (NHL). Therefore this feature does not differentiate lymphoma from leukemia. A patient with lymphoma would be more likely to have extensive rather than minimal nodal involvement. Both leukemia and lymphoma involve proliferation of lymphocytes or their precursors.

Which patient is most likely to experience anemia related to an increased destruction of red blood cells?

A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.

The nurse recognizes that which treatment option is appropriate for a patient diagnosed with chronic lymphocytic leukemia (CLL)?

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.

Cranial radiation therapy and intrathecal methotrexate are prescribed for a patient. The nurse suspects that the patient has which type of leukemia?

Acute lymphocytic leukemia (ALL)

The nurse expects that a patient will experience central nervous system manifestations with which type of leukemia?

Acute lymphocytic leukemia is associated with neurologic manifestations such as CNS involvement and increased intracranial pressure. Acute myelogenous leukemia is associated with gingival hyperplasia, mild hepatosplenomegaly, and anemia. Chronic lymphocytic leukemia is associated with splenomegaly, lymphadenopathy, and hepatomegaly. Chronic myelogenous leukemia is associated with sternal tenderness, weight loss, joint pain, bone pain, and massive splenomegaly.

The nurse recognizes that which type of leukemia is characterized by the proliferation of immature small lymphocytes in the bone marrow?

Acute lymphocytic leukemia is characterized by the presence of an excessive number of immature small lymphocytes in the bone marrow. Acute myelogenous leukemia is characterized by an increase in the number of myeloblasts. Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes. Chronic myelogenous leukemia occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow.

The nurse recalls that which type of leukemia accounts for 80% of acute leukemia in adults?

Acute myelogenous leukemia (AML): AML accounts for 15%-20% of acute leukemia in children and 80% in adults.

The nurse expects to observe which manifestations in a patient who experienced an acute blood loss of 2000 mL? Select all that apply.

Air hunger, clammy skin, and a decreased central venous pressure are the clinical manifestations seen in a patient who has sustained 2000 mL of acute blood loss. Lactic acidosis may occur in cases of 2500 mL of acute blood loss. Rare vasovagal syncope may occur if 500 mL of acute blood loss occurs.

The treatment plan for a patient with chronic lymphocytic leukemia (CLL) includes a drug that acts by binding to CD52, a panlymphocyte antigen present on both T and B cells. The nurse anticipates that what drug will be prescribed?

Alemtuzumab is used to treat chronic lymphocytic leukemia by binding to CD52, a panlymphocyte antigen present on both T and B cells. Lomustine acts by breaking DNA helix and interfering with DNA replication. Carboplatin acts by binding to DNA and RNA and inhibiting DNA replication. Cyclophosphamide damages DNA by causing breaks in the double-stranded helix

A patient's laboratory report reveals a hemoglobin (Hgb) level of 11 g/dL. The nurse expects to observe which clinical manifestation?

An Hgb range of 10 to 12 g/dL indicates mild anemia. Therefore the patient with an Hgb of 11 g/dL may experience palpitations. Glossitis is one of the manifestations of severe anemia in which the patient would have an Hgb level below 6 g/dL. Exertional dyspnea is seen in patients with mild anemia. However, dyspnea at rest is a manifestation of severe anemia. Roaring in the ears is seen in patients with moderate anemia whose Hgb values range between 6 and 10 g/dL.

The nurse will begin a patient's transfusion of packed red blood cells at 1030. The nurse should plan to stay in the patient's room until what time?

As part of standard procedure, the nurse remains with the patient for the first 15 minutes after hanging a blood transfusion. Patients who are likely to have a transfusion reaction more often will exhibit signs within the first 15 minutes that the blood is infusing. Ten minutes is not enough time to evaluate for adverse reactions; unless the patient is having an adverse reaction, it is not necessary to remain at the bedside for longer than 15 minutes.

Which term is used to indicate the solid masses that result from collection of leukemic cells?

Chloromas refers to the solid masses that result from collection of leukemic cells. Purpura refers to purple spots that occur on the skin as a result of a low platelet count. Petechiae are small red or purple spots on the skin from bleeding. Ecchymosis is discoloration of the skin from bleeding.

A patient is admitted to the emergency department in a state of shock with acute blood loss. The nurse reviews the patient's plan of care and should perform the interventions in what order?

