WBC Disorders
4 types of Leukemia
- AML (acute myelogenous leukemia) - CML (chronic myelogenous leukemia) - ALL (acute lymphocytic leukemia) - CLL (chronic lymphocytic leukemia)
Multiple myeloma risk factors
- African american, genetics - Old age - Obesity - Toxin/hazardous chemical exposures
Multiple myeloma CMs
- Anemia, Hypercalcemia - Bone pain, Pathological fractures - Renal insufficiency/failure
Hodgkin Lymphoma CMs
- Enlarged lymph nodes (neck) - Hepatosplenomegaly - Weight loss - Itching, Night sweats, Fever, Fatigue
3 types of WBC disorders
- Leukemia - Lymphoma - Multiple myeloma
Non Hodgkin Lymphoma CMs
- Lymphadenopathy - Extranodal disease
CLL CMs
- Lymphadenopathy - Hepatomegaly, Splenomegaly - Weight loss - Night sweats, Fever, Fatigue
ALL CMs
- enlarged lymph nodes - bone pain, bleeding - fever
Hodgkin Lymphoma risk factors
- genetics - immunosuppression - viral exposures
ALL risk factors
- genetics - prenatal xray exposure - postnatal exposure to high dose radiation
AML risk factors
- older age - smoker - chemo, radiation, long term toxin exposure
Non Hodgkin lymphoma risk factors
- weak immune system - H pylori
Which of the following clients is most at risk for developing chronic lymphocytic leukemia? A. A 70 year old White man B. A 60 year old Asian man C. A 40 year old White man D. A 20 year old Asian man
A. A 70 year old White man
A client with AML has pancytopenia. The nurse observes this client for which of the following conditions? A. Anemia, neutropenia, and thrombocytopenia B. Leukocytosis, polycythemia, and thrombocytopenia C. Anemia, neutropenia, and thrombocytosis D. Leukocytosis, thrombocytopenia and polycythemia
A. Anemia, neutropenia, and thrombocytopenia
A client with multiple myeloma (MM) has thrombocytopenia. Which treatment should the nurse expect for the client? (Select all that apply.) A. Antibiotic therapy B. Iron supplement C. Platelet transfusion D. Red blood cell transfusion
A. Antibiotic therapy C. Platelet transfusion Rationale: Thrombocytopenia is a low platelet count; therefore, treatment with a platelet transfusion would be expected. Anemia would be treated with an iron supplement or red blood cell transfusion. Antibiotic therapy may be incorporated to aid in the avoidance of infection due to neutropenia.
Which occupation is associated with elevated risk for non-Hodgkin lymphoma (NHL)? A. Farmer B. Radiologist C. Plumber D. Office manager
A. Farmer Rationale: Environmental factors such as exposure to pesticides, herbicides, wood preservatives, and other organic solvents have been implicated in the development of NHL. Exposure to these chemicals may account for the increased incidence of the disease found in some occupations, such as farming. It should be noted that the vast majority of people with identified risk factors associated with NHL never develop the disease. There is no evidence to support that the other occupations have an associated risk.
Which of the following conditions places a person at risk for developing chronic myelogenous leukemia? A. Living near a nuclear reactor accident B. Having a 20 pack year history of smoking C. Having a sibling with CML D. Having received xrays for sports injuries as a child
A. Living near a nuclear reactor accident
The nurse is admitting a client suspected of having acute myelogenous leukemia (AML). Which clinical manifestation should the nurse expect for this client? (Select all that apply.) A. Petechiae B. Mental status changes C. Fatigue D. Increased platelets E. Weakness
A. Petechiae B. Mental status changes C. Fatigue E. Weakness X Rationale: Signs and symptoms of acute myelogenous leukemia (AML) come from the degree of pancytopenia. The decreased level of RBCs, WBCs, and platelets cause symptoms such as fatigue, weakness, and mental status changes.
The nurse is reviewing risk factors for acute myelogenous leukemia (AML). Which risk factor is important to identify? (Select all that apply.) A. Smoking B. Herbicide exposure C. Exposure to benzene D. Ionizing radiation E. Chemotherapy
A. Smoking C. Exposure to benzene D. Ionizing radiation E. Chemotherapy Rationale: Acute myelogenous leukemia (AML) has risk factors such as smoking, previous chemotherapy, ionizing radiation, and exposure to benzene and petroleum products. Herbicide exposure is not associated with AML.
