Review Lymphoma

Pathophysiology of the Hematologic System > Pathophysiology

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Lymphoma

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Question 1:

A nurse is caring for a patient diagnosed with non-Hodgkin lymphoma (NHL)
Which statement by the patient indicates a correct understanding of NHL?

A. "NHL is characterized by Reed-Sternberg cells.” B. "NHL originates from abnormal T cells.” C. "NHL is a type of leukemia.” D. "NHL affects only the bone marrow.”

Answer and Explanation

Choice A:

Reed-Sternberg cells are characteristic of Hodgkin lymphoma, not non-Hodgkin lymphoma. Non-Hodgkin lymphoma involves abnormal B or T cells, not Reed-Sternberg cells.

Choice B:

This is the correct answer. Non-Hodgkin lymphoma can originate from abnormal B cells (B-cell NHL) or T cells (T-cell NHL) It is a heterogeneous group of lymphoid malignancies, and the understanding that it can originate from abnormal T cells is correct.

Choice C:

Non-Hodgkin lymphoma is not a type of leukemia. While both are types of blood cancers, they have distinct characteristics and origins.

Choice D:

Non-Hodgkin lymphoma does not affect only the bone marrow. It primarily involves the lymphatic system, which includes lymph nodes, spleen, and other lymphoid tissues.

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Question 2:

A client with lymphoma asks the nurse about the potential risk factors for the development of this condition.
What response by the nurse is accurate?

A. "Risk factors for lymphoma include exposure to radiation and certain chemicals.” B. "Lymphoma is solely caused by genetic factors, and lifestyle choices do not play a role.” C. "Only autoimmune diseases are associated with an increased risk of lymphoma.” D. "Age and ethnicity are not considered risk factors for lymphoma.”

Answer and Explanation

Choice A:

This is the correct answer. Risk factors for lymphoma include exposure to radiation, certain chemicals, and infections such as the Epstein-Barr virus. These factors can increase the risk of developing lymphoma.

Choice B:

Lymphoma is not solely caused by genetic factors. While genetics can play a role in some cases, it is a multifactorial disease influenced by various factors, including environmental and lifestyle factors.

Choice C:

Autoimmune diseases are not the only conditions associated with an increased risk of lymphoma. Other factors, as mentioned in choice A, can also contribute to the development of lymphoma.

Choice D:

Age and ethnicity can be considered risk factors for lymphoma. For example, certain types of lymphoma are more common in older individuals, and there may be variations in lymphoma incidence based on ethnicity.

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Question 3:

(Select all that apply):
A nurse is assessing a patient with lymphoma.
Which clinical manifestations should the nurse expect to find in this patient? Select all that apply.

A. Enlarged lymph nodes. B. Unexplained weight loss. C. Elevated blood sugar levels. D. Night sweats. E. Increased blood pressure.

Answer and Explanation

Choice A:

Enlarged lymph nodes are a common clinical manifestation of lymphoma. Lymphoma can cause the lymph nodes to become enlarged and painless.

Choice B:

Unexplained weight loss is a common systemic symptom of lymphoma. It is often one of the "B symptoms" used to classify the stage of lymphoma.

Choice C:

Elevated blood sugar levels are not typically associated with lymphoma. This is not a common clinical manifestation of the disease.

Choice D:

Night sweats are another common systemic symptom of lymphoma. They are also considered one of the "B symptoms" that may be present in patients with lymphoma.

Choice E:

Increased blood pressure is not a typical clinical manifestation of lymphoma. It is not directly related to the disease process.

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Question 4:

A client recently diagnosed with Hodgkin lymphoma asks the nurse about the main difference between Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL)
How should the nurse respond?

A. "HL is characterized by the presence of Reed-Sternberg cells, while NHL is not.” B. "NHL originates from T cells, whereas HL originates from B cells.” C. "Both HL and NHL have the same clinical manifestations.” D. "HL primarily affects the digestive tract, while NHL affects lymph nodes.”

