Leukemia PrepU
A patient is to receive doxorubicin as treatment for leukemia. The nurse would instruct the patient that the typical cycle would be repeated at which frequency? Every 3 weeks Every week Every other week Every 4 weeks
Doxorubicin is administered as a single IV dose and repeated every 21 days (3 weeks).
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? Implement neutropenic precautions. Eliminate direct contact with others who are infectious. Apply prolonged pressure to needle sites or other sources of external bleeding. Monitor temperature at least once per shift.
For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.
Acute lymphocytic leukemia (ALL) and acute myelocytic leukemia (AML) are two distinct disorders with similar presenting clinical features. What clinical feature do ALL and AML share? Night sweats Weight gain High fever Polycythemia
Although ALL and AML are distinct disorders, they typically present with similar clinical features. Both are characterized by an abrupt onset of symptoms, including fatigue resulting from anemia; low-grade fever, night sweats, and weight loss due to the rapid proliferation and hypermetabolism of the leukemic cells; bleeding because of a decreased platelet count; and bone pain and tenderness due to bone marrow expansion. Polycythemia is an increase in the erythrocytes in the blood. It is not an indication of leukemia.
A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? "We'll need to have a match to a donor." "The risk for rejection is much less with this type of transplant." "You won't need to receive the high doses of chemotherapy before the transplant." "You'll need to have an incision in your hip area to instill the cells."
An allogenic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.
The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? Calling the doctor if the child gets a sore throat Keeping a written copy of the treatment plan Writing down phone numbers and appointments Using acetaminophen if the child needs an analgesic
Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points but secondary to guarding against infection.
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "Acute leukemia develops slowly." "Chronic leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature." "In acute leukemia there are not many undifferentiated cells."
Chronic leukemia develops slowly, and the majority of leukocytes produced are mature. Acute leukemia develops quickly and the majority of leukocytes are undifferentiated cells
Which assessment findings support the client's diagnosis of acute myeloid leukemia? Select all that apply. Petechiae Enlarged lymph nodes Weakness and fatigue Enlarged heart Bone pain
Clients with AML may present with petechiae, enlarged lymph nodes, weakness, fatigue, and bone pain. An enlarged heart is not a typical finding with this disorder.
The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? WBC count of 4,200 cells/mcL Hematocrit of 38% Platelet count of 9,000/mm3 Creatinine level of 1.0 mg/dL
Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.
The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment. 1Oral steroids and vincristine through an intravenous line 2High-dose methotrexate and 6-mercaptopurine 3Low doses of 6-mercaptopurine and methotrexate 4Chemotherapy through an intrathecal catheter
Correct response: Oral steroids and vincristine through an intravenous line High-dose methotrexate and 6-mercaptopurine Low doses of 6-mercaptopurine and methotrexate Chemotherapy through an intrathecal catheter Explanation: During induction, the child receives oral steroids and IV vincristine. During consolidation, the child receives high doses of methotrexate and 6-mercaptopurine. During maintenance, the child receives low doses of methotrexate and 6-mercaptopurine. During central nervous system prophylaxis, the child receives intrathecal chemotherapy.
A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive? Induction therapy Supportive therapy Antimicrobial therapy Standard therapy
Despite advances in understanding of the biology of AML, substantive advances in treatment response rates and survival rates have not occurred for decades, with the exception of advances made in treating APL (see later discussion). Even for patients with subtypes that have not benefited from advances in treatment, cure is still possible. The overall objective of treatment is to achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow. Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks.
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Pancytopenia Thrombocytopenia Anemia Neutropenia
Fever and infection result from a decrease in neutrophils (neutropenia). Decreased red blood cells (anemia) cause weakness, fatigue, dyspnea on exertion, and pallor in AML. Pancytopenia, an overall decrease in all blood components, is not cause of fever in clients with AML. Decreased platelet count (thrombocytopenia) causes petechiae and bruising in AML.
A lymph node biopsy pathology report notes the presence of Reed-Sternberg cells on a client suspected of having a lymphoma. The nurse interprets the report as indicating: Hodgkin lymphoma Non-Hodgkin lymphoma Multiple myeloma Leukemia
Hodgkin lymphoma is a specialized form of lymphoma that features the presence of an abnormal cell called a Reed-Sternberg cell. Therefore the nurse should interpret the pathology report as indicating Hodgkin lymphoma.
A patient with acute lymphoblastic leukemia (ALL) is receiving imatinib on an inpatient basis. When planning the care of this patient, what assessment should be specified in the patient's plan of nursing care? daily weights assessment of deep tendon reflexes bilateral blood pressures pupillary response
Imatinib may be associated with edema and significant fluid overload. Patients should be weighed regularly and assessed for signs of fluid retention. Reflexes, bilateral inequalities in blood pressure, and alterations in pupil response are not associated with the use of imatinib.
