PATHO 2- CH.11 WBC Disorders

In general, the best prognosis for long-term disease-free survival occurs with A. ALL (acute lymphoid leukemia). B. CLL (chronic lymphoid leukemia). C. AML (acute myeloid leukemia). D. CML (chronic myeloid leukemia).

ANS: A ALL is highly curable in the pediatric population with an 85% survival rate in children. The average age of patients with CLL is 65 to 70 years. Median survival rate is less than 8 years. Patients younger than age 60 have a 4-year survival rate of 30% to 40% in AML. CML has seen a recent rise in overall 5-year survival rate from 22% to 67% with newer treatments and can be as high as 90%.

The patient is a 12-year-old boy with acute lymphoblastic leukemia (ALL). Manifestations of the patient's leukemia prior to treatment may include (Select all that apply.) a. anemia. b. leukocytosis. c. leukopenia. d. thrombocytopenia. e. anuria.

ANS: A, B, D Accumulation of leukemic cells in the bone marrow crowds out the production of normal red blood cells, platelets, and leukocytes that leads to anemia, leukocytosis, and thrombocytopenia. Leukopenia is not a manifestation of ALL. Anuria is not a manifestation of ALL.

A patient is diagnosed with hairy cell leukemia. The patient's laboratory results would most likely indicate a decrease in (Select all that apply.) A. granulocytes. B. platelets. C. white blood cells. D. red blood cells. E. melanocytes.

ANS: A, B, D At diagnosis, patients have hairy cells in the peripheral blood as well as reduced numbers of granulocytes, platelets, and red blood cells. White blood cells are not decreased in the presence of cancer. Melanocytes are pigment-producing cells of the skin.

8. Which clinical findings describe the typical presentation of ALL (acute lymphoid leukemia)? (Select all that apply.) A. Pain in long bones B. Hypercalcemia C. Fever D. None, usually asymptomatic E. Painless enlarged cervical lymph nodes F. Easy bruising

ANS: A, C, E The onset of symptoms of ALL is abrupt and may begin when a child refuses to walk due to long bone pain or begins to exhibit loss of appetite, fatigue, or abdominal pain. Bruising, fever, and infection are also common early findings. Vertebral fractures, elevated calcium levels, and bone pain are more frequently associated with plasma cell myeloma. Asymptomatic onset is generally found with CLL and is often found by accident on a routine blood count. Enlarged cervical lymph nodes are seen more commonly in Hodgkin disease.

A patient is diagnosed with stage IIA Hodgkin disease. This patient's clinical stage was most likely determined by (Select all that apply.) A. patient history. B. lymph node biopsy. C. laparotomy results. D. CT scan. E. physical examination.

ANS: A, D, E The patient's clinical stage is based on history, physical examination, and noninvasive procedures such as CT scanning. The patient's pathologic stage is determined by the results of invasive procedures, such as laparotomy and tissue biopsy.

A patient is seen in the clinic for reports of severe back pain. Her chest x-ray demonstrates generalized bone demineralization and compression fracture. Blood studies demonstrate elevated calcium levels. The most likely diagnosis is A. leukemia. B. myeloma. C. Hodgkin disease. D. back trauma.

ANS: B A diagnosis of plasma cell myeloma (multiple myeloma) is confirmed by the presence of hypercalcemia, which can contribute to the compression fracture. Patients with leukemia diagnoses do not exhibit bone demineralization or elevated calcium levels. Lymphadenopathy is a more common manifestation of Hodgkin disease. Compression fractures can be the result of back trauma, but not in the presence of the other radiographic and laboratory results.

A 5-year-old patient's parents report loss of appetite and fatigue in their child. The parents also state that the child refuses to walk as a result of pain. The child's most likely diagnosis is A. ALL (acute lymphoid leukemia). B. CLL (chronic lymphoid leukemia). C. AML (acute myeloid leukemia). D. CML (chronic myeloid leukemia).

ANS: A ALL is primarily a disorder of children with an abrupt onset of bone pain, bruising, fever, and infection. Children may refuse to walk and experience fatigue, loss of appetite, and abdominal pain. In CML, AML, and CLL, children do not complain of pain with walking. Additionally, chronic leukemia is most commonly found in adults.

