Leukemia & Hodgkins NCLEX

A nurse is assessing a client newly diagnosed with Stage I Hodgkin's lymphoma. Which area of the body would the nurse most likely find involved? "1. Back 2. Chest 3. Groin 4. Neck"

"(4. Neck is correct) At the time of diagnosis of stage I Hodgkin's lymphoma, a painless cervical lesion is often present. The back, chest, and groin areas may be involved in later stages."

A pediatric nurse clinician is discussing the pathophysiology related to childhood leukemia with a class of nursing students. Which statement made by a nursing student indicates a lack of understanding of the pathophysiology of this disease? " 1. Normal bone marrow is replaced by blast cells 2. Red blood cell production is affected 3. the platelet count is decreased 4. the presence of a reed-sternberg cell is found on biopsy"

4. Reed-sternberg Cell is found in Hodgkins

lymphoma

a group of blood cancers that develop in the lymphatic system involving the lymphocytes. can progress to spleen, GI, liver and bone marrow hodgkins and non hodgkins

hodgkins

classic presence of malignant cells called reed Stenberg (viral etiology cure rate good) painless lymph node enlargement, puritis, fever, sweat, fatigue, weight loss

non hodgkins

lymphoid tissue becomes largely infiltrated with malignant cells, spread is unpredicatable and localized. disease is rare increased risk with age prognosis vary treatment may include interferon, chemo, and or radiation swollen painful nodes, fatigue, sweat

improving nutrition

oral care before and after meals analgesia before meals appropriate treatment of nausea small frequent feeding soft foods moderate temp low microbial diet nutrition supplement

"A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. Which of the following is the appropriate and supportive response to the mother? "1. I'm not sure. I'll discuss it with the physician. 2. The child is too young to have radiation therapy. 3. It's very costly, and chemotherapy works just as well. 4. The physician would prefer that you discuss the treatment options with the oncologist."

"ANSWER: 2 Rationale: Radiation therapy is usually delayed until a child is 8 years of age, if posssible, to prevent retardation of bone growth and soft tissue development. Options 1,3, and 4 are inappropriate responses to the mother."

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"

(CORRECT: 1) The newly diagnosed client will need to betaught about the disease and about treat-ment options. The registered nurse cannot delegate teaching to a an LPN.

Which of the following findings yields a poor prognosis for a pediatric patient with leukemia? " 1) Presence of a mediastinal mass 2) Late CNS leukemia 3) Normal WBC count at diagnosis 4) Disease presents between age 2 and 10"

1) Presence of a mediastinal mass indicates a poor prognosis. The rest of the choices refer to diagnosis not prognosis.

A 21-year-old male with Hodgkin's lymphoma is a senior at the local university. He is engaged to be married and is to begin a new job upon graduation. Which of the following diagnoses would be a priority for this client? "a. Sexual dysfunction related to radiation therapy b. Anticipatory grieving related to terminal illness c. Tissue integrity related to prolonged bed rest d. Fatigue related to chemotherapy"

Answer A is correct. Radiation therapy often causes sterility in male clients and would be of primary importance to this client. The psychosocial needs of the client are important to address in light of the age and life choices. Hodgkin's disease, however, has a good prognosis when diagnosed early. Answers B, C, and D are incorrect because they are of lesser priority

A client has developed oral mucositis as a result of radiation to the head and neck. The nurse shouls teach the client to incorporate which of the following measures in his or her daily home care routine? a) oral hygiene should be performed in the morning and evening b) high-protein foods, such as peanut butter, should be incorporated in the diet c) a glass of wine per day will not pose any further harm to the oral cavity d) a combination of a weak saline and water solution should be used to rinse the mouth before and after each meal"

"2) D Oral mucositis (irritation, inflammation, and/or ulceration of the mucosa) commonly occurs in clients receiving radiation to the head and neck. Measures need to be taken to soothe the mucosa as well as provide effective cleansing of the oral cavity. A combination of a weak saline and water solution is an effective cleansing agent."

