Disorders of WBCs: Exam 5
1 (A cell saver is a device to catch the blood lost during orthopedic surgeries to reinfuse into the client, rather than giving the client donor blood products. The cells are washed with saline and reinfused through a filter into the client. The salvaged cells cannot be stored and must be used within four (4) hours or discarded because of bacterial growth.)
The client undergoing knee replacement surgery has a "cell-saver" apparatus attached to the knee when he arrives in the post-anesthesia care unit (PACU). Which intervention should the nurse implement to care for this drainage system? 1. Infuse the drainage into the client when a prescribed amount fills the chamber. 2. Attach an hourly drainage collection bag to the unit and discard the drainage. 3. Replace the unit with a continuous passive motion unit and start it on low. 4. Have another nurse verify the unit number prior to reinfusing the blood.
2 (Fresh fruits and flowers may carry bacteria or insects on the skin of the fruit or dirt on the flowers and leaves, so they are restricted around clients with low white blood cell counts.)
The nurse is caring for clients on an oncology unit. Which neutropenia precautions should be implemented? 1. Hold all venipuncture sites for at least five (5) minutes. 2. Limit fresh fruits and flowers. 3. Place all clients in reverse isolation. 4. Have the client use a soft-bristle toothbrush.
sentinel event
The nurse knows that a transfusion reaction is a serious reportable event and a _________ _________.
patency
The nurse preparing for blood administration should verify the __________ of the IV before requesting blood from the blood bank
ALL (acute lymphoblastic leukemia)
Types of Leukemia The following describes which type? -A rapid increase in the number of immature white blood cells
b (in complete remission the bone marrow and peripheral blood appear normal. The patient does not show nay evidence of disease upon physical examination. partial remission is a condition characterized by a lack of disease symptoms and a normal peripheral blood smear, but evidence of disease remains in the bone marrow. Molecular remission is the condition in which all molecular studies are negative for residual leukemia. Minimal residual disease indicates that tumor cells cannot be detected by morphologic examination but can be detected by molecular testing.)
When the posttreatment diagnostic studies for a patient with leukemia indicate normal bone marrow and peripheral blood, and the physical examination does not show any evidence of disease, which term will be used to describe the patients status? a. partial remission b. complete remission c. molecular remission d. minimal residual disease
a (Since ibritumomab tiuxetan contains a radioactive isotope, radiation precautions should be observed when patients receive the medication. Ibritumomab tiuxetan causes pancytopenia and increased bleeding risk; pts should avoid the use of aspirin or nonsteroidal antiinflammatory drugs, but acetaminophen can be safely used. Other medications can be taken with ibritumomab tiuxetan. Patients should be counseled to avoid pregnancy while receiving ibritumomab tiuxetan, b/c the medication is teratogenic.)
Which action will the nurse need to take when a pt has ibritumomab tiuxetan prescribed for treatment of non-hodgkins lymphoma? a. follow hospital policy regarding radiation precautions b. teach the pt to avoid using of acetaminophen during treatment c. avoid administering other medications with ibritumomab tiuxetan d. remind the patient to discontinue contraceptive use during treatment
d (A PET scan will be done after the initial chemo series to determine effectiveness and help decision making about future treatment. HL staging is done prior to treatment and is not revised after treatment. PTs. require early and ongoing follow-up after treatment b/c secondary cancers caused by chemo and radiation are common. A five year follow up interval would be too long. Maintenance chemo has not been found effective in HL.)
Which action will the nurse plan to take after a pt. has completed an initial series of chemo treatments for Hodgkins Lymphoma? a. coordinate testing to revise staging of the disease b. ask the patient to follow up at five year intervals c. arrange for ongoing maintenance chemotherapy d. schedule positron emission tomography (PET) scanning
b (AML accounts for 15% to 20% of acute leukemia in children and 80% in adults. ALL is most frequently seen in children, with a mean age of 15 years at diagnosis. CLL is a chronic leukemia seen mostly in older adults but is not an acute leukemia. CML is a chronic, rather than acute, leukemia seen in older adults.)
Which type of leukemia accounts for the majority of acute leukemia in adults? a. acute lymphocytic leukemia (ALL) b. acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)
Neutropenia
deficiency of neutrophils; reduction in number of circulating neutrophils; closely monitored in practice as indicator of pt's risk for infection
Leukopenia
low WBC count; reduction in number of circulating WBCs
lymphangiogram
radiographic images of lymph vessels and nodes following injection of contrast material =
mild neutropenia
An ANC of 1000 to 1500 indicates _______ _________
moderate neutropenia
An ANC of 500 to 999 indicates _____ _
leukemia
The following describes Therapeutic management for ______________ -Chemotherapy/radiation; target and kill the fast growing cells/overproduction of WBCs, but it also kills healthy cells, so there are several side effects, N/V, hair loss, mouth sores, etc. -Bone marrow transplant; later in treatment some pts may be eligible -neutropenic precautions: b/c of decreased WBCs; visitors, fresh flowers -bleeding precautions; b/c of decreased platelets -frequent rest periods; b/c of anemia and fatigue -oral hygiene; may have mouth sores/ open sores in mouth are a huge source of infection getting into blood stream
c (Since HIV infection increases the risk for developing Hodgkins or NHL, the finding of an enlarged and nontender lymph node will be reported to the HCP, and the nurse will anticipate diagnostic testing such as lymph node biopsy. The patient's BMI is within the normal range of 18.5 to 25. While current injectable drug use would be of concern, a history of injectable drug use is a common risk factor for HIV. The patients newly initiated treatment for HIV will need ongoing monitoring and follow-up but is not as concerning as the possible complication of Hodgkins lymphoma.)
Which finding will be of most concern when the nurse assesses a patient who is infected with human immunodeficiency virus (HIV) a. patients body mass index is 21 b. patient reports a history of injectable drug use c. patient has an enlarged and nontender cervical lymph node d. patient has just started multiple drug antiretroviral therapy
b (Enlarged lymph nodes are the most common initial finding in Hodgkins lymphoma. Skeletal pain might occur with bone involvement, but this would occur in later stages of the disease. T-cell blasts in the lymph nodes occur with some types of NHL but are not found in Hodgkins lymphoma, which is a lymphoma of B lymphocytes. Lymphoblasts in the cerebrospinal fluid are a diagnostic finding of acute lymphocytic lymphoma and would not be found in stage I Hodgkins lymphoma.)
Which finding will the nurse expect in a patient who is hospitalized with stage I Hodgkins lymphoma a. skeletal pain b. enlarged lymph nodes c. T-cell blasts in the lymph node d. Lymphoblasts in the cerebrospinal fluid
c (painless lymph node enlargement is the most common finding with NHL. Bone marrow suppression and low platelet count is sometimes seen with NHL. Dysuria might indicate urinary tract infection and is not an expected finding with NHL. Red and tender lymph nodes are seen with infection but are not typical of NHL.)
Which finding will the nurse expect when assessing a patient with a new diagnosis of Non-Hodgkins lymphoma (NHL) a. elevated platelet count b. patient report of dysuria c. painless lymphadenopathy d. red and tender lymph nodes
4 (Grieving is an independent problem, and the nurse can assess and treat this problem with or without collaboration.)
11. The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed? 1. Infection. 2. Anemia. 3. Nutrition. 4. Grieving.
660 ANC
15. The client diagnosed with leukemia has had a bone marrow transplant. The nurse monitors the client's absolute neutrophil count (ANC). Which is the client's neutrophil count if the WBCs are 2.2 (103) mm, neutrophils are 25%, and bands are 5%.____________________
2 (The client should be taught to practice birth control during treatment and for at least two (2) years after treatment has ceased. The therapies used to treat the cancer can cause cancer. Antineoplastic medications are carcinogenic, and radiation therapy has proved to be a precursor to leukemia. A developing fetus would be subjected to the internal conditions of the mother.)
21. Which information about reproduction should be taught to the 27-year-old female client diagnosed with Hodgkin's disease? 1. The client's reproductive ability will be the same after treatment is completed. 2. The client should practice birth control for at least two (2) years following therapy. 3. All clients become sterile from the therapy and should plan to adopt. 4. The therapy will temporarily interfere with the client's menstrual cycle.
1 (After the first 15 minutes during which the client tolerates the blood transfusion, it is appropriate to ask the unlicensed nursing assistant to take the vital signs as long as the assistant has been given specific parameters for the vital signs. Any vital sign outside the normal parameters must have an intervention by the nurse.)
23. The nurse and an unlicensed assistive personnel (UAP) are caring for clients in a bone marrow transplant unit. Which nursing task should the nurse delegate? 1. Take the hourly vital signs on a client receiving blood transfusions. 2. Monitor the infusion of antineoplastic medications. 3. Transcribe the doctor's orders onto the Medication Administration Record (MAR). 4. Determine the client's response to the therapy.
3 (This client has a potential for hemorrhage and is reporting blood in the vomitus. This client should be assessed first.)
59. The nurse is caring for clients on a medical floor. After the shift report, which client should be assessed first? 1. The client who is two-thirds of the way through a blood transfusion and has had no complaints of dyspnea or hives. 2. The client diagnosed with leukemia who has a hematocrit of 18% and petechiae covering the body. 3. The client with peptic ulcer disease who called over the intercom to say that he is vomiting blood. 4. The client diagnosed with Crohn's disease who is complaining of perineal discomfort.
1 (After a bone marrow biopsy, it is important that the client form a clot to prevent bleeding. The nurse should hold direct pressure on the site for five (5) to ten (10) minutes)
7. The nurse is assisting the HCP with a bone marrow biopsy. Which intervention postprocedure has priority? 1. Apply pressure to site for five (5) to ten (10) minutes. 2. Medicate for pain with morphine slow IVP. 3. Maintain head of bed in a high Fowler's position. 4. Apply oxygen via nasal cannula at 5 LPM.
d (A platelet count below 150,000/µL indicates thrombocytopenia. Prolonged bleeding from trauma or injury does not usually occur until the platelet counts are below 50,000/µL. Bleeding precautions (e.g., check all secretions for frank and occult blood) are indicated for patients with thrombocytopenia. Injections (including IVs) should be avoided; however, when needed for critical fluids and medications, IV access should be provided through the smallest bore devices that are feasible. Enoxaparin, an anticoagulant administered subcutaneously, is contraindicated in patients with thrombocytopenia. Monitoring temperature would be indicated in a patient with leukopenia.)
A patient with leukemia is admitted for severe hypovolemia after prolonged diarrhea. The platelet count is 43,000/uL. It is most important for the nurse to take which action? a. insert two 18 gauge IV catheters b. administer prescribed enoxaparin c. monitor the patients temperature every 2 hours d. check stools for presence of frank or occult blood
severe neutropenia
An ANC of less than 500 indicates _______ ________
22, 20
Blood components may be administered with a _____-gauge IV needle or catheter but may infuse better with ____g and larger
b, c, e (Bony degeneration from multiple myeloma causes calcium to be lost from bones, eventually causing hypercalcemia, which can lead to changes in neurologic, GI, and cardiac function and symptoms such as seizures, anorexia, and dysrhythmias. Diarrhea is not an expected complication with bone degeneration. Serum calcium levels will increase with bone lysis, leading to hypercalcemia.)
For which complications will the nurse assess when a patient with multiple myeloma develops bone degeneration? a. diarrhea b. seizures c. anorexia d. hypocalcemia e. cardiac problems
c (petechiae are minute hemorrhages into the skin that are seen in patients with bleeding disorders, such as thrombocytopenia. Purpura are larger discolored areas of bleeding that may occur when multiple petechiae coalesce. Bruises are larger areas of bleeding into the skin that occur with thrombocytopenia and might also be noted by the nurse in this patient. Ecchymoses are also larger areas of bleeding seen under the skin in patients with thrombocytopenia or other bleeding disorders.)
How will the nurse document the finding after noting multiple 1-mm red macules when assessing the skin of a patient with leukemia and thrombocytopenia a. purpura b. bruising c. petechiae d. ecchymosis
identification
Improper ________ is the most common cause of hemolytic transfusion reactions. -2 licensed nurses check pt. identification with the labeled blood component -at the bedside, not at the nurses station
increasing
In chronic leukemias (CLL and CML) you'll see _________ WBCs
acute, chronic, lymphocytic, myelogenous
Major types of leukemia; They are classified as _______ or ____________ and by the type of WBC involved, ________ or _______________
1, 2, 4
Most patients will tolerate infusing ____ unit of PRBCs over ______ hours. Blood should not hang for more than ______ hours as it increases the risk of bacterial growth in the product.
severe neutropenia
Patients with ________ ________ are at significantly increased risk of developing opportunistic infections and sepsis -often not able to manifest the classic signs of infection -minor infections can lead quickly to sepsis
pathological fracture
Patients with leukemia can suffer a ___________ ______ b/c some types of leukemia can make calcium leak out of the bone making the bones fragile.
neutrophils
Remember, __________ are the first responder cells responsible for the initial immune response
100.4
Safety alert for neutropenic patients -Neutropenic fever = ______ or greater and or new signs of infection and neutrophil count of <500 is a medical emergency
blood cultures
Safety alert for neutropenic patients -STAT ________ ____ should be drawn and antibiotics started within 1 hour
low-grade fever
Safety alert for neutropenic patients -__________ ________ ______ in a neutropenic patient is of great concern-may lead to septic shock and death if not treated promptly
anemia, neutropenia, thrombocytopenia
Symptoms of Leukemia A = _________ : decreased Hgb N = ___________ : risk of infection T = _____________: bleeding -THINK: leukemias = numerous immature white blood cells like ants in an ant colony
d (maintenance therapy involves treatment with a lower dose of drugs for prolonged period to help keep acute lymphocytic leukemia (ALL) in remission. Induction chemotherapy is the first step in the ALL chemotherapy regimen; consolidation therapy will be used after induction chemotherapy to continue to suppress the proliferation of leukemic cells. Intensification therapy uses higher drug doses than the initial induction therapy, and the patient will continue to feel ill due to continued bone marrow depression. The goal of induction therapy is to destroy all leukemic cells in tissue, blood, and bone marrow, not to help the patient's own bone marrow fight the leukemia.)
After the nurse has taught a patient with leukemia about the stages of chemotherapy, which patient statement indicates effective learning? a. consolidation therapy is the first step in my chemotherapy plan b. I can expect to feel a lot better once intensification therapy is started c. induction therapy will help my own bone marrow fight leukemia cells d. my maintenance therapy may continue for a long time after the initial chemotherapy
positive identification
After the nurse obtains the blood for a blood transfusion, she should make a ________ ________ of the donor blood and recipient
CML (chronic myelogenous leukemia)
Which type of leukemia affects men more than women; also common in older adults
Cytopenia
deficiency of cells in the blood =
1 (The five (5)-year mark is a time for celebration for clients diagnosed with cancer, but the therapies can cause secondary malignancies and there may be a genetic predisposition for the client to develop cancer. The client should continue to be tested regularly.)
The 33-year-old client diagnosed with Stage IV Hodgkin's lymphoma is at the five (5)- year remission mark. Which information should the nurse teach the client? 1. Instruct the client to continue scheduled screenings for cancer. 2. Discuss the need for follow-up appointments every five (5) years. 3. Teach the client that the cancer risk is now the same as for the general population. 4. Have the client talk with the family about funeral arrangements.
1 (The newly diagnosed client will need to be taught about the disease and about treatment options. The registered nurse cannot delegate teaching to a an LPN.)
10. The nurse and licensed practical nurse (LPN) are caring for clients on an oncology floor. Which client should not be assigned to the LPN? 1. The client newly diagnosed with chronic lymphocytic leukemia. 2. The client who is four (4) hours post-procedure bone marrow biopsy. 3. The client who received two (2) units of PRBCs on the previous shift. 4. The client who is receiving multiple intravenous piggyback medications.
induction therapy
The following describes which type of therapy? Administration of high doses of chemo with goal of remission Attempt to induce remission Seek to destroy leukemic cells in tissues, peripheral blood, and bone marrow Patient may become critically ill. Provide psychologic support as well
CLL (chronic lymphocytic leukemia)
Types of leukemia The following describes which type? -excessive buildup of relatively mature, but still abnormal blood cells
1 (It can be difficult to cross-match blood when antibodies are present. If imperfectly cross-matched blood must be transfused, the nurse must start the blood very slowly and stay with the client, monitoring frequently for signs of a hemolytic reaction)
13. The client diagnosed with thalassemia, a hereditary anemia, is to receive a transfusion of packed RBCs. The cross-match reveals the presence of antibodies that cannot be cross-matched. Which precaution should the nurse implement when initiating the transfusion? 1. Start the transfusion at 10-15 mL per hour for 15-30 minutes. 2. Re-crossmatch the blood until the antibodies are identified. 3. Have the client sign a permit to receive uncrossmatched blood. 4. Have the unlicensed nursing assistant stay with the client.
3 (3. Clients who have received a transplant must take immunosuppressive medications to prevent rejection of the organ. This immunosuppression blocks the immune system from protecting the body against cancers and other diseases. There is a high incidence of lymphoma among transplant recipients.)
16. Which client is at the highest risk for developing a lymphoma? 1. The client diagnosed with chronic lung disease who is taking a steroid. 2. The client diagnosed with breast cancer who has extensive lymph involvement. 3. The client who received a kidney transplant several years ago. 4. The client who has had ureteral stent placements for a neurogenic bladder.
