Ch. 24 Disorders of White Blood Cells
While taking a history on a pediatric client who appears to have Burkitt lymphoma, which question to the client and/or the family is likely to correlate with this diagnosis?
"Have you recently been diagnosed with Epstein-Barr virus (EBV)?"
A child has been home from camp for 2 weeks and reports a sore throat, low-grade fever, and enlarged cervical lymph nodes. After testing, it is determined the child has Epstein-Barr virus (EBV)-associated infectious mononucleosis. The parent asks, "How did my child acquire this type of infection?" Which is the best response by the nurse?
"The infection is acquired primarily through contact with infected oral secretions."
The nurse caring for a client with myelogenous leukemia anticipates the client will have abnormalities in which type of blood cell? Select all that apply.
- Granulocytes - Erythocytes - Thrombocytes
Which statements about acquired agranulocytosis are correct? Select all that apply.
- It is usually caused by drugs. - It is usually caused by autoimmune disease. - The major clinical problem is viral infections
The nurse is assessing a client newly diagnosed with Hodgkin lymphoma. Where should the nurse anticipate finding enlarged lymph nodes? Select all that apply.
- Neck - Axilla - Supraclavicular area
The nurse is caring for a client with secondary neutropenia. Which might be a possible cause of this condition? Select all that apply.
- Systemic lupus erythematosus - Felty syndrome
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.
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 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
Definitive diagnosis of multiple myeloma includes the triad of bone marrow plasmacytosis, lytic bone lesions, and:
Bence Jones proteins in the urine.
Select the option that best describes the production of T lymphocytes.
Bone marrow → thymus → lymph nodes
The nurse caring for a client in the early stage of multiple myeloma would anticipate the client to report which symptom?
Bone pain
A client's laboratory report indicates neutropenia, most likely drug induced. The nurse should frequently assess for which complication related to neutropenia?
Bronchial infection
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
The nurse is caring for a client who has a low level of T lymphocytes. The nurse plans care for a client with:
Decreased immune response
An older adult has an abnormally low neutrophil count. What is a major cause of neutropenia in this population?
Drug reactions
The nurse is conducting a staff in-service program on non-Hodgkin lymphomas. The nurse should include that essentially all people with Burkitt lymphoma have evidence of infection with:
EBV
Infectious mononucleosis is a lymphoproliferative disorder caused by the Epstein-Barr virus (EBV) that is usually self-limiting and nonlethal. Which complication can arise during this mostly benign disease?
Enlarged spleen
The nurse notes that a client is experiencing a triad of splenomegaly, recurrent pulmonary infections, and neutropenia. During the handoff report, the nurse should report the client is exhibiting which disease associated with antineutrophil antibodies?
Felty syndrome
The nurse's plan of care for a client with multiple myeloma should include interventions to prevent:
Fractures
A client reports a general deterioration in his health over the past several weeks. Which assessment and laboratory findings would be most closely associated with acute leukemia?
High blast cell counts and fever
A client with acute leukemia has developed gout and asks the nurse, "Why did this happen?" Which response is most accurate?
High uric acid levels
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:
Hodgkin lymphoma
The pathologist notes that the client has Reed-Sternberg cells. He knows that these cells are a diagnostic hallmark for which disorder?
Hodgkin lymphoma
A client arrives reporting fevers, chills, and night sweats. Upon assessment, the health care provider palpates an enlarged supraclavicular lymph node and suspects the client may have developed which disease?
Hodgkin lymphoma (HL)
The nurse assessing a client diagnosed with multiple myeloma should assess for which clinical manifestation associated with this diagnosis?
Hypercalcemia
A client with Hodgkin lymphoma is exhibiting some central nervous system (CNS) involvement. Which treatment measures will the health care provider likely prescribe?
Irradiation and chemotherapy
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?
Leukemia
The pediatrician knows that the most common cause of cancer in children is:
Leukemia
Which factor differentiates chronic leukemias from acute leukemias?
Leukemic cells are more fully differentiated in chronic than in acute leukemias.
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?
Lymph node biopsy
The nurse is conducting education for a client who is scheduled to undergo diagnostic testing for non-Hodgkin lymphoma (NHL). The nurse includes information on:
Lymph node biopsy
A client has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that originates in which body site?
Lymph nodes
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?
Maintenance therapy
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
A student nurse is taking microbiology and reviewing various types of cells. From which cell type are granulocytes derived?
Myeloid stem cells
The granulocyte cell lines are derived from:
Myeloid stem cells
The physician reviews a client's lab results and notes that the neutrophil count is 900/μL (0.90 x 109/L). This is known as:
Neutropenia
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)
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
Multiple myeloma is a malignancy of what part/type of cells or lymphoid system?
Plasma cells
A client is admitted with a suspected diagnosis of Hodgkin lymphoma (HL). Which diagnostic test would the nurse look for to confirm the diagnosis?
Presence of Reed-Sternberg cells
Following peripheral blood testing and a bone marrow biopsy, a client has been diagnosed with chronic myelogenous leukemia. Which abnormality is most likely to have preceded the client's diagnosis?
Presence of a Philadelphia chromosome
A 26-year-old client has an absolute neutrophil count of less than 500 cells/mm3 (0.50 x 109/L) Which interpretation of this lab value is accurate?
Severe neutropenia
A client's history and physical documents the presence of an indolent lymphoma. The nurse plans care for which type of lymphoma?
Slow-growing
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
What is the reason why bed rest and analgesics are expected treatments for infectious mononucleosis?
To relieve fever, headache, and sore throat
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 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 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
A client is prescribed the recumbent granulocyte colony-stimulating factor (CSF) filgrastim. The nurse evaluates the effectiveness by monitoring which laboratory value?
complete blood count (CBC)/differential
The nurse evaluating a client's blood work notes that the client's white blood cells are 9000/μL (9.0 x 109/L). The nurse should:
continue to monitor the client's blood work results.
A client who is being treated for small-cell lung cancer has been placed in protective isolation due to neutropenia. The most likely cause of this client's neutropenia is:
the effects of chemotherapy on white blood cell development.