"Which statement is correct about the rate of cell growth in relation to chemotherapy? "1. Faster growing cells are less susceptible to chemotherapy. 2. Nondividing cells are more susceptible to chemotherapy. 3. Faster growing cells are more susceptible to chemotherapy. 4. Slower growing cells are more susceptible to chemotherapy."

"Answer 3 The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Slow-growing and nondividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to destroy nondividing cells as the begin active cell division."

"The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following? "A. Petechiae, fever, fatigue B. Headache, papilledema, irritability C. Muscle wasting, weight loss, fatigue D. Decreased intracranial pressure, psychosis, confusion"

"Answer A is Correct. Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia."

"After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the client is neutropenic. The nurse should perform which of the following?" "A. advise the client to rest and avoid exertion B. prevent client exposure ot infections C. monitor the blood pressure frequently D. observe for increased bruising"

"Answer: B Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are responsible for the body's defense against infection. Rest and avoid exertion would be related to erythrocytes and oxygen carrying properties. Monitoring the blood pressure, and observing for bruising would be related to platelets and sign and symptoms of bleeding. Objective: Describe the major types of leukemia and the most common treatment modalities and nursing interventions."

"When caring for a client with a diagnosis of thrombocytopenia, the nurse should plan to: "a.Discourage the use of stool softeners b.Assess temperature readings every six hours c.Avoid invasive procedures d.Encourage the use of a hard, brittle toothbrush "

"Answer: C Rationale: Thrombocytopenia is a deficiency of platelets, and leaves the patient more prone to hemmorrhage. For this reason, avoiding invasive procedures will limit the risk of hemorrhage. Stool softeners should be encouraged, while hard brittle toothbrushes should be avoided. Temperature is not the most important vital to track in this patient"

During history taking of a client admitted with newly diagnosed Hodgkin's disease, which of the following would the nurse expect the client to report? "a) weight gain B) night sweats C) Severe lymph node pain D) Headache with minor visual changes"

"B - Assessment of a client with Hodgkin's disease most often reveals enlarged, painless lymph nodes, fever, malaise, and night sweats. Weight loss may be present if metastatic disease occurs. Headache and visual changes may occur if brain metastasis is present."

"A 68-year-old woman is diagnosed with thrombocytopenia due to acute lymphocytic leukemia. She is admitted to the hospital for treatment. The nurse should assign the patient: "A. To a private room so she will not infect other patients and healthcare workers B. To a private room so she will not be infected by other patients and healthcare workers C. To a semiprivate room so she will have stimulation during her hospitalization D. To a semiprivate room so she will have the opportunity to express her feelings about her illness"

"Correct Answer: B A. To a private room so she will not infect other patients and health care workers — poses little or no threat B. To a private room so she will not be infected by other patients and health care workers — CORRECT: protects patient from exogenous bacteria, risk for developing infection from others due to depressed WBC count, alters ability to fight infection C. To a semiprivate room so she will have stimulation during her hospitalization — should be placed in a room alone D. To a semiprivate room so she will have the opportunity to express her feelings about her illness — ensure that patient is provided with opportunities to express feelings about illness"

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the patient's nutritional intake? "A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods."

"Correct Answer: D The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to the foods that a patient will eat. Other Rationales: Increasing liquids at meals can cause a patient to feel full faster, leading to eating fewer calories. Eating three large meals isn't possible for a patient on chemotherapy due to the decreased taste sensation. Liquid protein supplements should when needed but they lead to less eating during mealtimes due to feeling of satiation."

"In formulating a nursing diagnosis of risk for infection for a client with chronic lymphoid leukemia (CLL), nursing measures should include: (Select all that apply.) "A. Maintaining a clean technique for all invasive procedures. B. Placing the client in protective isolation. C. Limiting visitors who have colds and infections. D. Ensuring meticulous handwashing by all persons coming in contact with the client."

"Correct Answers: B, C, D Rationale: Chronic lymphoid leukemia (CLL) is characterized by a proliferation and accumulation of small, abnormal mature lymphocytes in bone marrow, peripheral blood, and body tissues. Infections and fever are frequent complications of CLL."