1 (17. 1. Up to 90% of clients responds well to standard treatment with chemotherapy and radiation therapy, and those that relapse usually respond to a change of chemotherapy medications. Survival depends on the individual client and the stage of disease at diagnosis.)
17. The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about her prognosis. Which is the nurse's best response? 1. Survival for Hodgkin's disease is relatively good with standard therapy. 2. Survival depends on becoming involved in an investigational therapy program. 3. Survival is poor, with more than 50% of clients dying within six (6) months. 4. Survival is fine for primary Hodgkin's, but secondary cancers occur within a year.
2 (Clients with leukocytosis may be short of breath and somewhat confused as a result of decreased capillary perfusion to the lung and brain from excessive amounts of WBCs inhibiting blood flow through the capillaries.)
18. The client is diagnosed with chronic myeloid leukemia and leukocytosis. Which signs/symptoms would the nurse expect to find when assessing this client? 1. Frothy sputum and jugular vein distention. 2. Dyspnea and slight confusion 3. Right upper quadrant tenderness and nausea. 4. Increased appetite and weight gain
4 (This client is receiving blood. The nurse with experience on a medical-surgical floor should be able to administer blood and blood products.)
20. Which client should be assigned to the experienced medical-surgical nurse who is in the first week of orientation to the oncology floor? 1. The client diagnosed with non-Hodgkin's lymphoma who is having daily radiation treatments. 2. The client diagnosed with Hodgkin's disease who is receiving combination chemotherapy. 3. The client diagnosed with leukemia who has petechiae covering both anterior and posterior body surfaces. 4. The client diagnosed with diffuse histolytic lymphoma who is to receive two (2) units of packed red blood cells.
3 (Stage I lymphoma presents with no symptoms; for this reason, clients are usually not diagnosed until the later stages of lymphoma.)
22. Which clinical manifestation of Stage I non-Hodgkin's lymphoma would the nurse expect to find when assessing the client? 1. Enlarged lymph tissue anywhere in the body. 2. Tender left upper quadrant. 3. No symptom in this stage. 4. Elevated B cell lymphocytes on the CBC.
4 (Any time the nurse suspects the client is having a reaction to blood or blood products, the nurse should stop the infusion at the spot closest to the client and not allow any more of the blood to enter the client's body.)
24. Fifteen minutes after the nurse has initiated a transfusion of packed red blood cells the client becomes restless and complains of itching on the trunk and arms. Which intervention should the nurse implement first? 1. Collect urine for analysis. 2. Notify the lab of the reaction. 3. Administer diphenhydramine, an antihistamine. 4. Stop the transfusion at the hub.
4 (The unlicensed nursing assistant can assist a client to brush the teeth. Instructions about using soft-bristle toothbrushes and the need to report to the nurse any pink or bleeding should be given prior to delegating the procedure.)
58. The nurse and unlicensed nursing assistant are caring for clients on an oncology floor. Which nursing task would be delegated to the unlicensed nursing assistant? 1. Assess the urine output on a client who has had a blood transfusion reaction. 2. Take the first 15 minutes of vital signs on a client receiving a unit of PRBCs. 3. Auscultate the lung sounds of a client prior to a transfusion. 4. Assist a client who received ten (10) units of platelets in brushing teeth.
1, 3, 4 (The client must give permission to receive blood or blood products because of the nature of potential complications. Because infusing IV fluids can cause a fluid volume overload, the nurse must assess for congestive heart failure. Assessing the lungs includes auscultating for crackles and other signs of left-sided heart failure. Assessing the client for jugular vein distention, peripheral edema, and liver engorgement indicates right-sided failure. 4. Checking for allergies is important prior to administering any medication. Some medications are administered prior to blood administration.)
49. The client has a hematocrit of 22.3% and a hemoglobin of 7.7 mg/dL. The HCP has ordered two (2) units of packed red blood cells to be transfused. Which interventions should the nurse implement? Select all that apply. 1. Obtain a signed consent. 2. Initiate a 22-gauge IV. 3. Assess the client's lungs. 4. Check for allergies. 5. Hang a keep-open IV of D5W.
2 (2. The first action in a situation in which the nurse suspects the client has a fluid volume loss is to replace the volume as quickly as possible.)
50. The client is admitted to the emergency department after a motor-vehicle accident. The nurse notes profuse bleeding from a right-sided abdominal injury. Which intervention should the nurse implement first? 1. Type and cross-match for red blood cells immediately (STAT). 2. Initiate an IV with a #18-gauge needle and hang NS. 3. Have the client sign a consent for an exploratory laparotomy. 4. Notify the significant other of the client's admission.
3 (The correct procedure for administering a unit of blood over eight (8) hours is to have the unit split into halves. Each half unit is treated as a new unit and checked accordingly. This slower administration allows the compromised client, such as one with heart failure, to assimilate the extra fluid volume)
56. The HCP orders two (2) units of blood to be administered over eight (8) hours each for a client diagnosed with heart failure. Which intervention(s) should the nurse take? 1. Call the HCP to question the order because blood must infuse within four (4) hours. 2. Retrieve the blood from the laboratory and run each unit at an eight (8)-hour rate. 3. Notify the lab to split each unit into half units and infuse each half for four (4) hours. 4. Infuse each unit for four (4) hours, the maximum rate for a unit of blood.
4 (The priority in this situation is to prevent a further reaction if possible. Stopping the transfusion and changing the fluid out at the hub will prevent any more of the transfusion from entering the client's bloodstream.)
57. The client receiving a unit of PRBCs begins to chill and develops hives. Which action should be the nurse's first response? 1. Notify the laboratory and health-care provider. 2. Administer the histamine-1 blocker, Benadryl, IV. 3. Assess the client for further complications. 4. Stop the transfusion and change the tubing at the hub.
3 (Epogen is a biologic response modifier that stimulates the bone marrow to produce red blood cells. The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow would be generally ineffective for the desired results and would have the potential to stimulate malignant growth.)
7. Which medication is contraindicated for a client diagnosed with leukemia? 1. Bactrim, a sulfa antibiotic. 2. Morphine, a narcotic analgesic. 3. Epogen, a biologic response modifier. 4. Gleevec, a genetic blocking agent.
2 (2. Serum albumin is a measure of the protein content in the blood that is derived from the foods eaten; albumin monitors nutritional status.)
9. The nurse writes a nursing problem of "altered nutrition" for a client diagnosed with leukemia who has received a treatment regimen of chemotherapy and radiation. Which nursing intervention should be implemented? 1. Administer an antidiarrheal medication prior to meals. 2. Monitor the client's serum albumin levels. 3. Assess for signs and symptoms of infection. 4. Provide skin care to irradiated areas,
d (Since the client's question is vague, this is a signal to the nurse that the client wants to talk, so the nurse can ask additional questions to figure out where to take the conversation. The client may be worried and will break down and cry, in which case the nurse would offer presence. The client may want to know something specific about the course of the disease, in which case the nurse would give information. When a client wants to talk about his condition, the nurse must be honest and should not avoid discussion of a painful or sensitive situation.)
A 68-year-old client is being treated for leukemia, but his prognosis is very grim. The client asks the nurse about how he is doing. Which statement from the nurse is most appropriate? A. Based on what we have talked about, how do you think you are doing? B. Some people get to this point and they want to give up. Is that how you are feeling right now? C. Tell me your thoughts about reaching the end of your life and dying D. Are you worried about how sick you will get?
b (Septicemia can be a life-threatening condition for a client, particularly in someone who is immunocompromised, such as with a diagnosis of leukemia. Septicemia is dangerous because the infection is widespread and affects circulation and cardiac output. The client may develop alterations in vascular volume and capillary permeability, eventually affecting perfusion of the distal tissues. Without adequate treatment, it can lead to organ failure because of altered tissue perfusion.)
A client has been admitted to the hospital for surgery. The client has a history of leukemia and has developed septicemia. Which of the following situations is this client most likely at risk for? A. Impaired spontaneous ventilation B. Altered tissue perfusion C. Risk for thermal injury D. Risk for aspiration
a (in partial remission, there will be a lack of symptoms, and the peripheral blood smear will appear to be normal; however, evidence of disease in the bone marrow can be observed. In complete remission, there will be lack of symptoms and no evidence of disease in the bone marrow. In molecular remission, all molecular studies are negative for residual leukemia. In minimal residual disease, tumor cells are not detected by morphologic examination but can be identified by molecular testing.)
After treatment for leukemia a patient no longer experiences symptoms, and the peripheral blood smear is normal although there are abnormal cells in the bone marrow. The patient is in which stage of remission? a. partial remission b. complete remission c. molecular remission d. minimal residual disease
d (heparin-induced thrombocytopenia is treated by stopping administration of heparin. Rituximab acts to lyse B lymphocytes and is used to treat hematologic disease that affect B lymphocytes such as follicular non-Hodgkins lymphoma and chronic lymphocytic leukemia. Rituximab is also used to decrease antibody production by B lymphocytes in immune disorders such as immune thrombocytopenia.)
For which patient will the nurse question the health care provider's prescription for rituximab? a. patient with diagnosis of follicular lymphoma b. patient admitted with immune thrombocytopenia c. patient who has chronic lymphocytic leukemia d. patient with heparin-induced thrombocytopenia
a (ALL is most commonly seen in children. AML is more commonly seen in adults. CLL is commonly seen in older adults. CML is most commonly seen in older adults)
Which leukemia is most commonly seen in children? a. Acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. chronic myelogenous leukemia (CML)
normal saline
The nurse preparing for blood administration knows that she must use ________ _________ because dextrose solution or LR's cause clotting or hemolysis of blood cells
Y-type
The nurse preparing for blood administration knows that she needs ________ tubing to administer
additives, medications
The nurse preparing for blood administration knows that she should not add any ________ or __________ in the same tubing.
4 (4. Pain is expected, but it is a priority, and pain control measures should be implemented.)
12. The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assessment data warrant immediate intervention? 1. T 99, P 102, R 22, and BP 132/68. 2. Hyperplasia of the gums. 3. Weakness and fatigue. 4. Pain in the left upper quadrant.
4 (4. A biopsy is the removal of cells from a mass and examination of the tissue under a microscope to determine if the cells are cancerous. Reed-Sternberg cells are diagnostic for Hodgkin's disease. If these cells are not found in the biopsy, the HCP can rebiopsy to make sure the specimen provided the needed sample or, depending on involvement of the tissue, diagnose a non- Hodgkin's lymphoma.)
14. The client asks the nurse, "They say I have cancer. How can they tell if I have Hodgkin's disease from a biopsy?" The nurse's answer is based on which scientific rationale? 1. Biopsies are nuclear medicine scans that can detect cancer. 2. A biopsy is a laboratory test that detects cancer cells. 3. It determines which kind of cancer the client has. 4. The HCP takes a small piece out of the tumor and looks at the cells.
4 (Collaborative interventions involve other departments of the health-care facility. A chaplain is a referral that can be made, and the two disciplines should work together to provide the needed interventions.)
18. The nurse writes the problem of "grieving" for a client diagnosed with non-Hodgkin's lymphoma. Which collaborative intervention should be included in the plan of care? 1. Encourage the client to talk about feelings of loss. 2. Arrange for the family to plan a memorable outing. 3. Refer the client to the American Cancer Society's (ACS) Dialogue group. 4. Have the chaplain visit with the client.
4 (. Cancers of all types are definitively diagnosed through biopsy procedures. The pathologist must identify Reed-Sternberg cells for a diagnosis of Hodgkin's disease.)
19. Which test is considered diagnostic for Hodgkin's lymphoma? 1. A magnetic resonance image (MRI) of the chest. 2. A computed tomography (CT) scan of the cervical area. 3. An erythrocyte sedimentation rate (ESR). 4. A biopsy of the cervical lymph nodes.
2, 3, 5, 4, 1
26. The nurse is administering a transfusion of packed red blood cells to a client. Which interventions should the nurse implement? List in order of performance. 1. Start the transfusion slowly. 2. Have the client sign a permit. 3. Assess the IV site for size and patency. 4. Check the blood with another nurse at the bedside. 5. Obtain the blood from the laboratory.
c (A client who has had treatment for infection may be sent home with an infection that is unresolved. When this occurs, the nurse should teach the client about how to prevent transmission of the infection to others in the home. This includes laundering the infected person's clothes and bedding separately from others and using a dishwasher or hot setting on the dryer to kill microorganisms while cleaning.)
A client with leukemia is being discharged from the hospital and is going home with an infection. Which precautions would the nurse teach the client to implement at home that would best prevent him from transmitting the infection? A. Launder clothing and dry in a cool dryer or air dry in the basement of the house B. Wash all dishes by hand and do not use a dishwasher C. Wash the clothes of the infected person separately from the clothes of others in the family D. Disinfect contaminated surfaces in the home with hot water only
b, d, e (This is necessary to avoid catheter occlusion. The client must use aseptic technique, which includes avoiding contact with the open end of the catheter. A Groshong catheter is a type of central venous catheter that is used for long-term administration of IV medications. It is important for the nurse to instruct the client on how to care for their catheter at home. Included in this teaching is aseptic technique for handling the catheter ports, proper dressing change and how to detect problems with the catheter.)
A client with leukemia will go home with a Groshong catheter placed in the right subclavian vein to use for long-term administration of chemotherapy. Which information would the nurse provide to the client regarding care of the Groshong catheter at home? Select all that apply. A. The client cannot bathe or shower until the catheter has been removed B. The client should flush the catheter at least once per week C. The client should perform BID dressing changes D. The client should avoid touching the open end of the catheter if the cap has been removed E. The client should use aseptic technique when handling the catheter ports
a (competent adults have the right to make all health care decisions, including the right to refuse treatment based on their religious beliefs. The nurse should withhold the blood products in accordance with the patients wishes. Contacting the ethics committee is not necessary since the patients wishes are clear. Since the patient is competent, asking the family for permission to administer blood products would be unethical. Administration of blood products after the patient has confirmed not wanting a transfusion would be unethical)
A competent patient who reports being a Jehovah's witness is hospitalized with hemorrhage and confirms not wanting to receive blood products. Which action by the nurse is best when the patient becomes unconscious and packed red blood cells are prescribed? a. withhold the blood products and notify the HCP b. Contact the agency's ethics committee about whether to give blood c. contact the family for permission to administer blood products to the patient d. administer blood products with the intent of informing the patient after the procedure
a, c, d, e ( This is true of IVIG. It is given in a manner similar to administration of blood products. Intravenous immune globulin (IVIG) is a product found in blood plasma that may be administered to some clients as treatment for certain types of immune system disorders. The type and rate of administration is determined by the provider or pharmacist.)
A nurse has an order to administer IVIG to a client with leukemia. Which of the following is a true statement regarding this type of blood product? Select all that apply. A. IVIG may cause anaphylaxis with administration B. IVIG may be created from donors or synthetically manufactured C. IVIG is run through a transfusion similar to administration of blood products D. IVIG is used to treat immune system disorders E. IVIG is administered at a rate determined by the provider
d (Platelets are a type of blood product that requires careful monitoring and documentation, just as with any other type of blood product administration. When a transfusion is complete, the nurse should document the time that it ended, the client's response to the transfusion, vital signs, and any reactions that occurred.)
A nurse is administering platelets to a client with leukemia. After completing the transfusion, the nurse should document which information? A. The signatures verifying the blood product B. The type of product ordered for transfusion C. The client's activity during the transfusion D. The client's response to the transfusion
a, b ,c (Systemic inflammatory response syndrome (SIRS) describes the process of inflammation that occurs in response to trauma or infection. If the client has an infection and then develops septicemia, the body undergoes the process of SIRS. Clinical parameters for SIRS include a fever of more than 38°C (100.4°F) or less than 36°C (96.8°F). Clinical parameters for SIRS include a heart rate of more than 90 beats per minute. Systemic inflammatory response syndrome (SIRS) describes the process of inflammation that occurs in response to trauma or infection. If the client has an infection and then develops septicemia, the body undergoes the process of SIRS. Clinical parameters for SIRS include a fever of more than 38°C (100.4°F) or less than 36°C (96.8°F), heart rate of more than 90 beats per minute, respiratory rate of more than 20 breaths per minute, and a white blood cell count >12,000/mcL or <4,000/mcL.)
A nurse is caring for a client who has a history of leukemia. The client's body is demonstrating systemic inflammatory response syndrome (SIRS). Which of the following signs or symptoms would the nurse see with SIRS? Select all that apply. a. Heart rate of 95 bpm b. Fever of 101.8 F c. Temperature 96.2 F d. RR 18/minute e. WBC count of 10,000/mcL
d (Clients with cancer undergoing chemotherapy most often die from infection due to immunosuppression, NOT from the cancer itself. This is especially the case in clients with leukemia as the leukemia itself has suppressed their immune system as well. Handwashing and avoiding sick contacts is one of the best ways to prevent infection in these clients.)
A nurse is caring for a client with leukemia who is undergoing chemotherapy. The nurse is educating the client's family on what to expect throughout treatment. Which statement by the family would demonstrate understanding of education? A. "Leukemia will cause him to bleed significantly, so we should get him an electric razor." B. "The most likely complication he will experience from the leukemia is a stroke." C. "The most dangerous thing he will experience is the excessive vomiting and dehydration from chemo." D. "The most important thing we can do to help is wash our hands and keep sick people away from the home."
c (A child with leukemia is immunocompromised, which means they are extremely susceptible to infections. If an immunocompromised client presents with a fever over 38C, they require prompt attention to prevent potentially life-threatening sepsis. The nurse's first priority would be to start an IV so the child can receive extra fluids and antibiotics.)
