Review Leukemia

Pathophysiology of the Hematologic System > Pathophysiology

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Leukemia

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Question 1:

A nurse is providing education to a client newly diagnosed with leukemia.
Which statement by the nurse accurately describes leukemia?

A. "Leukemia is a benign disorder of the blood and bone marrow.” B. "Leukemia is characterized by the proliferation of normal white blood cells.” C. "Leukemia can lead to complications such as infection, bleeding, and anemia.” D. "Leukemia is caused by exposure to a single specific chemical.”

Answer and Explanation

Choice A:

Leukemia is not a benign disorder; it is a malignant cancer of the blood and bone marrow. Benign disorders do not involve uncontrolled cell proliferation.

Choice B:

Leukemia is not characterized by the proliferation of normal white blood cells. It involves the abnormal proliferation of immature white blood cells.

Choice C:

This is the correct answer. Leukemia can lead to complications such as infection, bleeding, and anemia. The abnormal white blood cells in leukemia crowd out normal blood cells, leading to a decreased ability to fight infections (due to low normal white blood cells), increased bleeding tendencies (due to low platelets), and anemia (due to low red blood cells)

Choice D:

Leukemia is not caused by exposure to a single specific chemical. Its exact cause is often unknown, but it is believed to involve a combination of genetic and environmental factors.

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Question 2:

A client with leukemia asks the nurse about the possible causes of the condition.
Which response by the nurse is correct?

A. "Leukemia is primarily caused by exposure to radiation.” B. "Leukemia is always linked to a family history of blood disorders.” C. "Genetic mutations or chromosomal abnormalities may increase the risk of leukemia.” D. "Leukemia is solely caused by viral infections.”

Answer and Explanation

Choice A:

While radiation exposure can increase the risk of leukemia, it is not the primary cause. Leukemia has multifactorial causes.

Choice B:

Leukemia is not always linked to a family history of blood disorders. While some genetic factors can increase the risk, it is not solely dependent on family history.

Choice C:

This is the correct answer. Genetic mutations or chromosomal abnormalities may increase the risk of leukemia. Certain genetic and chromosomal abnormalities are associated with a higher risk of developing leukemia.

Choice D:

Leukemia is not solely caused by viral infections. Viral infections are not the primary cause of leukemia.

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Question 3:

(Select all that apply): A nurse is caring for a patient with leukemia.
What are potential complications associated with leukemia that the nurse should monitor for? Select all that apply.

A. Infection. B. Bleeding. C. Hypertension. D. Organ damage. E. Gastrointestinal bleeding.

Answer and Explanation

Choice A:

Infection is a potential complication of leukemia because the disease impairs the normal functioning of white blood cells, making the patient more susceptible to infections.

Choice B:

Bleeding is a potential complication of leukemia due to low platelet counts (thrombocytopenia) Platelets are essential for blood clotting, and their deficiency can lead to bleeding tendencies.

Choice C:

Hypertension is not typically associated with leukemia. Leukemia primarily affects the blood and bone marrow and is not a direct cause of hypertension.

Choice D:

Organ damage is a broad term that can occur in many diseases, but it is not a specific complication directly associated with leukemia.

Choice E:

Gastrointestinal bleeding can occur as a complication of leukemia, especially if the disease affects the gastrointestinal tract or if there is a low platelet count.

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Question 4:

A nurse is assessing a patient with leukemia.
Which clinical manifestation should the nurse expect to find in this patient?

A. Increased platelet count. B. Elevated hemoglobin levels. C. Frequent infections. D. Normal white blood cell count.

Answer and Explanation

Choice A:

Increased platelet count. Rationale: Leukemia is a condition characterized by an overproduction of abnormal white blood cells (WBCs), which can crowd out normal blood cells. This overcrowding typically leads to a decrease in the production of other blood components, including platelets. Therefore, an increased platelet count would not be expected in a patient with leukemia. In fact, thrombocytopenia, or a decreased platelet count, is a common finding in leukemia due to the suppression of normal bone marrow function.

Choice B:

Elevated hemoglobin levels. Rationale: Leukemia does not typically cause elevated hemoglobin levels. Hemoglobin levels are usually within the normal range or may be decreased in some cases, especially if there is associated anemia. The primary concern in leukemia is the overproduction of abnormal WBCs, which can lead to anemia and other complications.