"A 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 decrease after the administration of antibiotics. 3. An abnormally low hemoglobin (Hb) and hematocrit (Hct) level. 4. Red blood cells that are larger than normal."

"Correct answer is 1. 1. A left shift indicates immature white blood cells are being produced and released into the circulating blood volume. This should be investigated for the malignant process of leukemia."

"A diagnosis of Hodgkin's disease is suspected in a 12 year old child seen in a clinic. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test results confirm the diagnosis of Hodgkin's disease? "1. Elevated vanillylmandelic acid urinary levels. 2. The presence of blast cells in the bone marrow. 3. The presence of Epstein-Barr virus in the blood. 4. The presence of Reed-Sternberg cells in the lymph nodes"

"Correct answer: #4 Hodgkin's disease is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-sternberg cells) is the classic characteristic of this disease. The presence of blast cells in the bone marrow indicates leukemia. Epstein Barr virus is associated with infectious mononucleosis. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma."

The nurse is assessing a client diagnosed with acute myeloid leukemia. 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."

"Correct: 1. 1. Fever and infection are hallmark symptoms of leukemia. They occur because the bone marrow is unable to produce WBCs of the number and maturity needed to fight infection (CORRECT). 2. Nausea and vomiting are symptoms related to the treatment of cancer but not to the diagnosis of leukemia (omit #2). 3. The clients are frequently fatigued and have low platelet counts. The platelet count is low as a result of the inability of the bone marrow to produce the needed cells (omit #3). 4. Cervical lymph node enlargement is associated with Hodgkin's lymphoma, and positive acid-fast bacillus is diagnostic for tuberculosis (omit #4)."

Which of the following laboratory values could indicate that a child has leukemia? "1. WBCs 32,000/mm3 2. Platelets 300,000/mm3 3. Hemoglobin 15g/dL 4. Blood pH of 7.35"

"Correct: 1. 1. YES! - A normal WBC count is approximately 4.5 mm3 - 11.0 mm3. In leukemia a high WBC count is diagnostic and is usually confirmed by a blood smear. 2-4. None of these indicate leukemia,"

"A child with leukemia is complaining of nausea. A nurse suspects that the nausea is related to the chemotherapy regimen. The nurse, concerned about the child's nutritional status, most appropriately would offer which of the following during this episode of nausea? "1. Cool, clear liquids 2. Low protein foods 3. Low-calorie foods 4. The child's favorite food"

"Correct: 1. With nausea, cool and clear liquids are better tolerated. Do not offer foods when the child is nauseated so he doesn't associate if with being sick. Support nutrition with oral supplements and foods high in proteins and calories"

"The client diagnosed with leukemia has central nervous system involvement. Whichinstructions 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"

"Correct: 3 1.Sleeping with the head of the bed elevatedmight relieve some intracranial pressure, but it will not prevent intracranial pressure from occurring.2.Analgesic medications for clients with cancer are given on a scheduled basis with a fast-acting analgesic administered PRN for break-through pain.3.Radiation therapy to the head and scalp area is the treatment of choice for central nervous system involvement of any cancer. If the radiation therapy destroys the hair follicle, the hair will not grow back.4.Cognitive deterioration does not usually occur"

"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."

"Correct: 4. 1. An MRI of the chest area will determine numerous disease entities, but it cannot determine the specific morphology of Reed-Sternberg cells, which are diagnostic for Hodgkin's disease. 2. A CT scan will show tumor masses in the area, but it is not capable of pathological diagnosis. 3. ESR laboratory tests are sometimes usedto monitor the progress of the treatmentof Hodgkin's disease, but ESR levels canbe elevated in several disease processes. 4. Cancers of all types are definitively diagnosed through biopsy procedures.The pathologist must identify ReedSternberg cells for a diagnosis ofHodgkin's disease (correct)"

"After a client with a potential diagnosis of leukemia is admitted to the hospital, the nurse should assess for which of the following? (Select all that apply.)" " A. Reports of fatigue and weakness B. An elevation in the leukocytes especially neutrophils C. Signs of bruising easily D. Recent weight gain"

"Correct: A, C ANSWER: Reports of fatigue and weakness Signs of bruising easily Rationale: General manifestations of leukemia result from anemia, infection, and bleeding. The client would complain of fatigue and weakness and show signs of bruising. Leukemic cells replace normal hematopoietic elements preventing the formation of mature leukocytes. Neutrophil count would be decreased. Because of an increased metabolism, weight loss may occur. Strategy: It is important to read every word in the question. Do not speed-read."