A nurse is reviewing signs and symptoms of acute lymphocytic leukemia (ALL). Which clinical manifestation is related to ALL? (Select all that apply.) A. Weakness B. Thrombocytopenia C. Bleeding D. Fever E. Increased red blood cells
A. Weakness B. Thrombocytopenia C. Bleeding D. Fever Rationale: Signs and symptoms of acute lymphocytic leukemia (AML) come from the degree of pancytopenia. The decreased level of RBCs, WBCs, and platelets cause symptoms such as fever, weakness, bleeding, and thrombocytopenia.
Which leukemia is life threatening?
AML
The nurse is admitting a client with a possible diagnosis of multiple myeloma. Which of the following findings would the nurse expect in this client? A. Chest pain B. Bone pain C. Joint pain D. Abdominal pain
B. Bone pain
Which treatment should the nurse expect for the client diagnosed with acute myelogenous leukemia (AML) to arrest the cellular proliferation? A. Radiation therapy B. Chemotherapy C. Monoclonal therapy D. Blood transfusion
B. Chemotherapy Rationale: Chemotherapy is the cornerstone treatment for acute myelogenous leukemia (AML). Chemotherapy is a general term used to describe drugs that arrest cellular proliferation by interfering with DNA synthesis and replication of both normal and malignant cells. The other therapies are not associated with AML.
Which treatment option should the nurse expect for a client diagnosed with Hodgkin lymphoma (HL) with CD20? A. Radiation therapy B. Monoclonal therapy C. Chemotherapy D. Growth factor support
B. Monoclonal therapy Rationale: When Hodgkin lymphoma (HL) has the CD20, monoclonal therapy is the best option due to the therapy targeting only CD20 cells rather than healthy cells. The other treatments also attack healthy cells in the body. Growth hormone supports neutrophil recovery.
Which condition should the nurse associate with the risk for acute lymphocytic leukemia (ALL)? A. Environmental pollution B. Current sepsis infection C. Down syndrome D. Exposure to pesticides
C. Down syndrome Rationale: Acute lymphocytic leukemia (ALL) has genetic and nongenetic risk factors. Down syndrome is an example of a genetic risk factor for ALL. Prenatal exposure to x-rays and postnatal exposure to high-dose radiation are nongenetic.
A nurse is examining a client who is newly diagnosed with Hodgkin lymphoma (HL). Which clinical manifestation is the nurse most likely to find at the initial diagnosis? A. Hepatomegaly B. Thrombocytopenia C. Enlarged cervical lymph nodes D. Enlarged axillae lymph nodes
C. Enlarged cervical lymph nodes Rationale: Enlarged cervical or supraclavicular lymph nodes are common at the initial diagnosis of Hodgkin lymphoma (HL). Enlarged axillae lymph nodes and hepatomegaly are not as common. Thrombocytopenia is not associated with HL.
Which of the following laboratory findings is most likely in the client with multiple myeloma? A. Hyperkalemia B. Hyponatremia C. Hypercalcemia D. Hypoglycemia
C. Hypercalcemia
The client at stage 3 of the Cotswolds Modificaiton of the Ann Arbor Staging System for Hodgkin lymphoma will exhibit which finding? A. A single involved lymph node B. Two involved lymph nodes on the same side of the diaphragm C. Involved lymph nodes on both sides of the diaphragm D. Widespread involvement of extranodal sites
C. Involved lymph nodes on both sides of the diaphragm
A client presents with anemia, loss of height, bone pain, hypercalcemia, elevated creatinine, and thrombocytopenia. Which hematologic disorder should the nurse suspect? A. Non-Hodgkin lymphoma (NHL) B. Chronic lymphocytic leukemia (CLL) C. Multiple myeloma (MM) D. Acute myelogenous leukemia (AML)
C. Multiple myeloma (MM) Rationale: Anemia (normocytic or normochromic) is a common symptom of multiple myeloma (MM), resulting from the infiltration of bone marrow by plasma cells. This process prevents the maturation of erythrocytes. Lacking an adequate number of red blood cells to carry oxygen can result in fatigue and pallor. The movement of plasma cells into the bone marrow can, in turn, lead to a loss of osteocytes and a resultant destruction of bone. This can manifest as pathologic fractures and bone pain. Loss of bone cells can result in the release of calcium into the bloodstream. This hypercalcemia can result in confusion and other mental status changes and may have adverse effects on the kidney, as evidenced by an elevated creatinine level.
