PrepU: Leukemia

A client diagnosed with chronic myeloid leukemia (CML) is reporting a feeling of abdominal fullness/discomfort, low-grade fever, night sweats, and bone pain. Based on these data, the nurse recognizes the client is most likely in which phase of the disease? A) Accelerated B) Chronic C) Terminal blast crisis D) Initial diagnosis

A) Accelerated

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? A) Maintenance therapy B) Induction therapy C) Intensification therapy D) Lysis therapy

A) Maintenance therapy

A child being treated for leukemia is diagnosed with neutropenia. What nursing instructions directly prevent client infections? Select all that apply. A)Avoid large crowds. B)Inspect the skin daily for scratches or scrapes. C)Increase the intake of fresh fruits and vegetables. D)Remove house plants, flowers, and goldfish from the home environment. E)Stay away from people who have obvious colds, rashes, or other infections.

A, B, D, E

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? A) "It will help rule out a second malignancy." B) "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." C) "The spinal tap will help relieve pressure and headache from your child." D) "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection."

B) "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? A) encouraging child to share feelings B) grouping nursing care C) following guidelines for reverse isolation D) providing age-appropriate activities

C) following guidelines for reverse isolation

A 32-year-old woman presents at her health clinic complaining of weakness, feeling of abdominal fullness, 6-month history of fatigue and night sweats. She added a multivitamin with iron and some extra meat and leafy greens to her diet but has not experienced an increase in energy. Upon assessment, her spleen was noted to be enlarged. Which diagnosis is most likely associated with her manifestations? A)Accelerated chronic myelogenous leukemia B)Stage A Hodgkin disease C)Infectious mononucleosis D)Chronic lymphocytic leukemia

A) Accelerated chronic myelogenous leukemia

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: A)"We should administer the drug on an empty stomach." B)"We should check our son's urine for glucose." C)"He might develop a rounded face from this drug." D)"We will need to gradually decrease the dosage."

A)"We should administer the drug on an empty stomach."

A client's laboratory report shows the presence of the Philadelphia chromosome. Which diagnosis should the nurse suspect the client has developed? A)Chronic myelogenous leukemia (CML) B)Hairy cell leukemia C)Non-Hodgkin lymphoma D)Chronic lymphocytic leukemia (CLL)

A)Chronic myelogenous leukemia (CML)

The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child? A) "You will need to lie still afterward to prevent a headache." B) "You may feel some pressure on your hip during the procedure." C) "You will have to lie on your back and hold your breath." D) "The numbing medicine on your skin will keep you from having pain."

B) "You may feel some pressure on your hip during the procedure."

A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host? A) Acute respiratory distress syndrome B) Graft-versus-host disease C) Remission D) Bone marrow depression

B) Graft-versus-host disease

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? A) Whole blood B) Platelets C) Ringer's lactate solution D) Albumin

B) Platelets

Which client has an absolute neutrophil count (ANC) that is critically low and the standard of care would recommend placement on neutropenic precautions? A)Client on long-term steroids for rheumatoid arthritis with WBC of 7000/µL (7 x 109/L). B)37-year-old client with leukemia being treated with chemotherapy with ANC of 400 (0.40 x 109/L). C)65-year-old client with prostate cancer receiving radiation therapy with neutrophil count of 2,000/μL (2.0 x 109/L). D)75-year-old client with renal failure receiving Epogen for anemia with hemoglobin level of 9.7 g/dL (97 g/L).

B)37-year-old client with leukemia being treated with chemotherapy with ANC of 400 (0.40 x 109/L).

An otherwise healthy 33-year-old woman experienced debilitating and persistent fatigue over a period of several weeks and was subsequently diagnosed with acute myeloid leukemia (AML). The woman has been admitted to the hospital for treatment. The nurse who is providing care for this patient should prioritize which of the following assessments? A)Assessing the woman for thrombosis and embolism B)Assessing the woman for signs and symptoms of infection C)Assessing the woman's heart rate, rhythm, and circulation D)Assessing the woman for signs and symptoms of fluid volume overload

B)Assessing the woman for signs and symptoms of infection

A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action? A) Ensure that all staff and visitors adhere to infection control precuations B) Space out the client's care to preserve energy and prevent fatigue C) Encourage the client to limit physical activity in order to reduce the risk of bleeding D) Provide small quantities of food several times per day, as tolerated

C) Ensure that all staff and visitors adhere to infection control precautions

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? A) Watchful waiting and close monitoring of the node over the following weeks B)Bone marrow transplant (BMT) C)Lymph node biopsy D)Radioactive isotope insertion

