PrepU: Chapter 11
A student makes the statement to a colleague, "Blood plasma is essentially just a carrier for the formed cells like red blood cells and white blood cells." What would be the most accurate response to this statement?
"Actually, plasma plays a significant role in nutrient and waste transport." Explanation: Plasma proteins are integral to transport. They are not noted to contribute to the inflammatory response, hematopoiesis, protein synthesis, or liver function.
The nurse is teaching the mother of an infant diagnosed with aplastic anemia about the pathophysiology of the disease. The nurse knows that the mother understands when the the mother identifies which of the following statements as the cause of aplastic anemia?
"My child's stem cells are not able to grow and divide." Explanation: Aplastic anemia develops when the multipotent stem cells fail to grow and provide cells for differentiation.
A nurse is assessing a patient presenting with symptoms of fatigue, fever, severe joint pain, and headache. Laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour. The patient asks what the blood test results mean. Which of the following is the most appropriate explanation for the nurse to provide?
"The ESR tests for the presence of inflammation in the body." Explanation: In anticoagulated blood, red blood cells aggregate and are deposited to the bottom of a tube. The rate of fall is often increased in inflammatory diseases. Normal values are 0-15 mm/hour for men and 1-20 mm/hour for women. Increased sedimentation rate indicates inflammation and is used as a baseline and trend indicator in managing inflammatory disorders. The nurse can explain the purpose of the test but cannot medically diagnose a patient.
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 Explanation: The absolute neutrophil count is supposed to be 1000/uL and neutropenia or a low neutrophil count is less than 1000/uL, placing the client at risk for infection, as nuetrophils play a critical role in fighting infection.
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 Explanation: The acclerated phase of CML is characterizd by splenomegaly, increase in basophil count, low grade fever, night sweats, bone pain, and weight loss as well as bleeding and bruising.
A patient 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 Explanation: A person with SLE (an autoimmune disease) with neutropenia would be considered to have acquired (not born with), autoimmune secondary neutropenia. Chronic refers to long-term conditions.
Which types of leukemias originate from the B cells? Select all that apply.
Acute lymphocytic leukemia Chronic lymphocytic leukemia Explanation: ALL and CLL originates from the B cells, while CML originates with the myeloid cells and AML originates with the myeloid precursor cells in the bone marrow.
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 Explanation: Eosinophils increase in number during allergic reactions and parasitic infections.
Which of the following statements most accurately conveys an aspect of lymphatic system activity?
B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures. Explanation: While both precursor B and T lymphocytes begin their development in the bone marrow, they migrate to peripheral lymphoid structures to complete the differentiation process. Stem cells are not located in the lymph nodes and circulation of white cells is not exclusive to the lymphatic circulatory system.
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. Explanation: The B lymphocytes (B cells) differentiate to form antibody-producing plasma cells that retain memory and are involved in humoral-mediated immunity.
Which of the following types of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions?
Basophils Explanation: The basophil is related to connective tissue mast cell because they contain similar granules and are believed to be involved in allergic and hypersensitivity reactions. Neutrophils, granulocytes, and B lymphocytes are not identified as being similar to mast cells.
When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant?
Basophils. Explanation: The basophils have granules that contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation.
Definitive diagnosis of multiple myeloma includes the triad of bone marrow plasmacytosis, lytic bone lesions, and what?
Bence-Jones proteins in the urine Explanation: Diagnosis of multiple myeloma is based on clinical manifestations, blood tests, and bone marrow examination. The classic triad of bone marrow plasmacytosis (more than 10% plasma cells), lytic bone lesions, and either the serum M-protein spike or the presence of Bence-Jones proteins in the urine is definitive for a diagnosis of multiple myeloma. Oligoclonal bands are indicative of multiple sclerosis, and BCR-ABL fusion protein is found in CML.
Select the option that best describes the production of T lymphocytes.
Bone marrow - thymus - lymph nodes Explanation: T lymphocytes leave the bone marrow as precursor T lymphocytes and travel to the thymus, where they differentiate into CD4 helper T cells and CD8 cytotoxic T cells. T lymphocytes also travel to the lymph nodes. The first option describes the production of B lymphocytes. The other options do not describe B- or T-lymphocyte production.
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 Explanation: Multiple myeloma presents primarily in the bones and bone marrow, and the first symptom is typically bone pain. Other symptoms include bone destruction, easy bruising, and fatigue. The other options are not generally seen as being the initial symptom of multiple myeloma.
