Leukemia
3
A 67-year-old who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. Which statement made by the patient when you are obtaining the admission history is of most concern? 1. "I've noticed that I bruise more easily since the chemotherapy started." 2. "My bowel movements are soft and dark brown." 3. "I take one aspirin every morning because of my history of angina." 4. "My appetite has decreased since the chemotherapy started."
b
A child with leukemia who is being treated with chemotherapy is visited by a grandmother who has brought flowers from her garden for the child. Which is the appropriate response by the nurse? a "I will get a vase for you." b "The flowers are beautiful, but the child cannot have them right now." c "Let me wash your vase before we put flowers in it." d "Place the flowers across the room from the child."
d
A client is diagnosed with a leukemia that is caused by uncontrolled proliferation of myeloblasts and hyperplasia of bone marrow and the spleen. The nurse recognizes that this pathophysiology is present in which type of leukemia? a Chronic myeloid leukemia b Acute lymphocytic leukemia c Chronic lymphocytic leukemia d Acute myeloid leukemia
a
A client is newly diagnosed with acute lymphocytic leukemia. The nurse understands that the client will display which pathophysiology? a Transformation of B lymphocyte cells into cells that resemble immature lymphocytes but do not mature b Proliferation of small, abnormal, mature lymphocytes, usually B lymphocytes c Abnormal proliferation of all bone marrow elements d Uncontrolled proliferation of myeloblasts
c
A client with acute myelocytic leukemia (AML) is scheduled for a bone marrow transplant (BMT). In reinforcing client and family teaching about BMT, what is the most appropriate statement by the nurse? a "The client will be in the operating room with the donor so that immediate transplantation can occur." b "A large bore needle will be inserted into the client's bone marrow where the donor marrow will be infused." c "The specially prepared marrow is infused intravenously to the client." d "The client will be brought to the radiation department to transplant the marrow."
c
A client with leukemia has developed stomatitis and is on neutropenic precautions. Mouthwash every 2 hours has been ordered for the client. Which physician order would the nurse question? a Normal saline solution b Viscous lidocaine (Xylocaine) c Hydrogen peroxide d Diluted baking soda
2
A patient in a long-term care (LTC) facility who has chronic lymphocytic leukemia has a nursing diagnosis of Activity Intolerance related to weakness and anemia. Which nursing activity will you delegate to the UAP? 1. Evaluating the patient's response to normal activities of daily living 2. Checking the patient's blood pressure and pulse rate after ambulation 3. Determining which self-care activities the patient can do independently 4. Assisting the patient in choosing a diet that will improve strength
1
A patient with acute myelogenous leukemia is receiving induction-phase chemotherapy. Which assessment finding requires the most rapid action? 1. Serum potassium level of 7.8 mEq/L 2. Urine output less than intake by 400 mL 3. Inflammation and redness of the oral mucosa 4. Ecchymoses present on the anterior trunk
3
A transfusion of PRBCs has been infusing for 5 minutes when the patient becomes flushed and tachypneic and says, "I'm having chills. Please get me a blanket." Which action should you take first? 1. Obtain a warm blanket for the patient. 2. Check the patient's oral temperature. 3. Stop the transfusion. 4. Administer oxygen.
2,1
After obtaining Ms. R's consent for a visit later today, you head off to see Ms. A. Her husband answers the door and tells you that Ms. A is resting so comfortably that he does not want you to disturb her. He explains, "She has been so short of breath lately that this is the best sleep she has had in a while." You talk him into allowing you to assess Ms. A and find that she is very difficult to awaken. She tries to respond to your questions, but her speech is so slurred that you are unable to understand her. The flow meter on her home oxygen unit is set at 6 L/min. Which nursing action is most appropriate next? 1. Auscultate Ms. A's anterior and posterior lung sounds. 2. Check Ms. A's oxygen saturation using pulse oximetry. 3. Continue to stimulate Ms. A until she can respond to you. 4. Notify the health care provider (HCP) about Ms. A's change in status. You obtain an oxygen saturation of 99% with the pulse oximeter. Which action is appropriate now? 1. Discontinue the patient's oxygen. 2. Draw a sample for arterial blood gas analysis. 3. Call the HCP and obtain an order to transport Ms. A to the hospital. 4. Remind the patient's husband about the reasons for using oxygen at low flow rates.
