WBC Disorders

4 types of Leukemia

- AML (acute myelogenous leukemia) - CML (chronic myelogenous leukemia) - ALL (acute lymphocytic leukemia) - CLL (chronic lymphocytic leukemia)

Multiple myeloma risk factors

- African american, genetics - Old age - Obesity - Toxin/hazardous chemical exposures

Multiple myeloma CMs

- Anemia, Hypercalcemia - Bone pain, Pathological fractures - Renal insufficiency/failure

Hodgkin Lymphoma CMs

- Enlarged lymph nodes (neck) - Hepatosplenomegaly - Weight loss - Itching, Night sweats, Fever, Fatigue

3 types of WBC disorders

- Leukemia - Lymphoma - Multiple myeloma

Non Hodgkin Lymphoma CMs

- Lymphadenopathy - Extranodal disease

CLL CMs

- Lymphadenopathy - Hepatomegaly, Splenomegaly - Weight loss - Night sweats, Fever, Fatigue

ALL CMs

- enlarged lymph nodes - bone pain, bleeding - fever

Hodgkin Lymphoma risk factors

- genetics - immunosuppression - viral exposures

ALL risk factors

- genetics - prenatal xray exposure - postnatal exposure to high dose radiation

AML risk factors

- older age - smoker - chemo, radiation, long term toxin exposure

Non Hodgkin lymphoma risk factors

- weak immune system - H pylori

Which of the following clients is most at risk for developing chronic lymphocytic leukemia? A. A 70 year old White man B. A 60 year old Asian man C. A 40 year old White man D. A 20 year old Asian man

A. A 70 year old White man

A client with AML has pancytopenia. The nurse observes this client for which of the following conditions? A. Anemia, neutropenia, and thrombocytopenia B. Leukocytosis, polycythemia, and thrombocytopenia C. Anemia, neutropenia, and thrombocytosis D. Leukocytosis, thrombocytopenia and polycythemia

A. Anemia, neutropenia, and thrombocytopenia

A client with multiple myeloma​ (MM) has thrombocytopenia. Which treatment should the nurse expect for the​ client? (Select all that​ apply.) A. Antibiotic therapy B. Iron supplement C. Platelet transfusion D. Red blood cell transfusion

A. Antibiotic therapy C. Platelet transfusion ​Rationale: Thrombocytopenia is a low platelet​ count; therefore, treatment with a platelet transfusion would be expected. Anemia would be treated with an iron supplement or red blood cell transfusion. Antibiotic therapy may be incorporated to aid in the avoidance of infection due to neutropenia.

Which occupation is associated with elevated risk for​ non-Hodgkin lymphoma​ (NHL)? A. Farmer B. Radiologist C. Plumber D. Office manager

A. Farmer Rationale: Environmental factors such as exposure to​ pesticides, herbicides, wood​ preservatives, and other organic solvents have been implicated in the development of NHL. Exposure to these chemicals may account for the increased incidence of the disease found in some​ occupations, such as farming. It should be noted that the vast majority of people with identified risk factors associated with NHL never develop the disease. There is no evidence to support that the other occupations have an associated risk.

Which of the following conditions places a person at risk for developing chronic myelogenous leukemia? A. Living near a nuclear reactor accident B. Having a 20 pack year history of smoking C. Having a sibling with CML D. Having received xrays for sports injuries as a child

A. Living near a nuclear reactor accident

The nurse is admitting a client suspected of having acute myelogenous leukemia​ (AML). Which clinical manifestation should the nurse expect for this​ client? (Select all that​ apply.) A. Petechiae B. Mental status changes C. Fatigue D. Increased platelets E. Weakness

A. Petechiae B. Mental status changes C. Fatigue E. Weakness X ​Rationale: Signs and symptoms of acute myelogenous leukemia​ (AML) come from the degree of pancytopenia. The decreased level of​ RBCs, WBCs, and platelets cause symptoms such as​ fatigue, weakness, and mental status changes.

The nurse is reviewing risk factors for acute myelogenous leukemia​ (AML). Which risk factor is important to​ identify? (Select all that​ apply.) A. Smoking B. Herbicide exposure C. Exposure to benzene D. Ionizing radiation E. Chemotherapy

A. Smoking C. Exposure to benzene D. Ionizing radiation E. Chemotherapy ​Rationale: Acute myelogenous leukemia​ (AML) has risk factors such as​ smoking, previous​ chemotherapy, ionizing​ radiation, and exposure to benzene and petroleum products. Herbicide exposure is not associated with AML.

