Which initial assessment finding(s) would the nurse expect in a client diagnosed with acute lymphocytic leukemia (ALL)?

Petechiae and epistaxis

Generalized edema and rash

Alopecia and pallor

Bradycardia and lethargy

Answer and Explanation

The Correct Answer is A

A.   Petechiae (small red or purple spots caused by bleeding under the skin) and epistaxis (nosebleeds) result from thrombocytopenia, which is a low platelet count often seen in leukemia. The compromised bone marrow function leads to inadequate production of platelets, resulting in bleeding and bruising.
B.   While generalized edema and rash can occur in various conditions, they are not specific to ALL and are not common initial findings. Edema might be seen in certain contexts (e.g., renal involvement or fluid overload), but it is not a hallmark of ALL.
C.   Alopecia (hair loss) and pallor (paleness) can occur in clients undergoing chemotherapy for ALL, but they are not typically initial findings at the time of diagnosis. Pallor may result from anemia, which can develop as a consequence of the disease, but it is not the most immediate or characteristic symptom of ALL.
D.   Bradycardia (slow heart rate) and lethargy are not typical initial findings of ALL. Lethargy could be present due to anemia or other systemic effects, but bradycardia is not commonly associated with the disease and would require further investigation for other underlying causes.

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Correct Answer is C

Explanation

A. While it's important to monitor the surgical dressing, changing it too frequently can increase the risk of infection and disrupt healing. Instead, nurses typically assess the dressing regularly and only change it if it's overly saturated or if ordered by a physician. It’s essential to follow specific protocols regarding dressing changes.
B. A While breast prostheses can be an important part of post-mastectomy care for some clients, it is usually recommended that clients wait until they have fully healed and received counseling regarding their options. Immediate encouragement may be premature, as physical and emotional adjustments take time after surgery.
C. This is an appropriate intervention. After axillary lymph node dissection, there is a risk of lymphedema in the affected arm. Placing a limb alert bracelet serves as a reminder to healthcare providers to avoid taking blood pressure or performing venipunctures on the affected arm, thus helping prevent complications.
D. While PCA can be an effective method for managing postoperative pain, the timing and dosage should be based on the specific prescription and the client's individual needs. It’s crucial to educate the client about the PCA device and its use, but the specific interval may vary based on the medication's parameters and the patient's condition.

A. Encourage the client to consider egg donation B. There should be no difficulty conceiving once the client is in full remission C. Encourage the couple to look into adoption once a cure is achieved D. The priority at this time is beginning treatment in the hope for an eventual cure

Correct Answer is A

Explanation

A. Egg donation involves collecting eggs from a woman before undergoing fertility-compromising treatments. These eggs can then be fertilized with sperm and frozen for future use. This allows couples to have biological children after completing cancer treatment.
B. There should be no difficulty conceiving once the client is in full remission. While it is possible for some women to conceive after completing treatment for ALL, the risk of fertility problems remains. Additionally, the time it takes to achieve full remission can vary, and there is no guarantee that fertility will return to normal.
C. Encourage the couple to look into adoption once a cure is achieved. While adoption is a viable option for couples who cannot have biological children, it is important to discuss all available options with the client and her husband before they make a decision.
D. The priority at this time is beginning treatment in the hope for an eventual cure. While it is important to prioritize the treatment of ALL, it is also important to address the couple's concerns about fertility. By discussing egg donation, the nurse can help the couple make informed decisions about their future.

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Blood Cell	Normal Ranges
Red blood cells (mature, circulating)	Male 4.51-6.01 million/mm3 Female: 4.01-5.51 million/mm3
Hemoglobin	Adult (15-64 yr) Male 14-17.3 g/dL Female 11.7-15.5 g/dL
Hematocrit	42% -52% in males 36% -48% in females
Reticulocytes	0.5% -2.5% of total RBC count
White blood cells (total)	4.5-11.1 103/mm3
Neutrophils	59% Bands 3% Segs-56%
Eosinophils	2.7%
Basophils	0.5%
Lymphocytes	34%
Monocytes	4%
Platelets	150,000-450,000/mm3

Which initial assessment finding(s) would the nurse expect in a client diagnosed with acute lymphocytic leukemia (ALL)?

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Naxlex Comprehensive Predictor Exams

A client returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. An appropriate nursing intervention in the postoperative care for the client includes:

Correct Answer is C

Explanation

The nurse caring for a 27-year-old female client diagnosed with acute lymphoblastic leukemia (ALL). She and her husband are concerned about the ability to eventually have children. What should the nurse include in the discussion with this client and her husband?

Correct Answer is A

Explanation

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