Which risk factor would be an expected finding in a client diagnosed with multiple myeloma (MM)? A. Immune suppression B. Bacterial infection C. Obesity D. Viral exposure
C. Obesity Rationale: Multiple myeloma (MM) has risk factors such as obesity and hazardous chemical exposure. Viral exposure, bacterial infection, and immune suppression are not associated with MM.
which leukemia is the most common type?
CLL
Which of the following statements made by the parent of a child with ALL demonstrates understanding of the treatment plan? A. Induction therapy is a cure for ALL. B. Consolidation therapy occurs if the disease returns. C. Induction therapy is repeated until the disease is in remission. D. Consolidation therapy eradicates the residual disease.
D. Consolidation therapy eradicates the residual disease.
Which of the following is the most common presenting sign of non-Hodgkin lymphoma? A. Reed Sternberg cells B. Bone pain C. Bleeding D. Enlarged lymph nodes
D. Enlarged lymph nodes
A nurse is preparing a presentation on signs of chronic myelogenous leukemia (CML). Which clinical manifestation would the nurse explain is typically found at the initial diagnosis? A. Bleeding B. Bone pain C. Fatigue and weakness D. None
D. None Rationale: Clients are typically asymptomatic at the initial diagnosis of chronic myelogenous leukemia (CML). As they develop symptoms, the symptoms relate to the extent of pancytopenia.
A client diagnosed with non-Hodgkin lymphoma (NHL) states, "My doctor says he's going to use radiation on local areas. What will this do?" How should the nurse respond? A. "It will temporarily slow down the growth while you prepare for more extensive treatment." B. "Localized radiation treatment will serve as a palliative therapy." C. "Radiation will kill the damaged cells and encourage healthy cells to grow." D. "It will kill the malignant cells by damaging genetic material."
D. "It will kill the malignant cells by damaging genetic material." Rationale: Radiation therapy refers to the therapeutic use of directed ionizing radiation to kill malignant cells by damaging the genetic material that controls cellular proliferation; therefore, it works best in cells that are dividing rapidly. In general, radiation therapy damages normal cells along with malignant cells; however, normal cells are better equipped to repair damaged DNA, while malignant cells are more likely to die. Radiation therapy is used to treat NHL in a local area.
2 types of lymphoma
Hodgkins and Non-Hodgkins Lymphoma
CLL risk factor
adult
CML risk factor
adult
CML CMs
depends on myeloid cell overproduction - infection (r/t neutrophils) - weakness & fatigue (r/t anemia) - bleeding (r/t thrombocytopenia) - splenomegaly - gouty arthritis - night sweats
Non hodgkin lymphoma pathogenesis
genetic mutation creates solid tumors
ALL pathogenesis
lymphoid cells are ineffective & leukemic cells overcrowd bone marrow & other organs
Hodgkin Lymphoma
neoplastic proliferation of Reed Sternberg cells
CML etiology
philadelphia chromosome
Multiple myeloma
proliferation of malignant plasma cells
How to diagnose ALL
signs of infection, anemia, bleeding & leukemic infiltration
The nurse is reviewing the history and physical for a client diagnosed with Hodgkin lymphoma (HL). Which condition documented should the nurse consider a risk factor? A. 20-year history as a woodworker B. Recurrent bacterial pneumonia C. Treatment with immunosuppressant drugs D. Exposure to pesticides and herbicides
C. Treatment with immunosuppressant drugs Rationale: Hodgkin lymphoma (HL) has risk factors such as familial factors, viral exposures, and immune suppression. Exposure to pesticides and herbicides, and an occupation as a woodworker, where the client would have been exposed to wood preservatives, are risk factors for non-Hodgkin lymphoma. Viral infections, not bacterial, are a risk factor for HL.
Which statement by the nurse is accurate regarding acute lymphocytic leukemia (ALL)? A. "ALL is an overproliferation of mature granulocytes." B. "ALL is a disease where the spleen produces abnormal cells." C. "ALL is a clonal disease." D. "ALL is myeloid leukemia."