A nurse is reviewing signs and symptoms of acute lymphocytic leukemia​ (ALL). Which clinical manifestation is related to​ ALL? (Select all that​ apply.) A. Weakness B. Thrombocytopenia C. Bleeding D. Fever E. Increased red blood cells

A. Weakness B. Thrombocytopenia C. Bleeding D. Fever Rationale: Signs and symptoms of acute lymphocytic leukemia​ (AML) come from the degree of pancytopenia. The decreased level of​ RBCs, WBCs, and platelets cause symptoms such as​ fever, weakness,​ bleeding, and thrombocytopenia.

Which leukemia is life threatening?

AML

The nurse is admitting a client with a possible diagnosis of multiple myeloma. Which of the following findings would the nurse expect in this client? A. Chest pain B. Bone pain C. Joint pain D. Abdominal pain

B. Bone pain

Which treatment should the nurse expect for the client diagnosed with acute myelogenous leukemia​ (AML) to arrest the cellular​ proliferation? A. Radiation therapy B. Chemotherapy C. Monoclonal therapy D. Blood transfusion

B. Chemotherapy ​Rationale: Chemotherapy is the cornerstone treatment for acute myelogenous leukemia​ (AML). Chemotherapy is a general term used to describe drugs that arrest cellular proliferation by interfering with DNA synthesis and replication of both normal and malignant cells. The other therapies are not associated with AML.

Which treatment option should the nurse expect for a client diagnosed with Hodgkin lymphoma​ (HL) with​ CD20? A. Radiation therapy B. Monoclonal therapy C. Chemotherapy D. Growth factor support

B. Monoclonal therapy ​Rationale: When Hodgkin lymphoma​ (HL) has the​ CD20, monoclonal therapy is the best option due to the therapy targeting only CD20 cells rather than healthy cells. The other treatments also attack healthy cells in the body. Growth hormone supports neutrophil recovery.

Which condition should the nurse associate with the risk for acute lymphocytic leukemia​ (ALL)? A. Environmental pollution B. Current sepsis infection C. Down syndrome D. Exposure to pesticides

C. Down syndrome ​Rationale: Acute lymphocytic leukemia​ (ALL) has genetic and nongenetic risk factors. Down syndrome is an example of a genetic risk factor for ALL. Prenatal exposure to​ x-rays and postnatal exposure to​ high-dose radiation are nongenetic.

A nurse is examining a client who is newly diagnosed with Hodgkin lymphoma​ (HL). Which clinical manifestation is the nurse most likely to find at the initial​ diagnosis? A. Hepatomegaly B. Thrombocytopenia C. Enlarged cervical lymph nodes D. Enlarged axillae lymph nodes

C. Enlarged cervical lymph nodes ​Rationale: Enlarged cervical or supraclavicular lymph nodes are common at the initial diagnosis of Hodgkin lymphoma​ (HL). Enlarged axillae lymph nodes and hepatomegaly are not as common. Thrombocytopenia is not associated with HL.

Which of the following laboratory findings is most likely in the client with multiple myeloma? A. Hyperkalemia B. Hyponatremia C. Hypercalcemia D. Hypoglycemia

C. Hypercalcemia

The client at stage 3 of the Cotswolds Modificaiton of the Ann Arbor Staging System for Hodgkin lymphoma will exhibit which finding? A. A single involved lymph node B. Two involved lymph nodes on the same side of the diaphragm C. Involved lymph nodes on both sides of the diaphragm D. Widespread involvement of extranodal sites

C. Involved lymph nodes on both sides of the diaphragm

A client presents with​ anemia, loss of​ height, bone​ pain, hypercalcemia, elevated​ creatinine, and thrombocytopenia. Which hematologic disorder should the nurse​ suspect? A. ​Non-Hodgkin lymphoma​ (NHL) B. Chronic lymphocytic leukemia​ (CLL) C. Multiple myeloma​ (MM) D. Acute myelogenous leukemia​ (AML)

C. Multiple myeloma​ (MM) ​Rationale: Anemia​ (normocytic or​ normochromic) is a common symptom of multiple myeloma​ (MM), resulting from the infiltration of bone marrow by plasma cells. This process prevents the maturation of erythrocytes. Lacking an adequate number of red blood cells to carry oxygen can result in fatigue and pallor. The movement of plasma cells into the bone marrow​ can, in​ turn, lead to a loss of osteocytes and a resultant destruction of bone. This can manifest as pathologic fractures and bone pain. Loss of bone cells can result in the release of calcium into the bloodstream. This hypercalcemia can result in confusion and other mental status changes and may have adverse effects on the​ kidney, as evidenced by an elevated creatinine level.