A client is experiencing the early stage of multiple myeloma. The nurse would assess the client for:
Bone pain Explanation Bone pain is one of the first symptoms to occur in approximately three fourths of all individuals diagnosed with multiple myeloma. Multiple myeloma presents primarily in the bones and bone marrow. The other choices are also signs and symptoms of the disease, however, not commonly the earliest.
A client is ordered the recumbent granulocyte CSF filgrastim. The nurse evaluates the effectiveness by monitoring which of the following?
CBC/diff Explanation: The nurse would evaluate the effectiveness of the recumbent granulocyte CSF by monitoring the client's CBC/diff, as the intended effect is to stimulate granulocyte maturation and increase neutrophil counts.
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 Explanation: T lymphocytes differentiate to form CD4+ helper T cells which serve to orchestrate the immune response. A client with low levels of T lymphocytes will have decreased immune response, which the nurse should consider when planning the client's care.
A client has a lymphoma that carries a risk of CNS involvement. The nurse anticipates the health care provider will prescribe:
CNS prophylaxis Explanation: Persons with lymphomas that carry a risk of CNS involvement usually receive CNS prophylaxis with high doses of chemotherapeutic agents or cranial irradiation. The other options would not benefit the client.
Monocytes, which are precursors of the mononuclear phagocyte system, are often referred to as macrophages when they enter the tissues.
Development of immune granulomas Engulf foreign material Functions as a macrophage in the tissues Function as an antigen-presenting cell
The nurse is conducting a staff in-service program on non-Hodgkin's lymphomas. The nurse should include that essentially all people with Burkitt lymphoma have evidence of infection with which of the following?
EBV Explanation: The nurse should include that nearly all people with Burkitt lymphoma have evidence of infection with the EBV virus.
During science class, a student asks, What is the difference between plasma and serum in the blood? The nurse responds that the primary difference between plasma and serum is that plasma contains:
Fibrinogen. Explanation: The major difference between plasma and serum is the presence of fibrinogen in the plasma from an anticoagulated centrifuged whole blood specimen. When blood is removed from the body for testing, it clots within 30 to 60 minutes. The clot contains the blood's cellular components emeshed in a insoluble fibrin network (formed by the polymerization of soluble plasma protein fibrinogen. The remaining fluid portion is the yellow liquid serum. This serum no longer contains fibrinogen because the fibrinogen originally present in uncoagulated blood was used up in the formation of the blood clot. Heparin, WBC and Hydrogen ions are incorrect.
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. Explanation: The ESR is a screening test for monitoring the fluctuations in the clinical course of a disease such as PMR. Symptoms of this inflammatory disorder include fatigue, fever, pain, and headache, which are all a result of the systemic effects of cytokine release. An individual who is diagnosed with PMR will have an initial ESR drawn. If the ESR is >60, the person is diagnosed with a severe PMR. Generally, the person is prescribed prednisone, and then at follow-up visits, the dose of prednisone will be gradually decreased depending on the ESR and the person's symptoms.
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 Explanation: The finding of blast cells in the bone marrow is indicative of leukemia.
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 Explanation: Diagnostic testing for NHL includes a lymph node biopsy and immunophenotyping to determine the lineage and clonality.
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. Neutrophils are very mobile and are the first cells to go to an area of tissue damage. Erythrocytes (RBCs) contain O2-carrying protein that functions in the transport of oxygen. Albumin, a plasma protein does not pass through the pores in the capillary wall to enter the interstitial fluid and therefore contributes to the plasma osmotic pressure and maintenance of blood volume.
The nurse is presenting at an educational event to a group of clients with cancer. What would the nurse cite as the most commonly occurring hematologic cancer?
Non-Hodgkin lymphomas Explanation: Non-Hodgkin lymphomas represent the cancer with the second fastest rate of increase in the United States and the most commonly occurring hematologic cancer. Neoplasms of immature B cells include lymphoblastic leukemia/lymphoma (i.e., ALL). They are not classed as NHLs. Mantle cell lymphoma is one of the mature B-cell lymphomas.
Which of the following is the name of the fluid that remains after blood clots?
Serum Explanation: Serum is the name of the fluid after blood clots.
A 26-year-old female client has a neutrophil count of less than 500 ?L. The nurse would interpret this as:
Severe neutropenia Explanation: A moderate neutropenia diagnosis would be consistent with a count of 500 to 1000 ?L. Normal count would be 5000 to 10,000 ?L. Mild neutropenia would be 1000 ?L and severe neutropenia at less than 500 ?L.
When looking at a granulocyte under a microscope, the anatomy student would describe it as:
Shaped like a sphere with multi-lobar nuclei. Explanation: Granulocytes are spherical and have distinctive multi-lobar nuclei. They are all phagocytic cells that are identifiable because of their cytoplasmic granules. Answers A, B, and C are incorrect. Agranulocytes (lacking granular cytoplasm). Monocytes have a large amount of cytoplasm and a nucleus in the shape of a kidney. Erythrocytes lack a cell nucleus.