c
Emily Hartford is a 56-year-old woman who was diagnosed with leukemia 8 months ago. She was treated with chemotherapy during the past 6 months and continues to experience occasional anorexia and mild weight loss. She has coped well with the gastrointestinal symptoms throughout the chemotherapy treatments, experiencing only a 12-lb weight loss. Ms. Hartford asks you what else she could do to address her nutritional needs in light of these symptoms. What intervention would you anticipate being included in the treatment plan to address her nutritional needs? a Limit beverage consumption for 60 minutes after meals b Medicate for pain within 1 hour after eating c Frequently eat high-calorie, low-fat foods throughout the day d Consume a protein snack once a day
c
A client with leukemia is scheduled to receive an autologous bone marrow transplant. When providing education, the nurse informs the family that the client will need to remain hospitalized in a private room for how long a period of time? a 3 to 5 weeks b 1 to 3 weeks c 6 to 8 weeks d 9 to 11 weeks
b
A client with chromic myeloid leukemia (CML) is admitted to a clinic. The nurse understands the client is least likely to be part of which demographic group? a Older than 65 years b Younger than 20 years c Female d Male
1
After you receive the change-of-shift report, which patient will you assess first? 1. 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit 2. 38-year-old with aplastic anemia who needs teaching about decreasing infection risk before discharge 3. 40-year-old with lymphedema who requests help in putting on compression stockings before getting out of bed 4. 60-year-old with non-Hodgkin lymphoma who is refusing the prescribed chemotherapy regimen
d
While caring for a client with leukemia, the nurse plans which of the following goals with the client? a Will experience minimal bleeding b Will experience mild infections c Will have no anxiety d Will manage self-care activities
1
You are making a room assignment for a newly arrived patient whose laboratory test results indicate pancytopenia. Which patient will be the best roommate for the new patient? 1. Patient with digoxin toxicity 2. Patient with viral pneumonia 3. Patient with shingles 4. Patient with cellulitis
b
Cassandra Millot is a 32-year-old woman who teaches elementary school and was in good health until 2 weeks ago, when she was diagnosed with acute lymphocytic leukemia (ALL). She has a basic understanding of the treatment options. Ms. Millot asks you what the difference is between an allogeneic and autologous bone marrow transplant. Which is your best response to Ms. Millot? a "Chemotherapy is used before allogeneic transplants but not autologous transplants." b "Your own bone marrow cells are used in an autologous transplant, while a matched donor's cells are used in an allogeneic transplant." c "You do not have to wait for the reestablishment of bone marrow function after an allogeneic transplant like you do after an autologous transplant." d "Bone marrow cells are transplanted before radiation therapy in allogeneic transplants and after radiation therapy in autologous transplants."
c
Which finding is a risk factor in the development of leukemia? a. the client is an avid stamp collector b. the client works as a computer programer c. the client had radiation for hodgkins lymphoma d. the clients grandmother had stomach cancer
a,b,d
Which interventions address the increased risk for bleeding in clients with leukemia? (Select all that apply.) a Avoid taking rectal temperatures b Apply pressure to necessary injection sites c Recommend ingestion of bland foods d Monitor for blood in stool e Encourage use of tampons
a
Which is the most common type of leukemia in children and adolescents? a Acute lymphocytic leukemia (ALL) b Chronic lymphocytic leukemia (CLL) c Chronic myeloid leukemia (CML) d Acute myeloid leukemia (AML)
d
The nurse is caring for a 2-year-old who has symptoms consistent with acute myelocytic leukemia and is in the hospital for diagnosis. When planning care for this child, the nurse offers which developmentally appropriate toy for diversion? a Push-pull toy lawn mower b Jigsaw puzzle c Pencil and paper to draw d Large picture books
4
You are transferring a patient with newly-diagnosed chronic myeloid leukemia to an LTC facility. Which information is most important to communicate to the LTC charge nurse before transferring the patient? 1. Philadelphia chromosome is present in the patient's blood smear. 2. Glucose level is elevated as a result of prednisone (Deltasone) therapy. 3. There has been a 20-lb weight loss over the last year. 4. The patient's chemotherapy has resulted in neutropenia.
4
You obtain the following data about a patient admitted with multiple myeloma. Which information has the most immediate implications for the patient's care? 1. The patient reports chronic bone pain. 2. The blood uric acid level is very elevated. 3. The 24-hour urine test shows Bence Jones proteins. 4. The patient reports new-onset leg numbness.
