Pathophysiology PrepU Chp 11
Which of the following patients have an absolute neutrophil count that is critically low and the standard of care would recommend they be placed on neutropenic precautions?
37 year old patient with leukemia being treated with chemotherapy with ANC of 400.
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 evaluating a client's bloodwork determines that a client has an increased risk for infection based on which of the following lab results?
Absoulute neutrophil count of 800/uL
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
The leukemia most commonly found in children and adolescents is recognized as:
Acute lymphocytic leukemia (ALL)
A patient comes to the clinic with a runny nose and scratchy throat. The nurse is evaluating the white blood cell count, which shows an elevated number of white blood cells and an increased percentage of eosinophils. Which of the following is the most likely cause of the symptoms?
Allergic reaction
The nurse is elaborating on treatment options for a client with multiple myeloma. The nurse includes which of the following? Select all that apply.
Allogenic transplantation "Mini" transplants Alkalizing agents and prednisone
The cloning of the genes for most of the hematopoietic growth factors has been accomplished. The recombinant proteins that are produced are used in a wide range of clinical problems. What diseases have these proteins been used to fight?
Aplastic anemia and the anemia of kidney failure
A patient comes to the clinic following exposure to chicken pox. The patient states he had chicken pox as a child but was worried about getting sick again. Which of the following statements best explains humoral-mediated immunity to the patient?
B lymphocytes (B cells) in the body produce antibodies to fight infections. Once exposed, the cells retain memory and are able to quickly fight off pathogens during re-exposure and prevent the disease from reoccurring.
When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant?
Basophils
Select the option that best describes the production of T lymphocytes.
Bone marrow - thymus - lymph nodes
A patient is suspected of having acute leukemia. Which of the following diagnostic tests does the nurse prepare for to verify that diagnosis?
Bone marrow biopsy
A client is experiencing the early stage of multiple myeloma. The nurse would assess the client for:
Bone pain
Which of the following is the first symptom of multiple myeloma that a patient typically presents with on a visit to the primary care provider?
Bone pain
Which of the following types of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions?
Bsophils
The nurse is planning a prevention program for infectious mononucleosis. The best target audience for the program is which of the following?
College students living in a dorm
The nurse is caring for a client who has a low levels of T lymphocytes. The nurse plans care for a client with which of the following?
Decreased immune response
The nurse reading a client's history and physical notes that the client has a history of leukopenia. The nurse interprets this to mean that the client has which of the following?
Decreased leukocytes
A nurse is caring for a newborn that has developed a low platelet count. Which of the following could be the cause?
Decreased thrombopoietin (TPO)
A nursing professor is teaching nursing students about the immune system. The instructor knows that teaching has been successful when a student correctly identifies which of the following as being roles of the monocyte? Select all that apply.
Development of immune granulomas Engulf foreign material Functions as a macrophage in the tissues Function as an antigen-presenting cell
Infectious mononucleosis is a lymphoproliferative disorder caused by the Epstein-Barr virus (EBV) that is usually self-limiting and nonlethal. Which of the following complications can arise during this mostly benign disease?
Enlarged spleen
A nurse is evaluating laboratory results of a patient diagnosed with a parasitic infection. The tests reveal a large group of cells that are membrane bound with granules in their cytoplasm that are aiding in the destruction of the parasite. Which of the following cells is the nurse evaluating?
Eosinophil
Endemic Burkitt lymphoma occurs in regions of Africa where what other infections are common?
Epstein-Barr and malaria
A 16-year-old male client who has been diagnosed with infectious mononucleosis asks the health care provider what caused the condition. The best response would be:
Epstein-Barr virus (EBV)
Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to help with their chronic anemia?
Erythropoietin (EPO).
The nurse's plan of care for a client with multiple myeloma should include interventions to prevent which of the following?
Fractures
A patient being treated for polymyalgia rheumatica (PMR) comes to the clinic for a follow-up visit. The current erythrocyte sedimentation rate (ESR) rate has decreased from 60 mm/hour to 30 mm/hour and the patient is afebrile, denies any headaches, and reports a decrease in joint pain and fatigue. Based on these findings, the nurse anticipates which of the following changes to the treatment plan?
Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks.
Which of the following assessment and laboratory findings would be most closely associated with acute leukemia?
High blast cell counts and fever.