Choice C:

Frequent infections. Rationale: Frequent infections are a common clinical manifestation of leukemia. The abnormal WBCs produced in leukemia are often ineffective in fighting off infections, which can result in a weakened immune system. Patients with leukemia are more susceptible to bacterial, viral, and fungal infections.

Choice D:

Normal white blood cell count. Rationale: A normal white blood cell count would not be expected in a patient with leukemia. Leukemia is characterized by an increased number of abnormal white blood cells in the bloodstream. This condition often leads to leukocytosis, an elevated white blood cell count.

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Question 5:

A client with leukemia is receiving chemotherapy as part of the treatment plan.
What is the primary goal of chemotherapy in leukemia management?

A. To increase the number of abnormal white blood cells. B. To reduce the risk of viral infections. C. To promote the proliferation of normal blood cells. D. To decrease the number of abnormal white blood cells in the body.

Answer and Explanation

Choice A:

To increase the number of abnormal white blood cells. Rationale: The primary goal of chemotherapy in leukemia management is to decrease the number of abnormal white blood cells in the body. Chemotherapy agents are used to target and destroy rapidly dividing cancer cells, including the abnormal white blood cells produced in leukemia. Increasing the number of abnormal white blood cells would be counterproductive to leukemia treatment.

Choice B:

To reduce the risk of viral infections. Rationale: While chemotherapy can weaken the immune system temporarily, its primary goal is not to reduce the risk of viral infections. Chemotherapy is administered to target cancer cells and reduce their numbers. However, it does come with the side effect of suppressing the immune system, making patients more susceptible to infections of various types, including viral infections.

Choice C:

To promote the proliferation of normal blood cells. Rationale: Chemotherapy's primary goal in leukemia management is not to promote the proliferation of normal blood cells. While it may indirectly help in restoring normal blood cell production by reducing the competition from abnormal white blood cells, its primary focus is on targeting and reducing the population of cancerous white blood cells.

Choice D:

To decrease the number of abnormal white blood cells in the body. Rationale: This is the correct answer. Chemotherapy in leukemia management aims to reduce the number of abnormal white blood cells, thereby controlling the progression of the disease and alleviating symptoms associated with leukemia.

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Question 6:

A nurse is assessing a patient with leukemia.
The patient reports experiencing fever, chills, night sweats, and recurrent infections.
Which of the following statements made by the nurse is appropriate in this situation?

A. "These symptoms are common in leukemia, and we will monitor your condition closely.” B. "You must have caught a cold; these symptoms are not related to leukemia.” C. "I think you might be exaggerating your symptoms; leukemia doesn't cause these issues.” D. "Leukemia only causes bleeding problems, not infections.”

Answer and Explanation

Choice A:

"These symptoms are common in leukemia, and we will monitor your condition closely." Rationale: This is the appropriate response by the nurse. Fever, chills, night sweats, and recurrent infections are common symptoms in patients with leukemia due to the weakened immune system caused by the abnormal white blood cells. The nurse acknowledges the patient's concerns and provides reassurance that their symptoms are related to leukemia while also emphasizing the importance of monitoring and managing the condition.

Choice B:

"You must have caught a cold; these symptoms are not related to leukemia." Rationale: This response is incorrect because it dismisses the patient's symptoms and attributes them to a common cold. It's essential for the nurse to consider leukemia-related symptoms seriously and not downplay them, as timely intervention and management are crucial.

Choice C:

"I think you might be exaggerating your symptoms; leukemia doesn't cause these issues." Rationale: This response is inappropriate as it questions the patient's credibility and dismisses their concerns. Leukemia can indeed cause the reported symptoms due to its impact on the immune system and blood cell production. Empathy and support are important when caring for leukemia patients.

Choice D:

"Leukemia only causes bleeding problems, not infections." Rationale: This response is incorrect as it provides inaccurate information. While bleeding problems can occur in some types of leukemia, such as acute promyelocytic leukemia, leukemia can also lead to a weakened immune system and increased susceptibility to infections. The nurse should provide accurate information and address the patient's concerns appropriately.

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Question 7:

A client with leukemia presents with fatigue, weakness, pallor, and dyspnea.
The client asks the nurse about the cause of these symptoms.
Which response by the nurse is correct?

