Question 1

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?

Accepted Answer

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.

Question 2

The nurse explains that acute leukemia is caused by

Accepted Answer

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.

Question 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

Accepted Answer

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.

Question 4

A client has been receiving MOPP (mechlorethamine, vincristine [Oncovin], procarbazine, prednisone) therapy for treatment of Hodgkin's 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 nurse's response will include that ABVD

Accepted Answer

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

Question 5

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

Accepted Answer

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.

Question 6

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

Accepted Answer

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.

Question 7

A client with Hodgkin's disease is staged at III. The nurse plans care knowing this means there

Accepted Answer

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

Question 8

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

Accepted Answer

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.

Question 9

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)

Accepted Answer

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.

Question 10

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

Accepted Answer

Some evidence shows that the Epstein Barr virus (EBV) is believed to be a causative agent of Hodgkin's 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.

Question 11

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?

Accepted Answer

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.

Question 12

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.)

Accepted Answer

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.

Question 13

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

Accepted Answer

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

Question 14

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

Accepted Answer

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.

Question 15

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

Accepted Answer

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

Question 16

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

Accepted Answer

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.

Quiz 79: Management of Clients with Leukemia and Lymphoma