Collaborative care is initially concerned with replacing blood volume to prevent shock. The source of the hemorrhage should then be identified in order to stop the blood loss. Once volume replacement is established, RBC loss is corrected by administering packed RBCs. The patient may also need supplemental iron because the availability of iron affects the marrow production of erythrocytes.

When is consolidation therapy indicated in patients with leukemia?

Consolidation therapy is started after remission is achieved in patients with leukemia. Maintenance therapy is initiated after postinduction therapy, which consists of both intensification and consolidation therapy. Intensification therapy should be given immediately after induction therapy. Induction therapy is given initially when the treatment is indicated in the patient.

A patient with leukemia experiences frequent infections and fever. The nurse recalls that the pathophysiologic events that cause the clinical manifestations occur in what order?

Correct 1. Leukemia causes increase in the number of blast cells Correct 2. Blast cells replace bone marrow Correct 3. Decrease in the number of lymphocytes Correct 4. Suppression of immunity in the body

A patient with cancer who is receiving methotrexate therapy has developed anemia. The nurse recognizes that which therapies may benefit this patient? Select all that apply.

Epoetin alfa Oral folic acid: Epoetin alfa is used to treat anemia related to cancer and its therapies. Methotrexate leads to folic acid deficiency resulting in megaloblastic anemia. Therefore folic acid therapy is given to treat the patient. Oral iron is administered to patients with iron deficiency anemia, which is seen mostly in premenopausal and pregnant women. Blood transfusions are required to keep the approximate hemoglobin level to at least 10 g/dL in the case of thalassemia and severe anemia. Parenteral vitamin B12 is administered to treat cobalamin deficiency caused by pernicious anemia.

A patient that is receiving treatment for thalassemia show evidence of hemolysis. The nurse anticipates a prescription for which supplementation?

Folic acid is given if there is any evidence of hemolysis in patients with thalassemia. Zinc supplementation is required in patients with thalassemia after chelation therapy, because zinc levels may decline. Vitamin B12 supplementation is required for patients with megaloblastic anemias. Ascorbic acid supplementation may be needed during chelation therapy in patients receiving treatment for thalassemia, because it increases urinary excretion of iron.

The nurse recalls that the role of folic acid in erythropoiesis is what?

Folic acid promotes maturation of red blood cells (RBC). Ascorbic acid aids in the absorption of iron. Iron and pyridoxine promote hemoglobin synthesis. Copper helps in the mobilization of iron from tissue to plasma.

The nurse provides education to a group of nursing students about hematopoietic stem cell transplantation (HSCT) therapy as treatment for acute lymphocytic leukemia (ALL). What is appropriate for the nurse to include in the education?

Hematopoietic stem cell transplantation (HSCT) involves removal of the patient's hematopoietic stem cells. Patients with allogeneic HSCT may show signs of infections like pneumonia. There are chances of relapse of leukemia after HSCT therapy. HSCT is associated with complications in patients with allogeneic HSCT. These complications include graft-versus-host disease.

The diagnostic findings of a patient with chronic myelogenous leukemia indicate the presence of the Philadelphia chromosome. The patient's plan of care includes a drug that targets the genes responsible for the origin of the Philadelphia chromosome. The nurse expects that what medication will be prescribed?

Imatinib acts by targeting the BCR-ABL protein. The Philadelphia chromosome, which is present in 90 to 95 percent of patients with chronic myelogenous leukemia, originates from a translocation between the BCR gene on chromosome 22 and the ABL gene on chromosome 9. Doxorubicin acts by directly binding to the DNA and inhibiting its synthesis. Methotrexate acts by interfering with folic acid metabolism. Mercaptopurine acts by interfering with purine metabolism.

The nurse recalls that the steps involved in the pathophysiology of leukemia occur in what chronologic order?

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.

A patient is undergoing aggressive chemotherapy treatment, during which the patient becomes critically ill. The nurse recognizes that the findings indicate that the patient is in which stage of chemotherapy?

Induction therapy involves an aggressive treatment to destroy leukemic cells in the tissues, peripheral blood, and bone marrow to attain remission. The patient becomes critically ill during this therapy, because the chemotherapeutic agents severely depress the bone marrow. Maintenance therapy involves treatment with lower doses of drugs for a prolonged period. Consolidation therapy is given after remission is achieved and is used to eliminate leukemic cells that are not clinically or pathologically evident. Intensification therapy involves high doses of drugs and is given after induction therapy and after remission is achieved.

The nurse recalls that which condition may cause patient anemia due to decreased hemoglobin synthesis?