A. "These symptoms are unrelated to leukemia; they may be due to other health issues.” B. "Leukemia can lead to low red blood cell counts, causing fatigue and pallor.” C. "Leukemia primarily affects the muscles, leading to weakness and dyspnea.” D. "You might have an iron deficiency causing these symptoms, not leukemia.”

Answer and Explanation

Choice A:

"These symptoms are unrelated to leukemia; they may be due to other health issues." This response is not accurate because leukemia can indeed cause symptoms such as fatigue, weakness, pallor, and dyspnea. Leukemia often leads to a decrease in red blood cell production, which can result in anemia, leading to these symptoms.

Choice C:

"Leukemia primarily affects the muscles, leading to weakness and dyspnea." This response is incorrect. Leukemia primarily affects the bone marrow and blood cells, not the muscles. The symptoms mentioned are more related to the low red blood cell count caused by leukemia.

Choice D:

"You might have an iron deficiency causing these symptoms, not leukemia." This response is not entirely accurate because while iron deficiency can also lead to similar symptoms, it does not exclude the possibility of leukemia. Leukemia can coexist with other health issues, including iron deficiency anemia.

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Question 8:

A nurse is educating a group of patients with leukemia about diagnostic tests.
Select all the appropriate diagnostic tests for leukemia.

A. Chest x-ray. B. Electrolyte levels. C. Cytogenetic analysis. D. Lumbar puncture. E. Urinalysis.

Answer and Explanation

Choice A:

"Chest x-ray." Chest x-rays are not typically used as diagnostic tests for leukemia. They are more relevant in assessing lung and chest conditions.

Choice B:

"Electrolyte levels." Electrolyte levels are relevant in leukemia because abnormal electrolyte levels can be a sign of complications or imbalances associated with the disease.

Choice C:

"Cytogenetic analysis." Cytogenetic analysis is a crucial diagnostic test for leukemia. It helps identify specific genetic abnormalities in leukemia cells, which can guide treatment decisions and prognosis.

Choice D:

"Lumbar puncture." A lumbar puncture (spinal tap) can be used in leukemia to evaluate the cerebrospinal fluid for the presence of leukemia cells. Leukemia can sometimes spread to the central nervous system, making this test important for diagnosis and staging.

Choice E:

"Urinalysis." Urinalysis is not a standard diagnostic test for leukemia. It is primarily used to assess kidney function and screen for urinary tract infections.

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Question 9:

A patient with leukemia is undergoing a bone marrow aspiration and biopsy.
The patient asks the nurse about the purpose of this procedure.
What response by the nurse is accurate?

A. "This procedure is done to remove excess fluid from your bones.” B. "We are checking for bone fractures and joint problems.” C. "It helps us evaluate your bone marrow for abnormalities.” D. "We are looking for signs of anemia in your bones.”

Answer and Explanation

Choice A:

"This procedure is done to remove excess fluid from your bones." This response is incorrect. Bone marrow aspiration and biopsy are not performed to remove excess fluid from the bones. Their purpose is to obtain a sample of bone marrow for examination.

Choice B:

"We are checking for bone fractures and joint problems." This response is not accurate. Bone marrow aspiration and biopsy are not used to assess bone fractures or joint problems. They are specifically used to diagnose conditions related to the bone marrow, such as leukemia.

Choice D:

"We are looking for signs of anemia in your bones." While anemia can be related to abnormalities in the bone marrow, this response does not fully capture the scope of bone marrow aspiration and biopsy. These procedures are used to assess a wide range of bone marrow disorders beyond just anemia.

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Question 10:

A client with leukemia is concerned about the risk of central nervous system involvement.
The nurse explains a diagnostic procedure related to this concern.
What procedure is the nurse likely referring to?

A. Chest x-ray. B. Lumbar puncture. C. CT scan. D. Bone marrow aspiration.

Answer and Explanation

Choice A:

Chest x-ray Chest x-ray is not typically used to diagnose central nervous system involvement in leukemia. It is primarily used to assess the condition of the lungs and chest cavity. Therefore, it is not the correct procedure for the nurse to be referring to in this context.

Choice B:

Lumbar puncture A lumbar puncture, also known as a spinal tap, is the diagnostic procedure the nurse is likely referring to when discussing the risk of central nervous system involvement in leukemia. It involves the insertion of a needle into the spinal canal to collect cerebrospinal fluid (CSF) for analysis. This procedure is essential in assessing whether leukemia cells have spread to the central nervous system. Leukemic cells in the CSF can indicate central nervous system involvement, which may require specific treatment approaches.