A nurse is performing the initial assessment of a child with a history of acute leukemia who was brought into the emergency department. The nurse discovers the child has a temperature of 38.5C. Which action is the first priority in this situation? A. Begin cooling the client with ice packs B. Assess for signs of dehydration C. Start an IV on the client D. Check a stool sample
b(The patient with a favorable prognosis early-stage Hodgkin's lymphoma (stage 1A) will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.Note: Some of acronyms for drug protocols use the brand/trade name of drugs (Adriamycin, Oncovin). These brand/trade names have been discontinued but the drugs are still available as generic drugs.)
A patient has been diagnosed with stage 1A Hodgkins lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? a. Brentuximab vedotin (adcetris) b. two to four cycles of ABVD c. Four to six cycles of ABVD e. BEACOPP: bleomycin, etoposide, doxorubicin (adriamycin), cyclophosphamide, vincristine (oncovin), procarbazine, and prednisone
a (patients with ALL have a high probability of having leukemic infiltration of the CNS. The spread of leukemia to the CNS is not expected in CLL. AML does not typically infiltrate the CNS. CML is not associated with leukemic spread of to the CNS)
A patient with which type of leukemia is likely to experience central nervous system (CNS) manifestations of the disease? a. acute lymphocytic leukemia (ALL) b. Chronic lymphocytic leukemia (CLL) c. acute myelogenous leukemia (AML) d. chronic myelogenous leukemia (CML)
a (patients with ALL have high probability of having leukemic infiltration of the CNS. The spread of leukemia to the CNS is not expected in CLL. AML does not typically infiltrate the CNS. CML is not associated with leukemic spread to the CNS)
A patient with which type of leukemia is likely to experience central nervous system (CNS) manifestations of the disease? a. acute lymphocytic leukemia (ALL) b. chronic lymphocytic leukemia (CLL) c. acute myelogenous leukemia (AML) d. chronic myelogenous leukemia (CML)
b (Attaining remission is the initial goal of care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the white blood cell count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia, waiting may be done to attain remission, but not with AML.)
A pt. has been diagnosed with acute myelogenous leukemia (AML). What should the nurse educate the patient that care will focus on? a. leukapheresis b. attaining remission c. one chemo agent d. waiting with active supportive care
c (The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.)
A pt. is being treated for Non-Hodgkins Lymphoma (NHL) What should the nurse first teach the patient about the treatment a. skin care that will be needed b. method of obtaining the treatment c. treatment type and expected side effects d. GI tract effects of treatment
c (the initial treatment for AML will be combination chemotherapy. If the white blood cell count is higher than 100,000/uL, then leukapheresis is needed currently. Total body radiation may be done prior to hematopoietic stem cell transplantation (HSCT), but remission will be achieved with chemotherapy first. HSCT may be an option, but remission with chemotherapy will be achieved prior to considering HSCT.)
After a patient is diagnosed with acute myelogenous leukemia (AML), which topic will the nurse plan to teach first? a. Leukapheresis b. total body radiation c. combination chemotherapy d. hematopoietic stem cell transplant
d, e, (CT and PET are used to locate all sites of abnormal lymph node enlargement and organ involvement, data which determines the stage of the lymphoma. Lumbar puncture might be used in non-Hodgkin's lymphoma to determine whether there is central nervous system involvement. Bone marrow biopsy is used to check for bone marrow infiltration by the abnormal lymphocytes. A complete blood count will show whether there are nonspecific findings such as anemia or thrombocytopenia.)
After a patient lymph node biopsy is positive for lymphoma, which diagnostic tests will the nurse anticipate for staging of the lymphoma? Select all that apply. a. Lumbar puncture b. Bone marrow biopsy c. Complete blood count d. CT e. Positron emission tomography (PET)
a (painless lymph node enlargement and weight loss in a 22 year old patient indicate possible Hodgkins or non-hodgkins lymphoma, and the nurse would expect that lymph node biopsy would be rapidly done to rule out lymphoma. Teaching about chemotherapy side effects would be needed if the biopsy results are positive for lymphoma. The patient's immunization history will be important to know prior to chemotherapy but is not needed prior to lymph node biopsy and is not the next action the nurse would take. PET may be needed if the biopsy results are positive to determine lymphoma stage.)
After nothing painless cervical lymph node enlargement for a 22 year old patient who is being seen in the clinic b/c of weight loss, which interprofessional action will the nurse expect to implement next? a. teaching about lymph node biopsy b. educating about chemotherapy side effects c. updating the patients immunization history d. scheduling full-body positron emission tomography (PET)
c (since thrombocytopenia increases the risk for bleeding, the nurse will inspect the skin for bruises or petechiae. Lymphadenopathy is a common symptom of some leukemias but does not cause thrombocytopenia. Although patients with leukemia do have an increased risk for infection and fever, a low platelet count would not cause fever. Ulcers of the oral mucosa can occur due to poor immune function in leukemia but are not caused by thrombocytopenia.)
After noting that a patient with leukemia has thrombocytopenia, which action will the nurse plan to take? a. palpate lymph nodes for swelling b. check temperature for elevation c. inspect skin for bruising or petechiae d. Examine oral mucosa for ulceration
a (since chloroma is a solid mass of leukemic cells, the nurse would assess the patient for any obvious solid masses. The nurse will assess carefully for petechiae in a patient with thrombocytopenia. Inspection of the oral mucosa will be important for a patient increased risk for infection b/c of neutropenia or acute lymphocytic leukemia. Increased sweating may be seen in some types of leukemia but is not associated with the presence of a chloroma.)
After reading in a leukemia patient's chart that the patient has chloroma, which action would the nurse take? a. assess for any solid masses b. check for petechiae or purpura c. inspect the oral mucosa for ulcers d. ask about any increased sweating
c (chronic myelogenous leukemia is characterized by the proliferation of mature neoplastic granulocytes in the bone marrow, as seen in patient C. Acute myelogenous leukemia is characterized by the proliferation of myeloblasts. Acute lymphocytic leukemia is characterized by the uncontrolled proliferation of immature small lymphocytes in the bone marrow. Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes in the bone marrow.)
After teaching a class about the different types of leukemia, the nursing instructor recognizes that the teaching has been effective when the students identify that which patient has chronic myelogenous leukemia? a. Patient A: uncontrolled proliferation of immature small lymphocytes in the bone marrow b. Patient B: proliferation of myeloblasts c. Patient C: proliferation of mature neoplastic granulocytes in the one marrow d. Patient D: accumulation of small, mature-appearing lymphocytes in the bone marrow
d (Rationale In stage II of Hodgkin's disease and non-Hodgkin's disease, there is an involvement of two or more lymph nodes on one side of the diaphragm but not both sides of diaphragm. In stage I, there is an involvement of a single lymph node, generally the cervical node. In stage IV, there is involvement of other organs besides lymph nodes, such as the liver or bone marrow. In stage III, there is lymph node involvement above and below the diaphragm)
After the nurse educator has discussed the staging of Hodgkin's lymphoma with students, which statement made by a student indicates a need for more teaching? a. "In stage I, there is an involvement of a single lymph node." b. "In stage IV, there is an involvement outside the lymph nodes." c. "In stage III, there is lymph node involvement above and below the diaphragm." d. "In stage II, there is an involvement of two or more lymph nodes on both sides of the diaphragm."
a (although anemia may be nonspecific finding in Hodgkins lymphoma, this severely low hemoglobin level require further diagnostic testing and treatment and should be reported quickly to the health care provider. The nurse will anticipate actions such as further diagnostic testing and possible red blood cell transfusion. Tachycardia is a common B symptom finding in Hodgkins lymphoma; the nurse will continue to monitor heart rate, but no immediate action is needed. Night sweats indicate a poorer prognosis for Hodgkins lymphoma but are a common B symptom of lymphoma and do not need immediate further diagnostic testing or treatment. Bilateral enlarged nodes indicate that the patient likely has stage II Hodgkins lymphoma but do not require any immediate action by the nurse.)
After the nurse performs an admission assessment for a patient with possible hodgkins lymphoma, which finding is MOST important to report to the health care provider? a. hemoglobin 7.4 mg/dL b. heart rate 107 beats/minute c. patient report of soaking nights sweat d. bilateral enlarged axillary lymph node
decreased
In acute leukemias (ALL and AML) you'll see ________ WBCs b/c of how quickly the disease is progressing
a, c, b, e, d, f(dyspnea and chills starting soon after initiation of blood transfusion indicate a likely acute hemolytic reaction, and the nurse will immediately stop the transfusion and start infusing normal saline to prevent further hemolysis and complications, such as acute kidney injury (acute renal failure). B/c hypotension and tachycardia may occur, the nurse will need to take BP and pulse quickly after stopping the transfusion and starting the saline infusion; vital signs will need to be monitored on an ongoing basis. To determine the cause of the reaction, the blood bag and tubing will be sent to the laboratory. Ongoing monitoring for complications such as hyperkalemia and acute kidney injury is needed, and the nurse will need to collect blood and urine specimens at intervals specified by the hospital policy. Documentation of the patients symptoms and possible transfusion reaction can be done last, although this is also an important action.)
In which order will the nurse take these actions for a patient who reports shortness of breath and chills a few minutes after a transfusion of packed red blood cells is started? a. stop transfusion and disconnect tubing b. Take BP and pulse c. infuse IV normal saline d. Collect required blood and urine specimens at recommended internals e. send blood bag and tubing to laboratory for examination f. document transfusion reaction in patient record
d (malaise and weakness at 10 days following multidrug chemo can be an indication of anemia (decreased red blood cell level) and/or immunosuppression (decreased white blood cell level). This is best assessed with a CBC. A UA assesses for urinary tract infection, which presents with symptoms of urinary urgency, frequency, and dysuria. LFTs assess for decreased hepatic function due to potential toxic effects of the chemotherapy. Hepatic dysfunction would present as right upper quadrant pain, liver enlargement on abdominal palpation, and jaundice. A BMP assesses for electrolyte imbalance, which is most often the result of vomiting following chemo.)
Malaise and weakness in a patient after receiving multidrug chemo 10 days ago can be assessed with which lab test? a. Urinalysis (UA) b. liver function tests (LFTs) c. basic metabolic panel (BMP) d. complete blood count (CBC)
3 (Radiation therapy to the head and scalp area is the treatment of choice for central nervous system involvement of any cancer. Radiation therapy has longer-lasting side effects than chemotherapy. If the radiation therapy destroys the hair follicle, the hair will not grow back.)
The client diagnosed with leukemia has central nervous system involvement. Which instructions should the nurse teach? 1. Sleep with the head of the bed elevated to prevent increased intracranial pressure. 2. Take an analgesic medication for pain only when the pain becomes severe. 3. Explain that radiation therapy to the head may result in permanent hair loss. 4. Discuss end-of-life decisions prior to cognitive deterioration.
1 (A left shift indicates that immature white blood cells are being produced and released into the circulating blood volume. This should be investigated for the malignant process of leukemia.)
The client diagnosed with leukemia is being admitted for an induction course of chemotherapy. Which laboratory values indicate a diagnosis of leukemia? 1. A left shift in the white blood cell count differential. 2. A large number of WBCs that decreases after the administration of antibiotics. 3. An abnormally low hemoglobin (Hgb) and hematocrit (Hct) level. 4. Red blood cells that are larger than normal.
1, 3, 4, 5 (All of the bone marrow cells must be destroyed prior to "implanting" the healthy bone marrow. High-dose chemotherapy and full-body irradiation therapy are used to accomplish this.3. The best bone marrow donor comes from an identical twin; next best comes from a sibling who matches. The most complications occur from a matched unrelated donor (MUD). The client's body recognizes the marrow as foreign and tries to reject it, resulting in graft-versus-host disease (GVHD). 4. The CBC must be monitored daily to assess for infections, anemia, and thrombocytopenia. 5. Clients will have at lest one multiple-line central venous access. These clients are seriously ill and require multiple transfusions and antibiotics.)
The client diagnosed with leukemia is scheduled for a bone marrow transplant. Which interventions should be implemented to prepare the client for this procedure? Select all that apply. 1. Administer high-dose chemotherapy. 2. Teach the client about autologous transfusions. 3. Have the family members' HLA typed 4. Monitor the complete blood cell count daily. 5. Provide central line care per protocol.
2 (Dye is injected between the toes of both feet and then scans are performed in a few hours, at 24 hours, and then possibly once a day for several days.)
The client diagnosed with non-Hodgkin's lymphoma is scheduled for a lymphangiogram. Which information should the nurse teach? 1. The scan will identify any malignancy in the vascular system. 2. Radiopaque dye will be injected between the toes. 3. The test will be done similar to a cardiac angiogram. 4. The test will be completed in about five (5) minutes.
4 (4. In this form of leukemia the cells seem to escape apoptosis (programmed cell death), which results in many thousands of mature cells clogging the body. Because the cells are mature, the client may)
The client is diagnosed with chronic lymphocytic leukemia (CLL) after routine laboratory tests during a yearly physical. Which is the scientific rationale for the random nature of discovering the illness? 1. CCL is not serious, and clients die from other causes first. 2. There are no symptoms with this form of leukemia. 3. This is a childhood illness and is self-limiting. 4. In early stages of CLL the client may be asymptomatic.
4 (4. An elevated white blood cell count is what is being described in the term "leukocytosis"—" leuko" means "white" and "cyto" refers to "cell." Leukocytosis is the opposite of leukopenia.)
The client is diagnosed with leukemia and has leukocytosis. Which laboratory value would the nurse expect to assess? 1. An elevated hemoglobin. 2. A decreased sedimentation count. 3. A decreased red cell distribution width. 4. An elevated white blood cell count
3 (Perineal care after each bowel movement, preferably with an antimicrobial soap, is performed to reduce bacteria on the skin.)
The client is placed on neutropenia precautions. Which information should the nurse teach the client? 1. Shave with an electric razor and use a soft toothbrush. 2. Eat plenty of fresh fruits and vegetables. 3. Perform perineal care after every bowel movement 4. Some blood in the urine is not unusual.
4 (Epogen or Procrit are forms of erythropoietin, the substance in the body that stimulates the bone marrow to produce red blood cells. A client may be prescribed iron preparations to prevent depletion of iron stores and erythropoietin to increase RBC production. A unit of blood can be withdrawn once a week beginning at 6 weeks prior to surgery. No phlebotomy will be done within 72 hours of surgery.)
The client is scheduled to have a total hip replacement in two (2) months and has chosen to prepare for autologous transfusions. Which medication would the nurse administer to prepare the client? 1. Prednisone, a glucocorticoid. 2. Zithromax, an antibiotic. 3. Ativan, a tranquilizer. 4. Epogen, a biologic response modifier.
886 mL
The client received two (2) units of packed red blood cells of 250 mL with 63 mL of preservative each during the shift. There was 240 mL of saline remaining in the 500- mL bag when the nurse discarded the blood tubing. How many milliliters of fluid should be documented on the intake and output record?____________________
1 (O (O negative) blood is considered the universal donor because it does not contain the antigens A, B, or Rh. (AB is considered the universal recipient because a person with this blood type has all the antigens on the blood).)