An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which characteristic of this patient's current health status may preclude the use of imatinib? The patient has type 2 diabetes mellitus that is controlled using diet and oral antihyperglycemics. The patient has chronic heart failure resulting in significant peripheral edema. The patient experienced a mild ischemic stroke several years ago and had transient ischemic attacks last year. The patient had a total knee arthroplasty several months earlier.
Imatinib may be associated with edema. Patients should be weighed regularly and assessed for signs of fluid retention that could be severe. The risk of edema increases with higher doses of imatinib and age greater than 65 years. Previous strokes, orthopedic surgery, or well-controlled diabetes may not contraindicate the use of imatinib.
A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host? Acute respiratory distress syndrome Graft-versus-host disease Remission Bone marrow depression
Patients who undergo HSCT have a significant risk of infection, graft-versus host disease (in which the donor's lymphocytes [graft] recognize the patient's body as "foreign" and set up reactions to attack the foreign host), and other complications.
A client's laboratory report shows the presence of the Philadelphia chromosome. Which diagnosis should the nurse suspect the client has developed? Chronic myelogenous leukemia (CML) Hairy cell leukemia Non-Hodgkin lymphoma Chronic lymphocytic leukemia (CLL)
The Philadelphia chromosome translocation is found in more than 90% of persons with chronic myelogenous leukemia (CML) and in some persons with acute leukemia.
The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child? "You will need to lie still afterward to prevent a headache." "You may feel pressure on your hip during the procedure." "You will have to lie on your back and hold your breath." "The numbing medicine on your skin will keep you from having pain."
The bone marrow aspiration is performed on the iliac crest if the child is older and on the femur if the child is an infant. Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. A lidocaine/prilocaine cream is applied to the skin anywhere from 1 to 3 hours prior to the procedure to help numb the site where the needle will be inserted. Bone marrow apsirations and biopsies are usually performed with conscious sedation. If the child is an infant or there are special circumstances the procedure may be performed under anesthesia. The child is placed on the side for the procedure so the health care provider has better access to the iliac crest. The child will need to rest after the procedure to prevent bleeding, but is not required to lay flat on the back. Children who have had a lumbar puncture may need to lie on the back and are at risk for a headache.
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the bestresponse by the nurse? "It will help rule out a second malignancy." "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." "The spinal tap will help relieve pressure and headache for your child." "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection."
The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system. It is common for a chemotherapy medication, usually methotrexate, to be administered immediately following lumbar puncture as treatment for potential infiltration. The other responses are incorrect.
The nurse is talking with a 9-year-old child diagnosed with acute leukemia who will soon begin chemotherapy. The child expresses worry that when her hair falls out friends won't like her or want to play with her anymore. Which response by the nurse would be best? Reassure the child that her hair will grow back in 3 to 6 months. Tell the child that having chemotherapy is the only way she'll get better. Talk with her and her family about wearing a wig, cap, or scarf. Distract the child with a book or educational computer games.
The child undergoing chemotherapy may want to wear a wig, especially when returning to school. Encourage the family to choose the wig before chemotherapy is started so that it matches the child's hair and the child has time to get used to it. A cap or scarf often is appealing to a child, particularly if it carries a special meaning for him or her. The hair will most likely grow back, chemotherapy is necessary, and distraction can decrease the anxiety, but these are not the best responses for this child.
A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action? Ensure that all staff and visitors adhere to infection control precautions. Space out the client's care to preserve energy and prevent fatigue. Encourage the client to limit physical activity in order to reduce the risk of bleeding. Provide small quantities of food several times per day, as tolerated.
The client's combination of cancer and bone marrow suppression creates an acute risk for infection. As a result, infection control is vital to maintaining the client's health and safety. Nutrition and energy conservation strategies are also important, but infection control is a safety priority. The client likely has a risk for bleeding, but the harm of activity limitation outweighs the benefits for most clients.
The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? Earache, stiff neck, or sore throat Blisters, ulcers, or a rash appear Temperature of 101° F (38.3° C) or greater Difficulty or pain when swallowing
The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes, or difficulty or pain when swallowing are reasons to seek medical care, but are not as grave as the risk of infection.
Based solely on the inheritable condition, a child with Down syndrome is susceptible for developing which type of cancer? Acute lymphocytic leukemia (ALL) Kidney cancer Brain cancer Non-Hodgkin lymphoma
There are some inheritable conditions that increase susceptibility to childhood and even adult cancer. An example is Down syndrome, which increases the risk of acute lymphoblastic leukemia (ALL) and acute myloid leukemia (AML). The other cancers listed are not known to be associated with the diagnosis of Down syndrome.
Which is a growth-based classification of tumors? Sarcoma Carcinoma Malignancy Leukemia
Tumors classified on the basis of growth are described as benign or malignant. Tumors that are classified on the basis of the cell or tissue of origin are carcinomas, sarcomas, lymphomas, and leukemias.