Answer and Explanation

Choice A:

Hodgkin lymphoma (HL) is characterized by the presence of Reed-Sternberg cells, which are large, abnormal B lymphocytes with multi-lobed nuclei. These cells are typically present in HL and are a hallmark feature that distinguishes it from non-Hodgkin lymphoma (NHL) Reed-Sternberg cells are not found in NHL. This difference in cell type is one of the main distinctions between HL and NHL.

Choice B:

This statement is not accurate. NHL can originate from both T cells and B cells, while HL primarily originates from B cells. However, the presence of Reed-Sternberg cells is the more distinguishing feature between the two.

Choice C:

This statement is incorrect. HL and NHL have different clinical manifestations, and their pathogenesis and treatment also differ significantly. While some symptoms may overlap, they are not the same.

Choice D:

This statement is incorrect. HL primarily affects lymph nodes, and it can also spread to other organs. NHL, on the other hand, can affect various organs, including lymph nodes, but it does not primarily affect the digestive tract. Again, the presence of Reed-Sternberg cells is a more critical distinguishing factor.

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Question 5:

A nurse is explaining the pathophysiology of lymphoma to a group of nursing students.
What key process occurs in the development of lymphoma?

A. Lymphocytes undergo apoptosis and eliminate the tumor cells. B. Altered lymphocytes proliferate and form a tumor mass. C. The tumor mass inhibits angiogenesis. D. The tumor cells are unable to spread beyond the lymphatic system.

Answer and Explanation

Choice A:

Lymphoma is characterized by the abnormal proliferation of lymphocytes, not their apoptosis. In lymphoma, lymphocytes become altered and undergo uncontrolled growth, leading to the formation of a tumor mass.

Choice B:

This is the correct answer. In lymphoma, altered lymphocytes proliferate and form a tumor mass. This abnormal proliferation of lymphocytes is a key process in the development of lymphoma.

Choice C:

The tumor mass in lymphoma does not inhibit angiogenesis. In fact, it may induce angiogenesis to supply nutrients to the growing tumor. Angiogenesis is the process of forming new blood vessels, and it is often seen in tumors to ensure their blood supply.

Choice D:

Lymphoma tumor cells can spread beyond the lymphatic system to other parts of the body. This spread is a significant concern in lymphoma, as it can lead to metastasis. Therefore, this statement is not accurate.

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Question 6:

A nurse is caring for a patient with suspected lymphoma.
The patient complains of painless swelling of multiple lymph nodes in the neck and armpit.
What other symptoms should the nurse assess for in this patient?

A. "I have been experiencing night sweats recently.” B. "I have gained weight over the last few months.” C. "I have a constant cough that won't go away.” D. "I have been feeling weak and fatigued.”

Answer and Explanation

Choice A:

Night sweats are one of the B-symptoms associated with lymphoma. B-symptoms are systemic symptoms that include night sweats, unexplained weight loss, and fever. These symptoms can be indicative of lymphoma, and their presence should be assessed in a patient with suspected lymphoma.

Choice B:

Unexplained weight loss is another B-symptom commonly associated with lymphoma. It can be a sign of lymphoma-related metabolic changes. Assessing weight loss is important in evaluating a patient with suspected lymphoma.

Choice C:

A constant cough that won't go away is not typically associated with lymphoma. While lymphoma can cause respiratory symptoms if it involves lymph nodes in the chest, such as mediastinal lymph nodes, a persistent cough is not a primary symptom.

Choice D:

Feeling weak and fatigued can be a non-specific symptom seen in various medical conditions, including lymphoma. However, it is not a B-symptom and does not specifically point to lymphoma. While fatigue can be associated with the disease, it is essential to consider other symptoms like night sweats and unexplained weight loss when assessing a patient for lymphoma.

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Question 7:

A client diagnosed with Hodgkin's lymphoma (HL) presents with enlarged lymph nodes and Reed-Sternberg cells in the biopsy specimen.
What other symptoms are commonly associated with HL?

A. "I often have fever with temperatures exceeding 38°C.” B. "I've noticed significant weight loss in the past 6 months.” C. "I experience abdominal pain and fullness.” D. "I have difficulty breathing.”

Answer and Explanation

Choice A:

Fever exceeding 38°C is a common symptom in HL, known as "Pel-Ebstein fever." This cyclic pattern of fever is characteristic of Hodgkin's lymphoma, but it is not the only common symptom. Therefore, this choice is partially correct but not the most comprehensive.

