patho phys ch 11
The health care provider suspects a client may have developed a leukemia that originates from the B cells. Which cancers would the nurse associate with B cell lymphocytes?
Acute lymphocytic leukemia (ALL) and chronic lymphocytic leukemia (CLL)
The nurse is presenting at an educational event to a group of clients with cancer. What would the nurse cite as the most commonly occurring hematologic cancer?
Non-Hodgkin lymphomas
A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked to name the first chromosomal abnormality that identifies cancer, one student correctly answered:
Philadelphia
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 prolonged chronic phase of leukemia.
The nurse is caring for a client with chronic myelogenous leukemia (CML) and notes that the client has splenomegaly and an increased basophil count as well as night sweats, bone pain, and a low grade fever. The nurse interprets the symptoms as indicating that the client is in which phase of the clinical course of CML?
accelerated
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?
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
When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant?
basophils
Which type of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions?
basophils
The nurse caring for a client in the early stage of multiple myeloma would anticipate the client to report which symptom?
bone pain
A student makes the statement to a colleague, "Blood plasma is essentially just a carrier for the formed cells like red blood cells and white blood cells." What would be the most accurate response to this statement?
"Actually, plasma plays a significant role in nutrient and waste transport."
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."
A 70-year-old woman has received a diagnosis of chronic myelogenous leukemia (CML) after a clinical investigation sparked by the presence of leukocytosis in her routine blood work. What clinical course should her care provider tell her to expect?
"You could remain the chronic stage of CML for several years before it accelerates and culminates in a crisis."
Which client has an absolute neutrophil count (ANC) that is critically low and the standard of care would recommend placement on neutropenic precautions?
37-year-old client with leukemia being treated with chemotherapy with ANC of 400 (0.40 x 109/L).
A client is diagnosed with infectious mononucleosis. When was this client most likely infected with the Epstein-Barr virus (EBV)?
4-8 weeks earlier
In which individuals would a clinician most suspect multiple myeloma as a diagnosis?
A 40-year-old man who has had 3 broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated.
In which client would a clinician most suspect multiple myeloma as a diagnosis?
A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated.
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
The nurse evaluating a client's blood work determines that a client has an increased risk for infection based on which lab result?
Absolute neutrophil count of 800/μL (0.80 x 109/L)
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
Which types of leukemias originate from the B cells? Select all that apply.
Acute lymphocytic leukemia Chronic lymphocytic leukemia
Which client is most likely to have a workup to rule out Hodgkin lymphoma?
Adult client concerned about an enlarged lymph node in the axilla
Which lymphatic tissue is associated with mucous membranes and is called mucosa-associated lymphatic tissue, or MALT? Select all that apply.
Alimentary canal and genitourinary systems
Which type of lymphocyte is involved with humoral-mediated immunity?
B lymphocytes
Definitive diagnosis of multiple myeloma includes the triad of bone marrow plasmacytosis, lytic bone lesions, and:
Bence Jones proteins in urine
In which mature B-cell lymphoma do clients have virtually 100% evidence of previous Epstein-Barr virus (EBV) infection?
Burkitt lymphoma
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?
Chest auscultation reveals crackles in her lower lung fields bilaterally.
In which conditions are Bence Jones proteins not found in the lab analysis? Select all that apply.
Chronic lymphocytic leukemia Chronic myelogenous leukemia Hodgkin lymphoma
A client's laboratory report shows the presence of the Philadelphia chromosome. Which diagnosis should the nurse suspect the client has developed?
Chronic myelogenous leukemia (CML)
The nurse working on a cancer unit is assessing clients for neutropenia. Which client has the greatest risk?
Client receiving IV chemotherapy
To have stem cells for transplantation, clients are given specific agents to increase the quantity and migration of the cells from the bone marrow. What is the agent used to accomplish this?
Cytokine growth factor
A nurse is caring for a newborn that has developed a low platelet count. What could be the cause?
Decreased thrombopoietin (TPO)
Endemic Burkitt lymphoma occurs in regions of Africa where what other infections are common?
Epstein-Barr and malaria
Aplastic anemia is the result of which condition?
Failure of multipotent stem cells to grow
A client being treated for polymyalgia rheumatica (PMR) comes to the clinic for a follow-up visit. The current erythrocyte sedimentation rate (ESR) rate has decreased from 60 mm/hour to 30 mm/hour and the client is afebrile, denies any headaches, and reports a decrease in joint pain and fatigue. Based on these findings, the nurse anticipates which change to the treatment plan?
Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks.
A client who has received chemotherapy has a steadily decreasing white blood cell count. To increase the neutrophil count, the nurse anticipates administering:
Granulocyte colony-stimulating factor
A client is suspected of having leukemia and is having diagnostic tests performed to determine the type of leukemia. Which form of leukemia does the nurse recognize has the classic symptoms of pruritus and intermittent fevers associated with night sweats?
Hodgkin lymphoma (HL)
A client is admitted to the emergency department with a diagnosis of polycythemia. The nurse plans to assess for symptoms related to which problem?
Increased blood viscosity
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.
Which statements about infectious mononucleosis are inaccurate? Select all that apply.
It results from infection by mycoplasma. It is transmitted by sexual contact. It is mainly a disease of postmenopausal women.
Which type of macrophages are found in the liver?
Kupffer cells
A client arrives for a scheduled bone marrow aspiration and biopsy. The nurse explains to the client that which position(s) is best for accessing the posterior iliac crest for aspiration? Select all that apply.
Lateral decubitus Prone
A nurse educator is explaining to a group of students the differences between leukemias and lymphomas. With respect to classification of these diseases, which explanation is most accurate?
Leukemia arises from precursors in marrow, and lymphomas originate in peripheral lymphoid structures.
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.
The granulocyte cell lines are derived from:
Myeloid stem cells
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
The nurse is evaluating a client's blood work results. Which lab result should the nurse recognize as outside of the normal limits?
Neutrophils 950/μL (0.95 x 109/L)
When a white blood cell with differential count reveals an acute infection, which statement is correct regarding the client's neutrophils?
Neutrophils are the first white blood cell to elevate in an acute infection.
Acute lymphocytic leukemia (ALL) and acute myelocytic leukemia (AML) are two distinct disorders with similar presenting clinical features. What clinical feature do ALL and AML share?
Night sweats
Which intervention would be most appropriate by the nurse caring for a client in the neutropenic phase of cyclic neutropenia?
Perform/assist with oral care
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:
Pluripotent stem cells
A client's history documents the presence of a myelocytic leukemia. The nurse interprets this to mean that the leukemia is:
Predominant cell is myelocytic
A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to the touch. Which of the following hematologic processes is most likely occurring in the bone marrow in response to the infection?
Proliferation of immature neutrophils
The nurse planning care for a client with acute lymphoblastic leukemia (ALL) should include the use of:
Soft bristle toothbrush
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?
Staphylococcus aureus
Drug-induced neutropenia is a disease that has significantly increased in incidence over the last several decades. What is the attributing factor in the increased incidence of drug-induced neutropenia?
Treatment of cancer by chemotherapeutic drugs
A nurse is reviewing the laboratory data for a hospitalized client. The nurse would be most concerned about which finding?
White blood cell (WBC) count of 2800/µL (2.80 x 109/L)
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
The nurse is caring for a client with cyclic neutropenia. The nurse understands that this is which type of neutropenia?
congenital
A nurse on an oncology floor is treating a client who is anemic following chemotherapy. The drugs being administered are designed to increase the number of red blood cells in circulation. These drugs are likely agonists of:
cytokines.
The nurse caring for a client in the induction therapy phase understands that the intent of the therapy is to:
elicit a remission
Which colony-stimulating factor (CSF) is given to clients with end-stage renal disease to help with chronic anemia?
erythropoietin (EPO)
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:
fibrinogen
Which glycoprotein is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia?
growth factors and cytokines
The pathologist notes that the client has Reed-Sternberg cells. He knows that these cells are a diagnostic hallmark for which disorder?
hodgkin lymphoma
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?
multiple myeloma
The nurse is teaching the mother of an infant diagnosed with aplastic anemia about the pathophysiology of the disease. The nurse knows that the mother understands when the the mother identifies which statement as the cause of aplastic anemia?
my child's stem cells are not able to grow and divide
Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the:
neutrophils
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
When looking at a granulocyte under a microscope, the anatomy student would describe it as:
shaped like a sphere with multilobar nuclei.
When assessing the mouth of a client receiving chemotherapy, which of the following should the nurse interpret as a possible indicator of neutropenia?
stomatitis