The client with O+ blood is in need of an emergency transfusion but the lab does not have any O+ blood available. Which potential unit of blood could be given to the client? 1. The O- unit. 2. The A+ unit. 3. The B+ unit. 4. Any Rh+ unit.
lymphoma
The following are risk factors for _____________ * infection with Epstein-Barr *Genetic predisposition *Occupational herbicide or chemical exposure *HIV-infected patients *Immunosuppression due to drug therapy following organ transplant *Possible cause including viral infections and exposure to chemical agents
Hodgkin's lymphoma
The following describes which type of lymphoma? -Malignant condition characterized by proliferation of abnormal giant, multinucleated cells, called Reed-Sternberg cells, which are located in lymph nodes -Also, rapid proliferation of abnormal lymphocytes impairs immune system. Infections are common -More common in men -Peak incidence from 15-36 and then after age 50
leukemia
The following describe the clinical manifestations of ___________ Fever and infection are hallmark symptoms of leukemia. The bone marrow is not able to produce WBCs of number and maturity to fight infection Enlarged lymph nodes, spleen and liver Decreased hemoglobin, hematocrit and platelets WBCs normal, elevated or decreased Weight loss, anorexia, fatigue Recurrent infections Unexplained bleeding Bone pain: Infiltration of bone marrow- susceptibility to fractures, leukemic cells actually invade the periosteum, causes severe pain
leukemia
The following describe the risk factors for ___________ Chemicals such as benzene, radiation, viruses, chemotherapy (alkylating agents), previous radiation-treated cancer Genetic factors- Down syndrome; Bloom Syndrome (a rare inherited disorder, characterized by short stature, a skin rash that develops after exposure to the sun, and a greatly increased risk of cancer)
leukemia
The following describes Assessment for ____________ -Symptoms are very nonspecific, very generalized. There are a few things that when you put them all together that something isnt right. -weight loss -fever -infections -night sweats -pain in bones and joints (b/c its cancer of the bone marrow) -Aplastic anemia . pallor, fatigue . easy bleeding and bruising (thrombocytopenia) (b/c the bone marrow isn't functioning properly and aren't producing RBCs or platelets correctly either) -increased WBC in CLL and CML -decreased WBC in ALL and AML
leukemia
The following describes DIAGNOSIS of ________ How do we diagnose _________? First we look at the clinical picture. -WBC count differential (can breakdown all the types of WBCS; we break this down and we see a large production of either lymphocyte cells or myeloid cells) -Bone marrow biopsy (just gives you more specific focus on the cells) -Characterized by the type of WBC affected . Acute lymphocytic _______ (ALL) usually seen in children, under age of 15 . Chronic lymphocytic ______ (CLL) elderly 50-170 . Acute Myelogenous _____ (AML) usually peaks at about 60 years old . Chronic Myelogenous ________ (CML) risk increases w/ age -Acute is more serious than chronic and acute myelogenous __________ is more serious than acute lymphocytic _______.
leukemia
The following describes ______ -A cancer of the bone marrow: -remember that the bone marrow is responsible for the production of RBC, WBC and platelets, but _________ primarily involves the WBCs. As ______ takes over, we begin to see an OVERPRODUCTION of WBCs. The problem is they're abnormal, underdeveloped, immature cells so they cant function or perform like a normal WBC. What does a WBC do? Its entirely responsible for our immune system and fighting off infection. So if all of the WBCs we have are abnormal, we aren't going to be able to fight off infection, not going to be able to heal wounds, or take care of our immune system needs. The shift in overproduction of WBCs also hinders RBCs and platelets. There's fewer RBCs b/c the bone marrow continues making the immature WBC instead of everything else. -Excessive production of abnormal, underdeveloped WBCs
autotransfusion
The following describes _______ -Collect, filter and return patients own blood lost during a major surgery or from a traumatic injury -Blood automatically and continuously infused -OR collect the blood for less than 4 hours then reinfuse -Coagulation studies for the patient receiving ____________ is important! *At risk for blood clots when blood is filtered through the system and would prevent reinfusion *This blood may get depleted of its normal coagulation factors
autologous blood transfusion
The following describes ________ _______ _____________ -removing whole blood from a person and transfusing that blood back into the same person -may be collected for future transfusion, such as elective surgeries (orthopedic surgery) -Not done within 72 hours of time for surgery -Primary advantage is prevention of viral infections from another person's blood -This blood can be frozen and stored for up to 10 years if not required to use it.
multiple myeloma
The following describes ________ ________ Malignancy in which B-cell lymphocytes multiply uncontrollably and infiltrate bone marrow, lymph nodes, spleen and other tissues (Reminder that Plasma cells are B cells that develop to produce antibodies (immunoglobulins). Causes excessive production and secretion of Bence Jones proteins (monoclonal or M proteins) from the malignant cells and can be detected in the blood and urine. These proteins are toxic to the kidneys and may lead to kidney failure Without treatment, progresses to bone destruction, bleeding problems, kidney failure, immunosuppression and death Cause unknown; possible exposure to chemical such as benzene, metals, herbicide, and insecticides, genetic factors and viral infection
leukemia
The following describes _________ -Cancer that usually begin in the bone marrow and result in high numbers of abnormal white blood cells (lymphocytes)
lymphoma
The following describes __________ -Tumors of the lymph tissue-lymph nodes, or lymph tissue-spleen, GI tract, liver or bone marrow -Characterized by proliferation of lymphocytes and progressive, painless enlargement of lymph nodes -Rapid growth of abnormal lymphocytes leads to immune system suppression, causing the person to be more susceptible to infection -Hodgkin's -Non-Hodgkin's (NHL)
leukemia
The following describes _____________ Bone marrow becomes almost totally filled with immature WBCs and undifferentiated leukocytes, called leukemic cells. These cells proliferate rapidly and have a prolonged life span. They are not able to perform the function of mature WBCs, so they are ineffective in reducing inflammation or infection Because RBC and platelet- producing cells are crowded out, severe anemia, splenomegaly, and bleeding difficulties occur
myelosuppression, neutropenia
The following describes care of a patient with ____________ and_____________ Private room, positive-pressure or HEPA filtration, depending on risk; Chlorhexidine bathing if central venous catheter Good handwashing or alcohol- based hand rubs No fresh flowers or potted plants in room Monitor vitals q 4h, including temperature Assist patient in coughing and deep-breathing exercises Use strict aseptic technique for all invasive procedures Monitor WBCs daily and neutrophil count Teach patient to avoid eating raw fruits and vegetables, undercooked meat, eggs, and fish Teach patient to avoid crowds and people who might be ill Teach patient to refrain from changing pet litter boxes
maintenance therapy
The following describes which type of therapy, it follows consolidation therapy Lower doses of the same drugs given every 3 to 4 weeks Goal is to keep the body free of leukemic cells.
CML (chronic myelogenous leukemia)
The following describes collaborative care for which type of leukemia? -•Tyrosine kinase inhibitors- imatinib mesylate (Gleevec) dasatinib, nilotinib Works by blocking signals within the leukemic cells that express the abnormal protein Do not take with antacids and grapefruit- interferes with absorption Side effects: fluid retention evident in pleural or pericardial effusions, peripheral edema, hepatoxicity Other treatment: chemotherapy, radiation, HSCT, interferon, leukapheresis *can be potentially cured with stem cell transplant if pt is healthy enough, someone younger than 65; most meds don't work well with grapefruit juice or antacids
AML (acute myelogenous leukemia)
The following describes collaborative care for which type of leukemia? S/S: fatigue, weakness, headache, mouth sores, anemia, bleeding, fever, infection, sternal tenderness, gingival hyperplasia, mild hepatosplenomegaly Chemotherapy- induction therapy and consolidation therapy Autologous or allogeneic hematopoietic stem cell transplant (HSCT) Hematopoietic stem cell transplantation (HSCT) is the new name for bone marrow transplantation Death usually occurs from infection or bleeding, caused by the disease or the treatment **Anemia with this type is a late sign; may be candidate for stem cell transplant; need transfusions, antibiotics
leukemia
The following describes the collaborative care for ________ as a whole Usually suspected by history and physical symptoms, and a peripheral blood smear that has immature forms of leukocytes, frequently with low blood counts. Usually has decreased H&H, low platelet count and an abnormal white blood cell count Blood counts, Peripheral blood smear, Chromosome analysis- Philadelphia chromosome Bone marrow aspiration or biopsy is needed for a definitive diagnosis Lumbar puncture and CT scan to determine if any CNS involvement, once diagnosis confirmed Once a diagnosis of leukemia has been made, collaborative care is focused on the initial goal of attaining remission. In some cases, such as nonsymptomatic pt. with CLL, watchful waiting with active supportive care may be appropriate Chemotherapy is the mainstay of the treatment for leukemia Corticosteroids Radiation therapy
neutropenia
The following describes the collaborative care for _________ Diagnostics: WBC count w diff, bone marrow aspiration and biopsy Determine cause of neutropenia Identify offending organism if infection Begin antibiotic therapy Blood culture STAT (before antibiotics) Administer hematopoietic growth factors
multiple myeloma
The following describes the collaborative care for ___________ ____________ Clinical manifestations: bone pain, lethargy, confusion, fatigue; pathologic bone fractures, recurrent infection, hypercalcemia, renal failure Monitor for sudden numbness in legs- loss of motor or sensory function is an emergency- may have spinal cord compression caused by regional myeloma cell growth compressing the spinal cord :Should be evaluated and treated immediately to prevent further loss of function. Diagnostics: Elevated monoclonal protein level in serum or urine Bone marrow biopsy to confirm diagnosis Pancytopenia and hypercalcemia (ca+ lost from bone) MRI, PET, CT scan-findings of lesions on bones- bone thinning with areas of bone loss resembling "swiss cheese" Electrophoresis of plasma proteins- presence of M protein Presence of Bence Jones protein in urine Seldom cured, but treatment can relieve symptoms, produce remission and prolong life Chemotherapy with corticosteroids is usually first treatment recommended High dose chemotherapy followed by HSCT Radiation for painful bone lesions Immunotherapy and targeted therapy Encourage fluid intake of 3L per day to dilute the calcium overload in the blood and to prevent protein from precipitating in the renal tubules Pain measures Bisphosphonate therapy to reduce bone loss Pamidronate (Aredia) and zoledronic acid (Zometa) Bisphosphonates are given monthly by IV infusion. Patient should be adequately hydrated before giving drug. Renal toxicity may occur if IV infusion of drug is given in less than 15 min. Calcium, vitamin D, and fluoride supplements for bone structure Plasma exchange therapy (plasmapheresis) to remove M proteins to treat acute renal failure Treat infections promptly Monitor kidney function Orthopedic support Precautions for pathologic fractures
Non-Hodgkin's lymphoma
The following describes the collaborative care for which type of Lymphoma? -Clinical manifestations include: . painless lymph node enlargement . organ system involvement with mass in mediastinum can cause respiratory distress .abdominal masses can affect ureters, leading to renal dysfunction . splenomegaly can cause abdominal discomfort can cause abdominal pain nausea and anorexia; . CNS involvement with headaches, peripheral or cranial nerve symptoms, altered mental status, seizures -Diagnosis: . biopsy of node or mass and the same staging system as for the other type of Lymphoma -Prognosis is generally poorer than that of the other type of Lymphoma. Because this type originates in the lymphoid tissue, it is often widely distributed in the nodes, bone marrow, or blood by the time the diagnosis is made.
Hodgkin's lymphoma
The following describes the collaborative care for which type of lymphoma? - Diagnostics: . excisional lymph node biopsy . bone marrow biopsy . CT and MRI scans . PET scan for staging and assessing response to therapy -Cause remains unknown, the main risk factors are infection with Epstein-Barr virus, HIV, pt receiving immunosuppressive therapy and veterans exposed to agent orange -Diagnosis and grade with biopsy of nose or mass reveals Reed-Sternberg cells -S/S include:. .painless enlargement of cervical or supraclavicular nodes of neck, axillary or inguinal lymph nodes; recent weight loss, fever, drenching night sweats, anorexia, malaise, fatigue, pruritis -Chemotherapy (2-4 months) followed by radiation in involved area -ABVD regime; doxyrubicin (adriamycin), bleomycin, vinblastine, and decarbazine for more advanced disease -Radiation -HSCT -Therapy must be aggressive. Will be at risk for potentially life-threatening problems trying to cause a remission -Consequence of treatment is later development of secondary malignancies such as AML and Non-Hodgkin lymphoma, lung and breast cancer.
CML (chronic myelogenous leukemia)
The following describes which type of leukemia? Pathology: excessive growth of mature neoplastic granulocytes in bone marrow that move into bloodstream and infiltrate spleen and liver, causing enlargement Affects men more than women; common in older adults Most often associated with benzene exposure and high doses of radiation; in 90% to 95% of cases of ____, Philadelphia chromosome is present Often asymptomatic in early stages and often diagnosed when a routine blood test shows abnormal cell counts Increased lymphocyte count (may exceed 100,000); RBCs and platelets may be normal or in later stages of illness, decreased S/S: no symptoms at first; fatigue, weakness and fever; sternal tenderness; weight loss; joint and bone pain; splenomegaly; lymphadenopathy
lymphoma
The following describes the different techniques used to diagnose ___________ CBC- in Hodgkin's include anemia, decreased lymphocytes, increased eosinophils, increased platelets, elevated sedimentation rate In non-Hodgkin's disease, abnormal findings are often not seen until late in disease when pancytopenia occurs In Hodgkin's disease- serum alkaline phosphatase- elevated from bone and liver involvement and serum calcium - from bone involvement and decreased blood proteins Diagnostic studies for either include CXR or CT of lung - to check for mediastinal mass, lung or pleural involvement CT scan of abdomen- to evaluate liver and spleen Lymph node biopsy- of largest, most central enlarged lymph node; to check for both Hodgkin's or non-Hodgkin's disease -presence of Reed-Sternberg cells confirms dx of Hodgkin's Lymphangiography- x-ray imaging of lymph glands and lymph vessels after injection of contrast medium- to detect extent of lymph node involvement Bone scan- to identify bone involvement in non-Hodgkin's disease Bone marrow, liver and spleen biopsy- to identify or exclude further organ involvement Staging laparotomy- to obtain biopsy of retroperitoneal lymph nodes and both lobes of liver and remove the spleen
Non-Hodgkin's lymphoma
The following describes the interprofessional care for which type of lymphoma? If low grade disease, may do "watchful waiting" or radiation alone HSCT may be used If aggressive, may do combination chemotherapy and radiation For aggressive disease .Rituximab which targets the antigen on the B cells .Combination chemotherapy- CHOP or R-CHOP which is rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine (Oncovin), prednisone is now considered standard treatment Nursing care for effects of chemotherapy and radiation Myelosuppression, nausea, hair loss, risk of infection (significant) And care depends on location of lymphoma American Cancer Society developed behavior recommendations for cancer survivors .Avoiding smoking .Maintaining a normal body mass index (BMI) .Improving nutrition (consuming fruits and vegetables) .Engaging in at least 150 minutes of aerobic physical activity per week
leukemia
The following describes the key points for ___________ 1. Immature cells - proliferation of underdeveloped WBCs, they cant function like they're supposed to 2. Classification - Myeloid v. Lymphoid WBCs, acute vs chronic: AML is the most common and most severe 3. Infection Risk - unable to fight infection, weak, aches, anemia; aplastic anemia; pale, bruise easily 4. Chemo and Radiation - kills fast growing cells, including health ones; make sure to manage pts symptoms 5. Avoid complications - neutropenic and bleeding precautions, oral care.
leukemia
The following describes the priority Nursing concepts for __________ -Cellular Regulation: want to deal with excess production of WBCS -Infection Control: at risk for developing infections -Clotting; b/c RBCs and platelets are low -We want to support through chemo, prevent infections, use bleeding precautions to prevent injury
blood transfusion reaction
The following describes what what the nurse should do in the event her patient has a ________ ________ _________ . mild to life threatening if it occurs . STOP the transfusion . Maintain a patent IV line with normal saline solution . Notify the blood bank and the HCP immediately . Recheck identifying tags and numbers . Monitor vital signs and Urine output . Treat symptoms per HCP order . Save the blood bag and tubing and send to the blood bank . collect required blood and urine specimens to evaluate for hemolysis . Document on transfusion reaction form and patient chart
AML (acute myelogenous leukemia)
The following describes which type of Leukemia? Pathology: uncontrolled proliferation of myeloblasts and hyperplasia of bone marrow and spleen Most symptoms result from neutropenia and thrombocytopenia. Bone marrow aspiration shows an excess of immature WBCs; low to high WBC count, low platelet and RBC count Common in older adults, may affect children and young adults Strongly associated with toxins, genetic disorders, and treatments of other cancers
non-Hodgkin's lymphoma
The following describes which type of Lymphoma? -Lymphoid tissue malignancy of uncontrolled proliferation of T and B lymphocytes that do not contain Reed-Sternberg cells. Tend to start in the peripheral lymph nodes and spread early to tissues throughout the body. So spreads by bloodstream. -More common and more fatal than the other lymphoma; can involve any organ or tissue; may be slow growth or rapidly growing and quickly fatal -more common in men -prognosis ranges from excellent to poor, depending on the identified cell type and grade of differentiation -No common cause identified but incidence has increased in people with immunodeficiencies or autoimmune disorders; prior treatment for cancer; prior organ transplant; viral infections (Epstein-Barr and HIV) and exposure to pesticides, solvents, dyes, or defoliating agents, including agent orange.
CML (chronic myelogenous leukemia)
The following describes which type of leukemia? -Normal myeloid cells with this type continue to be produced; increase in immature cells; they don't work like they should or need to; chromosomes 22 and 9 are translocated in this type and we call that a Philadelphia chromosome; with ______ they'll usually have a chronic stable phase that can last several years; but then they can go into an accelerated phase and only last a few months; its unpredictable; they find this usually when they come to the doctor for something else; white count can be even higher than 100,000
ALL (acute lymphocytic leukemia)
The following describes which type of leukemia? -Pathology: immature lymphocytes proliferate in bone marrow, most are B cells. Onset is usually rapid; lymphoblasts in bone marrow and peripheral tissue crowd out normal cells- so leads to thrombocytopenia, leukopenia, and anemia Low H&H, low platelets, decreased, normal or increased WBC count; presence of Philadelphia chromosome in 20-25% of patients S/S fever and infections; bleeding; anemia; bone pain and pain from enlarged liver and spleen; neurologic s/s (headache, vomiting, lethargy, cranial nerve involvement) Treatment: chemotherapy; cranial radiation therapy, intrathecal methotrexate or cytarabine, allogeneic HSCT Expected outcome of treatment is complete remission *Most common type in children and young adults; have at least an 80% cure rate in children
CLL (chronic lymphocytic leukemia)
The following describes which type of leukemia? Pathology: proliferation of small, abnormal, mature-appearing lymphocytes in bone marrow, spleen and liver. RBC and platelets may be normal at first and reduced later. WBC may be elevated or reduced (in early stage, lymphocytes can >100,00) Occurs more commonly in adults, esp older adults S/S lymphadenopathy throughout the body and splenomegaly; may progress to fevers, drenching sweats (esp at night) and unintentional wt. loss Treatment: often requires no treatment; chemotherapy, radiation, splenectomy, colony-stimulating factors, allogeneic HSCT
consolidation therapy
The following describes which type of therapy? Its given after induction therapy: Lower doses of chemo given once bone marrow has recovered from induction therapy to assure that all leukemic cells have been destroyed Started after remission is achieved Eliminate remaining leukemic cells that may not be pathologically evident
2 (2. The platelet count of 22 103 indicates a platelet count of 22,000. The definition of thrombocytopenia is a count less than 100,000. This client is at risk for bleeding. Bleeding precautions include decreasing the risk by using soft-bristle toothbrushes and electric razors and holding all venipuncture sites for a minimum of five (5) minutes.)