Which risk factor would be an expected finding in a client diagnosed with multiple myeloma​ (MM)? A. Immune suppression B. Bacterial infection C. Obesity D. Viral exposure

C. Obesity ​Rationale: Multiple myeloma​ (MM) has risk factors such as obesity and hazardous chemical exposure. Viral​ exposure, bacterial​ infection, and immune suppression are not associated with MM.

which leukemia is the most common type?

CLL

Which of the following statements made by the parent of a child with ALL demonstrates understanding of the treatment plan? A. Induction therapy is a cure for ALL. B. Consolidation therapy occurs if the disease returns. C. Induction therapy is repeated until the disease is in remission. D. Consolidation therapy eradicates the residual disease.

D. Consolidation therapy eradicates the residual disease.

Which of the following is the most common presenting sign of non-Hodgkin lymphoma? A. Reed Sternberg cells B. Bone pain C. Bleeding D. Enlarged lymph nodes

D. Enlarged lymph nodes

A nurse is preparing a presentation on signs of chronic myelogenous leukemia​ (CML). Which clinical manifestation would the nurse explain is typically found at the initial​ diagnosis? A. Bleeding B. Bone pain C. Fatigue and weakness D. None

D. None ​Rationale: Clients are typically asymptomatic at the initial diagnosis of chronic myelogenous leukemia​ (CML). As they develop​ symptoms, the symptoms relate to the extent of pancytopenia.

A client diagnosed with​ non-Hodgkin lymphoma​ (NHL) states,​ "My doctor says​ he's going to use radiation on local areas. What will this​ do?" How should the nurse​ respond? A. ​"It will temporarily slow down the growth while you prepare for more extensive​ treatment." B. ​"Localized radiation treatment will serve as a palliative​ therapy." C. ​"Radiation will kill the damaged cells and encourage healthy cells to​ grow." D. ​"It will kill the malignant cells by damaging genetic​ material."

D. ​"It will kill the malignant cells by damaging genetic​ material." Rationale: Radiation therapy refers to the therapeutic use of directed ionizing radiation to kill malignant cells by damaging the genetic material that controls cellular​ proliferation; therefore, it works best in cells that are dividing rapidly. In​ general, radiation therapy damages normal cells along with malignant​ cells; however, normal cells are better equipped to repair damaged​ DNA, while malignant cells are more likely to die. Radiation therapy is used to treat NHL in a local area.

2 types of lymphoma

Hodgkins and Non-Hodgkins Lymphoma

CLL risk factor

adult

CML risk factor

adult

CML CMs

depends on myeloid cell overproduction - infection (r/t neutrophils) - weakness & fatigue (r/t anemia) - bleeding (r/t thrombocytopenia) - splenomegaly - gouty arthritis - night sweats

Non hodgkin lymphoma pathogenesis

genetic mutation creates solid tumors

ALL pathogenesis

lymphoid cells are ineffective & leukemic cells overcrowd bone marrow & other organs

Hodgkin Lymphoma

neoplastic proliferation of Reed Sternberg cells

CML etiology

philadelphia chromosome

Multiple myeloma

proliferation of malignant plasma cells

How to diagnose ALL

signs of infection, anemia, bleeding & leukemic infiltration

The nurse is reviewing the history and physical for a client diagnosed with Hodgkin lymphoma​ (HL). Which condition documented should the nurse consider a risk​ factor? A. ​20-year history as a woodworker B. Recurrent bacterial pneumonia C. Treatment with immunosuppressant drugs D. Exposure to pesticides and herbicides

C. Treatment with immunosuppressant drugs ​Rationale: Hodgkin lymphoma​ (HL) has risk factors such as familial​ factors, viral​ exposures, and immune suppression. Exposure to pesticides and​ herbicides, and an occupation as a​ woodworker, where the client would have been exposed to wood​ preservatives, are risk factors for​ non-Hodgkin lymphoma. Viral​ infections, not​ bacterial, are a risk factor for HL.

Which statement by the nurse is accurate regarding acute lymphocytic leukemia​ (ALL)? A. ​"ALL is an overproliferation of mature​ granulocytes." B. ​"ALL is a disease where the spleen produces abnormal​ cells." C. ​"ALL is a clonal​ disease." D. ​"ALL is myeloid​ leukemia."

C. ​"ALL is a clonal​ disease." ​Rationale: Like the other hematologic​ malignancies, acute lymphocytic leukemia​ (ALL) is considered to be a clonal disease​ (one in which all malignant cells derive from a single errant​ cell). ALL ultimately develops when the initially transformed leukemic cell divides and passes on the alterations in genetic material to descendant​ cells, or​ progeny, and these altered cells escape detection by the immune system.​ AML, not​ ALL, is a myeloid leukemia. Chronic myeloid leukemia​ (CML) is a form of leukemia characterized by overproliferation of mature granulocytes. ALL is not the result of the spleen producing abnormal cells.