Iron deficiency may cause anemia due to decreased hemoglobin synthesis. Leukemia may cause anemia due to a decreased number of red blood cell (RBC) precursors. Cobalamin deficiency may result in anemia due to defective DNA synthesis. G6PD enzyme deficiency is hereditary and causes increased RBC destruction (hemolytic anemias).

The nurse cares for a patient with iron-deficiency anemia. Which nursing diagnostic statement associated with the condition is the highest priority?

Iron is necessary for hemoglobin synthesis. Hemoglobin is responsible for oxygen transport in the body. With iron-deficiency anemia a subnormal hemoglobin level cannot carry enough oxygen to the tissues. This results in impaired tissue oxygenation caused by impaired gas exchange. Deficient fluid volume and decreased cardiac output are not directly associated with iron-deficiency anemia. An impaired breathing pattern may develop as a result of impaired gas exchange.

The nurse recalls what information about the Philadelphia chromosome's role in leukemia?

It interferes with normal cell cycle events: The protein that is encoded by the newly created BCR-ABL gene on the Philadelphia chromosome interferes with normal cell cycle events such as the regulation of cell proliferation. The Philadelphia chromosome is not specific to diagnose CML, because it is also found in ALL and occasionally in AML. The Philadelphia chromosome is present in 20 to 25 percent of patients with ALL. It is present in 90 to 95 percent of patients with CML and is a diagnostic hallmark of CML.

The white blood cell count of a patient with leukemia is 120,000 cells/µL. The nurse identifies that which emergency treatment would be most beneficial for the patient?

Leukapheresis Certain patients with leukemia 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 that has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient?

Maintaining oxygenation is a priority, because sickling episodes frequently are triggered by low oxygen tension in the blood, which commonly is caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity also will be used, but oxygenation is the priority.

The diagnostic findings of a patient with leukemia indicate the presence of the Philadelphia chromosome and excessive lymphoblasts in the bone marrow and cerebrospinal fluid. The patient reports frequent episodes of fever, nausea, vomiting, and lethargy. The nurse anticipates a prescription for which medication that will be administered intrathecally?

Methotrexate The presence of the Philadelphia chromosome, and excessive lymphoblasts in the bone marrow and cerebrospinal fluid indicate acute lymphocytic leukemia. These patients experience frequent episodes of fever, nausea, vomiting and lethargy. Intrathecal methotrexate is prescribed to prevent central nervous system involvement in acute lymphocytic leukemia patients. Rituximab is used to treat chronic lymphocytic leukemia. Alemtuzumab is used to treat chronic lymphocytic leukemia. Arsenic trioxide is used to treat acute promyelocytic leukemia, a type of acute myelogenous leukemia.

The nurse reviews the diagnostic results of a patient that received treatment for leukemia. All of the patient's molecular studies are negative for residual leukemia. The nurse recognizes that the patient is experiencing what condition?

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

A nurse is caring for a patient with anemia that requires lifelong iron supplementation. To ensure maximum effectiveness of the therapy, what should the nurse include in the patient's plan of care? Select all that apply.

Monitor the patient for liver problems Evaluate the patient's response to the therapy Continue the supplementation for two to three months after hemoglobin levels return to normal: While undergoing therapy the nurse should evaluate the improvement in hemoglobin levels during every visit and should take necessary steps if hemoglobin levels do not improve. Long-term iron supplementation can cause liver dysfunction; therefore the patient should be evaluated for liver function abnormalities. Iron therapy should be continued for two to three months after hemoglobin levels return to normal to replenish the iron stores in the body. Iron supplementation should not be stopped once hemoglobin levels are back to normal. Iron therapy is not associated with psychologic problems; hence there is no need to monitor for psychologic changes.

A patient with peptic ulcer disease has a history of bloody stools, a hemoglobin level of 10 g/dL, and a total iron level of 40 mcg/dL. The nurse would assess for which clinical manifestations as a result of these laboratory findings? Select all that apply.

Pallor Cheilitis Paresthesias: The normal range of total serum iron level is 50 to 175 mcg/dL. The normal range of hemoglobin is 13.2 to 17.3 g/dL in males and 11.7 to 15.5 g/dL in females. Therefore a hemoglobin value of 10 g/dL and total iron of 40 mcg/dL are indicative of iron deficiency anemia, which may be due to blood loss from peptic ulcer disease. The clinical manifestations of iron deficiency anemia are pallor, cheilitis (inflammation of the lips), and paresthesias. Hepatomegaly may occur in patients with thalassemia due to iron deposition. Jaundice occurs due to prominent hemolysis of red blood cells in patients with thalassemia.