The laboratory results for a male client diagnosed with leukemia include RBC count 2.1 mm x 10-6, WBC 150 mm x 103, platelets 22 x 103, K+ 3.8 mEq/L, Na+ 139mEq/L. Based on these results, which interventions should the nurse teach the client? 1. Encourage the client to eat foods high in iron. 2. Instruct the client to use an electric razor when shaving. 3. Discuss the importance of limiting sodium in the diet. 4. Instruct the family to limit visits to once a week.
neutropenia
The most common cause of _________ is chemotherapy and immunosuppressive therapy.
15
The nurse administering a blood transfusion knows that she must stay with her patient for the first _______ minutes of the transfusion. This is most likely time for the pt. to have an adverse reaction-this can not be delegated.
1 (Clients in late stages of Hodgkin's disease experience drenching diaphoresis, especially at night; fever without chills; and unintentional weight loss. Early-stage disease is indicated by a painless enlargement of a lymph node on one side of the neck (cervical area). Pruritus is also a common symptom.)
The nurse is admitting a client with rule-out Hodgkin's lymphoma. When the nurse assesses the client, which data would support this diagnosis? 1. Night sweats and fever without "chills." 2. Edematous lymph nodes in the groin. 3. Malaise and complaints of an upset stomach. 4. Pain in the neck area after a fatty meal.
1 (Fever and infection are hallmark symptoms of leukemia. They occur because the bone marrow is unable to produce white blood cells of the number and maturity needed to fight infection.)
The nurse is assessing a client diagnosed with acute myeloid leukemia (AML). Which assessment data support this diagnosis? 1. Fever and infections. 2. Nausea and vomiting. 3. Excessive energy and high platelet counts. 4. Cervical lymph node enlargement and positive acid-fast bacillus.
c (a low grade fever greater than 100.4 in a patient with a neutrophil count below 500/uL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.)
The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse see first a. 60 yr old pt with a bp of 92/64 mm Hg and Hgb of 9.8 g/dL b. 50 yr old pt with a RR of 26 bpm and an elevated D-dimer c. 40 yr old pt with temp of 100.8 and a neutrophil count of 256/uL d. 30 yr old pt with a puluse of 112 bmp and a wbc count of 14,000/uL
a (uptake noted in a single cervical lymph node aligns with stage I lymphoma b/c a single node is positive. Uptake noted in cervical and mediastinal lymph is stage II lymphoma b/c multiple nodes on one side of the diaphragm are positive. Uptake noted in cervical and mesenteric lymph nodes align with stage III lymphoma b/c multiple nodes are involved on both sides of the diaphragm. Uptake noted in cervical, mediastinal, mesenteric, and hepatic areas aligns with stage IV lymphoma b/c multiple nodes are involved on both sides of the diaphragm and outside of the diaphragm in the hepatic area.)
The nurse is reviewing imaging results on lymphoma patients. Which report reflects nodal involvement at stage I? a. report one: uptake noted in a single cervical lymph node b. report two: uptake noted in cervical and mediastinal lymph nodes c. report three: uptake noted in cervical and mesenteric lymph nodes d. report four: uptake noted in cervical, mediastinal, mesenteric, and hepatic areas
b (uptake noted in cervical and mediastinal lymph stage II lymphoma b/c multiple nodes on one side of the diaphragm are positive. Uptake noted in a single cervical lymph node aligns with stage I lymphoma b/c a single node is positive. Uptake noted in cervical and mesenteric lymph nodes align with stage III lymphoma b/c multiple nodes are involved on both sides of the diaphragm. Uptake noted in cervical, mediastinal, mesenteric, and hepatic areas aligns with stage IV lymphoma b/c multiple nodes are involved on both sides of the diaphragm and outside the diaphragm in the hepatic area.)
The nurse is reviewing imaging results on lymphoma patients. Which report reflects nodal involvement at stage II? a. report one: uptake noted in a single cervical lymph node b. report two: uptake noted in cervical and mediastinal lymph nodes c. report three: uptake noted in cervical and mesenteric lymph nodes d. report four: uptake noted in cervical, mediastinal, mesenteric, and hepatic areas
3 (The client cannot donate blood for 6 months after a pregnancy because of the nutritional demands on the mother.)
The nurse is working in a blood bank facility procuring units of blood from donors. Which client would not be a candidate to donate blood? 1. The client who had wisdom teeth removed a week ago. 2. The nursing student who received a measles immunization 2 months ago. 3. The mother with a six (6)-week-old newborn. 4. The client who developed an allergy to aspirin in childhood.
premedicated
The nurse preparing for blood administration knows that her patient can be ____________ with antihistimine and hydrocortisone prior.
hang, 30
The nurse preparing for blood administration knows that she must ________ the blood as soon as it arrives on the floor and that if it isnt used in _______ minutes she must return it to the blood bank.
before, 15, 30
The nurse preparing for blood administration knows that she must take vital signs ________ and again in _____ minutes, then every ______ until the transfusion is completed.
c (sore throat is an assessment finding related to cognitive-perceptual health patters in a patient with leukemia. Nausea comes under the nutritional-metabolic health pattern. Epistaxis is an assessment finding related to activity-exercise. Easy bruising comes under the nutritional-metabolic health pattern)
The nurse recognizes that which assessment finding is related to cognitive perceptual health patterns in a patient with leukemia? a. nausea b. epistaxis c. sore throat d. easy bruising
d (PET is a noninvasive means of determining whether a patient has mediastinal lymphadenopathy. Barium enemas would be used in the diagnosis of lymphadenopathy that impacted on the lower GI tract. Upper endoscopy would be used to evaluate for possible upper GI lymphadenopathy. Abdominal ultrasound would be used for evaluation of abdominal symptoms that might occur with lymphadenopathy that compressed on abdominal structures such as the kidneys, small intestine, or colon.)
The nurse will plan teaching about which type of diagnostic test for a patient with suspected mediastinal lymphadenopathy? a. barium enema b. upper endoscopy c. abdominal ultrasound d. PET scan
d (A client with a blood cancer such as leukemia receives chemotherapy to completely wipe out their bone marrow so that the bone marrow can be replaced with healthy bone marrow cells.)
The oncology nurse is caring for a client with leukemia. The nurse knows that the purpose of chemotherapy in this client is for which reason? A. To catch the microscopic cancer cells that could have been missed during surgery B. To reduce the size of the tumor C. To eliminate cancer cells in the blood to prepare the client for targeted radiation therapy to the bone marrow D. To wipe out the bone marrow completely
a (multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.)
The patient is admitted with hypercalcemia, polyurea, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem would most likely cause these manifestations? a. multiple myeloma b. thrombocytopenia c. megaloblastic anemia d. myelodysplastic syndrome
a, d, b, c (in leukemia, immature WBCs, such as malignant and blast cells, proliferate. Blast cells replace bone marrow resulting in bone marrow failure, which causes a decrease in red blood cells (RBCs), WBs, and platelets. Anemia and pallor occur due to reduction in RBC count. The decrease in WBC count leads to immunosuppression, resulting in infection.)
The steps involved in the pathophysiology of leukemia occur in which chronologic order? a. proliferation of immature white blood cells (WBCs) b. reduction in erythrocyte, leukocyte, and platelet count c. occurrence of anemia, pallor, and infection d. replacement of bone marrow with blast cells
absolute neutrophil count (ANC)
To calculate ______, multiply the total WBC count X the percentage of neutrophils; the percentage of neutrophils consists of the segmented (Fully mature) neutrophils) + the bands (almost mature neutrophils) -For example: The patient diagnosed with leukemia has had a bone marrow transplant. The nurse monitors the patients ______. What is the _______ if WBC's are 2.2 ((10 to the 3rd power)mm, neutrophils are 25% and the bands are 5% -To determine the absolute neutrophil count, first the WBC count must be determined. 2.2 multiplied by 1000 (10to 3rd power) = 2200. Multiply that by 30 (25%nuetrophils + 5% bands) to obtain 6600 and divide by 100 to determine _____ of 660 -Lab slip may say Segs or Plys -Lab result: WBC = 1600; polys = 48%; bands = 5% -Polys (48%) + bands (5%) = 53% -WBC (1600) x polys and bands (54% = 848 -Assess for infection and perform interventions
a, e (Lumbar puncture and CT are used to detect leukemic cells outside of the blood and bone marrow. Morphologic study, histochemical study, and cytogenetic method are used to identify leukemic cell type and help in choice of chemotherapy regiment and other treatments)
To determine whether a patients leukemia has affected other organs besides bone marrow and blood, which diagnostic studies will be prescribed? Select all that apply a. lumbar puncture b. morphologic study c. histochemical study d. cytogenetic method e. CT
CML (chronic myeloid leukemia)
Types of leukemia The following describes which type -the increased and unregulated growth of predominantly MYELOID cells in the bone marrow and the accumulation of these cells in the blood.
AML (acute myeloid leukemia)
Types of leukemia The following describes which type? -a rapid increase in the number of abnomral white blood cells in bone marrow that interfere with the production of normal blood cells -its the most common -its the most dangerous
d (enlarged mediastinal lymph nodes may lead to compression of the superior vena cava; the nurse will assess the neck for vein distention, facial and upper extremity swelling, cough, and dyspnea. Bone pain may occur with Hodgkins lymphoma but is not necessarily associated with mediastinal node enlargement. Paraplegia may occur with spinal cord compression but would occur with nodal enlargement below the diaphragm. Renal failure may occur with hypercalcemia secondary to bone involvement but would not be typically associated with mediastinal lymphadenopathy.)
When a PET scan for a patient with Hodgkins lymphoma shows enlarged mediastinal lymph nodes, the nurse will plan to assess for which complications? a. bone pain b. paraplegia c. renal failure d. superior vena cava syndrome
c (Burkitts lymphoma is caused by abnormal replication of B-cell blasts in the lymph nodes, and immature B lymphocytes would be t typically found in the lymph nodes with this type of lymphoma. Abnormal natural killer cells would be seen in natural-killer cell lymphoma. The presence of Reed-Sternberg cells indicates Hodgkins Lymphoma. Well-differentiated abnormal T-lymphocytes would be found in some T=cell lymphomas.)
When a Pt. has Burkitt's lymphoma, which finding will the nurse expect in the lymph node biopsy results? a. natural killer cells b. Reed Sternberg cells c. Immature B lymphocytes d. Well-differentiated T lymphocytes
c (molecular remission is the condition in which all molecular studies are negative for residual leukemia. Partial remission is the condition in which there is lack of symptoms of the disease in the bone marrow. Complete remission is the condition in which the bone marrow and the peripheral blood appear normal. Minimal residual disease refers to the tumor cells that cannot be detected by morphologic examination but can be detected by molecular testing)
When a leukemia patients post-chemotherapy molecular studies are negative for residual leukemia, which type of remission ahs the patient achieved? a. partial remission b. complete remission c. molecular remission d. minimal residual disease
C (molecular remission is the condition in which all molecular studies are negative for residual leukemia. partial remission is the condition in which there is a lack of symptoms of the disease and a normal peripheral blood smear but evidence of disease in the bone marrow. Complete remission is the condition in which the bone marrow and the peripheral blood appear normal. Minimal residual disease refers to the tumor cells that cannot be detected by morphologic examination but can be detected by molecular testing.)
When a leukemia patients post-chemotherapy molecular studies are negative for residual leukemia, which type of remission has the patient achieved? a. partial remission b. complete remission c. molecular remission d. minimal residual disease
b, c, d (Blood studies may show hypercalcemia from bone involvement and hypoalbuminemia if there is liver involvement for a patient with Hodgkin's lymphoma. Reed-Sternberg cells are giant lymphocytes that are characteristic of Hodgkin's lymphoma. Anemia is sometimes seen in Hodgkins lymphoma, but polycythemia would not be expected. Bence Jones proteins are characteristic of multiple myeloma)
When a patient has Hodgkin's lymphoma that involves the bone and the liver, which diagnostic findings will the nurse expect? Select all that apply a. Polycythemia b. hypercalcemia c. Hypoalbuminemia d. Reed-Sternberg cells e. Bence Jones protein
c (Rationale An MRI scan is useful in NHL to determine whether there is CNS involvement. Peripheral blood analysis might be used to check for complications such as anemia, thrombocytopenia, or liver involvement but would not be useful in detecting CNS involvement. Bone marrow aspiration might be done to detect bone marrow involvement but would not help to detect CNS involvement. A PET scan with CT is used to stage NHL and to assess the response to therapy)
When a patient has been diagnosed with non-Hodgkin's lymphoma (NHL), which diagnostic test will be used to assess for central nervous system (CNS) involvement? a. Peripheral blood analysis b. Bone marrow aspiration c. MRI d. Positron emission tomography (PET) scan
b (itching and hives indicate that the patient is experiencing a blood transfusion reaction. The transfusion should be discontinued immediately and disconnected in order to minimize complications of the transfusion reaction. An infusion of normal saline may be started after the blood transfusion has been discontinued and disconnected. After the transfusion has been stopped, the nurse will assess the patient, including assessing BP and then notifying the health care provider. The antihistamine may be given to relieve itching and hives after the blood is discontinued and disconnected.)
When a patient receiving a transfusion of packed red blood cells reports itching and develops hives on the chest and abdomen, which action will the nurse take first? a. infuse normal saline b. stop the blood transfusion c. take the patients Bp d. give the prescribed antihistimine
d (enlarged intrathoracic lymph nodes may place pressure on the superior vena cava and cause superior vena cava syndrome. Paraplegia may occur with compression of the lower spinal cord by enlarged nodes. Liver dysfunction may occur with spread to the liver, which would occur more commonly with lymph node involvement below the diaphragm. Renal dysfunction can occur if enlarged nodes place pressure on urinary tract structures.)
When a patient with Hodgkin's Lymphoma has mediastinal node involvement, the nurse will monitor for which complication? a. paraplegia b. liver dysfunction c. renal dysfunction d. superior vena cava syndrome
b (the patient's diagnosis of ALL, symptoms, and lumbar puncture results indicate infiltration of leukemic cells into the CNS, and intrathecal administration of methotrexate will likely be prescribed. Rituximab is a monoclonal antibody that helps in treatment of lymphocytic disorders, such as chronic lymphocytic leukemia and non-Hodgkin's lymphoma. Alemtuzumab is a monoclonal antibody used to treat lymphocytic disorders, such as chronic lymphocytic leukemia and non-Hodgkin's lymphoma. Filgrastim is a myeloid growth factor used to increase neutrophil count in patients with neutropenia)
When a patient with a cute lymphocytic leukemia (ALL) experiences nausea, vomiting, and lethargy, and when lumbar puncture is positive for lymphoblasts, the nurse will plan to teach about which treatment a. rituximab infusion b. intrathecal methotreaxate c. Iv alemtuxumab d. Filgrastim subcutaneous
a (ALL commonly involves the CNS, and cranial radiation may be used because many chemotherapy drugs do not cross the blood-brain barrier. B/c the patients confusion indicates a serious complication of ALL, the nurse would not offer reassurance. B/c chemotherapy drugs do not cross the blood-brain barrier, larger drug doses would not be effective in treating leukemic invasion of the CNS, although intrathecal methotrexate or cytarabine may be administered. Monoclonal antibody treatment would not be effective for CNS involvement of leukemia)
When a patient with acute lymphocytic leukemia (ALL) develops confusion due to infiltration of the brain by leukemic cells, which action will the nurse plan to take a. prepare teaching about cranial radiation b. offer reassurance that confusion is expected in ALL c. Administer larger doses of the current chemotherapy drugs d. Educate about the benefits of monoclonal antibody treatment
a (partial remission is a condition in which there is a lack of symptoms of the disease and a normal peripheral blood smear but evidence of the disease in the bone marrow. Complete remission refers to the condition in which the bone marrow and the peripheral blood appear normal. Molecular remission is the condition in which all molecular studies are negative for residual leukemia. Minimal residual disease refers to the tumor cells that cannot be detected by morphologic examination but can be detected by molecular testing.)
When a patient with leukemia has completed induction therapy with resolution of leukemia symptoms, normal peripheral blood smear testing, and some leukemic cells in the bone marrow testing, how will the patients status be described? a. partial remission b. complete remission c. molecular remission d. minimal residual disease
c (because leukapheresis and hydroxyurea are typically used to treat WBC counts of greater than 100,000/uL, the patients WBC level of 85,000/uL indicates successful treatment. A hemoglobin level of 11 g/dL is low but would not be used to evaluate whether leukapheresis and hydroxyurea treatment has been effective. The platelets are lower than normal range, but platelet count is not a marker for effective leukapheresis and hydroxyurea treatment in leukemia. An ANC of 1500/uL is low (although not in neutropenic range). ANC level is not a marker for effective treatment with leukapheresis and hydroxyurea.)