Choice C:

CT scan While a CT scan can provide valuable information about various parts of the body, it is not the primary procedure used to diagnose central nervous system involvement in leukemia. CT scans are typically more useful for assessing solid organs and structures, not for analyzing cerebrospinal fluid.

Choice D:

Bone marrow aspiration Bone marrow aspiration is a diagnostic procedure used to assess the bone marrow and is crucial for diagnosing leukemia and determining the subtype of leukemia. It does not directly assess central nervous system involvement, so it is not the procedure the nurse is likely referring to in this context.

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Question 11:

A nurse is caring for a patient with leukemia who is at risk for infection.
Which nursing intervention should the nurse prioritize?

A. "I will administer platelet transfusions as prescribed.” B. "I will provide supplemental oxygen as needed.” C. "I will implement neutropenic precautions such as hand hygiene and isolation.” D. "I will administer erythropoietin to manage anemia.”

Answer and Explanation

Choice A:

"I will administer platelet transfusions as prescribed." Administering platelet transfusions is an important nursing intervention for a leukemia patient who is at risk for bleeding due to low platelet counts (thrombocytopenia) However, the question specifically asks about infection risk, and platelet transfusions do not address that concern. Platelet transfusions are given to manage bleeding or prevent excessive bleeding, not to prevent or manage infections.

Choice B:

"I will provide supplemental oxygen as needed." Supplemental oxygen may be necessary for leukemia patients who are experiencing respiratory distress, but it does not directly address the patient's risk of infection. In this case, infection risk is the primary concern, and implementing infection control measures should take precedence.

Choice C:

"I will implement neutropenic precautions such as hand hygiene and isolation." Neutropenic precautions are essential for leukemia patients with low neutrophil counts (neutropenia) because they are highly susceptible to infections. Isolation measures, strict hand hygiene, and infection control practices are crucial to reduce the risk of exposure to pathogens. This is the highest priority nursing intervention in this situation, as it directly addresses the patient's risk of infection.

Choice D:

"I will administer erythropoietin to manage anemia." Administering erythropoietin is appropriate for managing anemia in leukemia patients, but it does not address the patient's immediate risk of infection. Anemia and infection are both important considerations in leukemia care, but infection control should take precedence when discussing a patient at risk for infection.

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Question 12:

A client with leukemia is experiencing pain.
What action should the nurse take to manage the client's pain?

A. "I will assess pain location, intensity, quality, and frequency.” B. "I will provide nutritional support.” C. "I will administer targeted therapy.” D. "I will encourage verbalization of feelings and concerns.”

Answer and Explanation

Choice A:

"I will assess pain location, intensity, quality, and frequency." Assessing the client's pain is the initial and essential nursing action when a client with leukemia is experiencing pain. Pain assessment provides valuable information about the nature and severity of the pain, which is necessary to develop an appropriate pain management plan. Understanding the location, intensity, quality, and frequency of pain helps the nurse determine the most effective interventions, such as medications, positioning, or comfort measures, to alleviate the pain.

Choice B:

"I will provide nutritional support." Providing nutritional support is essential for clients with leukemia, especially if they are experiencing poor appetite, weight loss, or nutritional deficiencies. However, in the context of a client experiencing pain, assessing and managing the pain should be the immediate priority. Pain can significantly affect a client's ability to eat and tolerate nutritional support, so addressing pain first is crucial.

Choice C:

"I will administer targeted therapy." Administering targeted therapy may be part of the client's overall leukemia treatment plan, but it is not the appropriate initial action for managing pain. Pain assessment and intervention should come before considering any specific treatment modalities. Targeted therapy is aimed at treating the underlying leukemia, whereas pain management focuses on improving the client's comfort and quality of life.

Choice D:

"I will encourage verbalization of feelings and concerns." Encouraging verbalization of feelings and concerns is an important aspect of holistic nursing care, but it should not take precedence over pain assessment and management in this situation. While addressing emotional and psychosocial needs is essential, the client's physical comfort and pain relief should be the immediate priority when they are experiencing pain.

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Question 13:

(Select all that apply): A nurse is providing psychosocial support to a patient with leukemia.
Which actions should the nurse take to provide effective psychosocial support?

