Chapter 79: Management of Clients with Leukemia and Lymphoma Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 79: Management of Clients with Leukemia and Lymphoma

MULTIPLE CHOICE

1. The nurse explains that acute leukemia is caused by

a.

accumulation of immature blast cells.

b.

excessively rapid mitosis of leukemic cells.

c.

proliferation of neutrophils.

d.

undifferentiated blast cells entering bone marrow.

ANS: A

Leukemia is caused by an accumulation of immature and useless blast cells in the marrow that undergo a clonal change and ultimately crowd out and interfere with the production of other blood cells. The cell division of leukemic cells is much slower than that of other normal cells.

DIF: Comprehension/Understanding REF: pp. 2116-2117

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. The nurse reviewing a hematology report recognizes pancytopenia, which is when

a.

cellular components of the blood are reduced.

b.

platelets are immature and dividing rapidly.

c.

red cells have become polymorphic.

d.

white cells are poorly undifferentiated.

ANS: A

Pancytopenia is a condition in which the leukemic process has reduced or obliterated all other cellular components of the blood.

DIF: Analysis/Analyzing REF: p. 2117 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

3. The nurse reviewing a hematology report of a client with chronic leukemia brings to the attention of the physician a change that may indicate a blast crisis may be occurring, which is

a.

a drastic decrease in monocytes.

b.

a hemoglobin drop to 9 g/dl.

c.

myeloid cell precursors >20%.

d.

thrombocytic proliferation.

ANS: C

When the myeloid cell precursors rise in excess of 20% in the circulating volume and 30% in the marrow, it is a strong suggestion that blast crisis may be occurring. This condition usually brings on death within 6 months of the onset.

DIF: Application/Applying REF: p. 2117 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

4. The nurse preparing a client with acute leukemia for the induction phase of chemotherapy explains that the objective of this phase is to

a.

decrease the number of monocytes.

b.

induce complete remission.

c.

reduce long bone pain and splenomegaly.

d.

shock the marrow into producing normal cells.

ANS: B

The induction phase is a period of time in which there is an intense course of chemotherapy designed to bring about complete remission.

DIF: Comprehension/Understanding REF: p. 2118 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

5. When the nurse records a platelet count of 20,000/mm3, the most appropriate nursing action is to

a.

encourage iron-rich foods.

b.

increase fluid intake.

c.

institute bleeding precautions.

d.

place the client in protective isolation.

ANS: C

Teach the client and significant others to institute bleeding precautions during periods of thrombocytopenia. Bleeding precautions include: soft toothbrushes and non-alcoholic rinses, no flossing, no nose-blowing or picking, administering stool softeners, not allowing women to douche or use tampons, using only electric razors, no injections, nothing in the rectum, no aspirin-containing compounds, avoiding urinary catheters, gentle suctioning if needed, removing sharp objects from the room and padding furniture, placing a pressure-reducing mattress on the bed, using care with the blood pressure cuff, and only using paper tape.

DIF: Application/Applying REF: pp. 2122-2123

OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Client Safety

6. The nurse caring for a client who had a bone marrow transplant this morning should observe the client for manifestations of

a.

graft-versus-host disease.

b.

hemorrhage.

c.

pulmonary complications.

d.

Sjgrens syndrome.

ANS: C

Potential immediate adverse reactions are allergic (e.g., urticaria, chills, fever), volume overload, and pulmonary complications secondary to fat emboli. GVHD does occur but not until 7-30 days after the infusion.

DIF: Analysis/Analyzing REF: p. 2132 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

7. After a bone marrow transplant, a client develops GVHD and is readmitted to the hospital. The nurse intervenes to prevent which potential complication of treatment for GVHD?

a.

Anorexia

b.

Bleeding

c.

Hypoglycemia

d.

Infection

ANS: D

The standard treatments for GVHD include high doses of methylprednisolone, antithymocyte globulin, antilymphocyte globulin, cyclosporine, and anti-T-cell immunotoxins. These agents all cause immunosuppression and hence the client must be protected from infection. Hyperglycemia often occurs with high-dose steroid therapy.

DIF: Analysis/Analyzing REF: p. 2133 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

8. A client with stage I GVHD following a bone marrow transplant is very depressed because he has developed this complication. The nurse should base interactions with this client on the fact that stage I GVHD

a.

is likely to prevent successful engraftment.

b.

may prevent leukemic relapse.

c.

is treatable with steroids.

d.

is usually fatal very quickly.

ANS: B

Whereas severe GVHD is usually fatal, researchers believe that a complete absence of this immune reaction increases the risk of leukemic relapse. When interacting with the client, the nurse should use this information as the basis of therapeutic communication.

DIF: Application/Applying REF: p. 2133 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Therapeutic Communication

9. A client with Hodgkins disease is staged at III2. The nurse plans care knowing this means there

a.

are nodes on both sides of the diaphragm with para-aorta involvement.

b.

are nodes on both sides of the diaphragm with portal involvement.

c.

is involvement of a single lymphoid structure.

d.

might be a single node on one side of the diaphragm.

ANS: A

Classification III2 indicates that there are nodes on both sides of the diaphragm with involvement of para-aortic, iliac, or mesenteric nodes.