When a patient with leukemia is receiving leukapheresis and hydroxyurea, which laboratory result indicates successful treatment? a. hemoglobin of 11g/dL b. Platelet count of 100,000/uL c. White blood cell (WBC) count of 85,000/uL d. absolute neutrophil count (ANC) of 1500/uL
c (a lymph node excisional biopsy is needed in NHL to determine the cell type and pattern, which guides the choice of treatment regiments. An upper endoscopy may be done to asses for GI involvement but will not be useful in determining cell type of pattern. CT will show how far the NHL has progressed and is used for staging but is not as helpful in determining choice of chemotherapy. MRI will be helpful for staging of NHL and detecting central nervous system involvement but is not as useful for determining which chemotherapy regimen will be most effective)
When a patient with non-Hodgkin's lymphoma (NHL) is being evaluated to determine what type of chemotherapy regimen will be used, which test will be most helpful? a. upper endoscopy b. CT d. Lymph node excisional biopsy e. MRI
b (because CLL is frequently asymptomatic for a long time and progresses slowly, asymptomatic older patients may not need treatment and may be followed closely until symptoms develop and treatment is needed. Imatinib targets the Philadelphia chromosome that is seen in chronic myelogenous leukemia and acute lymphocytic leukemia but would not be appropriate for this patient with CLL. HSCT would not typically be an option for an older asymptomatic patient since HSCT has a risk for treatment-related death. High-dose induction chemotherapy would be considered but would likely not be done because of the likelihood of critical illness during induction chemotherapy.)
When an 80-year-old patient is diagnosed with chronic lymphocytic leukemia (CLL) after a routine blood test showed mild anemia but is otherwise asymptomatic, which interprofessional care will the nurse expect? a. Imatinib infusion b. regularly scheduled follow-up c. hematopoietic stem cell transplant (HSCT) d. high-dose induction chemotherapy
b (since hypotension may indicate hemorrhage and shock in a patient who has a splenectomy, the nurse will report the BP to the health care provider and expect to implement further diagnostic testing and treatment. An increase in platelet count is normal after splenectomy as platelets that were previously trapped in the spleen are released into circulation. An increase in white blood cell count may occur as part of the inflammatory response after surgery or as more white blood cells are released into circulation post-splenectomy. A patient report of postoperative pain needs to be addressed but is not as important as possible shock in a postoperative patient.)
When caring for a patient after a splenectomy, which finding is MOST important for the nurse to communicate to the health care provider? a. platelet count 470,000 u/L b. BP 92/46 mm Hg c. White blood cells 12,000 u/L d. patient report of 8/10 pain
a (acute lymphocytic leukemia is associated with hypercellular bone marrow with lymphoblasts (immature lymphocytes). Acute myelogenous leukemia is characterized by an increase in the number of myeloblasts (immature myelocytes). Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes. Chronic myelogenous leukemia occurs as a result of the excessive development of mature granulocytes in the bone marrow.)
When diagnostic testing shows hypercellular bone marrow with lymphoblasts, the nurse expects the patient to be diagnosed with which type of leukemia? a. acute lymphocytic (ALL) b. Acute myelogenous leukemia (AML) c. chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)
d (HSCT may be used to achieve a cure for Hodgkins lymphoma once chemo has achieved a remission. Corticosteroids may be part of the chemo regimen but are not used alone to treat lymphoma or as maintenance therapy after remission is achieved. Targeted radiation therapy may be part of the initial treatment but is not needed once remission has been received. Maintenance chemo does not contribute to survival once remission has been achieved for Hodgkins lymphoma)
When initial treatment for stage III Hodgkins lymphoma has been successful and the pt. is in remission, the nurse anticipates that which type of therapy may be prescribed to follow the initial treatment? a. corticosteroids b. targeted radiation c. maintenance chemo d. hematopoietic stem cell transplantation (HSCT)
a (assessment of the cognitive perceptual functional health pattern will include sensory data, such as numbness of the feet. The other questions also will help collect important data but are not directed toward sensory, cognitive, or perceptual patient information. Past health history of chemotherapy may help to determine whether the patient is having a relapse of leukemia. Knowledge about gum bleeding or oral pain is collected as part of the nutritional-metabolic functional health patter and will help the nurse plan diet and oral care for this patient. Family history of leukemia or cancer may help to determine what type of leukemia the patient has and what treatment will be best and falls in the health perception-health management functional health pattern.)
When interviewing a patient with leukemia, which question would the nurse ask to obtain information about the patients cognitive-perceptual functional health pattern? a. have you experienced numbness or tingling of the feet b. do you have any past history of chemotherapy for cancer c. have you noticed any gum bleeding or oral pain recently d. is there any family history of leukemia or other cancers
b (the most common chemotherapeutic regimen prescribed for early stage Hodgkins lymphoma is doxorubicin (adriamycin), belomycin, vinblastine, and dacarbazine (ABVD regimen). Rituximab is used in treatment of non-Hodgkins lymphoma and multiple other hematologic disorders but is not used to treat Hodgkins lymphoma. Fludarabine is a chemotherapeutic agent used in non-Hodgkin's lmphoma and leukemia. Ibritumomab tiuxetan is used in treatment of non-Hodgkins lymphoma.)
Which chemotherapeutic medication will the nurse anticipate administering for a patient with stage IA Hodgkins lymphoma? a. Rituximab b. Bleomycin c. Fludarabine d. Ibritumomab tiuxetan
a (maintenance therapy involves treatment with lower doses of drugs given every few weeks for a prolonged period. Admission to the hospital may be needed for induction chemotherapy but will not be expected for maintenance chemotherapy. Although infection risk is higher when aggressive induction or consolidation chemotherapy is administered, maintenance chemotherapy will also affect bone marrow, and the patient will need to continue with infection control measures, such as hand washing. Induction chemotherapy involves an aggressive treatment to destroy leukemic cells in the tissues.)
Which action will the nurse take when the patient is receiving maintenance chemotherapy? a. teach that chemotherapy will be scheduled every 3 to 4 weeks b. Admit the patient to the hospital for daily chemotherapy infusions c. offer reassurance that infection control measures can be discontinued d. plan for intense and aggressive chemotherapy to suppress bone marrow
a (Rationale Tumor lysis syndrome is a common complication of chemotherapy for Burkitt's NHL, and the nurse will plan to administer IV fluids and monitor intake and output carefully to prevent and detect this complication. Antibiotic therapy will not be administered for Burkitt's NHL unless the patient develops an infection. There is no need to assess grip strength or neurologic status more frequently. Although Hodgkin's lymphoma has an 80% long-term survival level with treatment, NHL has a much poorer prognosis.)
Which action would the nurse plan to take when a patient is being treated with chemotherapy for Burkitt's non-Hodgkin's lymphoma (NHL)? a. Carefully monitor intake and output measurements. b. Administer concurrent IV antibiotics. c. Check grip strength and orientation more frequently. d. Teach the patient that there is an 80% chance of survival.
a, b, c (b/c the patient will be on neutropenic precautions and visitors will be limited, the nurse should set aside time to sit with the patient, as this can alleviate loneliness and provide support. The nurse should also determine the patients interests and hobbies to plan further activities. The nurse could also contact the information technology department to determine video conference call capability for the patient to be able to keep in contact with friends and families. The nurse can provide support but should arrange for pastoral care to offer religious support and prayer. Young children should refrain from visiting as the patients immune system will be compromised and young children can harbor infection.)
Which actions would the nurse take to decrease feelings of isolation in a patient with leukemia who has been admitted for induction therapy? Select all that apply a. set aside time to sit with patient b. determine interests and hobbies c. arrange for video conference calls d. provide religious support and prayer e. allow the patients young children to visit
a (A WBC count of 150,000uL indicates leukostasis, which causes thickening of the blood and decreases circulation. Rapid treatment is needed for this life-threatening complication, and the nurse will immediately notify the health care provider. Severe bone pain needs rapid treatment but is not life-threatening. Multiple ecchymoses and petechiae are common in leukemia b/c of associated low platelet count; monitoring of platelets and bleeding is needed but this is not life-threatening and does not need immediate treatment. The patient's oral ulcers will need treatment to improve appetite and nutrition, but this complication of leukemia is not life-threatening.)
Which assessment finding by the nurse who is caring for a patient with leukemia is most important to report to the health care provider? a. white blood cell count of 150,000 uL b. patient report of severe bone pain c. multiple ecchymoses and petechiae d. poor appetite secondary to oral ulcers
c (ALL can affect organs such as the liver and the spleen. When leukemic cells infiltrate the liver, it can cause impaired function and jaundice, as bilirubin metabolism is impaired. Fever and bone pain are related to increased lymphocyte production. Pallor is related to decreased red blood cell production.)
Which assessment finding indicates possible hepatic involvement in a patient newly diagnosed with acute lymphocytic leukemia (ALL)? a. fever b. pallor c. jaundice d. bone pain
a (the blood urea nitrogen level is elevated and indicates possible renal failure, which can occur with tumor lysis syndrome associated with NHL. Further diagnostic testing and treatment are needed to prevent chronic renal failure. Weight loss is systemic symptom of NHL and does not need any immediate treatment. Night sweats are sometimes see as a systemic manifestation of NHL and do not require any rapid intervention. Painless lymphadenopathy is the most common finding is NHL.)
Which assessment finding will be most important to report to the health care provider when the nurse is caring for a patient diagnosed with non-hodgkins lymphoma (NHL) a. blood urea nitrogen level of 42 mg/dL b. weight loss of 10lb (4.5kg) over a month c. Patient report of soaking night sweats d. Painless inguinal lymph node enlargement
c (in partial remission, symptoms are absent and the blood smear is normal, but abnormal cells remain in the bone marrow. A patient who reports ongoing chronic fatigue would not meet the criteria for partial remission since ongoing fatigue is a symptom of leukemia. A patient with abnormalities in the peripheral blood smear would not bee the criteria for partial remission since peripheral blood smears are normal in partial remission. A patient with negative molecular studies for residual leukemia would more likely be in complete remission since these studies indicate that no evidence of leukemic cells remains.)
Which assessment finding would the nurse expect when caring for a patient who has achieved partial remission after the initial prescribed chemotherapy for acute leukemia? a. patient report of chronic fatigue b. abnormalities in the peripheral blood smear c. blast cells remaining in the bone marrow d. negative molecular studies for residual leukemia
a, e, f (Photophobia, neck stiffness and pain, and headache are clinical manifestations of meningeal irritation, which occurs with infiltration of leukemic cells into the CNS. Assessment for pallor may indicate anemia but is not useful in assessing for spread of leukemia to the CNS. Abdominal pain may occur in patients with leukemia but is not a manifestation of CNS infiltration. Peripheral pulses may be weak if the patient is anemic, but poor peripheral pulse quality is not associated with CNS involvement in leukemia)
Which assessments by the nurse are the most important when a patient with acute lymphocytic leukemia has CNS infiltration of leukemic cells? Select all that apply a. observe for photophobia b. check conjunctiva for pallor c. inquire about abdominal pain d. assess peripheral pulse quality e. ask about neck stiffness or pain f. question the patient about headaches
b (b/c lymph nodes both above and below the diaphragm are involved, the patient is in stage III of the disease. The letter A indicates the absence of systemic symptoms, and the letter B indicates their presence. B/c the patient presents with systemic symptoms, such as fever, night sweats, the stage of the disease would have been stage IIIA. In stage IVA, other internal organs such as the liver would be involved but the patient would not be experiencing fever, night sweats, and weight loss. In stage IVB, internal organs such as the liver would be involved and the patient would report the B symptoms of fever, night sweats, and weight loss.)
Which clinical stage of lymphoma will the nurse suspect for a patient who has enlarged mediastinal and retroperitoneal lymph nodes and reports fever, night sweats, and weight loss? a. Stage IIIA b. Stage IIIB c. Stage IVA d. Stage IVB
d (Immunosuppression is a risk factor for NHL, and the nurse will screen for NHL, such as lymph node enlargement. Immunosuppression is not a risk factor for hemochromatosis. Increased risk for multiple myeloma does not occur with use of immunosuppressants. Immunosuppression is not a risk factor for polycythemia vera)
Which complication will the nurse assess for when caring for a clinic patient who takes an immunosuppressive medication after having a kidney transplant? a. Hemochromatosis b. Multiple myeloma c. Polycythemia vera d. Non-Hodgkin's lymphoma (NHL)
d (High levels of calcium and uric acid caused by tumor lysis syndrome may lead to acute kidney injury (acute renal failure) in patients with NHL. Jaundice may occur with NHL due to spread to the liver but is not caused by tumor lysis syndrome. Bone pain may occur with NHL if there is bone involvement but is not related to tumor lysis syndrome. Paraplegia may occur in NHL if enlarged lymph tissue pushes on the spinal cord but is not caused by tumor lysis syndrome)
Which complication will the nurse monitor for when a patient with nonHodgkin's lymphoma (NHL) develops tumor lysis syndrome? a. Jaundice b. Bone pain c. Paraplegia d. Renal failure
c (Hodkins lymphoma is a malignant condition characterized by proliferation of abnormal giant, multinucleated cells called Reed-Sternberg cells, which are located in the lymph nodes. Polycythemia is characterized by an increased number of red blood cells. Multiple myeloma is characterized by the presence of Bence Jones protein in blood and urine. The presence of Reed-Sternberg cells helps to differentiate Hodgkin's lymphoma from NHL)
Which diagnosis is confirmed by a biopsy showing Reed-Sternberg cells? a. polycythemia b. multiple myeloma c. Hodgkins lymphoma d. Non-Hodgkins lymphoma
c (the Philadelphia chromosome is present in 90% to 95% of patients with CML and is a diagnostic hallmark of CML. Thrombocytopenia may occur with CML, but thrombocytosis would not be expected. Since CML is characterized by abnormal myelocytes (not abnormal lymphocytes) and does not typically invade the central nervous system, lymphoblasts in the cerebrospinal fluid are not an expected finding. In CML, the bone marrow would contain abnormal but mature myelocytes.)
Which diagnostic finding is a hallmark of chronic myelogenous leukemia (CML)? a. thrombocytosis b. lymphoblasts in cerebrospinal fluid c. presence of Philadelphia chromosome d. hypercellular bone marrow with lymphoblasts
d (PET Is helpful to define all sites and determine the clinical stage of Hodgkins lymphoma. Barium enemas would be used to help determine the impact of Hodgkins lymphoma on lower GI tract function. An upper endoscopy would be used to assess for the effect of lymphoma on upper GI tract function. A CBC would be helpful in determining whether lymphoma has infiltrated the bone marrow.)
Which diagnostic study is helpful in determining the clinical stage of Hodgkin's lymphoma? a. barium enema b. upper endoscopy c. complete blood count (CBC) d. Positron emission tomography (PET)
b (a bone marrow biopsy provides a sample to determine the presence of leukemic cells. Blood cultures are done to detect the presence of microorganisms, such as bacteria or fungi, in the blood. Blood cultures will not detect leukemic cells. An MRI creates a detailed image of the organs and tissue in the body but does not identify specific cell types. A wood's lamp examination is usually done on the surface of the skin and can detect the presence of bacterial or fungal skin infections.)
Which diagnostic test allows the health care provider to directly visualize the presence of leukemic cells? a. blood culture b. bone marrow biopsy c. MRI d. Woods lamp examination
b (the presence of Reed-Sternberg cells in a lymph node biopsy specimen is the main diagnostic feature of Hodgkins lymphoma disease. Lymphoblasts in the cerebrospinal fluid indicate acute lymphocytic leukemia. Hypercellular bone marrow with myeloblasts is a diagnostic finding of acute myelogenous leukemia. The philadelphia chromosome is a sign of chornic myelogenous leukemia.)
Which diagnostic test result indicates a diagnosis of Hodgkins lymphoma? a. lymphoblasts in the cerebrospinal fluid b. Reed-Sternberg cells in the lymph node c. Hypercellular bone marrow with myeloblasts d. Philadelphia Chromosome in the bone marrow cells.
c (b/c extra-lymphoid sites such as the liver may be affected when Hodgkins Lymphoma originates from below the diaphragm, liver functioning testing and liver biopsy are done to check for spread of lymphoma to the liver and the nurse will need to review results of these tests. Pulse oximetry may be done but is not likely to be affected by retroperitoneal hodgkins lymphoma. An echocardiogram may be done but is not likely to be affected by hodgkins lymphoma located in the retroperitoneal space. Stool testing for occult blood may be prescribed for other reasons but is unlikely to be affected by Hodgkins lymphoma)
Which diagnostic test result is MOST important for the nurse to check when a patient has a new diagnosis of Hodgkins Lymphoma with the initial enlarged node located in the retroperitoneal area? a. pulse oximetry b. echocardiogram c. liver function test d. stool test for occult blood
b (since bone marrow proliferation of abnormal lymphocytes leads to decreased RBCs and thrombocyte production, the nurse will expect low numbers of RBCs and platelets. Low leukocyte alkaline phosphate is associated with chronic myelogenous leukemia. Acute myelogenous leukemia is characterized by hypercellular bone marrow with myeloblasts. Increased numbers of immature myelocytes are found in patients with acute myelogenous leukemia.)
Which diagnostic test result will the nurse expect for a patient who has been diagnosed with acute lymphocytic leukemia? a. low leukocyte alkaline phosphatase b. decreased platelets and red blood cells (RBCs) c. Hypercellular bone marrow with myeloblasts d. elevated numbers of immature myelocytes
d (CLL is associated with the accumulation of small, mature-appearing lymphocytes in the bone marrow. Large numbers of myeloblasts are characteristics of acute myelogenous leukemia. Mild anemia is seen in CLL, and the nurse would not expect elevations in red blood cells, hemoglobin, or hematocrit. The Philadelphia chromosome is a diagnostic hallmark of chronic myelogenous leukemia (CML))
Which diagnostic test result will the nurse expect when a patient is admitted with chronic lymphocytic leukemia (CLL)? a. large numbers of myeloblasts in bone marrow b. elevated red blood cell count, hemoglobin, and hematocrit d. presence of Philadelphia Chromosome is affected blood cells e. many small mature-appearing lymphocytes in bone marrow
b, c (the initial diagnostic tests for leukemia are bone marrow biopsy and peripheral blood evaluation. The other tests would be done only if initial testing indicated leukemia. Lumbar puncture would be used to determine whether leukemic cells had infiltrated the CNS. A CT scan would be done to detect spread of leukemic cells to other organs and tissues. Morphologic and histologic examination would be done if abnormal cells were detected in the peripheral blood or bone marrow.)