"The mother of a 5-year-old child asks the nurse questions regarding the importance of vigilant use of sunscreen. Which information is most important for the nurse to convey to the mother? "A. Appropriate use of sunscreen decreases the risk of skin cancer. B. Repeated exposure to the sun causes premature aging of the skin. C. A child's skin is delicate, and burns easily. D. In addition to causing skin cancer, repeated sun exposure predisposes the child to other forms of cancer."

"Correct: A. Appropriate use of sunscreen decreases the risk of skin cancer. While all of the answer choices are correct, recommending the use of sunscreen to decrease the incidence of skin cancer is the best response. Nursing Process: Implementation Category of Client Need: Health Promotion and Maintenance Cognitive Level: Application"

"The nurse and the unlicensed assistive personnel (UAP) are caring for clients in a bone marrow transplantation unit. Which nursing task should the nurse delegate? "A. Take the hourly vital signs on a client receiving blood transfusions. B. Monitor the infusion of antineoplastic medications. C. Transcribe the HCP's orders onto the Medication Administration Record. D. Determine the client's reponse to the therapy."

"Correct: A. Explanation: A. After the first 15 minutes during which the client tolerates the blood transfusion, it is appropriate to ask the UAP to take the vital signs as long as the UAP has been given specific parameters for the vital signs. Any vital sign outside the normal parameters must have an intervention by the nurse. B. Antineoplastic medication infusions must be monitored by a chemotherapy-certified, competent nurse. C. This is the responsibility of the word secretary or the nurse, not the unlicensed personnel. D. This represents the evaluation portion of the nursing process and cannot be delegated."

"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"

"Correct: C 1. Because of the ineffective or nonexistent WBCs characteristic of leukemia, the body cannot fight infections, and antibiotics are given to treat infections. 2. Leukemic infiltrations into the organs or the CNS cause pain. Morphine is the drug of choice for most clients with cancer. 3. Epogen is a biologic response modifier that stimulates the bone marrow to produce RBCs. 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. 4. Gleevec is a drug that specifically works in leukemic cells to block the expression of the BCR-ABL protein, preventing the cells from growing and dividing."

"Nursing considerations related to the administration of chemotherapeutic drugs include which of the following? "A. Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells. B. Infiltration will not occur unless superficial veins are used for the intravenous infusion. C. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. D. Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary."

"Correct: C 3. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. 1. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. 2. Infiltration and extravasations are always a risk, especially with peripheral veins. 4. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward. Level of cognitive ability: Analysis Area of client needs: Physiologic Integrity/Pharmacologic and Parenteral Therapy Integrated process: Teaching/Learning; Nursing Process: Implementation"

The client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? "a) fatigue b) weakness c) weight gain d) enlarged lymph nodes"

"D - Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease."

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy . The nurse notes that the platelet count is 20,000/ul. Based on the laboratry result, which intervention will the nurse document in the plan of care? 1 Mointor closely for signs of infection 2. Mointor the temperature every 4hours 3. Initate prptective isolation precautions 4. Use soft small toothbrush for mouth care

Correct Ans 4 If a child is severely thrombocytopenic and has a platelet count less than 20,000/ul, bleeding precautions need to be initated because of increased risk of bleeding or hemorrhage. Options 1,2,3 are related to the prevention of infection rather than bleeding

"The client asks the nurse to explain what it means that his Hodgkin's disease is diagnosed at stage 1A. Which of the following describes the involvement of the disease? "1. Involvement of a single lymph node. 2. Involvement of two or more lymph nodes on the same side of the diaphragm. 3. Involvement of lymph node regions on both sides of the diaphragm. 4. Diffuse disease of one or more extralymphatic organs."

