Leukemia

12) A client who presents with complaints of easily bruising, bleeding gums, and petechiae may be suffering from what complication of leukemia? A) Thrombocytopenia B) Anemia C) Hepatomegaly D) Neutropenia

Answer: A Explanation: A) The manifestations of thrombocytopenia, a common complication of leukemia, include petechiae, purpura, ecchymoses, epistaxis, hematomas, hematuria, and gastrointestinal bleeding. Anemia can be a late manifestation of thrombocytopenia. Hepatomegaly is an enlarged liver. Neutropenia increases the risk of infection in clients with leukemia. However, anemia, hepatomegaly, and neutropenia do not cause bleeding.

10) A nurse is caring for a client with chronic myeloid leukemia (CML) who is neutropenic. Which interventions will the nurse implement to ensure this client's safety? Select all that apply. A) Teach the client to maintain good personal hygiene. B) Encourage the client to eat a diet low in protein. C) Administer granulocyte colony-stimulating factor (G-CSF) as ordered. D) Administer neutrophil colony-stimulating factor (N-CSF) as ordered. E) Administer a prophylactic gram-negative antibiotic.

Answer: A, C Explanation: A) A client who is neutropenic has a decrease in the level of white blood cells (WBCs) and is susceptible to infection and/or disease. To ensure the safety of the client with neutropenia, the nurse will teach the client to maintain good personal hygiene, administer granulocyte colony-stimulating factor (G-CSF) as ordered, and administer a broad-spectrum antibiotic as ordered. The client should be taught to eat a diet high in protein, not low in protein.

11) A nurse is planning care for a client with leukemia. The nurse chooses "Risk for Bleeding" as the nursing diagnosis. Which interventions support this nursing diagnosis? Select all that apply. A) Educate client to not strain during bowel movements. B) Use nonelectric razor when providing grooming for client. C) Limit parenteral injections. D) Apply pressure to arterial puncture sites for 5 minutes. E) Encourage client to deep breathe and huff cough frequently.

Answer: A, C Explanation: A) The client at risk for bleeding has specific interventions to which the nurse should adhere. The nurse should educate the client to not strain during bowel movements and to use an electric razor to avoid bleeding. The nurse should also limit the use of parenteral injections and apply 15 to 20 minutes of pressure to any arterial puncture sites. The nurse should discourage the client from forceful coughing to prevent further bleeding.

3) The nurse is teaching a class at a local community center about decreasing risk factors for cancer. Which risk factors should the nurse include in the teaching regarding leukemia? Select all that apply. A) Smoking B) Diets low in fat C) Exposure to infectious agents D) Bloom syndrome E) Decreased exercise

Answer: A, C, D Explanation: A) A higher incidence of leukemia is associated with chromosomal defects such as Bloom syndrome, exposure to infectious agents, and cigarette smoking. Low-fat diets are not a risk factor for leukemia, and neither is lack of exercise.

4) The nurse is planning care for a client with acute myeloid leukemia (AML). Which diagnoses are priorities for this client to minimize the risk of complications associated with AML? Select all that apply. A) Risk for Infection B) Ineffective Thermoregulation C) Imbalanced Nutrition, Less than Body Requirements D) Fluid Volume Excess E) Risk for Bleeding

Answer: A, E Explanation: A) AML results in neutropenia (decreased neutrophils = risk of infection) and thrombocytopenia (decreased platelets, which leads to increased risk of bleeding). Therefore, actions to minimize these risks are priorities when caring for clients with AML. Unlike clients with other types of leukemia, the client with AML does not have a problem with fluid shifts, edema, heat intolerance, or weight loss that would require nursing intervention.

8) A nurse working in the pediatric intensive care unit (PICU) is caring for a child with leukemia. What is the most common type of leukemia in children? A) Chronic lymphocytic leukemia B) Acute lymphocytic (lymphoblastic) leukemia C) Acute myeloid (myeloblastic) leukemia D) Chronic myeloid (myelogenous) leukemia.

Answer: B Explanation: Acute lymphoblastic leukemia is the most common type of leukemia in children and adolescents. The other choices are also types of leukemia, but these types of leukemia are more common in adults and are not common in children.