Which diagnostic tests will the nurse teach about first when a patient with fatigue and bone pain needs evaluation for possible leukemia. Select all that apply a. lumbar puncture b. bone marrow biopsy c. peripheral blood evaluation d. CT scan e. Morphologic and histochemical examination
a, b, e (characteristics of the sick role include dependence, alteration of familial roles and responsibilities, and withdrawing from family and friends. Lack of interest in socializing, depending on family members for health care decision making, and referring all management of children to a spouse are indications that the patient is taking on the sick role. Insistence on continuing to work indicates ongoing independence and (in many cases) ongoing interaction with others. Refusing assistance with household chores indicates independence.)
Which emotional changes may be associated with the sick role for a young adult who has recently been diagnosed with acute myelogenous leukemia (AML)? Select all that apply a. lack of interest in socializing with friends b. dependence on family to make health care decisions c. insistence on continuing to work d. referring all management of children to spouse e. refusing assistance with household chores
d(A lumbar puncture is performed in a patient with lymphoma to rule out central nervous system involvement. Bone marrow biopsy would determine whether there is bone marrow involvement in the lymphoma. Cell differentiation would be determined by analysis of the lymph node biopsy. The lymph node biopsy would be analyzed to establish which type of lymphocytes are affected.)
Which explanation will the nurse give a patient with non-Hodgkin's lymphoma about the purpose of a planned lumbar puncture? a. To rule out any bone marrow involvement b. To determine the level of cell differentiation c. To establish which lymph cell type is involved d. To find any central nervous system involvement
a (after a bone marrow biopsy confirms the diagnosis of leukemia, a CT scan is used to detect leukemic cells outside of blood and bone marrow. The specific type of leukemia is determined based on analysis of leukemic cells found in the bone marrow. The presence of the Philadelphia chromosome is determined by analysis of abnormal cells found in the blood and bone marrow. Analysis of cell differentiation in leukemic cells determines whether the leukemia is acute or chronic.)
Which explanation will the nurse give when a patient whose bone marrow biopsy indicates leukemia asks about the purpose of a scheduled CT test? a. to locate any spread of leukemia to body organs b. to determine the specific type of leukemia c. to identify the presence of the Philadelphia chromosome d. to find out whether the leukemia is acute or chronic
b (ALL is characterized by a proliferation of immature white blood cells and frequently infiltrates the central nervous system (CNS); it is treated initially with IV combination chemotherapy and intrathecal chemotherapy to prevent CNS involvement. ALL is rapidly progressive, and patients deteriorate quickly without treatment. Affected lymphocytes in ALL are immature and poorly differentiated; radiation is not an initial treatment. ALL is not infectious in nature, and antibiotics are not used to treat ALL)
Which explanation would the nurse give when the patient with acute lymphocytic leukemia (ALL) asks for clarification about the disease and expected treatment? a. ALL is frequently slowly progressive and may not need treatment immediately b. ALL is initially treated with both IV and intrathecal chemotherapy drugs c. ALL is characterized by well differentiated lymphocytes and may be initially treated with radiation d. ALL is caused by an infectious agent and usually is initially treated with multiple antibiotics
a (wheezing and dyspnea indicate a possible hypersensitivity reaction to rituximab, and the nurse will immediately stop the infusion and notify the health care provider. The BP indicates a need for ongoing monitoring, but no other immediate action is needed. B symptoms, such as fever and night sweats, are sometimes associated with non-Hodgkins lymphoma and would not need any immediate action by the nurse. Enlarged lymph nodes are frequent symptom in non Hodgkins lymphoma, and this finding does nto require any immediate nursing action)
Which finding by the nurse requires immediate action when a patient with non-Hodgkins lymphoma is receiving rituximab? a. wheezing and dyspnea b. BP 168/100 mmHg c. Patient report of fever and night sweats d. multiple enlarged cervical lymph nodes
d (High-grade Hodgkins Lymphoma is manifested with B symptoms of fever, night sweats, and weight loss, which signify a worse prognosis. A nontender and mobile cervical lymph node is a common early manifestation of Hodgkins lymphoma. Unusual fatigue is a common manifestation of Hodgkins lymphoma. Elevated erythrocyte sedimentation rare is a nonspecific and common lab change with Hodgkins Lymphoma.)
Which finding by the nurse when assessing a patient with newly diagnosed Hodgkins lymphoma is MOST important to communicate to the HCP? a. mobile cervical lymph node b. patient report of unusual fatigue c. elevated erythrocyte sedimentation rate d. patient report of night sweats, fever, and weight loss
d (AML leads to decreased production of platelets (thrombocytopenia), which increases bleeding time and leads to bruising. Neutropenia frequently occurs as a complication of chemotherapy and would increase risk for infection but would not be typical in untreated AML and would not be associated with increased bruising. Since bone marrow production of red blood cells is reduced in leukemia, anemia rather than polycythemia would be expected. Lymphocytosis may occur with acute lymphocytic leukemia but would not be expected in a patient with AML )
Which laboratory finding will the nurse expect after assessing a patient with acute myelogenous leukemia (AML) who has multiple bruises? a. neutropenia b. polycythemia c. lymphocytosis d. thrombocytopenia
b (since angioedema indicates a hypersensitivity reaction to rituximab and may cause airway obstruction, the nurse will stop the infusion and notify the health care provider immediately, anticipating prescriptions for medications such as antihistimines and corticosteroids. Diarrhea is a possible adverse effect rituximab and needs to be treated but does not require immediate action or stopping the medication. Anemia may occur with rituximab and chemotherapy, but a hematocrit of 30% does not need immediate treatment or indicate that rituximab should be stopped. Thrombocytopenia may occur with rituximab, but a platelet count of 90,000 u/L will not lead to spontaneous bleeding and does not require a change in therapy.)
Which finding for a patient who is receiving rituximab as part of chemotherapy for non-hodgkins lymphoma will be MOST important for the nurse to report quickly to the health care provider? a. diarreha b. angioedema c. hematocrit 31% d. platelet count 90,000 u/L
d (new bilateral leg weakness in a patient with Hodgkins lymphoma may indicate pressure of the lymphoma on the spinal cord and needs immediate treatment to prevent paraplegia. Anemia is a common nonspecific finding in Hodgkins lymphoma and does not indicate a need for rapid intervention. Elevated temperature is a common systemic finding in Hodgkins lymphoma and no rapid intervention by the HCP is indicated. Enlarged lymph nodes are the most common initial finding in Hodgkins lymphoma and do not need to be reported quickly to the HCP.)
Which finding in a patient with Hodgkins lymphoma is MOST important to report to the HCP? a. hematocrit 32% b. temp 100.4 c. bilateral inguinal enlarged lymph nodes d. patient report of new bilateral leg weakness
c (Imatinib targets the Philadelphia chromosome, which is a major characteristic of CML; absence of this abnormal chromosome indicates that the medication has been effective. Thrombocytopenia would resolve with successful treatment of CML, but improvement in platelet count is not the best marker for effectiveness of imatinib. The number of immature banded neutrophils will decrease as more mature neutrophils are produced with successful treatment, but this is not the best indicator of effective treatment. The number of abnormal nucleated red blood cells (RBCs) will decrease as the bone marrow produces more normal cells, but a lower number abnormal RBCs is not the best marker for effective CML treatment.)
Which finding in a patient with chronic myelogenous leukemia (CML) is the best indicator that the prescribed Imatinib has been effective? a. resolution of thrombocytopenia b. lower numbers of banded neutrophils c. absence of the Philadelphia chromosome d. Reduction in number of nucleated red blood cells
c (vomiting may be an indication of increased intracranial pressure secondary to infiltration of leukemic cells into the central nervous system. The nurse would report this immediately to the health care provider and anticipate prescriptions for antiemetics, IV fluids, and further diagnostic testing. Pallor would be reported but is common in ALL due to anemia. Anorexia would be reported but is a common finding in ALL. Lymphadenopathy would be reported but is a frequent finding in ALL.)
Which finding will be most important to report to the health care provider when the nurse assesses a patient with newly diagnosed acute lymphocytic leukemia (ALL)? a. pallor b. anorexia c. vomiting d. lymphadenopathy
a (nausea and vomiting in a patient with ALL may indicate increased intracranial pressure caused by infiltration of leukemic cells into the CNS, which will require action to lower intracranial pressure and to treat the CNS infiltration, as well as interventions, such as antiemetics and IV fluids. Painless scrotal swelling is sometimes associated with ALL and does not require any immediate action. Weight loss is a common symptom of leukemia and will need to be addressed but does not need immediate action. Generalized lymphadenopathy is commonly seen with ALL.)
Which finding will be of most concern in a pt. who has acute lymphocytic leukemia (ALL)? a. nausea and vomiting b. painless scrotal swelling c. recent weight loss of 10lb (4.5kg) d. cervical and axillary lymphadenopathy
b, d, e (Clinical manifestations of CLL include splenomegaly, lymphadenopathy, and hepatomegaly. Diagnostic findings include mild anemia, thrombocytopenia, and total WBC count greater than 100,000/uL. Since infiltration of leukemic cells into the central nervous system is not expected with CLL, confusion is not a typical finding. Hemoglobin levels decrease, and anemia is seen in CLL)
Which findings will the nurse expect for a patient who has a diagnosis of chronic lymphocytic leukemia (CLL)? Select all that apply a. confusion b. hepatomegaly c. hemoglobin 19 g/dL d. Platelet count 50,000/mcL e. White blood cell (WBC) count 110,000/mcL
a (Rationale Pesticide exposure increases risk for leukemia and non-Hodgkin's lymphomas, and farm workers are more likely to develop these illnesses than the general population. Office managers are not at higher risk for cell changes that may lead to cancer. Police officers are not at higher risk for development of leukemia or lymphoma. College professors are not at higher risk for leukemia or lymphoma.)
Which group of people is at high risk for developing leukemia and nonHodgkin's lymphoma? a. Farm workers b. Office managers c. Police officers d. College professors
b, d (The major characteristic of lymphoma is painless lymph node enlargement. Weight loss, fever, and drenching night sweats are characterized as B manifestations of Hodgkin and non-Hodgkin's lymphomas and indicate a poorer prognosis in both types of lymphoma. Clinical manifestations of thalassemia do not include enlarged lymph nodes, weight loss, fever, or night sweats. Megaloblastic anemias are not characterized by lymphadenopathy, weight loss, fever, or night sweats. Myelodysplastic syndrome does not include symptoms of fever, weight loss, night sweats or lymphadenopathy. Immune thrombocytopenic purpura symptoms do not include enlarged lymph nodes, fever, night sweats, or weight loss.)
Which hematologic diseases may have symptoms of weight loss, fever, drenching night sweats, and painless lymph node enlargement? Select all that apply. a. Thalassemia b. Burkitt's lymphoma c. Megaloblastic anemia d. Hodgkin's lymphoma e. Myelodysplastic syndrome f. Immune thrombocytopenic purpura
a, c, d, e (Indolent NHL may be treated with the monoclonal antibody rituximab, external beam irradiation, and with either single-agent or combo chemotherapy. Thalidomide would not be typically used for NHL, although it is a treatment for multiple myeloma.)
Which treatment options will the nurse anticipate when caring for a patient with a newly diagnosed stage I indolent (low-grade) non-Hodgkins lymphoma (NHL)? Select all that appy a. Rituximab b. Thalidomide c. External beam irradiation d. Single-agent chemotherapy e. combination chemotherapy
a (the protein that is encoded by the newly created BCR-ABL gene on the Philadelphia chromosome interferes with normal cell cycle events such as the regulation of cell proliferation. Absence of the Philadelphia chromosome is an expected marker for remission in leukemia; if the Philadelphia chromosome persists, the patient is not in remission. The Philadelphia chromosome occurs most frequently in chronic myelogenous leukemia but is sometimes found ina cute lymphocytic leukemia and occasionally in acute myelogenous leukemia. It is not found with chronic leukocytic leukemia. The Philadelphia chromosome is not a congenital defect but occurs later in life b/c of exposure to factors such as oncogenes, environment, and viruses.)
Which information about the Philadelphia chromosome in leukemia is accurate? a. it interferes with the regulation of cell proliferation b. it persists even after leukemia is in complete remission c. it occurs most frequently in chronic leukocytic leukemia d. it presents as a congenital defect in children who develop leukemia
b, d, e (Chemotherapy is the initial treatment for H. Lymphoma, and long-term survival exceeds 80%. B symptoms, such as fever, night sweats, and weight loss, indicate a worse prognosis and are common. Hodgkins lymphoma usually starts in a single node but can spread diffusely and infiltrate other organs. Anemia may occur b/c of decreased red blood cell production and increased red blood cell destruction, but polycythemia is not a complication of H's. lymphoma.)
Which information is accurate about Hodgkin's lymphoma? Select all that apply a. extranodal spread doe snot occur b. treatment includes chemotherapy c. polycythemia is frequently a complication d. long-term survival exceeds 80% for all stages e. fever, drenching night sweats, and weight loss are common
b (the subjective data category includes information taken from the patient, such as the patient reporting exposure to chemical toxins. The objective data category includes information regarding diagnostic findings, such as Philadelphia chromosome. The observed information related to the integumentary findings, like reddish-brown cutaneous filtrates, is documented in the objective data section. Bleeding gums would be noted by the nurse and documented in the objective data section)
Which information obtained by the nurse during the admission of a patient with leukemia would be documented under the subjective data section? a. gingival bleeding b. exposure to chemical toxins c. presence of Philadelphia chromosome d. Presence of reddish-brown cutaneous infiltrates
d (Graft-versus-host disease is a common complication following allogenic HSCT as the donor cells attack the patients own cells, causing symptoms such as rashes, diarrhea, and jaundice. B/c HSCT involves eradication of the patients own hematopoietic stem cells and causes severe immune suppression, risk for life-threatening infection is high. Relapse may occur even with HSCT. Autologous HSCT involves using the patients own stem cells, while allogenic HSCT is done using donor cells)
Which information will the nurse include when teaching a patient about allogenic hematopoietic stem cell transplantation (HSCT) therapy as treatment for leukemia? a. infection risk is low with allogenic HSCT b. Relapse is rare after allogenic HSCT treatment c. Allogenic HSCT involves use of the patients own stem cells d. Graft versus host disease is a complication of allogenic HSCT
c (since neutropenia is a common adverse effect of leukemia chemotherapy, education about how to prevent infection and clinical manifestations of infection is important to include in patient education. While leukemia treatment does have severe side effects, the side effects resolve when treatment is stopped. There is no indication that the patient needs assistance when getting out of bed for safety reasons, and insisting that assistance is needed will encourage over-dependence and may cause depression. While feeling isolated is a common consequence of leukemia and leukemia treatment, the nurse will plan ways to help the patient to avoid feeling isolated rather than stating that feelings of isolation are inevitable.)
Which information will the nurse include when teaching a patient who is receiving chemotherapy for leukemia? a. the treatment has severe side effects, some of which will be permanent b. you need to use your call light to ask for help every time you get out of bed c. prevention and early detection of infection are important during leukemia treatment d. feeling isolated is a common and unavoidable consequence of leukemia treatment.
b (in maintenance therapy, treatment is provided every three to four weeks for a prolonged period with lower doses of the drugs. Intensification and consolidation are the terms used to describe post-induction or post-remission therapy. Maintenance chemotherapy is given at lower doses and longer intervals and is better tolerated by patients; severe bone marrow depression and critical illness are not expected.)
Which information will the nurse include when teaching a pt. with leukemia about maintenance chemotherapy? a. it is the high-dose treatment given immediately after induction therapy b. chemotherapy is given every three to four weeks for a prolonged period c. intensification and consolidation are other terms used to describe this therapy d. severe bone marrow depression and critical illness are common complications
d (NHLs are a heterogeneous group of malignant neoplasms of primarily B-cell, T-cell, or natural killer (NK) cell origin. NHL is frequently disseminated and affects nonlymphatic organs, such as the brain or liver. While B symptoms such as fever, night sweats, and weight loss can occur, they are uncommon in NHL. NHL can affect persons of any age while Hodgkin's lymphoma has a bimodal peak incidence at ages 15 to 30 and over 55 years old.)
Which information would the nursing instructor include when teaching about non-Hodgkin's lymphoma (NHL)? a. NHL is confined to the regional lymph nodes and lymphatic tissues. b. Night sweats, fever, and weight loss are common associated symptoms. c. Incidence is most frequent at ages 15 to 30 years or over 55 years of age. d. NHL is a broad group of malignant neoplasms with a variety of presentations.
c (the patients extremely elevated white blood cell count indicates leukostatsis, which causes thickening of the blood and decrease in circulation to vital organs such as the lungs. The patients shortness of breath and white blood cell count will be rapidly reported by the nurse who will anticipate interprofessional actions such as oxygen, IV fluids, and leukapheresis. The platelet count is lower than normal but would not explain the patients shortness of breath or need rapid treatment. The erythrocyte (red blood cell) count is slightly low but is not a likely cause for the dyspnea and does not need immediate treatment. An ANC of 1200/uL is low but not at the neutropenic level, which would increase risk for infection; the ANC does not explain the patients shortness of breath or require any rapid intervention.)