Choice B:

Significant unexplained weight loss over a period of six months or less is a classic "B" symptom associated with HL. B symptoms are systemic symptoms that indicate a more advanced stage of the disease and typically include fever, night sweats, and weight loss exceeding 10% of the patient's baseline. This choice is correct and represents a hallmark of HL.

Choice C:

Abdominal pain and fullness are not typically associated with Hodgkin's lymphoma. These symptoms are more commonly linked to other lymphoproliferative disorders or non-Hodgkin's lymphoma (NHL)

Choice D:

Difficulty breathing is not a primary symptom of Hodgkin's lymphoma. While it is possible for HL to cause enlarged lymph nodes in the mediastinum, leading to compression of the airways, this is not a common presenting symptom.

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Question 8:

A nurse is educating a group of nursing students about lymphoma.
Which of the following statements regarding lymphoma types and subtypes are accurate? (Select all that apply)

A. Hodgkin's lymphoma (HL) is commonly associated with leukemic phase. B. Mantle cell lymphoma presents with tumors in the follicles of the lymph nodes. C. Burkitt lymphoma is associated with Helicobacter pylori infection. D. Follicular lymphoma is associated with t(14;18) translocation. E. Diffuse large B-cell lymphoma is a less aggressive type of NHL.

Answer and Explanation

Choice A:

Hodgkin's lymphoma (HL) is not commonly associated with a leukemic phase. It is generally characterized by the presence of Reed-Sternberg cells and is divided into classical and nodular lymphocyte-predominant types. Leukemic phases are more commonly seen in non-Hodgkin's lymphomas (NHL), not HL.

Choice B:

Mantle cell lymphoma is associated with tumors in the mantle zone, which surrounds the follicles of the lymph nodes. This choice is correct as it accurately describes the location of tumors in this subtype of NHL.

Choice C:

Burkitt lymphoma is not typically associated with Helicobacter pylori infection. Burkitt lymphoma is more commonly linked to Epstein-Barr virus (EBV) infection.

Choice D:

Follicular lymphoma is indeed associated with the t(14;18) translocation, which results in the overexpression of the BCL-2 gene. This genetic abnormality is a hallmark of follicular lymphoma.

Choice E:

Diffuse large B-cell lymphoma (DLBCL) is a more aggressive type of NHL, not a less aggressive one. DLBCL is the most common subtype of NHL and is characterized by rapidly growing large B cells.

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Question 9:

A client with suspected lymphoma is undergoing diagnostic evaluation.
Which of the following tests or procedures is NOT typically part of the diagnostic process for lymphoma?

A. Lumbar puncture. B. Bone marrow biopsy. C. Chest X-ray. D. Blood tests.

Answer and Explanation

Choice A:

Lumbar puncture is not typically part of the routine diagnostic evaluation for lymphoma. Lymphoma primarily affects the lymphatic system and peripheral blood, so cerebrospinal fluid analysis (which is obtained through lumbar puncture) is generally not required unless there is a specific suspicion of central nervous system involvement. It is more commonly used in the evaluation of neurological conditions, infections, or conditions affecting the central nervous system.

Choice B:

Bone marrow biopsy is commonly included in the diagnostic workup for lymphoma because it helps assess the extent of bone marrow involvement, which is essential for staging and treatment planning.

Choice C:

Chest X-ray is often performed as part of the initial evaluation for lymphoma, especially to check for mediastinal lymph node enlargement or lung involvement.

Choice D:

Blood tests, including a complete blood count (CBC) and blood chemistry, are routinely performed in the diagnostic process for lymphoma. These tests can provide valuable information about the patient's overall health, including potential abnormalities in blood cell counts and markers of organ function.

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Question 10:

A nurse is conducting a health history assessment for a patient with lymphoma.
What information should the nurse prioritize collecting during this assessment?

A. "Tell me about the characteristics of your symptoms.” B. "Do you have a family history of cardiovascular disease?” C. "Have you ever had surgery?” D. "What is your favorite type of food?”