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 Explanation: Neutrophils provide the first line of defense against organisms that inhabit the skin and gastrointestinal tract. Thus, skin infections and ulcerative necrotizing lesions of the mouth are common types of infection in neutropenia.
Chronic lymphocytic leukemia (CLL) commonly causes hypogammaglobulinemia. This makes clients with CLL more susceptible to infection. What are the most common infectious organisms that attack clients with CLL?
Staphylococcus aureus Explanation: Hypogammaglobulinemia is common in CLL, especially in persons with advanced disease. An increased susceptibility to infection reflects an inability to produce specific antibodies and abnormal activation of complement. The most common infectious organisms are those that require opsonization for bacterial killing, such as Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae. Mycobacterium tuberculosis, Pseudomonas aeruginosa, and Escherichia coli are not infectious agents common in clients with CLL.
When assessing the mouth of a client receiving chemotherapy, which of the following should the nurse interpret as a possible indicator of neutropenia?
Stomatitis When assessing the oral cavity, the nurse should interpret stomatitis as a possible indicator of neutropenia. Other clinical indicators of mild to moderate neutropenia include mild skin lesions, pharyngitis, and diarrhea.
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. Explanation: Inflammatory diseases, such as systemic lupus erythematosus, are a common indicator for an ESR test. The other health problems noted are less commonly marked by inflammatory processes.
A nurse on an oncology floor is treating a client who is anemic following chemotherapy. The drugs being administered are designed to increase the number of red blood cells in circulation. These drugs are likely agonists of:
cytokines. Explanation: RBC production is directed by cytokines and growth factors. Lymphokines are used for communication between lymphocytes, and trophic and secondary hormones are too broad an answer to this question.
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. Explanation: Lymph node biopsy provides the definitive diagnosis of Hodgkin lymphoma, which is the client's most likely medical diagnosis. BMT would be premature at this stage in care. An induction phase is used in the treatment of acute leukemias. Monitoring the client without further testing or treatment would be unsafe.
Which of the following is the most common leukocyte in normal blood?
Neutrophilic granulocyte Explanation: Neutrophilic granulocyte is the most common leukocyte in normal blood.
The nurse is reviewing the client's laboratory report. Select the report that represents a normal value for leukocytes.
6500 cells/mL Explanation The number of leukocytes, or white blood cells, in the peripheral circulation normally ranges from 4500 to 10,500 cells/mL (4.5 to 10.5 × 109/L).
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 Explanation: Hepatitis and splenomegaly are common manifestations of infectious mononucleosis and are thought to be immune mediated. Hepatitis is characterized by hepatomegaly, nausea, anorexia, and jaundice. Although discomforting, it usually is a benign condition that resolves without causing permanent liver damage. The spleen may be enlarged two to three times its normal size, and rupture of the spleen is an infrequent complication. Cranial nerve palsies, not peripheral nerve palsies, can occur. Lymph nodes do not rupture. Severe bacterial infections are complications of Kostmann syndrome.
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) Explanation: EBV is the usual causative factor that results in the development of infectious mononucleosis. People with HIV may be at more risk for contacting mononucleosis. EBV may contribute to lymphoproliferative disorders, such as non-Hodgkin lymphoma.
A child diagnosed with acute lymphocytic leukemia undergoes aggressive high-dose chemotherapy and is scheduled for an autologous stem cell transplant. Which of the following treatments would the nurse anticipate administering? Select all that apply.
Erythropoietin (EPO) to stimulate red blood cell production Granulocyte colony-stimulating factor (G-CSF) to promote the proliferation of all neutrophils Thrombopoietin (TPO) to stimulate platelet development Macrophage colony-stimulating factor (M-CSF) to increase macrophage colonies. Explanation: Many cytokines stimulate the growth and production of new blood cells. CSFs promote the growth of hematopoietic cell colonies. The CSFs that act on committed progenitor cells include EPO; TPO; GM-CSF, which stimulates progenitors for granulocytes, monocytes, erythrocytes, and megakaryocytes; G-CSF, which promotes the proliferation of neutrophils; and M-CSF, which induces macrophage colonies. Growth factors are used to increase peripheral stem cells for transplantation and to accelerate cell proliferation after bone marrow engraftment. Administration of a flu vaccine is contraindicated with immunosuppression.
Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to help with their chronic anemia?