C. "ALL is a clonal disease." Rationale: Like the other hematologic malignancies, acute lymphocytic leukemia (ALL) is considered to be a clonal disease (one in which all malignant cells derive from a single errant cell). ALL ultimately develops when the initially transformed leukemic cell divides and passes on the alterations in genetic material to descendant cells, or progeny, and these altered cells escape detection by the immune system. AML, not ALL, is a myeloid leukemia. Chronic myeloid leukemia (CML) is a form of leukemia characterized by overproliferation of mature granulocytes. ALL is not the result of the spleen producing abnormal cells.
A client recently diagnosed with chronic lymphocytic leukemia (CLL) asks what to expect from treatment. How should the nurse respond? A. "Immunotherapy can be used to help stop the growth of the cancer." B. "Since this is a fast-growing disease, the doctors will be aggressive." C. "CLL cannot be cured, but chemotherapy can slow the progression." D. "You might be a candidate for a stem cell transplant, which will cure your disease."
C. "CLL cannot be cured, but chemotherapy can slow the progression." Rationale: Chronic lymphocytic leukemia (CLL) has no cure, but chemotherapy can be used to slow progression. Chemotherapy is given to stop the cancer cells from growing, and immunotherapy may be used to stimulate the body's own defenses in fighting the disease. A reduced-intensity allogeneic transplant should be explored for clients who have a clinically progressive disease that does not respond to other treatments. CLL generally progresses slowly, often with long periods of stability and occasional, spontaneous remissions. In clients with early-stage disease and without symptoms, watchful waiting is generally indicated. Stem cell transplant is not a treatment for CLL.
The nurse is preparing a presentation on hematologic cancers. Which statement should the nurse include? A. "Benign cells start in the bone marrow and lymph tissues." B. "Benign cells develop from stem cells." C. "Malignancies develop due to cellular mutations." D. "Malignancies develop from only the lymph system."
C. "Malignancies develop due to cellular mutations." Rationale: Malignancies develop as a result of one or more mutations in a single cell or a group of cells that result in immature and/or ineffective hematopoietic cells. The mutations may occur at any time during the process of maturation and differentiation may affect any of the blood cell lines in the hematopoietic system. Benign cells are not cancerous and do not invade other tissues.
A nurse is asked who is most at risk for developing non-Hodgkin lymphoma (NHL). Which client is most at risk? A. 60-year-old African American woman B. 50-year-old man of European descent C. 65-year-old woman of European descent D. 52-year-old woman of Hispanic descent
C. 65-year-old woman of European descent Rationale: Non-Hodgkin lymphoma (NHL) occurs across all age groups, including children, although incidence rates are much higher in older individuals than in younger people. The incidence of NHL is highest in Americans of European descent, followed by Hispanics and African Americans. Approximately 19,790 individuals were expected to die from NHL in 2015.
Which explanation by the nurse best describes multiple myeloma (MM)? A. "MM is characterized by the proliferation of malignant plasma cells." Your answer is correct. B. "MM is an overproliferation of mature granulocytes in the lymph tissues." C. "MM is a disease that involves benign overproliferation of T cells." D. "MM is associated with a decreased number of plasma cells in the blood."
A. "MM is characterized by the proliferation of malignant plasma cells." Rationale: For development of multiple myeloma (MM), the most common genetic variations appear to be associated with the inactivation of tumor-suppressing genes or the activation of genes known to be associated with B-cell proliferation. The translocation (rearrangement) of genetic sequences seems to lead to an activation of mechanisms that leads to an increase in the number of plasma cells that then move into the bone marrow. Chronic myeloid leukemia (CML), not MM, is a form of leukemia characterized by overproliferation of mature granulocytes. B cells, not T cells, are involved in MM.
Which statement describes the development of chronic myeloid leukemia (CML)? A. "CML develops from an overproduction of B cells in the lymph tissues." B. "CML develops from an underproduction of immature blast cells." C. "CML arises from a genetic translocation that occurs at the stem cell level." D. "CML arises from the impaired DNA repair associated with certain inherited disorders."
C. "CML arises from a genetic translocation that occurs at the stem cell level." Rationale: Chronic myeloid leukemia (CML) arises when a well-known genetic alteration, the 9;22 translocation (Philadelphia chromosome), occurs at the stem cell level and results in overproduction of mature granulocytes, not B cells, in the bone marrow. A number of inherited genetic disorders are associated with ALL, not CML. CML is staged on the number of blast cells, but it is not how it develops.
