Acute Lymphocytic Anemia Optional EAQ's + Clicker Questions
The nurse recalls that which type of leukemia accounts for 80% of acute leukemia in adults? 1) Acute lymphocytic leukemia (ALL) 2) Acute myelogenous leukemia (AML) 3) Chronic lymphocytic leukemia (CLL) 4) Chronic myelogenous leukemia (CML)
AML accounts for 15%-20% of acute leukemia in children and 80% in adults.
Cranial radiation therapy and intrathecal methotrexate are prescribed for a patient. The nurse suspects that the patient has which type of leukemia? 1) Acute lymphocytic leukemia (ALL) 2) Acute myelogenous leukemia (AML) 3) Chronic lymphocytic leukemia (CLL) 4) Chronic myelogenous leukemia (CML)
Correct 1 Acute lymphocytic leukemia (ALL) is commonly associated with the central nervous system (CNS). The primary health care provider prescribes intrathecal methotrexate or cytarabine to reduce the chances of CNS involvement. Cranial radiation therapy is given when the leukemia involves CNS. Acute myelogenous leukemia is not associated with CNS involvement. CNS leukemia is not commonly associated with chronic lymphocytic leukemia. Chronic myelogenous leukemia usually does not affect CNS.
The nurse recalls that which leukemia is most commonly seen in children? 1) Acute lymphocytic leukemia (ALL) 2) Acute myelogenous leukemia (AML) 3) Chronic lymphocytic leukemia (CLL) 4) Chronic myelogenous leukemia (CML)
Correct 1 Acute lymphocytic leukemia is most commonly seen in children. Acute myelogenous leukemia, chronic lymphocytic leukemia, and chronic myelogenous leukemia are commonly seen in older adults.
The nurse expects that a patient will experience central nervous system manifestations with which type of leukemia? 1) Acute lymphocytic leukemia (ALL) 2) Chronic lymphocytic leukemia (CLL) 3) Acute myelogenous leukemia (AML) 4) Chronic myelogenous leukemia (CML)
Correct 1 Acute myelogenous 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.
A patient with leukemia asks the nurse, "What causes the reddish-purplish colored spots on my skin?" The nurse should explain that the spots are due to what condition? 1) Low platelet count 2) Low neutrophil count 3) Low erythrocyte count 4) Low lymphocyte count
Correct 1 Leukemia is associated with bone marrow failure and a low platelet count. A low platelet count results in bleeding, which causes red- to purple-colored spots on the skin. A low neutrophil count is not associated with red- to purple-colored spots on the skin. A low erythrocyte count results in anemia, which causes weakness and pallor. A low lymphocyte count results in immunosuppression, leading to infection and fever.
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? 1) Leukemia causes increase in the number of blast cells 2) Blast cells replace bone marrow 3) Decrease in the number of lymphocytes 4) Suppression of immunity in the body
Correct 1, 2, 3, 4 Leukemia is characterized by an increased number of immature white blood cells that are malignant, blast cells. These blast cells replace bone marrow, leading to bone marrow failure. This results in a decrease in the number of lymphocytes. Low lymphocyte count leads to immunosuppression, resulting in infections and fever.
The nurse identifies that the stages of chemotherapy for the treatment of leukemia are administered in what order? 1) Induction therapy 2) Intensification therapy 3) Consolidation therapy 4) Maintenance therapy
Correct 1, 2, 3, 4 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.
The nurse recalls that the steps involved in the pathophysiology of leukemia occur in what chronologic order? 1) Proliferation of immature white blood cells 2) Replacement of bone marrow with blast cells 3) Reduction in RBC, WBC, and platelet count 4) Occurrence of anemia, pallor, and infection
Correct 1, 2, 3, 4 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.
The nurse is caring for a young adult recently diagnosed with acute myelogenous leukemia (AML). The onset of the illness was abrupt, and family members are attempting to adjust to the patient's sick role. Identify characteristics of the sick role. Select all that apply. 1) The patient becomes withdrawn. 2) The patient becomes dependent. 3) The patient remains as independent as possible. 4) The patient's family role and responsibilities are altered. 5The patient refuses to stop working contrary to the primary health care provider's advice.
Correct 1, 2, 4 Characteristics of the sick role include dependence, alteration of familial roles and responsibilities, and withdrawing from family and friends. The patient in the sick role does not exercise as much independence as possible. The patient in the sick role does not refuse to follow the primary health care provider's advice regarding work restrictions.