C) Lymph node biopsy

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? A) WBC count of 4,200 cells/uL B) Hematocrit of 38% C) Platelet count of 9,000/mm3 D) Creatinine level of 1.0 mg/dL

C) Platelet count of 9,000/mm3

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) a self-limiting infection with the Epstein-Barr virus B) a high risk of pathologic bone fractures C) a prolonged chronic phase of leukemia D) hyperuricemia

C) a prolonged chronic phase of leukemia

The nurse is talking with a 9-year-old child diagnosed with acute leukemia who will soon begin chemotherapy. The child expresses worry that when her hair falls out friends won't like her or want to play with her anymore. Which response by the nurse would be best? A)Reassure the child that her hair will grow back in 3 to 6 months. B)Tell the child that having chemotherapy is the only way she'll get better. C)Talk with her and her family about wearing a wig, cap, or scarf. D)Distract the child with a book or educational computer games.

C)Talk with her and her family about wearing a wig, cap, or scarf.

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)a self-limiting infection with the Epstein-Barr virus. B)a high risk of pathologic bone fractures. C)a prolonged chronic phase of leukemia. D)hyperuricemia.

C)a prolonged chronic phase of leukemia.

The nursing instructor is discussing the diagnosis of cancer with their nursing class. The instructor tells her students that scientists have predicted that gene therapy will one day play a large role in the prediction, diagnosis, and treatment of cancer. What cancer is gene therapy currently being investigated in the treatment of? A) Pancreatic B) Osetosarcomas C) Leukemia D) Melanoma

D) Melanoma

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? A)Hemolytic anemia B)Polycythemia vera C)Leukemia D)Multiple myeloma

D) Multiple myeloma

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? A) Pancytopenia B) Thrombocytopenia C) Anemia D) Neutropenia

D) Neutropenia

When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence? A)Neuroblastoma B)Osteogenic sarcoma C)Non-Hodgkin lymphoma D)Acute lymphoblastic leukemia (ALL)

D)Acute lymphoblastic leukemia (ALL)

Which types of leukemias originate from the B cells? Select all that apply. A) Acute lymphocytic leukemia B) Acute myelogenous leukemia C) Chronic lymphocytic leukemia D) Chronic myelogenous leukemia

A) Acute lymphocytic leukemia C) Chronic lymphocytic leukemia

Based solely on the inheritable condition, a child with Down syndrome is susceptible for developing which type of cancer? A)Acute lymphocytic leukemia (ALL) B)Kidney cancer C)Brain cancer D)Non-Hodgkin lymphoma

A) Acute lymphocytic leukemia (ALL)

The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? A) Allopurinol B) Filgrastim C) Hydroxyurea D) Asparaginase

A) Allopurinol

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? A)Calling the doctor if the child gets a sore throat B)Keeping a written copy of the treatment plan C)Writing down phone numbers and appointments D)Using acetaminophen if the child needs an analgesic

A) Calling the doctor if the child gets a sore throat

A lymph node biopsy pathology report notes the presence of Reed-Sternberg cells on a client suspected of having a lymphoma. The nurse interprets the report as indicating: A)Hodgkin lymphoma B)Non-Hodgkin lymphoma C)Multiple myeloma D)Leukemia

A) Hodgkin lymphoma

A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive? A)Induction therapy B)Supportive therapy C)Antimicrobial therapy D)Standard therapy

A) Induction therapy

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? A)Child reports facial palsy and vision problems B)Observing petechiae, purpura, or unusual bruising C)Noting adventitious breath sounds during auscultation D)Palpation of abdomen reveals enlarged liver and spleen

A)Child reports facial palsy and vision problems

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? A)Leukemia B)Hodgkin disease C)Non-Hodgkin disease D)Neutropenia

A)Leukemia

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor? A)Observation reveals nystagmus and head tilt. B)Vital signs show blood pressure measures 120/80 mm Hg. C)Examination shows temperature of 101.4° F (38.6°C) and headache. D)Observation reveals a cough and labored breathing.

A)Observation reveals nystagmus and head tilt.

A child with acute lymphocytic leukemia is given leucovorin, a folinic acid, after high-dose methotrexate therapy. It is important to administer this drug because leucovorin: A)prevents methotrexate that is not incorporated into leukemia cells from entering normal cells. B)helps methotrexate enter leukemia cells the same as insulin helps glucose enter cells. C)is an experimental drug to ensure resistance to infection during methotrexate therapy. D)will encourage bone marrow to build new cells after methotrexate therapy.