A. "Establish a trusting relationship with the patient and family.” B. "Provide information and education about the disease and treatment options.” C. "Administer analgesics as prescribed.” D. "Facilitate coping strategies and referrals to support groups or counselors.” E. "Respect the patient's values and preferences.”

Answer and Explanation

Choice A:

Establishing a trusting relationship with the patient and their family is crucial when providing psychosocial support. Trust is the foundation for effective communication and the development of a therapeutic nurse-patient relationship. It allows the patient to feel comfortable sharing their thoughts, concerns, and emotions, which can be especially important in the case of a serious illness like leukemia.

Choice B:

Providing information and education about the disease and treatment options is essential in helping the patient and their family understand what they are facing. This knowledge empowers them to make informed decisions about their care and fosters a sense of control over the situation. Education can also reduce anxiety and fear associated with the unknown.

Choice C:

Administering analgesics as prescribed is not a primary action for providing psychosocial support to a leukemia patient. While pain management is important, it is not directly related to psychosocial support. The focus of psychosocial support is on emotional and psychological well-being.

Choice D:

Facilitating coping strategies and referrals to support groups or counselors is essential in helping the patient and their family navigate the emotional challenges of leukemia. Coping strategies can include relaxation techniques, stress management, and emotional expression. Support groups and counseling provide a safe space for patients to share their experiences and receive emotional support from peers or professionals.

Choice E:

Respecting the patient's values and preferences is a fundamental aspect of patient-centered care. Each patient is unique, and their values and preferences should guide the care they receive. This respect enhances the patient's sense of autonomy and dignity, contributing to their overall well-being.

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Question 14:

A client with leukemia is receiving chemotherapy.
What are potential side effects of chemotherapy that the nurse should monitor for in this client?

A. "Rash, edema, fatigue, and diarrhea.” B. "Nausea, vomiting, alopecia, and mucositis.” C. "Difficulty breathing, cytokine release syndrome, and neurotoxicity.” D. "Skin irritation, fatigue, nausea, and dysphagia.”

Answer and Explanation

Choice A:

Rash, edema, fatigue, and diarrhea are not typical side effects of chemotherapy. While fatigue can occur, the other symptoms mentioned are not commonly associated with chemotherapy.

Choice B:

Nausea, vomiting, alopecia (hair loss), and mucositis (inflammation of the mucous membranes) are common side effects of chemotherapy. Monitoring for these side effects is essential because they can significantly impact the patient's quality of life and may require supportive care interventions such as antiemetic medications for nausea and vomiting or oral care for mucositis.

Choice C:

Difficulty breathing, cytokine release syndrome, and neurotoxicity are more commonly associated with certain immunotherapy or targeted therapy treatments rather than traditional chemotherapy. These side effects are not typical for chemotherapy in leukemia patients.

Choice D:

Skin irritation, fatigue, nausea, and dysphagia are mentioned, but they are not the most common side effects of chemotherapy in leukemia patients. The primary side effects to monitor in this context are as stated in choice B.

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Question 15:

A nurse is caring for a patient with leukemia who is receiving radiation therapy.
What are potential side effects of radiation therapy that the nurse should educate the patient about?

A. "Skin irritation, fatigue, and nausea.” B. "Neutropenia, thrombocytopenia, and anemia.” C. "Fever, chills, and hypotension.” D. "Graft-versus-host disease and organ damage.”

Answer and Explanation

Choice A:

Skin irritation, fatigue, and nausea are potential side effects of radiation therapy. Skin irritation is common at the site where radiation is administered. Fatigue is a general side effect of radiation therapy, and nausea can occur if radiation is delivered to the abdomen or gastrointestinal area.

Choice B:

Neutropenia, thrombocytopenia, and anemia are more commonly associated with chemotherapy than radiation therapy. These are hematological side effects caused by the suppression of blood cell production in the bone marrow.

Choice C:

Fever, chills, and hypotension are not typical side effects of radiation therapy. These symptoms may be associated with other medical conditions or infections but are not directly related to radiation therapy.

Choice D:

Graft-versus-host disease (GVHD) and organ damage are potential complications of bone marrow or stem cell transplantation, not radiation therapy. GVHD occurs when the transplanted cells attack the recipient's tissues, and organ damage can result from various factors in the transplant process.

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Leukemia

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