A patient that reports recent weight loss, fever, and night sweats is diagnosed with chronic lymphocytic leukemia. The nurse expects what dianostic findings? Select all that apply. 1) Hepatomegaly 2) Sternal tenderness 3) Hemoglobin 19 g/dL 4) Platelet count 50,000/mcL 5) White blood cell count 110,000/mcL
Correct 1, 4, 5 Clinical manifestations of CLL include splenomegaly, lymphadenopathy, and hepatomegaly. Diagnostic findings include mild anemia, thrombocytopenia, and total white blood cell (WBC) count greater than 100,000/mcL. Hemoglobin levels decrease. Sternal tenderness does not occur in CLL.
When is consolidation therapy indicated in patients with leukemia? 1) After maintenance therapy 2) After remission is achieved 3) Immediately after induction therapy 4) Initially when the treatment is indicated
Correct 2 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.
The nurse is reviewing the hematologic test results of a patient with leukemia. Which test result places the patient at high risk for developing infection? 1) Platelet count 150,000/µL 2) Absolute neutrophil count (ANC) 500 cells/µL 3) Total red blood cell (RBC) count 4.3 × 106/µL 4) Mean corpuscular hemoglobin concentration (MCHC) 35%
Correct 2 Neutropenia indicates an increased risk of developing infection. Platelet count, total RBC count, and MCHC are in the normal range.
The nurse recalls that which tests are considered primary methods for diagnosing leukemias? Select all that apply. 1) Lumbar puncture 2) Bone marrow examination 3) Peripheral blood evaluation 4) Computed tomography (CT) scan 5) Morphologic and histochemical examination
Correct 2, 3 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.
Which diagnostic tool should the nurse include in the plan of care when determining the needs of a patient who is suspected of having leukemia? 1) BRAC studies 2) Liver function testing 3) Bone marrow aspiration 4) Estrogen and progesterone status
Correct 3 Bone marrow examinations, such as a bone marrow aspiration, is a diagnostic tool for leukemia. BRAC studies are conducted for a patient suspected of having breast cancer. Liver function testing is conducted for a patient suspected of having liver cancer. Estrogen and progesterone status checks are performed for patients suspected of having uterine cancer.
A patient with acute myelogenous leukemia (AML) has completed the prescribed cycles of cytotoxic chemotherapy, and documentation indicates that the patient is in partial remission. How should the nurse interpret this documentation? 1) No tumor cells were detected by morphologic examination, but can be identified by molecular testing. 2) Physical examination reveals no evidence of the disease, and the bone marrow and peripheral blood appear normal. 3) Symptoms are absent, and there is a normal peripheral blood smear, but there is evidence of the disease in the bone marrow. 4) There are no physical symptoms or bone marrow abnormalities, and molecular studies are negative for residual leukemia.
Correct 3 Remission is a phase in which the patient does not exhibit any cancer symptoms. In partial remission, symptoms are absent and the blood smear is normal, but the disease may be evident in the bone marrow. If a patient is in molecular remission, there are no signs of residual leukemia in molecular studies. In minimal residue disease, tumor cells are not detected by morphologic examination but can be identified by molecular testing. A complete remission means that there is no evidence of the disease on physical examination, and the bone marrow and peripheral blood appear normal.
A patient with acute lymphocytic leukemia (ALL) asks for clarification about the disease. The nursing response should be based on which understanding of the disease? 1) ALL is infectious in nature and characterized by increased white blood cells 2) ALL is malignant in nature and characterized by increased circulating red blood cells 3) ALL is inflammatory in nature and characterized by solid tumor formation in the lymph nodes 4) ALL is malignant in nature and characterized by a proliferation of immature white blood cells
Correct 4 Acute lymphocytic leukemia (ALL) is a malignant disorder of blood-forming tissues characterized by a proliferation of immature white blood cells. ALL is not infectious, nor is it inflammatory or characterized as a solid tumor of the lymph nodes. ALL does involve proliferation of white blood cells, not red blood cells.
The nurse provides information to a student nurse about the stages of chemotherapy for a patient with leukemia. Which statement made by the student indicates effective learning? 1) "The patient becomes critically ill during consolidation therapy." 2) "Consolidation therapy is an aggressive treatment to destroy leukemic cells." 3) "Induction therapy is used to eliminate the leukemic cells that are clinically not evident." 4) "Maintenance therapy involves treatment with lower doses of drugs for a prolonged period."
Correct 4 Maintenance therapy involves treatment with a lower dose of drugs for a prolonged period than what is used in induction therapy. The patient becomes critically ill during induction therapy, because it involves severe bone marrow depression. Induction therapy is an aggressive treatment to destroy leukemic cells and to restore normal hematopoiesis. Consolidation therapy is given to eliminate the leukemic cells that are clinically non-evident.