Which laboratory finding in a patient with leukemia who reports shortness of breath is most important to report quickly to the health care provider? a. platelet count 94,000 uL b. Erythrocyte count 3,200,000/uL c. white blood cell count 109,000/uL d. absolute neutrophil count (ANC) 1200/uL
b, c (acute lymphocytic leukemia is characterized by lymphoblasts in cerebrospinal fluid and hypercellular bone marrow with lymphoblasts. Acute myelogenous leukemia is characterized by an increase in the number of myeloblasts. Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes. Chronic myelogenous leukemia occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow. )
Which laboratory test results are consistent with a patients diagnosis of acute lymphocytic leukemia (ALL)? Select all that apply a. presence of increased number of myeloblasts b. presence of lymphoblasts in cerebrospinal fluid c. presence of hypercellular bone marrow with lymphoblasts d. presence of accumulated small, mature-appearing lymphocytes e. excessive development of mature neoplastic granulocytes in the bone marrow.
c (Hodgkins lymphoma originates in cervical lymph nodes in 60% to 70% of patients. The mediastinal lymph nodes are the second most common location for Hodgkins lymphoma. Hodgkins lymphoma also may occur in the axillary and inguinal lymph nodes.)
Which lymph nodes are most commonly affected in Hodgkins lymphoma? a. axillary b. inguinal c. cervical d. mediastinal
c (Imatinib is a newer therapeutic agent used as targeted therapy. It acts by targeting BCR-ABL protein and killing the abnormal CML cells without damaging normal cells. Other chemotherapeutic medications treat leukemia by inhibiting angiogenesis, inhibiting cell proliferation, and causing DNA fragmentation.)
Which mechanism of action for imatinib makes it effective in treating chronic myelogenous leukemia (CML)? a. inhibits angiogenesis b. inhibits cell proliferation c. targets BCR-ABL protein d. causes DNA fragmentation
a (Prednisone is included in combination chemotherapy for advanced-stage Hodgkin's lymphoma. Methotrexate is used for treatment of some leukemias and non-Hodgkin's lymphoma. Mitoxantrone is used for treatment of some leukemias and for nonHodgkin's lymphoma. Fludarabine is used to treat some leukemias and for nonHodgkin's lymphoma.)
Which medication may be included in the chemotherapy regimen for a patient with advanced-stage Hodgkin's disease? a. Prednisone b. Methotrexate c. Mitoxantrone d. Fludarabine
a (cranial radiation therapy is given to a patient when the leukemia involves the CNS. This is commonly observed in patients who have ALL, such as patient A. Acute myelogenous leukemia does not typically invade the CNS, and cranial radiation would not be anticipated for patient B. Chronic lymphocytic leukemia does not involve the CNS, and patient C will not require cranial radiation. Chronic myelogenous leukemia does not invade the CNS, so patient D will not need cranial radiation.)
Which of these four patients is most likely to need teaching about cranial radiation therapy? Patient A: acute lymphocytic leukemia Patient B: acute myelogenous leukemia Patient C: chronic lymphocytic leukemia Patient D: chronic myelogenous leukemia
d (Rituximab treatment can reactivate hepatitis B, and the health care provider will need to consider whether rituximab is appropriate for this patient. Anemia may occur with non-Hodgkin's lymphoma; a hematocrit of 34% is not a contraindication to rituximab treatment and does not require immediate treatment. Penicillin allergy is not a contraindication to rituximab treatment. The creatinine level of 0.7 mg/dL is in the normal range)
Which patient information is most important for the nurse to discuss with the health care provider prior to administration of the prescribed rituximab to a patient with non-Hodgkins lymphoma? a. hematocrit of 34% b. allergy to penicillin c. creatinine level of 0.7 mg/dL d. history of hepatitis B infection
c (Objective data includes diagnostic findings, such as a low platelet count. A pt. report of impotence would be included in subjective data since this information is not objectively verified by the nurse. Patient descriptions of symptoms, such as prolonged menstrual cycles, are included in subjective data. Since family history is obtained from the pt. and not observed or verfied by the nurse, this information is documented as subjective.)
Which patient information will be included when documenting objective data after the nurse has done the admission assessment for a patient with leukemia? a. patient report of impotence b. patient history of prolonged menses c. laboratory finding of low platelet count d. family history of Klinefelter syndrome
C (The Philadelphia chromosome is present in over 90% of pts with CML. It is considered an important indicator of continuing or recurrent chronic myelogenous leukemia after treatment. Hypercellular bone marrow with lymphoblasts indicates acute lymphocytic leukemia. Chronic myelogenous leukemia is characterized by anemia with low red blood cell count, hemoglobin, and hematocrit. Acute myelogenous leukemia is associated with high lactic dehydrogenase (LDH) levels.)
Which patients diagnostic findings are consistent with chronic myelogenous leukemia (CML)? a. patient a: diagnostic findings = hypercellular bone marrow with lymphoblasts b. patient b: diagnostic findings = high RBC count, Hgb and Hct c. patient c: diagnostic findings = presence of Philadelphia Chromosome d. patient d: diagnostic findings = elevated lactic dehydrogenase level
d (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.)
Which patients diagnostic follow-up studies after treatment for leukemia indicate minimal residual disease? a. patient a: molecular studies are negative for residual leukemia b. patient b. normal peripheral blood smear, evidence of disease in the bone marrow c. patient c: normal bone marrow and peripheral blood smear with no evidence of disease upon physical examination d. patient d: tumor cells cannot be detected by morphological study but can be identified by molecular testing.
b (since mediastinal node enlargement may cause pressure on airways, the most important question to ask is whether the patient is experiencing any difficulty with breathing since dyspnea may indicate a need for rapid intervention. Weight loss is a B symptom and would not be expected in a patient with stage IA HL. Since lymphadenopathy is painless unless it presses on nerves, chest pain would not be an expected finding in stage IA HL. Asking about difficulty with bowel movements or constipation would be important in a patient with abdominal lymph node enlargement but is not the most important question for a patient with mediastinal lymphadenopathy.)
Which question would be MOST important for the nurse to ask a patient who has stage IA Hodgkins lymphoma involving the mediastinum? a. how much weight have you lost b. do you have difficulty breathing c. what level of chest pain are you experiencing d. are you able to have daily soft bowel movements
C (this is the first dose of rituximab for this patient so the nurse would prioritize assessing for hypersensitivity reaction with particular attention to respiratory manifestations of bronchospasm and angioedema. Skin issues may manifest after radiation therapy starts, so that is not a priority at this time. Nausea may occur with drug administration but is not a life-threatening adverse effect, so it is not a priority over breathing. Familiarity with radiation therapy will not be assessed before checking for reaction to rituximab)
Which question would be a priority for the nurse to ask a patient after reviewing the following data? Situation: newly diagnosed non-hodgkins lymphoma treatment course started background: 22 year old female with non-hodgkins lymphoma assessment: first dose of rituximab started 20 minutes ago. Radiation oncology to state radiation plan at next tumor board meeting. Recommendation: Begin education of patient and family on radiation treatment course a. are you noticing any skin issues b. are you experiencing any nausea c. are you having any trouble breathing d. are you familiar with radiation therapy
a (ALL is commonly associated with infiltration of leukemic cells into the central nervous system (CNS), and intrathecal chemotherapy is used to reduce the chance of CNS involvement. Pain may occur with ALL but is not treated with intrathecal chemotherapy. Immune modulators may be given as part of treatment for leukemia but are not administered through the intrathecal route. Intrathecal chemotherapy does not decrease infection risk while patients are being treated for ALL.)
Which response will the nurse make when a patient who is being treated for acute lymphocytic leukemia (ALL) asks, "why do I need intrathecal chemotherapy?" a. to prevent infiltration of ALL into the brain b. To assist with management of pain caused by ALL c. To help boost immune response during ALL treatment d. to decrease the risk of infection during ALL treatment
c (abnormal lymphocytes are found mostly in the lymph nodes and tissues in a patient with lymphoma, and there are fewer abnormal cells in circulation. Abnormal lymphocytes are more likely to be found in the peripheral circulation with lymphocytic leukemias than with lymphoma. A defining characteristic of lymphoma is proliferation of abnormal lymphocytes in the nodes, leading to enlargement of the nodes. Granulocyte proliferation leads to myelogenous leukemias but not to lymphoma)
Which statement about lymphoma will the nurse make when a patient asks about the difference between lymphocytic leukemia and lymphoma? a. Lymphoma involves mostly peripheral lymphocytosis b. with lymphoma, there is very minimal nodal involvement c. with lymphoma there are fewer circulating abnormal cells d. lymphoma involves proliferation of granulocytes or their precursors
d (partial remission is characterized by a lack of symptoms and a normal peripheral blood smear, but evidence of disease in the bone marrow. Molecular remission indicates that all molecular studies are negative for residual leukemia. Minimal residual disease is defined as tumor cells that cannot be detected by morphologic examination but can be identified by molecular testing. In complete remission, there is no evidence of overt disease on physical examination, and the bone marrow and peripheral blood appear normal.)
Which statement does the nurse identify as being true about partial remission after leukemia treatment? a. all molecular studies for residual leukemia are negative b. tumor cells cannot be detected by morphologic examination, but they are present in molecular testing c. there is no evidence of overt disease on examination and the bone marrow and peripheral blood are normal d. there is a lack of symptoms and a normal peripheral blood smear, but evidence of the disease is still present in the bone marrow
2 (Blood is a medium for bacterial growth, and any bacteria contaminating the unit will begin to grow if left outside of a controlled refrigerated temperature for longer than four (4) hours, placing the client at risk for septicemia.)
Which statement is the scientific rationale for infusing a unit of blood in less than four (4) hours? 1. The blood will coagulate if left out of the refrigerator for longer than four (4) hours. 2. The blood has the potential for bacterial growth if allowed to infuse longer. 3. The blood components begin to break down after four (4) hours. 4. The blood will not be affected; this is a laboratory procedure
a (the patient with favorable prognosis early-stage Hodgkins Lymphoma will receive two to four cycles of chemotherapy with doxorubicin, belomycin, vinblastine, and dacarbazine (ABVD). More advanced Hodgkins lymphoma would be treated with six to eight cycles of chemo. Radiation may be used as a supplement for early stage Hodgkins lymphoma but is not usually the initial treatment. Hematopoietic stem cell transplantation would be typically be used for advanced or refractory Hodgkins lymphoma.)
Which teaching about initial treatment will the nurse plan when a patient has been diagnosed with stage 1A Hodgkins Lymphoma? a. expect two to four cycles of chemotherapy b. plan for six to eight cycles of chemotherapy c. anticipate weekly external beam radiation therapy d. prepare for hematopoietic stem cell transplantation
c (b/c the CNS is frequently affected by ALL, intrathecal therapy with methotrexate or cytarabine is given prophylactically to prevent CNS involvement. Elective splenectomy may be used in treating chronic lymphocytic leukemia. Rituximab may be used as part of combination therapy for ALL, but combined chemotherapy is the standard treatment for leukemia. Watchful waiting would not be used for an acute leukemia, although it might be used for chronic lymphocytic leukemia, which is frequently slowly progressive.)
Which therapy will the nurse anticipate for a patient with acute lymphocytic leukemia (ALL)? a. elective splenectomy b. monotherapy with rituximab c. intrathecal methotrexate administration d. watchful waiting with active supportive care
d (since chemotherapy is the most likely initial treatment for early NHL, the nurse will plan on teaching about side effects associated with chemotherapy. Since lymph node swelling in the early stage of NHL is usually nontender, pain control options are not necessary to teach. A 66 year old woman does not need information about how to preserve fertility. Patients with stage IA lymphoma do have not have night sweats, which are a defining B characteristic of lymphoma)
Which topic will be included when teaching a 66 year old woman who is starting treatment for stage 1A non-Hodgkins lymphoma (NHL)? a. options for pain control b. ways to preserve fertility c. management of night sweats d. side effects of chemotherapy
c (the patient aligns with a diagnosis of acute lymphocytic leukemia, which most often occurs in patients under the age of 20. Cranial radiation is a treatment modality for acute lymhocytic leukemia. Splenectomy is a treatment modality for chronic lymphocytic leukemia which is most common in aging adults. Leukapheresis is a treatment modality for chronic myelogenous leukemia, which is rare in children. Chemotherapy and antitumor antibiotic are treatment modalities for acute myelogenous leukemia, which occurs 80% in adults.)
Which treatment plan would the nurse anticipate incorporating into a patients plan of care based on the following information Demographics: 16 year old male Subjective findings; Fatigue, nausea, painful scrotum Objective findings: Lympadenopathy, hepatomegaly, anemia, positive for Philadelphia chromosome a. splenectomy b. leukapheresis c. cranial radiation d. chemotherapy
c (The standard treatment for favorable early-stage Hodgkins Lymphoma is combo chemotherapy with ABVD chemo regimen. Rituximab is a monoclonal antibody used in some leukemias and in NHL. Radiation is not a first-line treatment for Hodgkins lymphoma but may be added to chemo for higher stage disease or resistance to the initial chemotherapy. ESHAP combination chemo is used for aggressive non-Hodgkins lymphoma.)
Which treatment regimen will the nurse expect to administer for a patient with newly diagnosed stage IIA Hodgkins lymphoma? a. single agent therapy with rituximab b. radiation therapy to the involved site c. Doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy d. Etoposide, methylprednisolone (Solu-medrol), high-dose cytarabine (Ara-c), and cisplatin (platinol) (ESHAP) chemotherapy
b (Since acute kidney injury (acute renal failure) is a complication of tumor lysis syndrome, the nurse will anticipate a blood draw for blood urea nitrogen and creatinine levels to check renal function and electrolytes levels to assess for possible hyperkalemia. An abdominal ultrasound might be used for a patient with problems such as abdominal distension but would not be helpful in evaluating or treating tumor lysis syndrome. CT scans are used to assess for spread of lymphoma and assist in staging but would not be helpful in tumor lysis syndrome. Bone marrow biopsy is a useful tool for diagnosis of many hematologic disorders but is not helpful for diagnosis or guiding treatment of tumor lysis syndrome.)
Which type of diagnostic test will the nurse anticipate when a patient is admitted with suspected tumor lysis syndrome? a. Abdominal ultrasound to assess tumor size b. Blood draw for renal function and electrolytes c. CT for tumor staging d. Bone marrow biopsy to assess for abnormal cells
b (since acute kidney injury (acute renal failure) is a complication of tumor lysis syndrome, the nurse will anticipate a blood draw for blood urea nitrogen and creatinine levels to check renal function and electrolytes levels to assess for possible hyperkalemia. An abdominal ultrasound might be used for a pt. with problems such as abdominal distension but would not be helpful in evaluating or treating tumor lysis syndrome. CT scans are used to assess for spread of lymphoma and assist in staging but would not be helpful in tumor lysis syndrome. Bone marrow biopsy is a useful too for diagnosis of many hematologic disorders but is not helpful for diagnosis or guiding treatment of tumor lysis syndrome.)
Which type of diagnostic test will the nurse anticipate when a patient is admitted with suspected tumor lysis syndrome? a. abdominal ultrasound to assess tumor size b. blood draw for renal function and electrolytes c. CT for tumor staging d. Bone marrow biopsy to assess for abnormal cells
b (AML accounts for 15% to 20% of acute leukemia in children and 80% in adults. ALL is most frequently seen in children, with a mean age of 15 years at diagnosis. CLL is a chronic leukemia seen mostly in older adults but is not an acute leukemia. CML is a chronic, rather than acute, leukemia seen mostly in older adults.)
Which type of leukemia accounts for the majority of acute leukemia in adults? a. lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)
a (ALL is characterized by the presence of an excessive number of immature small lymphocytes in the bone marrow. AML is characterized by an increase in the number of myeloblasts. CLL is characterized by the accumulation of small, mature-appearing lymphocytes. CML occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow.)
Which type of leukemia is characterized by the proliferation of immature small lymphocytes in the bone marrow? a. acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)
a (ALL is characterized by the presence of an excessive number of immature small lymphocytes in the bone marrow. AML is characterized by an increase in the number of myeloblasts. CLL is characterized by the accumulation of small, mature-appearing lymphocytes. CML occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow.)
Which type of leukemia is characterized by the proliferation of immune small lymphocytes in the bone marrow? a. acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. chronic lymphocytic leukemia (CLL) d. chronic myelogenous leukemia (CML)
ALL (acute lymphocytic leukemia)
Which type of leukemia is most commo in children and young adults?
b (antibiotics are included in the treatment for helicobacter pylori gastric lymphoma b/c the bacteria contribute to the development of lymphoma. Phototherapy would be used to treat more superficial lymphomas such as cutaneous T-lymphoma. Radiation therapy might be used to treat resistant or refractory lymphoma but is not an initial treatment for Helicobacter pylori gastric lymphoma. Topical chemotherapy would be used for superficial lesions such as in cutaneous T-cell lymphoma.)
Which type of therapy will the nurse anticipate administering to a pt. who has newly diagnosed Helicobacter pylori gastric lymphoma? a. phototherapy b. antibiotic therapy c. radiation therapy d. topical chemotherapy
absolute neutrophil count (ANC)
a measure of the number of neutrophil granulocytes present in the blood the higher it is the greater resistance to infection