A patient is diagnosed with coagulopathy and receives a prescription for warfarin therapy. The nurse provides dietary education. Which statement made by the patient indicates that the teaching was effective?

Patients on warfarin therapy must be taught to identify foods high in vitamin K and to consume consistent amounts daily. Patients should be advised not to eat large amounts of green, leafy vegetables sporadically as this decreases the effectiveness of warfarin. A balanced diet that includes a consistent amount of vitamin K is necessary to maintain good health. As such, patients should not avoid foods containing vitamin K. Vitamin K is found in many fruits, vegetables, and meats.

Which finding supports the nurse's conclusion that a patient has pernicious anemia?

Pernicious anemia is characterized by the presence of a smooth, beefy-red tongue, and abdominal pain. Platelet function is reduced in the patient with leukemia; therefore, bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron deficiency anemia.

The nurse suspects that a patient has polycythemia vera based on which findings in the patient's laboratory reports? Select all that apply.

Polycythemia vera has increased cobalamin and hemoglobin levels, as well as the presence of increased white blood cell and red blood cell levels. Elevated levels of histamine and blood platelet count are seen in patients with polycythemia vera.

The nurse recognizes that which assessment finding is related to cognitive-perceptual health patterns in a patient with leukemia?

Sore throat is an assessment finding related to cognitive-perceptual health patterns in a patient with leukemia. Nausea comes under the nutritional-metabolic health pattern. Epistaxis is an assessment finding related to activity-exercise. Easy bruising also comes under the nutritional-metabolic health pattern.

Imatinib is prescribed as treatment for leukemia. What is its mechanism of action?

Targets BCR-ABL protein: Imatinib is a newer therapeutic agent used as targeted therapy. It acts by targeting BCR-ABL protein. Arsenic trioxide acts by inhibiting angiogenesis and cell proliferation, and causing DNA fragmentation and cell death.

Which laboratory report findings support the nurse's conclusion that a patient has thalassemia major? Select all that apply.

Thalassemia major is characterized by the presence of increased bilirubin levels, serum iron levels, and reticulocyte level. Thalassemia major is also characterized by the presence of decreased mean corpuscular volume and total iron-binding capacity.

A patient's laboratory reports show a low mean corpuscular volume (MCV) and a high reticulocyte count. The nurse suspects which condition?

Thalassemia: In thalassemia, a low mean corpuscular volume and a high reticulocyte count are observed. In sickle cell anemia, a normal MCV and low reticulocyte count are seen. In hemolytic anemia, a normal MCV and increased reticulocytes are found. An increased MCV and normal or low reticulocyte count occur due to a folic acid deficiency

The nurse recalls that which diagnostic finding is a hallmark of chronic myelogenous leukemia (CML)?

The Philadelphia chromosome is present in 90 to 95 percent of patients with chronic myelogenous leukemia (CML) and is referred to as a diagnostic hallmark of chronic myelogenous leukemia. Thrombocytopenia is not specific for CML. It is common in any type of leukemia. Acute lymphocytic leukemia (ALL) is usually associated with the presence of lymphoblasts in the cerebrospinal fluid. ALL and chronic lymphocytic leukemia are associated with hypercellular bone marrow with lymphoblasts.

The nurse provides discharge teaching to a patient with chronic anemia. What should the nurse include in the education?

The cause of chronic anemia is often inadequate dietary intake of foods high in iron. In most cases of iron-deficiency anemia, the condition may be prevented by consuming a nutritionally balanced diet. Attending a nutrition education session will increase compliance with the recommended diet. Taking supplements of vitamin C, which will increase iron absorption from the GI tract, avoiding large crowds, and discussing the possibility of long-term supplemental iron injections will not have a direct effect on post-discharge management of anemia.

A nurse mentor provides teaching to a group of nursing students about the cardiac manifestations of severe anemia. Which compensatory cardiac changes should the nurse include? Select all that apply.

The compensatory cardiac symptoms of severe anemia are tachycardia, heart failure, and intermittent claudication. The cardiac murmurs that occur in severe anemia are systolic, not diastolic, in nature. In severe anemia, there is an increase in pulse pressure.

