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Acute Leukemia
Text Mode Text version of the exam
1) A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the
regimen. The main reason for administering allopurinol as part of the clients chemotherapy regimen is
to:
Prevent metabolic breakdown of xanthine to uric acid
Prevent uric acid from precipitating in the ureters
Enhance the production of uric acid to ensure adequate excretion of urine
Ensure that the chemotherapy doesnt adversely affect the bone marrow
2) A nurse is caring for a patient with acute lymphoblastic leukemia (ALL). Which of the following is the
most likely age range of the patient?
3-10 years.
25-35 years.
45-55 years.
over 60 years.
3) The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). The nurse tells
the client that the purpose if the allopurinol is to prevent:
Nausea
Alopecia
Vomiting
Hyperuricemia
4) An African American client is admitted with acute leukemia. The nurse is assessing for signs and
symptoms of bleeding. Where is the best site for examining for the presence of petechiae?
The abdomen
The thorax
The earlobes
The soles of the feet
5) 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?
The client collects stamps as a hobby.
The client recently lost his job as a postal worker.
The client had radiation for treatment of Hodgkins disease as a teenager.
The clients brother had leukemia as a child.
6) A client with acute leukemia is admitted to the oncology unit. Which of the following would be most
important for the nurse to inquire?
Have you noticed a change in sleeping habits recently?
Have you had a respiratory infection in the last 6 months?
Have you lost weight recently?
Have you noticed changes in your alertness?
7) Francis with leukemia has neutropenia. Which of the following functions must frequently assessed?
Blood pressure
Bowel sounds
Heart sounds
Breath sounds
8) The treatment protocol for a client with acute lymphatic leukemia includes prednisone, methotrexate,
and cimetadine. The purpose of the cimetadine is to:
Decrease the secretion of pancreatic enzymes
Enhance the effectiveness of methotrexate
Promote peristalsis
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Prevent a common side effect of prednisone
9) A 4-year-old is admitted with acute leukemia. It will be most important to monitor the child for:
Abdominal pain and anorexia
Fatigue and bruising
Bleeding and pallor
Petechiae and mucosal ulcers
10) The nurse is reviewing the laboratory report of a client who underwent a bone marrow biopsy. The
finding that would most strongly support a diagnosis of acute leukemia is the existence of a large
number of immature:
lymphocytes
thrombocytes
reticulocytes
leukocytes
11) A leukemia patient has a relative who wants to donate blood for transfusion. Which of the following
donor medical conditions would prevent this?
A history of hepatitis C five years previously.
Cholecystitis requiring cholecystectomy one year previously.
Asymptomatic diverticulosis.
Crohns disease in remission.
12) A patient with leukemia is receiving chemotherapy that is known to depress bone marrow. A CBC
(complete blood count) reveals a platelet count of 25,000/microliter. Which of the following actions
related specifically to the platelet count should be included on the nursing care plan?
Monitor for fever every 4 hours.
Require visitors to wear respiratory masks and protective clothing.
Consider transfusion of packed red blood cells.
Check for signs of bleeding, including examination of urine and stool for blood.
13) Which of the following would the nurse identify as the initial priority for a child with acute lymphocytic
leukemia?
Instituting infection control precautions
Encouraging adequate intake of iron-rich foods
Assisting with coping with chronic illness
Administering medications via IM injections
14) A 22-year-old man is admitted to the hospital with complaints of fatigue and weight loss. Physical
examination reveals pallor and multiple bruises on his arms and legs. The results of the patients tests
reveal acute lymphocytic leukemia and thrombocytopenia. Which of the following nursing diagnoses
MOST accurately reflects his condition?
Potential for injury.
Self-care deficit
Potential for self-harm.
Alteration in comfort.
15) Which of the following would be the priority nursing diagnosis for the adult client with acute
leukemia?
Oral mucous membrane, altered related to chemotherapy
Risk for injury related to thrombocytopenia
Fatigue related to the disease process
Interrupted family processes related to life-threatening illness of a family member
16) The patient receiving mitoxantrone (Novantrone) for treatment of secondary progressive multiple
sclerosis (MS) is closely monitored for
leukopenia and cardiac toxicity.
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mood changes and fluid and electrolyte alterations.
renal insufficiency.
hypoxia.
17) Marie with acute lymphocytic leukemia suffers from nausea and headache. These clinical
manifestations may indicate all of the following except
effects of radiation
chemotherapy side effects
meningeal irritation
gastric distension
18) Situation: Stacy is diagnosed with acute lymphoid leukemia (ALL) and beginning
chemotherapy. Stacy is discharged from the hospital following her chemotherapy treatments. Which
statement of Stacys mother indicated that she understands when she will contact the physician?
I should contact the physician if Stacy has difficulty in sleeping.
I will call my doctor if Stacy has persistent vomiting and diarrhea.
My physician should be called if Stacy is irritable and unhappy.
Should Stacy have continued hair loss, I need to call the doctor.
19) A patient is undergoing the induction stage of treatment for leukemia. The nurse teaches family
members about infectious precautions. Which of the following statements by family members indicates
that the family needs more education?