Correct: 1. In the staging process, the designations A and B signify, respectively, that symptoms were or were not present when Hodgkin's disease was found. The Roman numerals I through IV indicate the extent and location of involvement of the disease. Stage I indicates involvement of a single lymph node; stage II, two or more lymph nodes on the same side of the diaphragm; stage III, lymph node regions on both sides of the diaphragm; and stage IV, diffuse disease of one or more extralymphatic organs.

leukemia

malignancy of the bone marrow resulting in unregulated proliferation and differentiation in stem cells caused by genetic and viral links or bone marrow related to bone marrow suppression acute myeloid leukemia (AML) chronic myeloid leukemia (CML) slower growing acute lymphocytic leukemia (ALL) Chronic lymphocytic leukemia (CLL) slower

chronic myeloid leukemia

uncommon in people under 20 life expectancy 3-5 years acquired mutation in myeloid sem ccells (BCR ABL gene releases protein causing abn proliferation) marrow expands bone, spleen or liver initial may be asymptomatic, malaise, anorexia, weight loss, confusion, SOB due to leukostasis, bone pain treat imatinib mestylate (gleevec) block signals in leukemic cells that express BCR-ABL protein, halt proliferation BMT or PBSCT may cure chemo as palliative

acute lymphocytic /lymphoid leukemia

uncontrolled proliferation of immature cells from lymphoid stem cell: B Lymph (75%) T lymph 25% impeding myeloid cell most common under 15 more in boys manifested by leukemic cell infiltration, symptoms of meningeal involvement and liver, spleen and bone marrow pain treat chemo (induction and corticosteroids) CNS irradiation imatinib mestylate if Philadelphia chromosome positive BMT or PBSCT monoclonal antibody therapy

"A client, diagnosed with chronic lymphocytic leukemia, is admitted to the hospital for treatment of hemolytic anemia. Which of the following measures, if incorporated into the nursing care plan, would best address the patient's needs? "1. Encourage activities with other patients in the day room. 2. Isolate him from visitors and patients to avoid infection. 3. Provide a diet high in Vitamin C 4. Provide a quiet environment to promote adequate rest."

"Correct: D. 1. does not meet need for rest 2. no info given about WBC or reverse isolation, on reverse isolation if neutrophil count is less than 500/mm3 3. needed for wound healing and resistance to infection, not best choice 4. primary problem activity intolerance due to fatigue. Correct"

"The client asks the nurse, "They say I have cancer. How can they tell if I have Hodgkin'sdisease from a biopsy?" The nurse's answer is based on which scientific rationale? "A.Biopsies are nuclear medicine scans that can detect cancer. B.A biopsy is a laboratory test that detects cancer cells. C.It determines which kind of cancer the client has. D.The HCP takes a small piece out of the tumor and looks at the cells."

"D-COrrect: A biopsy is the removal of cells from a massand examination of the tissue under amicroscope to determine if the cells arecancerous. Reed-Sternberg cells are diag-nostic for Hodgkin's disease. If these cellsare not found in the biopsy, the HCP can rebiopsy to make sure the specimen pro- vided the needed sample or, depending on involvement of the tissue, diagnose a non-Hodgkin's lymphoma"

"A client with acute leukemia is admitted to the oncology unit. Which of the following would be most important for the nurse to inquire? "a. ""Have you noticed a change in sleeping habits recently?"" b. ""Have you had a respiratory infection in the last 6 months?"" c. ""Have you lost weight recently?"" d. ""Have you noticed changes in your alertness?"""

Answer B is correct. The client with leukemia is at risk for infection and has often had recurrent respiratory infections during the previous 6 months. Insomnolence, weight loss, and a decrease in alertness also occur in leukemia, but bleeding tendencies and infections are the primary clinical manifestations; therefore, answers A, C, and D are incorrect.

"A 33-year-old male is being evaluated for possible acute leukemia. Which of the following would the nurse inquire about as a part of the assessment? "a. The client collects stamps as a hobby. b. The client recently lost his job as a postal worker. c. The client had radiation for treatment of Hodgkin's disease as a teenager. d. The client's brother had leukemia as a child."