Which type of leukemia primarily affects children? A. ALL (acute lymphoid leukemia) B. CLL (chronic lymphoid leukemia) C. AML (acute myeloid leukemia) D. Hairy cell leukemia

ANS: A ALL is primarily a disorder of children. The peak incidence occurs between the ages of 3 and 7 years. CLL is uncommon before the age of 40. The median age of presentation of AML is 64 years. Average onset of CML is between 57 and 60 years. The median age of presentation in hairy cell leukemia is around 55.

A diagnostic laboratory finding in myeloma is A. Bence Jones proteins in the urine. B. decreased platelet count. C. increased IgM antibody titer. D. elevated blood glucose levels.

ANS: A Bence Jones protein in the urine is a common clinical manifestation of plasma cell myeloma. It is also known to accumulate in the kidneys and cause kidney damage. Decreased platelet count is not usually a finding in plasma cell myeloma. IgM is not a factor in plasma cell myeloma. Glucose levels are not directly impacted in plasma cell myeloma.

Burkitt lymphoma is most closely associated with A. Epstein-Barr virus. B. radiation exposure. C. immunodeficiency syndromes. D. history of cigarette smoking.

ANS: A Epstein-Barr virus has been implicated in the development of Burkitt lymphoma. Radiation exposure is a factor in leukemia and lymphoma because of radiation damage. Immunodeficiency syndrome has not been found to be associated with Burkitt lymphoma. Carcinogens found in cigarette smoking are believed to predispose the emergence of malignancies, but are not directly associated with lymphoma.

The major cause of death from leukemic disease is A. infection. B. malnutrition. C. hypovolemic shock. D. kidney failure.

ANS: A Infection is the most common cause of death in the immunocompromised patient, because it can become a life-threatening sepsis. Malnutrition can be a side effect of the disease process or the treatment. Hypovolemic shock is not generally associated with leukemic disease. There is no direct connection between kidney failure and death in leukemia, although kidney failure may occur as a result of treatment.

The Philadelphia chromosome is a balanced chromosome translocation that forms a new gene called a. bcr-abl. b. Rb. c. p53. d. ARA-c.

ANS: A bcr-abl is the translocation of chromosomes 9 and 22, which are known as the Philadelphia chromosome. Rb is a retinoblastoma protein, which is not associated with the Philadelphia chromosome. p53 is a tumor suppressor not associated with the Philadelphia chromosome. ARA-c is a chemotherapeutic agent used to treat leukemia.

Which viruses have been implicated as cancer-causing agents? (Select all that apply.) A. Epstein-Barr B. Human T-cell leukemia C. Human immunodeficiency D. Herpes E. Shingles

ANS: A, B, C Epstein-Barr has been linked to Hodgkin disease and Burkitt lymphoma. Human T-cell leukemia virus is linked to the development of adult T-cell lymphoma and leukemia. HIV is linked to B-cell lymphomas. The herpesvirus has been long suspected as a mutagenic agent, but no definitive association has been found. Shingles has not been implicated as a cancer-causing agent.

A patient is diagnosed with myeloma. The nurse teaches the patient about the multiple tumor sites that can develop with this cancer. The possible tumor sites in myeloma include the (Select all that apply.) a. liver. b. spleen. c. bones d. pancreas. e. kidneys.

ANS: A, B, C, E Myeloma may invade bone, lymph nodes, liver, spleen, and kidneys. The pancreas is not usually a tumor site in myeloma.

A patient is diagnosed with stage III non-Hodgkin lymphoma and is preparing to undergo treatment. Which treatments may be used to treat this patient's cancer? (Select all that apply.) A. Radiation B. Bone marrow transplant C. Chemotherapy D. Lymph node transplant E. Monoclonal antibody therapy

ANS: A, B, C, E Radiation, chemotherapy, tissue-specific therapies such as monoclonal antibodies, and bone marrow transplants may all be applicable in treating non-Hodgkin lymphoma. A lymph node transplant is not used to treat non-Hodgkin lymphoma.

A patient is diagnosed with CML (chronic myeloid leukemia). The patient may experience which of these symptoms? (Select all that apply.) A. Fatigue B. Weight loss C. Abdominal discomfort D. Joint pain C. Sweats

ANS: A, B, C, E The usual clinical presentation of CML includes a high granulocyte count on the CBC and splenomegaly. Symptoms of CML include fatigue, weight loss, sweats, bleeding, and abdominal discomfort from the enlarged spleen. Joint pain is not a symptom of CML.