DIF: Application/Applying REF: p. 2127 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. A client has been receiving MOPP (mechlorethamine, vincristine [Oncovin], procarbazine, prednisone) therapy for treatment of Hodgkins disease. The treatment has changed to a protocol of ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, and dacarbazine). When the client asks the nurse for clarification about the change in protocol, the nurses response will include that ABVD

a.

can frequently produce a remission after only 1 cycle.

b.

negates the need for radiation therapy.

c.

prevents hypercalcemia.

d.

reduces the risk of leukemia.

ANS: D

The primary advantages of ABVD are its ease of delivery in full doses, fewer side effects, and less risk of development of leukemia.

DIF: Comprehension/Understanding REF: p. 2127 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

11. A client with Hodgkins lymphoma has relapsed after completing chemotherapy. The nurse plans care for this client understanding the probable treatment will be

a.

BMT or stem cell transplantation.

b.

immunosuppressants.

c.

more chemotherapy.

d.

systemic steroids.

ANS: A

Several recent studies have shown positive results and provide the basis for recommending either BMT or stem cell transplantation for clients with HD who have relapsed or who did not respond to the primary therapy.

DIF: Application/Applying REF: p. 2128 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

12. A client with leukemia has the nursing diagnosis Imbalanced Nutrition: Less Than Body Requirements. Which food offered by the nurse would the client be least likely to want?

a.

A sandwich

b.

Cold applesauce

c.

Hot soup

d.

Vanilla milkshake

ANS: C

Clients with leukemia tend to prefer cold foods, sandwiches, and milkshakes to hot or spicy foods. Of course, the nurse should assess the client for preferences and allow the client foods of choice if they are not otherwise contraindicated.

DIF: Application/Applying REF: p. 2123 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Nutrition and Oral Hydration

13. A nurse is educating high school students about avoiding risk factors for different diseases. When a teenager laughs off a recent infection with mononucleosis as a silly kissing disease, the nurse cautions him that mononucleosis is a risk factor for

a.

acute lymphoblastic leukemia.

b.

chronic lymphocytic leukemia.

c.

Hodgkins disease.

d.

severe bone marrow depression.

ANS: C

Some evidence shows that the Epstein Barr virus (EBV) is believed to be a causative agent of Hodgkins disease. The EBV is the causative agent in mononucleosis, and people who have a history of mono have a 2-3-fold increase in HD. Individuals, especially teenagers who are especially prone to mono, should take care to avoid it.

DIF: Comprehension/Understanding REF: p. 2125 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

MULTIPLE RESPONSE

1. A client with acute leukemia has an extremely high white count and is going to receive chemotherapy. The nurse should anticipate administering which agents to this client? (Select all that apply.)

a.

Allopurinol (Zyloprim)

b.

Increased IV fluids

c.

Rasburicase (Elitek)

d.

Urine acidifiers

ANS: A, B, C

If the white blood cell count is high when chemotherapy is initiated, tumor lysis syndrome can occur. This is potentially fatal, leading to increased serum uric acid, phosphate, and potassium levels and decreased serum calcium levels, and can manifest with seizures and fatal dysrhythmias. Prevention is a priority and includes options a, b, and c, and urine alkalinizing agents.

DIF: Analysis/Analyzing REF: p. 2119 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

2. A client with acute leukemia develops a neutrophil count of 450/mm3. The nurse should (Select all that apply)

a.

allow no plants or live flowers in the room.

b.

allow no visitors at this time.

c.

ensure strict adherence to hand-washing protocol.

d.

place the client on protective isolation.

e.

restrict the clients access to raw fruits and vegetables.

ANS: A, C, D, E

When the count is below 500/mm3, protective isolation should be instituted: bacteria-free diet, no fresh flowers or plants in the room, and visitors screened for the presence of an infection. This will help protect the client from infection and is part of an important TJC National Patient Safety Goal.

DIF: Analysis/Analyzing REF: p. 2121 OBJ: Application

MSC: Safe, Effective Care Environment Safety and Infection Control-Standard/Transmission Based/Other Precautions

3. A client contemplating chemotherapy for acute leukemia tells the nurse that s/he is concerned about the effects of chemotherapy on sexuality. Appropriate interventions by the nurse include (Select all that apply)

a.

describing the physical changes that may occur with chemotherapy affecting sexuality.

b.

explaining that because of fatigue or other causes, libido may be decreased during chemotherapy.

c.

informing the client and partner that you will call a social worker who can address their concerns.

d.

informing the client about some reproductive alternatives such as sperm banking and egg harvesting.

e.

offering information on alternative sexual positioning and techniques the client can try.

ANS: A, B, D, E

Options a, b, d, and e are excellent interventions for the nurse to provide. Option c is not the best choice. Although it is acceptable to make referrals to those with more expertise on subject matters like sexuality, all nurses need to be able to share information about sexuality concerns in the population of clients with whom the nurse most frequently works. A nurse should be able to anticipate and answer several of the most common sexual concerns/questions in his/her specialty area.

DIF: Application/Applying REF: p. 2124 OBJ: Intervention

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Human Sexuality

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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