Answer C is correct. Radiation treatment for other types of cancer can result in leukemia. Some hobbies and occupations involving chemicals are linked to leukemia, but not the ones in these answers; therefore, answers A and B are incorrect. Answer D is incorrect because the incidence of leukemia is higher in twins than in siblings.

a client has undergone a lymph node biopsy. the nurse anticipates that the report will reveal which result if the client has Hodgkin's lymphoma? "1. Reed-Sternberg cells. 2. Philadelphia chromosome. 3. Epstein-Barr virus. 4. Herpes simplex virus."

CORRECT #1. RATIONALE: histological isolation of Reed-Sternberg cells in lymph node biopsy examination is a diagnostic feature of Hodgkin's lymphoma. Philadelphia chromosome is attribted to chronic myelogenous leukemia. viruses are much smaller than can be visualized with cytology. STRATEGY: the core issue of the question is knowledge of characteristic findings in the diagnosis of lymphoma. use nursing knowledge and the process of elimination to make a selection.

multiple myeloma

destruction of bone=bone pain malignant disease of plasma cells in the bone marrow with destruction of bone 5yr survival dx bone marrow biopsy, mri, protein electrophoresis (serum and urine) + for M protein and Bencce- jones protein most common sign is bone pain, osteoporosis, fracture, elevated serum protein, hypercalcemia, renal damage, renal failure, anemia symptoms, fatigue, weak, increased serum viscosity and increased risk of bleeding and infection no cure- palliative chemo, corticosteroids, radiation help relive bone pain

mucositis

frequent gentle oral care soft toothbrush or if counts are low sponge tipped applicators rinse with saline or saline and baking soda or prescribed solutions perineal and rectal care

chronic lymphocytic leukemia

most common in older men 3-15 yr survival malignant b lymphocytes, most are maure, may escape apoptosis, resulting in excess accumulation of cells- keep growing manifestations- lymphadenopathy (pain) hepatomegaly, splenomegaly, in later stages anemia and thrombocytopenia; autoimmune complications with ES destroying RBCs and platelets B symptoms include fever, sweats, weightloss early stage may require no treatment, chemo, monoclonal antibody therapy

acute myeloid leukemia

most common non lymphocyic leukemia, defect in stem cells that differentiate myeloid cells affect all ages with peak at 60 SS fever, infection, bleeding, weakness, fatigue, pain from enlarged liver or spleen, hyperplasia of gums, bone pain treament aggressive chemo (induction therapy) kill the bone marrow absolute neutrophil count is zero. risk infection. then retransfuse

"The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, ""I don't understand how this could happen to us. We have been so careful to make sure our child is healthy."" Which response by the nurse is most appropriate? "A. Why do you say that? Do you think that you could have prevented this?"" B. ""This must be a difficult time for you and your family. Would you like to talk about how you are feeling?"" C. ""You shouldn't feel that you could have prevented the cancer. It is not your fault."" D.""Many children are diagnosed with cancer. It is not always life-threatening."""

"Answer B Parents of children diagnosed with cancer require major emotional support, and should be allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is telling the parents that there are many other children with cancer."

"The nurse writes a nursing problem of "altered nutrition" for a client diagnosed withleukemia 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"

"Answer: 2 1. The nurse should administer an antiemetic prior to meals, not an antidiarrheal medication 2. Serum albumin is a measure of the protein content in the blood that is derived form food eaten; albumin monitors nutritional status 3. Assessment of the nutritional status is indicated for this problem, not assessment of the s/sx of infections. 4. This addresses an altered skin integrity problem"

"What nursing diagnosis is seen with acute lymphocytic leukemia and thromocytopenia? "A. potential for injury B. self-care deficit C. potential for self harm D. alteration in comfort"

"Answer: A potential for injury Low platelet increases risk of bleeding from even minor injuries. Safety measures: shave with an electric razor, use soft tooth brush, avoid SQ or IM meds and invasive procedures (urinary drainage catheter or a nasogastric tube), side-rails up, remove sharp objects, frequently assess for signs of bleeding, bruising, hemorrhage. "

"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."