We will bring in books and magazines for entertainment.
We will bring in personal care items for comfort.
We will bring in fresh flowers to brighten the room.
We will bring in family pictures and get well cards.
20) A child with leukemia is being discharged after beginning chemotherapy. What instructions will the
nurse include in the teaching plan for the parents of this child?
Provide a diet low in protein and high in carbohydrates
Avoid fresh vegetables that are not cooked or peeled
Notify the M.D. if the childs temperature exceeds 101F (39C)
Increase the use of humidifiers throughout the house
21) The treatment for patients with leukemia is bone marrow transplantation. Which statement about
bone marrow transplantation is not correct?
The patient is under local anesthesia during the procedure
The aspirated bone marrow is mixed with heparin.
The aspiration site is the posterior or anterior iliac crest.
The recipient receives cyclophosphamide (Cytoxan) for 4 consecutive days before
the procedure.
22) What is the peak age range in acquiring acute lymphocytic leukemia (ALL)?
4 to 12 years.
20 to 30 years
40 to 50 years
60 to 70 years
23) A client jokes about his leukemia even though he is becoming sicker and weaker. The nurses most
therapeutic response would be:
Your laugher is a cover for your fear.
He who laughs on the outside, cries on the inside.
Why are you always laughing?
Does it help you to joke about your illness?
24) The laboratory results of the client with leukemia indicate bone marrow depression. The nurse
should encourage the client to:
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Increase his activity level and ambulate frequently
Sleep with the head of his bed slightly elevated
Drink citrus juices frequently for nourishment
Use a soft toothbrush and electric razor
25) During chemotherapy for lymphocytic leukemia, Mathew develops abdominal pain, fever, and horse
barn smelling diarrhea. It would be most important for the nurse to advise the physician to order:
enzyme-linked immunosuppressant assay (ELISA) test.
electrolyte panel and hemogram.
stool for Clostridium difficile test.
flat plate X-ray of the abdomen.
26) 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
to a private room so she will not infect other patients and health care workers.
to a private room so she will not be infected by other patients and health care
workers.
to a semiprivate room so she will have stimulation during her hospitalization.
to a semiprivate room so she will have the opportunity to express her feelings
about her illness.
Answers and Rationales
A. Prevent metabolic breakdown of xanthine to uric acid . The massive cell
destruction resulting from chemotherapy may place the client at risk for developing renal
calculi; adding allopurinol decreases this risk by preventing the breakdown of xanthine to
uric acid. Allopurinol doesnt act in the manner described in the other options.
A. 3-10 years. The peak incidence of ALL is at 4 years (range 3-10). It is
uncommon after the mid-teen years. The peak incidence of chronic myelogenous leukemia
(CML) is 45-55 years. The peak incidence of acute myelogenous leukemia (AML) occurs at
60 years. Two-thirds of cases of chronic lymphocytic leukemia (CLL) occur after 60 years.
D. Hyperuricemia . Allopurinol decreases uric acid production and reduces uric
acid concentrations in serum and urine. In the client receiving chemotherapy, uric acid
levels increase as a result of the massive cell destruction that occurs from the
chemotherapy. This medication prevents or treats hyperuricemia caused by chemotherapy.
Allopurinol is not used to prevent alopecia, nausea, or vomiting.
D. The soles of the feet . Petechiae are not usually visualized on dark skin. The
soles of the feet and palms of the hand provide a lighter surface for assessing the client for
petichiae.
C. The client had radiation for treatment of Hodgkins disease as a
teenager. 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.
B. Have you had a respiratory infection in the last 6 months? 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
D. Breath sounds . Pneumonia, both viral and fungal, is a common cause of
death in clients with neutropenia, so frequent assessment of respiratory rate and breath
sounds is required. Although assessing blood pressure, bowel sounds, and heart sounds is
important, it wont help detect pneumonia.
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D. Prevent a common side effect of prednisone . A common side effect of
prednisone is gastric ulcers. Cimetadine is given to help prevent the development of
ulcers.
C. Bleeding and pallor . The child with leukemia has low platelet counts, which
contribute to spontaneous bleeding.
D. leukocytes . Leukemia is manifested by an abnormal overpopulation of
immature leukocytes in the bone marrow.
A. A history of hepatitis C five years previously. Hepatitis C is a viral infection
transmitted through bodily fluids, such as blood, causing inflammation of the liver. Patients
with hepatitis C may not donate blood for transfusion due to the high risk of infection in
the recipient. Cholecystitis (gall bladder disease), diverticulosis, and history of Crohns
disease do not preclude blood donation.
D. Check for signs of bleeding, including examination of urine and stool
for blood. A platelet count of 25,000/microliter is severely thrombocytopenic and should
prompt the initiation of bleeding precautions, including monitoring urine and stool for
evidence of bleeding. Monitoring for fever and requiring protective clothing are indicated to
prevent infection if white blood cells are decreased. Transfusion of red cells is indicated for
severe anemia.