A)prevents methotrexate that is not incorporated into leukemia cells from entering normal cells.

The nurse assesses a patient for late-stage chronic lymphocytic leukemia (CLL) by looking for what? A) Lymphadenopathy B) Thrombocytopenia C) Hepatomegaly D) Splenomegaly

B) Thrombocytopenia

Which factor differentiates chronic leukemias from acute leukemias? A)Leukemic cells are disseminated throughout the body by the circulatory system. B)Leukemic cells are more fully differentiated in chronic than in acute leukemias. C)The prevalence among individuals with Down syndrome is high. D)They are cancers of the hematopoietic progenitor cells.

B)Leukemic cells are more fully differentiated in chronic than in acute leukemias.

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? A)Mycobacterium tuberculosis B)Pseudomonas aeruginosa C)Staphylococcus aureus D)Escherichia coli

C)Staphylococcus aureus

A nurse is caring for an asymptomatic client with acute myelogenous leukemia. The client has a total white blood cell (WBC) count of 0, a platelet count of 3,000 mm2, and a hemoglobin level of 9 mg/dl. The client has a single lumen central venous catheter in place and the health care provider has ordered the nurse to administer imipenem cilastatin 500 mg every 8 hours, transfuse 1 unit packed red blood cells (RBCs), give amphotericin B 40 mg I.V. over 4 hours, and transfuse 2 pheresis units of platelets. In what order should the nurse infuse these medications and blood products? A) Packed RBCs, amphotericin B, imipenem cilastatin, platelets B) Amphotericin B, imipenem cilastatin, platelets, packed RBCs C) Packed RBCs, platelets, imipenem cilastatin, amphotericin B D) Platelets, imipenem cilastatin, amphotericin B, packed RBCs

D) Platelets, imipenem cilastatin, amphotericin B, packed RBCs

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia? A)Perform a cardiovascular assessment every 4 hours. B)Check the client's history for a congenital link to thrombocytopenia. C)Monitor daily platelet counts. D)Closely observe the client's skin for petechiae and bruising.

D)Closely observe the client's skin for petechiae and bruising.

The nurse is preparing the medication leucovorin to provide to a child who is currently receiving methotrexate for a brain tumor. What should the nurse explain to the child and parents regarding the purpose of this medication? A)It will encourage bone marrow to build new cells after methotrexate therapy. B)It helps methotrexate enter leukemia cells the same as insulin helps glucose enter cells. C)It is an experimental drug to ensure resistance to infection during methotrexate therapy. D)It prevents methotrexate that is not incorporated into leukemia cells from entering normal cells.

D)It prevents methotrexate that is not incorporated into leukemia cells from entering normal cells.

A child diagnosed with acute lymphocytic leukemia undergoes aggressive high-dose chemotherapy and is scheduled for an autologous stem cell transplant. Which treatments would the nurse anticipate administering? Select all that apply. A)Erythropoietin (EPO) to stimulate red blood cell production B)Granulocyte colony-stimulating factor (G-CSF) to promote the proliferation of all neutrophils C)Thrombopoietin (TPO) to stimulate platelet development D)Macrophage colony-stimulating factor (M-CSF) to increase macrophage colonies. E)Flu vaccine to prevent child from contracting a viral infection during recovery

A, B, C, D

An oncology nurse who has worked for many years providing care for children with cancer has taken a job on an adult oncology unit of a hospital. What differences might the nurse anticipate in this new job? A) There will be a greater number of cancers that are epithelial in origin B) A greater proportion of the client will have cancer that involves the hematopoietic system C) The nurse will be working with more clients who have blastomas D) More clients will be receiving treatment for leukemia

A) There will be a greater number of cancers that are epithelial in origin

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? A)Leukemia arises from precursors in marrow, and lymphomas originate in spleen or bone marrow. B)Leukemia arises from peripheral lymphoid structures, and lymphomas originate in precursors in marrow. C)Leukemia arises from precursors in marrow, and lymphomas originate in peripheral lymphoid structures. D)Leukemias originate in lymph nodes, and lymphomas originate in peripheral lymphoid structures.

C)Leukemia arises from precursors in marrow, and lymphomas originate in peripheral lymphoid structures.

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myeloid leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? A)earache, stiff neck, or sore throat B)blisters, ulcers, or a rash appear C)temperature of 101°F (38.3°C) or greater D)difficulty or pain when swallowing

C)temperature of 101°F (38.3°C) or greater