A client recently diagnosed with chronic lymphocytic leukemia​ (CLL) asks what to expect from treatment. How should the nurse​ respond? A. ​"Immunotherapy can be used to help stop the growth of the​ cancer." B. ​"Since this is a​ fast-growing disease, the doctors will be​ aggressive." C. ​"CLL cannot be​ cured, but chemotherapy can slow the​ progression." D. ​"You might be a candidate for a stem cell​ transplant, which will cure your​ disease."

C. ​"CLL cannot be​ cured, but chemotherapy can slow the​ progression." ​Rationale: Chronic lymphocytic leukemia​ (CLL) has no​ cure, but chemotherapy can be used to slow progression. Chemotherapy is given to stop the cancer cells from​ growing, and immunotherapy may be used to stimulate the​ body's own defenses in fighting the disease. A​ reduced-intensity allogeneic transplant should be explored for clients who have a clinically progressive disease that does not respond to other treatments. CLL generally progresses​ slowly, often with long periods of stability and​ occasional, spontaneous remissions. In clients with​ early-stage disease and without​ symptoms, watchful waiting is generally indicated. Stem cell transplant is not a treatment for CLL.

The nurse is preparing a presentation on hematologic cancers. Which statement should the nurse​ include? A. ​"Benign cells start in the bone marrow and lymph​ tissues." B. ​"Benign cells develop from stem​ cells." C. ​"Malignancies develop due to cellular​ mutations." D. ​"Malignancies develop from only the lymph​ system."

C. ​"Malignancies develop due to cellular​ mutations." ​Rationale: Malignancies develop as a result of one or more mutations in a single cell or a group of cells that result in immature​ and/or ineffective hematopoietic cells. The mutations may occur at any time during the process of maturation and differentiation may affect any of the blood cell lines in the hematopoietic system. Benign cells are not cancerous and do not invade other tissues.

A nurse is asked who is most at risk for developing​ non-Hodgkin lymphoma​ (NHL). Which client is most at​ risk? A. ​60-year-old African American woman B. ​50-year-old man of European descent C. ​65-year-old woman of European descent D. ​52-year-old woman of Hispanic descent

C. ​65-year-old woman of European descent Rationale: Non-Hodgkin lymphoma​ (NHL) occurs across all age​ groups, including​ children, although incidence rates are much higher in older individuals than in younger people. The incidence of NHL is highest in Americans of European​ descent, followed by Hispanics and African Americans. Approximately​ 19,790 individuals were expected to die from NHL in 2015.

Which explanation by the nurse best describes multiple myeloma​ (MM)? A. ​"MM is characterized by the proliferation of malignant plasma​ cells." Your answer is correct. B. ​"MM is an overproliferation of mature granulocytes in the lymph​ tissues." C. ​"MM is a disease that involves benign overproliferation of T​ cells." D. ​"MM is associated with a decreased number of plasma cells in the​ blood."

​A. ​"MM is characterized by the proliferation of malignant plasma​ cells." Rationale: For development of multiple myeloma​ (MM), the most common genetic variations appear to be associated with the inactivation of​ tumor-suppressing genes or the activation of genes known to be associated with​ B-cell proliferation. The translocation​ (rearrangement) of genetic sequences seems to lead to an activation of mechanisms that leads to an increase in the number of plasma cells that then move into the bone marrow. Chronic myeloid leukemia​ (CML), not​ MM, is a form of leukemia characterized by overproliferation of mature granulocytes. B​ cells, not T​ cells, are involved in MM.

Which statement describes the development of chronic myeloid leukemia​ (CML)? A. ​"CML develops from an overproduction of B cells in the lymph​ tissues." B. ​"CML develops from an underproduction of immature blast​ cells." C. ​"CML arises from a genetic translocation that occurs at the stem cell​ level." D. ​"CML arises from the impaired DNA repair associated with certain inherited​ disorders."

​C. ​"CML arises from a genetic translocation that occurs at the stem cell​ level." Rationale: Chronic myeloid leukemia​ (CML) arises when a​ well-known genetic​ alteration, the​ 9;22 translocation​ (Philadelphia chromosome), occurs at the stem cell level and results in overproduction of mature​ granulocytes, not B​ cells, in the bone marrow. A number of inherited genetic disorders are associated with​ ALL, not CML. CML is staged on the number of blast​ cells, but it is not how it develops.