A. Instituting infection control precautions . Acute lymphocytic leukemia
(ALL) causes leukopenia, resulting in immunosuppression and increasing the risk of
infection, a leading cause of death in children with ALL. Therefore, the initial priority
nursing intervention would be to institute infection control precautions to decrease the risk
of infection. Iron-rich foods help with anemia, but dietary iron is not an initial intervention.
The prognosis of ALL usually is good. However, later on, the nurse may need to assist the
child and family with coping since death and dying may still be an issue in need of
discussion. Injections should be discouraged, owing to increased risk from bleeding due to
thrombocytopenia.
A. Potential for injury. Question: What nursing diagnosis is seen with acute
lymphocytic leukemia and thromocytopenia? Needed Info: Thromocytopenia: decreased
platelet count increases the patients risk for injury, normal count: 200,000-400,000 per
mm3. Leukemia: group of malignant disorders involving overproduction of immature
leukocytes in bone marrow. This shuts down normal bone marrow production of
erythrocytes, platelets, normal leukocytes. Causes anemia, leukopenia, and
thrombocytopenia leading to infection and hemorrhage. Symptoms: pallor of nail beds and
conjunctiva, petechiae (small hemorrhagic spot on skin), tachycardia, dyspnea, weight
loss, fatigue. Treatment: chemotherapy, antibiotics, blood transfusions, bone marrow
transplantation. Nursing responsibilities: private room, no raw fruits or vegs, small frequent
meals, O2, good skin care.
Potential for injury CORRECT: 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.
Self-care deficit may feel weak, doesnt address condition
Potential for self-harm implies risk for purposeful self-injury, not given
any info, assumption
Alteration in comfort patient is not comfortable, and comfort measures
would address problem
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B. Risk for injury related to thrombocytopenia . The client with acute
leukemia has bleeding tendencies due to decreased platelet counts, and any injury would
exacerbate the problem.
A. leukopenia and cardiac toxicity. Mitoxantrone is an antineoplastic agent
used primarily to treat leukemia and lyphoma but is also used to treat secondary
progressive MS. Patients need to have laboratory tests ordered and the results closely
monitored due to the potential for leukopenia and cardiac toxicity.
D. gastric distension . Acute Lymphocytic Leukemia (ALL) does not cause gastric
distention. It does invade the central nervous system, and clients experience headaches
and vomiting from meningeal irritation.
B. I will call my doctor if Stacy has persistent vomiting and
diarrhea. Persistent (more than 24 hours) vomiting, anorexia, and diarrhea are signs of
toxicity and the patient should stop the medication and notify the health care provider. The
other manifestations are expected side effects of chemotherapy.
C. We will bring in fresh flowers to brighten the room. During induction
chemotherapy, the leukemia patient is severely immunocompromised and at risk of serious
infection. Fresh flowers, fruit, and plants can carry microbes and should be avoided. Books,
pictures, and other personal items can be cleaned with antimicrobials before being brought
into the room to minimize the risk of contamination.
B. Avoid fresh vegetables that are not cooked or peeled
A. The patient is under local anesthesia during the procedure . Before the
procedure, the patient is administered with drugs that would help to prevent infection and
rejection of the transplanted cells such as antibiotics, cytotoxic, and corticosteroids. During
the transplant, the patient is placed under general anesthesia.
A. 4 to 12 years. The peak incidence of Acute Lymphocytic Leukemia (ALL) is 4
years of age. It is uncommon after 15 years of age.
D. Does it help you to joke about your illness? This non-judgmentally on
the part of the nurse points out the clients behavior.
D. Use a soft toothbrush and electric razor . Suppression of red bone marrow
increases bleeding susceptibility associated with thrombocytopenia, decreased platelets.
Anemia and leucopenia are the two other problems noted with bone marrow depression.
C. stool for Clostridium difficile test. Immunosuppressed clients for
example, clients receiving chemotherapy, are at risk for infection with C. difficile, which
causes horse barn smelling diarrhea. Successful treatment begins with an accurate
diagnosis, which includes a stool test. The ELISA test is diagnostic for human
immunodeficiency virus (HIV) and isnt indicated in this case. An electrolyte panel and
hemogram may be useful in the overall evaluation of a client but arent diagnostic for
specific causes of diarrhea. A flat plate of the abdomen may provide useful information
about bowel function but isnt indicated in the case of horse barn smelling diarrhea.
B. to a private room so she will not be infected by other patients and
health care workers.
Question: What are the needs of the patient with acute lymphocytic
leukemia and thrombocytopenia?
Needed Info: Lymphocytic leukemia, disease characterized by proliferation
of immature WBCs. Immature cells unable to fight infection as competently as mature
white cells. Treatment: chemotherapy, antibiotics, blood transfusions, bone marrow
transplantation.
Nursing responsibilities: private room, no raw fruits or vegs, small frequent
meals, O2, good skin care.
to a private room so she will not infect other patients and health
care workers poses little or no threat
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
to a semiprivate room so she will have stimulation during her
hospitalization should be placed in a room alone
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