4
You receive a change-of-shift report about the following patients. Which one will you assess first? 1. 26-year-old with thalassemia who has a hemoglobin level of 8 g/L and orders for a PRBC transfusion 2. 44-year-old who was admitted 3 days previously in a sickle cell crisis and has orders for a computed tomographic scan 3. 50-year-old with stage IV non-Hodgkin lymphoma who is crying and saying, "I'm not ready to die" 4. 69-year-old with chemotherapy-induced neutropenia who has an oral temperature of 100.1° F (37.8° C)
c
a four year old is admitted with acute leukemia, it will be most important to monitor the child for a. abdominal pain and anorexia b. fatigue and bruising c. bleeding and pallor d. petechiae and mucosal ulcers
c
A client with leukemia is prescribed a therapy that modifies the body's response to cancer cells. The nurse plans to educate the client about what therapy? a Radiation b Complementary c Biologic d Stem cell transplant
b
Chad Olsen is a 28-year-old man who was in good health until a few months ago. At that time, he began to feel tired and short of breath doing activities that he previously had done with no effort. He is a construction worker who works 10-hour days 5 or 6 days of the week. He has been diagnosed with acute lymphocytic leukemia (ALL) and has received chemotherapy for the past month. He tells you that he is having a difficult time with the diagnosis, changes from his previous life, and side effects of the chemotherapeutic medications. "After all this," he says, "I hope that I make it." Based on your knowledge and experience with similar clients, what do you anticipate will occur, which will guide your response to him? a Mr. Olsen will probably achieve an initial remission after prolonged treatment, which will be followed by an exacerbation that will not respond to treatment. b Mr. Olsen will most likely achieve complete remission. c Mr. Olsen will not likely achieve a state of remission with this disease. d Mr. Olsen will probably progress to the final stage of the disease within 1 year, unless remission is achieved within the first 6 months after the diagnosis is made.
a,b,c,d
The nurse is presenting information about leukemia at a health fair. Which risk factors that increase the incidence of leukemia will the nurse discuss? (Select all that apply.) a Smoking b Previous treatment for cancer c Genetics d Exposure to benzene e Presence of the HIV
a,b,d,e
The nurse is providing education to a client with chronic myeloid leukemia about ongoing needs. Which interventions would the nurse include when educating this client? (Select all that apply.) a Avoid alcohol-based mouthwash b Drink 5 to 8 glasses of water a day c Encourage participation in strenuous exercise d Complete oral hygiene frequently e Refrain from eating overly spicy foods
d
The nurse is assessing the coping skills of a client undergoing treatment for leukemia. What is the best time for the nurse to assess the client's management of issues such as nutrition, rest/sleep, medication administration, and psychosocial needs? a When the client is at home b When the client is receiving radiation therapy in the clinic c When the client is at work d When the client is receiving IV medication in the clinic
a,c,d,e
The nurse is caring for a client newly admitted with suspected leukemia. The nurse anticipates which tests will be ordered to confirm the diagnosis? (Select all that apply.) a Bone marrow aspiration b Sedimentation rate c White blood cell count d Red blood cell count e Platelet count
d
The nurse is caring for a client who is in the hospital for diagnostic testing. On physical assessment, the nurse notes an enlarged spleen, oral ulcerations, and a decreased level of consciousness. Which laboratory result would the nurse anticipate for this client? a Increased platelets b Hyperkalemia c Hypocalcemia d Increased white blood cell count
a,b,d
What are factors that increase the risk of developing leukemia? (Select all that apply.) a Cigarette smoking b Previous cancer treatment c Excessive caffeine ingestion d Diagnosis of Down syndrome e Obesity
d Rationale Providing mouth care before meals will assist in addressing the problem of insufficient calorie intake when caring for a client with ALL. Weighing the client daily, not weekly, will assist in addressing the problem of insufficient calorie intake when caring for a client with ALL. Medicating for pain 30 minutes, not 90 minutes, before meals will assist in addressing the problem of insufficient calorie intake when caring for a client with ALL. Providing low-fat meals, not high-fat meals, will assist in addressing the problem of insufficient calorie intake when caring for a client with ALL.