The nurse notes that a child's gums bleed easily and that the child has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms? A. Platelet count of 19,000/mm3 B. Prothrombin time of 11 to 15 seconds C. Hematocrit of 34 D. Leukocyte count of 14,000/mm3
Correct A
The nurse understands that the types of precautions needed for children receiving chemotherapy are based on which action of chemotherapeutic agents? A. Gastrointestinal upset B. Bone marrow suppression C. Decreased creatinine level D. Alopecia
Correct B
What is a priority nursing diagnosis for the 4-year-old child newly diagnosed with leukemia? A. Ineffective Breathing Pattern related to mediastinal disease B. Risk for Infection related to immunosuppressed state C. Disturbed Body Image related to alopecia D. Impaired Skin Integrity related to radiation therapy
Correct B
A child has just been diagnosed with acute lymphoblastic leukemia, and the mother is expressing guilt about not taking the child to the doctor right away. What response by the nurse is best? A. "Always call the physician when your child has a change in what is normal for him." B. "It is better to be safe than sorry." C. "It is common for parents not to notice subtle changes in their children's health." D. "I hope this delay does not affect the treatment plan."
Correct C
Parents of a child with acute lymphoblastic leukemia (ALL) ask about their child's prognosis. The nurse should base the response on the knowledge that A. leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission. B. research to find a cure for childhood cancers is very active. C. the majority of children go into remission and remain symptom free when treatment is completed. D. it usually takes several months of chemotherapy to achieve a remission.
Correct C
What should the nurse teach parents about oral hygiene for the child receiving chemotherapy? A. Brush the teeth briskly to remove bacteria. B. Use a mouthwash that contains alcohol. C. Inspect the child's mouth daily for ulcers. D. Perform oral hygiene twice a day.
Correct C
A child is in the hospital receiving chemotherapy, and the nurse suspects the child has an infection. What action by the nurse takes priority? A. Monitor the child's temperature. B. Assess the daily white blood cell count. C. Administer antibiotics. D. Obtain blood and urine cultures.
Correct D
A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, anemia, and fatigue is exhibiting symptoms most suggestive of which of the following? A. Ewing sarcoma B. Wilms' tumor C. Neuroblastoma D. Leukemia
Correct D
A nurse has taught the parents about home care of their child who has leukemia. Which statement made by the parents indicates an understanding of this teaching? A. "We will take our child's blood pressure daily." B. "We will restrict fluids in case there is central nervous system involvement." C. "We will make sure our child gets all immunizations in a timely manner." D. "We will take our child's temperature frequently."
Correct D
The nurse notes a reddened area on the forearm of a neutropenic child with leukemia. What action by the nurse is most appropriate? A. Massage the area. B. Turn the child more frequently. C. Document the finding and continue to observe the area. D. Notify the provider
Correct D
A patient with leukemia is undergoing maintenance therapy. The nurse recalls what information about this course of treatment? 1) It is the high-dose treatment given immediately after induction therapy. 2) Chemotherapy is given every three to four weeks for a prolonged period. 3) Intensification and consolidation are the terms used to describe this therapy. 4) 70 percent of patients with leukemia achieve complete remission after this therapy.
In maintenance therapy, treatment is provided every three to four weeks for a prolonged period with lower doses of the drugs. Intensification therapy is the high-dose treatment given immediately after induction therapy. Intensification and consolidation are the terms used to describe post-induction or post-remission therapy; 70 percent of patients diagnosed with leukemia achieve complete remission after induction therapy, not maintenance therapy.
The nurse identifies that which patient's findings indicate chronic myelogenous leukemia (CML)? 1) Patient A 2) Patient B 3) Patient C (Philadelphia chromosome) 4) Patient D
Patient with Philadelphia chromosome The Philadelphia chromosome is present in 90 to 95 percent of patients with chronic myelogenous leukemia. It is considered an important indicator of chronic myelogenous leukemia after treatment. Thus patient C is suffering from chronic myelogenous leukemia. Hypercellular bone marrow with lymphoblasts indicates acute lymphocytic leukemia. Chronic myelogenous leukemia is characterized by low RBC count, Hgb, and Hct. Acute lymphocytic leukemia is indicated on x-rays by transverse lines of rarefaction at the ends of the metaphysis of long bones.
The nurse is reviewing the diagnostic follow-up of patients with leukemia after their treatment. Which patient has minimal residual disease?
The condition in which tumor cells cannot be detected by morphologic study but can be identified by molecular testing is known as minimal residual disease. If the molecular studies of a patient are negative for residual leukemia, then it indicates molecular remission. Partial remission occurs when there is a normal peripheral blood smear, but there is evidence of disease in the bone marrow. Complete remission is characterized by normal bone marrow and peripheral blood smear, with no evidence of disease upon physical examination.