The nurse is caring for a patient with severe anemia. The nurse expects which compensatory respiratory changes? Select all that apply.

The compensatory respiratory changes that occur in severe anemia are tachypnea, orthopnea, and dyspnea at rest. Impaired thought process is a neurologic symptom associated with severe anemia. Dyspnea on exertion is seen in mild anemia.

The nurse identifies that the stages of chemotherapy for the treatment of leukemia are administered in what order?

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 not evident. 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.

An initial emergency plan of care for a patient with leukemia includes leukapheresis and hydroxyurea. The nurse concludes that the treatments were prescribed based on which laboratory parameter?

The initial emergent treatment with leukapheresis and hydroxyurea is indicated if the patient has a high WBC count of 100,000 cells/μL or more. The normal range of hemoglobin is 13.2 to 17.3 g/dL in males and 11.7 to 15.5 g/dL in females. Therefore a hemoglobin value of 9 g/dL is indicative of severe anemia and a blood transfusion would be beneficial to this patient. The normal range of platelets is 150,000 to 400,000/μL. Therefore the platelet count of 90,000/μL is indicative of thrombocytopenia. Patients with leukemia may have thrombocytopenia due to bone marrow depression. Thrombocytopenia is treated using colony stimulating factors and platelet transfusions. The normal lactate dehydrogenase level is 140 to 280 mcg/dL. This will be elevated due to tissue damage that occurs from cancer cell destruction.

The nurse reviews a patient's medical record and notes assessment findings which include fatigue, arthralgia, abdominal pain, weight loss, an enlarged liver, and a total body iron level of 70 g. The nurse suspects which condition?

The normal range of total body iron is 2 to 6 g and its concentration exceeds 50 g in case of hemochromatosis. Fatigue, arthralgia, abdominal pain, weight loss, and enlarged liver and spleen are the clinical manifestations of hemochromatosis. Polycythemia is characterized by laboratory manifestations such as elevated hemoglobin and RBC count, low to normal erythropoietin, elevated WBC, platelet, uric acid, and cobalamin levels. The clinical manifestations include headaches, vertigo, dizziness, tinnitus, and visual disturbances. In patients with sickle cell disease, the peripheral blood smear will show sickled cells and abnormal reticulocytes. The patient may have elevated serum bilirubin levels, and bone and joint deformities. In patients with iron deficiency anemia, the laboratory findings indicate a low total body iron and hemoglobin levels along with clinical manifestations such as glossitis, cheilitis, and pallor.

A patient has a prescription written at 1000 for two units of packed red blood cells. If the transfusion is picked up from the laboratory at 1015, the nurse should plan to hang the unit no later than what time?

The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank, which would be at 1045. 1030, 1100, and 1115 are not consistent with this policy.

A patient receives a new prescription for a transfusion of two units of packed red blood cells (PRBCs). The nurse should take which action to ensure patient safety?

The patient's identifying information (name, date of birth, medical record number) on the identification bracelet should match exactly the information on the blood-bank tag that has been placed on the unit of blood. If any information does not match, the transfusion should not be hung because of possible error and risk to the patient. Blood tubing, not primary tubing, is needed for blood transfusion and should not be administered as a secondary infusion. The nurse should remain with the patient for 15 minutes following initiation of transfusion.

The diagnostic findings of a patient with leukemia indicate the presence of the Philadelphia chromosome and excessive lymphoblasts in the bone marrow and cerebrospinal fluid. The patient reports frequent episodes of fever, nausea, vomiting, and lethargy. The nurse anticipates a prescription for which medication that will be administered intrathecally?

The presence of the Philadelphia chromosome, and excessive lymphoblasts in the bone marrow and cerebrospinal fluid indicate acute lymphocytic leukemia. These patients experience frequent episodes of fever, nausea, vomiting and lethargy. Intrathecal methotrexate is prescribed to prevent central nervous system involvement in acute lymphocytic leukemia patients. Rituximab is used to treat chronic lymphocytic leukemia. Alemtuzumab is used to treat chronic lymphocytic leukemia. Arsenic trioxide is used to treat acute promyelocytic leukemia, a type of acute myelogenous leukemia.

A patient with neutropenia asks how the prescribed protective (reverse) isolation helps prevent the spread of organisms. What primary explanation should the nurse give?

The primary purpose of protective, or reverse, isolation is to reduce transmission of organisms to the patient from sources outside the patient's environment. The use of special techniques to destroy discharge or handle the patient's linen and personal items and preventing the spread from the patient to others are not the purpose of protective isolation.