7) The nurse is caring for a client with leukemia who is experiencing neutropenia as a result of chemotherapy. Which action should the nurse include in the plan of care for this client? A) Replace hand hygiene with gloves. B) Restrict visitors with communicable illnesses. C) Restrict fluid intake. D) Insert an indwelling urinary catheter to prevent skin breakdown.

Answer: B Explanation: In the neutropenic client, visitors with communicable infections should be restricted. Fluid intake should be encouraged. Gloves may be appropriate but should never replace hand hygiene. Invasive procedures such as indwelling catheters should be avoided.

9) A pediatric nurse is caring for a child with acute lymphoblastic leukemia (ALL). When providing education to the child's parents regarding this disease, which topics should the nurse include? Select all that apply. A) ALL is characterized by abnormal proliferation of all bone marrow elements. B) This form of leukemia is the most common type among children and adolescents. C) Most cases of ALL result from the malignant transformation of B cells. D) Malignant lymphocytes are able to effectively maintain immunity. E) The onset of ALL is usually gradual.

Answer: B, C Explanation: Acute lymphoblastic leukemia (ALL) is the most common type of leukemia among children and adolescents. Most cases of ALL result from the malignant transformation of B cells. The onset of ALL is usually acute and rapid. Malignant lymphocytes are immature and do not function effectively to maintain immunity. Chronic myeloid leukemia (CML) is characterized by abnormal proliferation of all bone marrow elements.

2) An adult client reports to the nurse an inability to tolerate usual exercise and the feeling of fatigue. The client states that these symptoms have been gradual over time. Which physical assessment findings, along with the client's verbal complaints, would indicate chronic lymphocytic leukemia (CLL)? Select all that apply. A) Joint pain B) Pallor C) Splenomegaly D) Abnormal bleeding E) Edema

Answer: B, C, E Explanation: The symptoms for CLL are insidious and occur over time, affecting older adults. The client may exhibit splenomegaly, pallor, edema, and lymphadenopathy. Bone and joint pain with abnormal bleeding are characteristics of acute myeloid leukemia (AML), which also occurs in older clients.

1) A client is receiving chemotherapy for acute lymphocytic leukemia. While providing care for this client, which clinical manifestations would indicate tumor lysis syndrome? Select all that apply. A) Thrombocytopenia B) Cardiac arrhythmia C) Respiratory distress D) Changes in urine output E) Upper-extremity edema

Answer: B, D Explanation: A) Tumor lysis causes a metabolic emergency. The release of intracellular contents into the circulation cause hyperkalemia, hyperuricemia, and hyperphosphatemia, which may lead to cardiac arrhythmias, renal failure, and even death. Thrombocytopenia occurs with a hematological emergency. Space-occupying lesions can cause respiratory distress and upper-extremity edema.

5) A young school-age boy is admitted with newly diagnosed acute lymphocytic leukemia. The multidisciplinary team is meeting to plan care for this child and family. Which statement by the parents should receive priority in the nursing planning process? A) "His brother is upset about the amount of time we are away from home." B) "Can we plan a trip out of town sometime this summer?" C) "We are afraid that he will dislodge his central line at school." D) "How are we going to pay for his treatment?"

Answer: C Explanation: Dislodging the central line is an imminent, potentially life-threatening concern. Financial worries, although a significant concern, would not take precedence over a potentially life-threatening concern. Questions about travel and other family matters should be addressed, but they are not acute issues. The impact of the illness on the client's brother is a realistic concern, but not acute or life-threatening.

6) The nurse is assisting the healthcare provider with a bone marrow aspiration and biopsy on a client who has leukemia. The client also has thrombocytopenia. Upon completing the test, which intervention is a priority for the nurse? A) Dispose of the equipment used, and clean the area properly. B) Label and refrigerate the specimen obtained by the physician. C) Hold pressure on the wound for approximately 5 minutes. D) Make certain the client understands the purpose of the test.

Answer: C Explanation: The most important task for the nurse is to prevent bleeding after the biopsy. Holding pressure on the wound for 5 minutes is effective. Dealing with the specimen is accomplished by a third party or after the nurse stabilizes the client. An explanation of the test is performed before the procedure is begun. Cleaning the area is completed after the client is stable and the specimen is sent to the laboratory.