What is the correct definition of complete remission (CR) of leukemia? A. CR is the absence of leukemic cells in the blood. B. CR is less than 5% blasts in marrow and normal CBC values. C. CR is absence of leukemic cells regardless of CBC values. D. CR is less than 5% leukemic cells in the blood.

ANS: B Complete remission (CR) is a return to normal hematopoiesis. The bone marrow must have less than 5% blasts and must be maintained for at least 4 weeks in order to achieve CR. CR is an absence of leukemic cells, in addition to normal red cell, platelet, and neutrophil counts. CR must include normal hematopoiesis as well as an absence of leukemic cells. CR must include less than 5% blasts in marrow in addition to no detectible neoplastic cells.

The nurse educating a patient on a new diagnosis of non-Hodgkin lymphoma would provide which information in the teaching plan? A. The pattern of spread is contiguous. B. There may be gastrointestinal tract involvement. C. Usually there is no metastasis to the liver. D. It normally does not affect bone marrow function.

ANS: B One feature that distinguishes non-Hodgkin lymphoma from Hodgkin lymphoma is that GI involvement is more common. A contiguous spread of the disease, uncommon liver metastasis, and sparing of bone marrow are more common in Hodgkin lymphoma.

Renal insufficiency is a common complication of which disease? A. Chronic myeloid leukemia (CML) B. Chronic lymphoid leukemia (CLL) C. Myeloma D. Hodgkin disease

ANS: C Renal insufficiency is seen in 30% to 50% of patients with plasma cell myeloma because of hyperproteinemia, Bence Jones protein, hypercalcemia, and hyperuricemia. Chronic myeloid leukemia is manifested by splenomegaly. Chronic lymphoid leukemia is a disease that affects lymphoid tissues and bone marrow. Malignancy along lymphatic pathways is more typical of Hodgkin disease.

While in the hospital for management of acute lymphoid leukemia (ALL), a patient develops severe thrombocytopenia. The most appropriate action for this condition is A. anticoagulant therapy. B. chemotherapy. C. activity restriction. D. isolation.

ANS: C Thrombocytopenia can produce a life-threatening hemorrhage. Patients with this condition should be protected from trauma and placed on activity restriction to reduce the risk of bleeding. Anticoagulant therapy in a patient with thrombocytopenia could actually cause the patient more bleeding. Thrombocytopenia is a complication of leukemia and chemotherapy. Chemotherapy is not an appropriate treatment option for thrombocytopenia. Isolation is not effective in managing the risk of hemorrhage.

Autologous stem cell transplantation is a procedure in which A. there is a high rejection rate. B. stem cells are transferred to the patient from an HLA-matched donor. C. stem cells are transferred to the patient from an identical twin. D. stem cells are harvested from the patient and then returned to the same patient.

ANS: D In autologous transplantation, the stem cells are collected from the patient's own blood and then stored and reinfused in the same patient after chemotherapy and radiation. The use of autologous transplants eliminates the problem of graft-versus-host disease. Transplant from a closely matched donor is known as allogeneic transplant. In autologous transplant, stem cells are used from the patient's own blood.

The patient diagnosed with acute lymphoid leukemia (ALL) must undergo several weeks of chemotherapy. The most serious complication of chemotherapy is a. vomiting. b. anemia. c. alopecia. d. infection.

ANS: D Infection is the most troublesome complication of chemotherapy for the immunosuppressed patient, and infection is a major cause of death in a leukemic patient. Nausea and vomiting are common findings in the treatment phase. While anemia is a common complication of the disease and treatment, it is not as serious as immunosuppression. Alopecia is an unfortunate side effect of chemotherapy, but is not a life-threatening complication.

Which form of leukemia demonstrates the presence of the Philadelphia chromosome? A. ALL (acute lymphoid leukemia) B. CLL (chronic lymphoid leukemia) C. AML (acute myeloid leukemia) d. D. CML (chronic myeloid leukemia)

ANS: D The majority of CML cases are characterized by malignant granulocytes that carry the Philadelphia chromosome. ALL is manifested by the malignant transformation of B cells and some T cells. CLL is associated with T-cell transformation. The Philadelphia chromosome is not seen in CLL. AML is associated with a transformation of a myeloid stem cell