Erythropoietin (EPO). Explanation: The CSFs that act on committed progenitor cells include erythropoietin (EPO) which stimulates RBC production. TPO stimulates platelets. Neupogen is for white blood cell production. Interleukin is a cytokine utilized as a immune response agent.
Which of the following is the main job of lymphocytes?
Immune reaction Explanation: Immune reaction is the main job of lymphocytes.
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 Explanation: Hodgkin lymphoma includes fevers, chills, night sweats, and weight loss. Pruritus and intermittent fevers associated with night sweats are classic symptoms of Hodgkin lymphoma. Most persons with Hodgkin lymphoma present with painless enlargement of a single node or group of nodes. Multiple myeloma presents with bone pain. The classic presentation of endogenous Burkitt lymphoma is a destructive tumor in the jaw and other facial bones. The manifestations of NHL depend on the lymphoma type.
A lymph node biopsy pathology report notes the presence of Reed-Sternberg cells on a patient suspected of having a lymphoma. The nurse interprets the report as indicating which of the following?
Hodgkin's lymphoma Explanation: Hodgkin's lymphoma is a specialized form of lymphoma that features the presence of an abnormal cell called a Reed-Sternberg cell. Therefore the nurse should interpret the pathology report as indicating Hodgkin's lymphoma.
The nurse is aware that a client diagnosed with multiple myeloma is most at risk for:
Hypercalcemia Explanation: The main sites involved in multiple myeloma are the bones and bone marrow. In addition to the abnormal proliferation of marrow plasma cells, there is proliferation and activation of osteoclasts, which lead to bone resorption and destruction. This increased bone resorption predisposes the individual to pathologic fractures and hypercalcemia.The other options will not cause alterations in serum calcium.
A client with acute leukemia has developed gout. The nurse is aware that this results from:
Hyperuricemia Explanation: Hyperuricemia occurs as the result of increased proliferation or increased breakdown of purine nucleotides secondary to leukemic cell death that results from chemotherapy. It may increase before and during treatment. Prophylactic therapy with allopurinol, a drug that inhibits uric acid synthesis, is routinely administered. Diet will contribute to gout.
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 Explanation: Unregulated overproduction of the red cell mass is termed polycythemia, which causes a thickening of the blood and an increased risk of blood clots.
Which of the following therapies are part of the treatment for acute lymphocytic leukemia (ALL)? Select all that apply.
Induction Intensification Maintenance Explanation: Treatment of ALL and AML (acute myelogenous leukemia) consists of several phases and includes induction therapy, which is designed to elicit a remission; intensification therapy, which is used to produce a further reduction in leukemic cells after a remission is achieved; and maintenance therapy, which serves to maintain the remission. There is no consolidation therapy phase.
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. Explanation: A decrease in the number of neutrophils places an individual at risk for infection. Neutrophils are not directly involved in the antibody-mediated immune process and his neutropenia is infection-related, not cyclic.
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. Explanation: Acquired neutropenia encompasses a broad spectrum of causative processes and includes primary and secondary autoimmune neutropenia, infection-related neutropenia, and drug-induced neutropenia.
Which type of macrophages are found in the liver?
Kupffer cells Explanation: Rationale: Macrophages found in the liver are known as Kupffer cells. Histiocytes are macrophages found loose in connective tissue, and microglial cells are brain macrophages. Monocytes are referred to macrophages when they enter the tissues.
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 Explanation: One of the characteristics resulting from the proliferating osteoclasts in multiple myeloma is the unregulated production of a monoclonal antibody referred to as the M protein. In most cases the M protein is either IgG or IgA. This phenomenon is not present in cases of AML, ALL, or Hodgkin lymphoma.
A student nurse is taking microbiology and reviewing various types of cells. From which of the following cell types are granulocytes derived?
Myeloid stem cells Explanation: Macrophages play an important role in immune response by activating lymphocytes and by presenting antigens to T cells. Leukocyte development begins with the myeloid and lymphoid stem cells in the bone marrow. Granulocytes are derived from myeloid stem cells.
The granulocyte cell lines are derived from which of the following?
Myeloid stem cells Explanation: Leukocyte development begins with the myeloid and lymphoid stem cells in the bone marrow. The granulocyte and monocyte cell lines derive from the myeloid stem cells and the lymphocytes from the lymphoid stem cells. Metamyelocytes mature to become mature neutrophils. Monoblasts are derived from monocytes.
The nurse is speaking to a group of genetic students touring the hospital's laboratory. The nurse talks about the possibility of a genetic predisposition for the leukemias being suggested because of the increased incidence of the disease among a number of congenital disorders. Which congenital disorders are these? (Select all that apply.)