"Correct Answer: 1. 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. 2.Investigational therapy regimens would not be recommended for clients initially diagnosed with Hodgkin's because of the expected prognosis with standard therapy. 3.Clients usually achieve a significantly longer survival rate than six (6) months. Many clients survive to develop long-term secondary complications. 4.Secondary cancers can occur as long as 20 years after a remission of the Hodgkin's disease has occurred."

"A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? "A. malaise B. seizures C. neuropathy D. lymphadenopathy"

"Correct Answer: A 1. Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers. 2. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma. 3. Neuropathy is a side effect of certain chemotherapeutic agents. 4. Lymphadenopathy is one of the findings of lymphoma."

"A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that "a. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT). b. the transplant of the donated cells is painful because of the nerves in the tissue lining the bone. c. donor bone marrow cells are transplanted immediately after an infusion of chemotherapy. d. the transplant procedure takes place in a sterile operating room to minimize the risk for infection."

"Correct Answer: A The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drug."

"Multiple drugs are often used in combinations to treat leukemia and lymphoma because: "a. there are fewer toxic and side effects b. the chance that one drug will be effective is increased c. the drugs are more effective without causing side effects d. the drugs work by different mechanisms to maximize killing of malignant cells"

"Correct answer: D Combination therapy is the mainstay of treatment for leukemia. The three purposes for using multiple drugs are to (1) decrease drug resistance, (2) minimize the drug toxicity to the patient by using multiple drugs with varying toxicities, and (3) interrupt cell growth at multiple points in the cell cycle."

Which of the following manifestations would be directly associated with Hodgkin's disease? "a. bone pain b. generalized edema c. petechiae and purpura d. painless, enlarged lymph nodes"

"Correct answer: D Rationale: Hodgkin's disease usually presents as painless enlarged lymph nodes. The diagnosis is made by lymph node biopsy."

"The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a suspected malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to: "a. Motivate change in unhealthy lifestyles. b. Educate her about the seven warning signs of cancer. c. Instruct her about healthy stress relief and coping practices. d. Allow her to communicate about the meaning of this experience."

"Correct answer: D Rationale: While the patient is waiting for diagnostic study results, the nurse should be available to actively listen to the patient's concerns and should be skilled in techniques that can engage the patient and the family members or significant others in a discussion about their cancer-related fears."

A 4 yo is admitted for abdominal pain. She has been pale and excessively tired and is bruising easily. On physical exam, lymphadenopathy and hepatosplenomaegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. Which diagnostic study would confirm this diagnosis "1. Platelet count 2. LUmbar puncture 3. bone marrow biopsy 4. wbc count"

"Correct: 3. 3 leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test is microscopic exam of bone marrow obtained by bone marrow aspirate and biopsy. a lumbar puncture may be done to look for blast cells in the scfluid that indicate CNS disease. The wbc count may be normal, high or low in leukemia an altered platelet count occurs as a result of the disease but also may occur as a result of chemotherapy and does not confirm the diagnosis"

"The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assess-ment 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."

"Correct: 4 1.These vital signs are not alarming. The vitalsigns are slightly elevated and indicate moni-toring at intervals, but they do not indicate animmediate need. 2.Hyperplasia of the gums is a symptom of myeloid leukemia, but it is not an emergency. 3.Weakness and fatigue are symptoms of thedisease and are expected. 4.Pain is expected, but it is a priority, andpain control measures should be imple-mented."

A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every 2 hours. Which of the following outcome criteria would the nurse use? " a. Body temperature of 99°F or less b. Toes moved in active range of motion c. Sensation reported when soles of feet are touched d. Capillary refill of < 3 seconds"

Answer D is correct. It is important to assess the extremities for blood vessel occlusion in the client with sickle cell anemia because a change in capillary refill would indicate a change in circulation. Body temperature, motion, and sensation would not give information regarding peripheral circulation; therefore, answers A, B, and C are incorrect.