A patient is diagnosed with acute lymphocytic leukemia (ALL). Which diagnostic finding supports the conclusion?

The x-ray of a patient with acute lymphocytic leukemia shows transverse lines of rarefaction at the ends of the metaphysis of the long bones. Low leukocyte alkaline phosphatase is associated with chronic myelogenous leukemia. Acute lymphocytic leukemia is associated with a low platelet and RBC count. Acute myelogenous leukemia is characterized by hypercellular bone marrow with myeloblasts.

The nurse provides teaching to a patient who receives a prescription for an iron supplement. What should the nurse include in the education?

Undiluted liquid iron may stain the patient's teeth; therefore liquid iron should be diluted and ingested through a straw. Iron is best absorbed as ferrous sulfate (Fe2+) in an acidic environment. Therefore iron supplements should be taken about an hour before meals when the duodenal mucosa is acidic. Orange juice contains vitamin C (ascorbic acid), which enhances iron absorption. Therefore it is advisable to take vitamin C supplements along with iron. Constipation may occur commonly in patients who are prescribed iron therapy. Therefore it is advisable to take laxatives and stool softeners when receiving iron therapy.

The nurse reviews the history of an older patient and notes increased fatigue, headache, pale skin, and glossitis. The nurse suspects the patient has microcytic, hypochromic anemia and should provide what teaching?

With microcytic, hypochromic anemia, there may be an iron, B6, or copper deficiency, thalassemia, or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals as it is absorbed best in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider.

The nurse is caring for a patient admitted for treatment of sickle cell disease (SCD). The nurse recalls that with repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially which one?

With repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially the spleen, lungs, kidneys, and brain. Organs that have a need for large amounts of O2, like the lungs, are most often affected and form the basis for many of the complications of SCD. Although the liver, heart, and stomach may be affected, they are less so when compared to the lungs.

Cytarabine + idarubicin

Zinc supplementation Oral deferasirox (Exjade) Continued blood transfusions Ascorbic acid supplementation The patient has thalessemia, is anemic, and has a history of blood transfusions. Oral deferasirox (Exjade) is a chelating agent that binds with iron to prevent iron overload. Such chelation therapy reduces zinc in the body, so zinc supplements should be administered. Blood transfusions are performed to keep the hemoglobin level at approximately 10 g/dL. Adequate hemoglobin promotes erythropoiesis and prevents spleen enlargement. Ascorbic acid supplements increase the excretion of iron in the urine, so they are administered during the chelation therapy. Blood transfusions and hemolysis lead to iron overload, so iron supplements should not be administered.

The nurse recalls that which tests are considered primary methods for diagnosing leukemias? Select all that apply.

Bone marrow examination and peripheral blood evaluation are considered primary methods for diagnosing and classifying types of leukemias. Lumbar puncture and CT scan are used to detect leukemic cells outside of the blood and bone marrow. Morphologic and histochemical examinations are used to detect cell type and stages of development.

A patient with leukemia is undergoing maintenance therapy. The nurse recalls what information about this course of treatment?

Chemotherapy is given every three to four weeks for a prolonged period.

The diagnostic findings of a patient indicate uncontrolled proliferation of myeloblasts. The nurse anticipates that what drugs will be prescribed for induction therapy?

Cytarabine + idarubicin

The nurse recalls that which condition results in anemia due to synthesis of defective DNA in the body?

Folic acid deficiency can cause the synthesis of defective deoxyribonucleic acid (DNA) and result in anemia. A decreased number of red blood cell precursors results in anemia in patients with myelodysplasia and Fanconi syndrome. Increased red blood cell destruction can result in anemia in patients with G6PD enzyme deficiency.

The nurse recalls that hemolytic anemia can be caused by which extrinsic factors?

Infectious agents, such as malaria, are c extrinsic factors that can lead to acquired hemolytic anemias. Membrane abnormalities, such as paroxysmal nocturnal hemoglobinuria, cause increased RBC destruction and are hereditary (intrinsic) factors, Abnormal hemoglobin, such as sickle cell disease, and enzyme deficiencies are intrinsic factors that lead to hereditary (intrinsic) hemolytic anemias.

The nurse is caring for a patient with leukemia. The nurse recalls that which condition may occur due to infiltration of leukemic cells in the patient's body systems?

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.