Neurofibromatosis Fanconi anemia Down syndrome Explanation: The existence of a genetic predisposition to develop acute leukemia is suggested by the increased leukemia incidence among a number of congenital disorders, including Down syndrome, neurofibromatosis, and Fanconi anemia. Cushing syndrome is not a genetic disorder, nor is Prader-Willi syndrome.
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. Explanation: Thrombocytopenia is a decreased number of platelets, which places the patient at high risk for bleeding.
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 Explanation: Thrombocytes, or platelets, are circulating cell fragments of the large megakaryocytes that are derived from the myeloid stem cell. They function to form the platelet plug to help control bleeding after injury to a vessel wall. Their cytoplasmic granules release mediators required for the blood coagulation process. Thrombocytes have a membrane but no nucleus, cannot replicate, and, if not used, last approximately 10 days in the circulation before the phagocytic cells of the spleen remove them.
Progenitor cells, or parent cells, for the production of myeloid and lymphoid cells are derived from which of the following?
Pluripotent stem cells Explanation: A small population of cells called pluripotent stem cells are capable of providing progenitor cells, or parent cells, for myelopoiesis and lymphopoiesis, processes by which myeloid and lymphoid blood cells are made. Unipotent cells are the progenitors for each of the blood cell types and come from pluripotent stem cells. Multipotential progenitor cells act as parent cells for multiple types of blood cells. Myeloproliferative cells do not exist.
The entire hematopoietic system, including the precursor erythroids, myelocytes, lymphocytes, and megakaryocytes are derived from a small population of cells. These cells are known as which of the following?
Pluripotent stem cells Explanation: The entire hematopoietic system arises from a small number of stem cells that differentiate to form blood cells and replenish the bone marrow by a process of self-renewal. All of the hematopoietic precursors (erythroids, myelocytes, lymphocytes and megakaryocytes) are derived from pluripotent stem cells. These cells are capable of providing progenitor cells. Several levels of differentiation lead to the development of committed unipotent cells. Pluripotent stem cells give rise to the lymphoid stem cells.
A client's history documents the presence of a myelocytic leukemia. The nurse interprets this to mean that the leukemia is which of following?
Predominant cell is myelocytic Explanation: In myeloctic leukemias, the predominant cell type is myelocytic regardless of whether the leukemia is chronic or acute.
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 Explanation: HL has the presence of Reed-Sternberg cells and originates in a single node or chain of nodes (rather than extranodal sites). Bence Jones proteins are related to multiple myeloma; Epstein-Barr is related to mononucleosis and H. pylori with gastric ulcer disease.
What is the name of the region of the lymph nodes that contain most of the T cells?
The paracortex Explanation: The portion of the cortex between the medullary and superficial cortex is called the paracortex. The region contains most of the T cells in the lymph nodes. The B-cell-dependent cortex consists of two types of follicles: immunologically inactive follicles, called primary follicles, and active follicles that contain germinal centers called secondary follicles. There is no primary cortex in the lymph nodes.
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 Explanation: Umbilical cord blood from HLA-matched donors is a transplant option for children and carries less risk of graft-versus-host disease. Stem cell transplants focus on correcting bone marrow failure, immunodeficiencies, hematologic defects and malignancies, and inherited errors of metabolism. Sources of the stem cells include bone marrow and umbilical cord blood, which replenish the recipient with a normal population of pluripotent stem cells. Stem cell transplants may be derived from the client (autologous) or from a histocompatible donor (allogeneic). Autologous transplants are often used to replenish stem cells after high-dose chemotherapy or irradiation.
Which is the reason why bed rest and analgesics are expected treatments for infectious mononucleosis?
To relive fever, headache, and sore throat Explanation: Rationale: The typical treatment will consist of bed rest and analgesics to keep the patient comfortable. Antivirals, transfusions and antibiotics are not required.
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 Explanation: The nurse should anticipate orders that include white blood cell count as this teenager is experiencing symptoms of possible mononucleosis, including severe pharyngitis, a fever, and prodromal period that includes maliase. Typically, the peripheral blood of those with mononucleosis includes increase in number of leukocytees with a white blood cell count of 10,000 cells/uL, 30 percent of which are leukocytes.
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 Explanation: Leukocytes are crucial to our defense against disease. The high WBC count in this would indicate that the patient has an inflammatory or infectious process ongoing, which may be the cause of the patient's pain, and that further diagnostic testing is needed.
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. Explanation: Diffuse large B-cell lymphomas are a heterogenous group of aggressive germinal or postgeminal center noeplasms. They evolve rapidly, are multifocal, nodal and extranodal. They are rapidly fatal if left untreated.