When planning care for a client with acute lymphocytic leukemia (ALL), the nurse addresses the problem of insufficient calorie intake. What nursing intervention will assist in addressing this problem? a Medicate for pain 90 minutes before meals b Weigh the client weekly c Provide high-fat meals throughout the day d Provide mouth care before meals
3,4
When you arrive at Mr. I's condominium, his wife answers the door and tells you that Mr. I is very lethargic and a little confused today. Usually he is well oriented and cheerful, in spite of his diagnosis of right-sided lung cancer. Which information noted during your assessment is the best indicator that rapid nursing action is needed? 1. Breath sounds are decreased on the right posterior chest. 2. Mr. I says that his appetite has not been very good recently. 3. Mr. I's oral temperature is 101° F (38.3° C). 4. The oral mucosa is pale and dry. You call the oncologist to discuss Mr. I's condition and obtain an order to call an ambulance to transport him to the hospital ED for evaluation. Which information is most important to communicate when you call a report to the ED? 1. Mr. I has lung cancer and decreased breath sounds. 2. Mr. I's appetite and oral intake are decreased. 3. Mr. I has an order for a CBC blood sample to be drawn today. 4. Mr. I is receiving chemotherapy and has a fever.
a,c,e
Which assessment findings of the skin and mucous membranes may be noted with leukemia? (Select all that apply.) a Ulcers b Pruritic rash c Bruising d Decreased skin turgor e Petechiae
a,b,c
Which biological therapies are used in the treatment of leukemia? (Select all that apply.) a Interferons b Colony stimulating factors c Interleukins Cyclophosphamide Imatinib mesylate
d
Which diagnostic test for leukemia determines the risk of bleeding? a White blood cell count b Bone marrow aspiration c Red blood cell count d Platelet count
d
Which nursing diagnosis is of highest priority for a client hospitalized for a bone marrow transplant to treat relapse of acute myelocytic leukemia? a Anxiety b Disturbed Body Image c Imbalanced Nutrition: Less than Body Requirements d Ineffective Protection
Ans: 1 The newly-admitted patient should be assessed first, because the baseline assessment and plan of care need to be completed. The other patients also need assessments or interventions but do not need immediate nursing care. Focus: Prioritization
24. After you receive the change-of-shift report, which patient will you assess first? 1. 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit 2. 38-year-old with aplastic anemia who needs teaching about decreasing infection risk before discharge 3. 40-year-old with lymphedema who requests help in putting on compression stockings before getting out of bed 4. 60-year-old with non-Hodgkin lymphoma who is refusing the prescribed chemotherapy regimen
a
A client is newly diagnosed with acute lymphocytic leukemia. The nurse would anticipate that the client will be started on what chemotherapy medication? a Prednisone with asparaginase (Elspar) b Imatinib mesylate (Gleevec) c Fludarabine (Fludara) d All-trans retinoic acid (ATRA)
Ans: 4 A patient with neutropenia is at increased risk for infection, so the LTC charge nurse needs to know about the neutropenia to make decisions about the patient's room assignment and to plan care. The other information also will impact planning for patient care, but the charge nurse needs the information about neutropenia before the patient is transferred. Focus: Prioritization
20. You are transferring a patient with newly-diagnosed chronic myeloid leukemia to an LTC facility. Which information is most important to communicate to the LTC charge nurse before transferring the patient? 1. Philadelphia chromosome is present in the patient's blood smear. 2. Glucose level is elevated as a result of prednisone (Deltasone) therapy. 3. There has been a 20-lb weight loss over the last year. 4. The patient's chemotherapy has resulted in neutropenia.
Ans: 1 Fatal hyperkalemia may be caused by tumor lysis syndrome, a potentially serious consequence of chemotherapy in acute leukemia. The other symptoms also indicate a need for further assessment or interventions but are not as critical as the elevated potassium level. Focus: Prioritization
21. A patient with acute myelogenous leukemia is receiving induction-phase chemotherapy. Which assessment finding requires the most rapid action? 1. Serum potassium level of 7.8 mEq/L 2. Urine output less than intake by 400 mL 3. Inflammation and redness of the oral mucosa 4. Ecchymoses present on the anterior trunk
3
A 22-year-old with stage I Hodgkin disease is admitted to the oncology unit for radiation therapy. During the initial assessment, the patient tells you, "Sometimes I'm afraid of dying." Which response is most appropriate at this time? 1. "Many individuals with this diagnosis have some fears." 2. "Perhaps you should ask the doctor about medication." 3. "Tell me a little bit more about your fear of dying." 4. "Most people with stage I Hodgkin disease survive."
a,d,e
The charge nurse is reviewing the plan of care for a client newly diagnosed with leukemia with a decreased neutrophil count. Which interventions indicate that the focus of care is to prevent infection? (Select all that apply.) a Maintain strict hand hygiene measures b Monitor hydration status c Avoid invasive procedures d Monitor white blood cell values e Implement protective isolation precautions