A client is seen by the health care provider. The client states he has been experiencing fevers, chills, and night sweats. Upon further assessment, the health care provider palpates an enlarged supraclavicular lymph node. The health care provider recognizes the manifestations as:
Hodgkin lymphoma
A client with acute leukemia has developed gout. The nurse is aware that this results from:
Hyperuricemia
A patient is admitted to the emergency department with a diagnosis of polycythemia. The nurse plans to assess for symptoms related to which of the following problems?
Increased blood viscosity
A 44 year-old male hospital client with a diagnosis of end-stage acquired immunodeficiency syndrome (AIDS) has been placed on neutropenic precautions that limit his interaction with visitors, staff and other clients. What is the underlying rationale for these precautions?
Insufficient levels of neutrophils make him particularly susceptible to infections.
Which of the following statements about 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.
Which type of macrophages are found in the liver?
Kupffer cells
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?
Luekemia
The nurse is conducting patient education for a client who is scheduled to undergo diagnostic testing for non-Hodgkin's lymphoma (NHL). The nurse includes information on which of the following?
Lymph node biopsy
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
The physician reviews a client's lab results and notes that the neutrophil count is 900/uL. This is known as which of the following?
Neutropenia
A nurse sends a blood sample to the lab for analysis. Assuming the sample is normal, the nurse anticipates which of the following white blood cells (WBCs) will account for the highest percentage?
Neutrophils
Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the:
Neutrophils.
A nurse is reviewing a client's complete blood count (CBC) which indicates thrombocytopenia. Based on this result which action should the nurse include in the plan of care?
Place the client on bleeding precautions.
The nurse is caring for a client with leukemia that 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?
Platelets
A client is admitted with a suspected diagnosis of Hodgkin lymphoma (HL). Select the diagnostic manifestation that would confirm the diagnosis.
Presence of Reed-Sternberg cells
The nurse is caring for a client with multiple myeloma with Bence-Jones proteins. With this "light chain" form of the disease, it is important for the nurse to include assessment for which of the following?
Renal disease
A client laboratory report indicates neutropenia. The nurse is aware the client is at greatest risk for development of infection. The most important area for the nurse to assess would be:
Skin
A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which of the following treatments that can correct bone marrow deficiencies?
Stem cell transplant
A patient is diagnosed with acute leukemia. Which of the following treatment therapies can be used to correct bone marrow failure and treat malignancies?
Stem cell transplant
When assessing the mouth of a client receiving chemotherapy, which of the following should the nurse interpret as a possible indicator of neutropenia?
Stomatitis
A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which of the following clients would be most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered? An adult with:
Systemic lupus erythematosus.
Which of the following statements best conveys a characteristic of red blood cells?
They contribute to the maintenance of blood pH.
A 6-year-old child is having a stem cell transplant using umbilical cord blood. What benefit does the nurse understand that this type of transplant will have for the child?
This type of transplant creates less risk of graft-versus host disease
Which is the reason why bed rest and analgesics are expected treatments for infectious mononucleosis?
To relive fever, headache, and sore throat
A nurse is reviewing laboratory data for an elderly patient. Which of the following laboratory values should the nurse be most concerned about?
White blood cell (WBC) count 3500/mL
A nurse is reviewing the laboratory data for a hospitalized client. The nurse would be most concerned about which finding?
White blood cell (WBC) count of 2800/µL
A high school teenager comes to the emergency room with symptoms that include the abrupt onset of severe pharyngitis and a high fever. The teenager reports that in the previous four days he has "just not felt well." The nurse anticipates orders to include which of the following?
White blood cell count
The nurse is reviewing the complete blood count (CBC) and white blood cell (WBC) differential of a client admitted with lower right abdominal pain. Which laboratory results are the most important for the nurse to communicate to the health care provider?
White blood cells (WBCs) 18,500/µL
Which of the following diagnostic test results are abnormal? Select all that apply.
White blood cells: 3.8 × 109/L Platelets: 500 × 103 Red blood cells: 6.6 × 1012/L
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.
The nurse evaluating a client's blood work notes that the client's white blood cells are 9000. The nurse should:
continue to monitor the client's blood work results.
A 20-year-old client has presented for care because she has a cervical lymph node on the right side of her neck that is firm and enlarged, and has been so for several weeks. Palpation of the node is painless. The nurse should document this assessment finding and anticipate:
facilitating the client's lymph node biopsy.