Answer and Explanation

Choice A:

When assessing a patient with lymphoma, it is crucial to gather information about the characteristics of their symptoms. Lymphoma symptoms can vary widely depending on the type, stage, and location of the cancer. Understanding the specific symptoms, such as fatigue, night sweats, enlarged lymph nodes, unexplained weight loss, and itching, can help the nurse assess the severity and progression of the disease. This information guides the healthcare team in making a diagnosis, determining the appropriate treatment plan, and monitoring the patient's response to treatment.

Choice B:

"Do you have a family history of cardiovascular disease?" While family history is important for assessing the risk of various health conditions, including cardiovascular disease, it is not the primary concern when assessing a patient with lymphoma. Lymphoma is a type of cancer, and the focus should be on gathering information related to cancer symptoms and risk factors.

Choice C:

"Have you ever had surgery?" The patient's surgical history may be relevant for their overall health assessment, but it is not the top priority when assessing a patient with lymphoma. The nurse should first focus on collecting information directly related to lymphoma symptoms, diagnosis, and treatment.

Choice D:

"What is your favorite type of food?" The patient's food preferences are not relevant to the assessment of lymphoma. This question does not provide essential information for evaluating the patient's condition or developing an appropriate care plan.

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Question 11:

A nurse is providing education and information to a patient with lymphoma.
Which of the following topics should the nurse include in the education process?

A. "I will explain the type and subtype of lymphoma.” B. "I will discuss the treatment options available.” C. "I will provide information on potential side effects.” D. "I will give you all the necessary medications.”

Answer and Explanation

Choice A:

Educating the patient about the type and subtype of lymphoma is crucial for their understanding of the disease. Lymphomas can be classified into various types, including Hodgkin lymphoma and non-Hodgkin lymphoma, each with different subtypes. Knowing the specific type and subtype of lymphoma helps the patient comprehend their diagnosis, prognosis, and treatment options, as these can vary significantly among different lymphoma types.

Choice B:

"I will discuss the treatment options available." Providing information about treatment options is an essential part of educating a patient with lymphoma. However, understanding the type and subtype of lymphoma comes first because treatment decisions are often based on this classification. Therefore, choice A takes precedence in the education process.

Choice C:

This information helps the patient prepare for what to expect during treatment.

Choice D:

"I will give you all the necessary medications." While medication management is a crucial aspect of lymphoma treatment, it should be discussed after the patient has been informed about their specific lymphoma type, treatment options, and potential side effects. The choice of medications depends on the treatment plan tailored to the patient's diagnosis.

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Question 12:

A client with lymphoma is experiencing pain and itching.
What nursing interventions should be implemented to address these symptoms?

A. "I will administer analgesics and antipyretics as prescribed.” B. "I will provide comfort measures such as cool compresses and lotion application.” C. "I will recommend avoiding all physical activity.” D. "I will perform surgery to alleviate the pain and itching.”

Answer and Explanation

Choice A:

"I will administer analgesics and antipyretics as prescribed." Administering analgesics (pain relievers) can be a helpful intervention if the client is experiencing pain, but it may not effectively address itching. Antipyretics (fever-reducing medications) are not relevant to addressing pain and itching in lymphoma patients unless they have a fever as well.

Choice B:

Providing comfort measures, such as cool compresses and lotion application, is an appropriate nursing intervention to address pain and itching in a client with lymphoma. Itching is a common symptom in some lymphomas, and these measures can help soothe the skin and alleviate discomfort. Administering analgesics (as mentioned in choice A) may be necessary for pain relief, but it is not the primary intervention for itching.

Choice C:

"I will recommend avoiding all physical activity." While it may be necessary for some patients to limit physical activity during certain phases of lymphoma treatment, recommending complete avoidance of physical activity is not a standard intervention for addressing pain and itching associated with lymphoma. In fact, gentle movement and exercises may be beneficial for maintaining mobility and overall well-being.

Choice D:

"I will perform surgery to alleviate the pain and itching." Surgical intervention is not a primary or standard approach for addressing pain and itching in lymphoma patients. Surgery is typically reserved for specific cases, such as lymph node biopsy or removal, and would not be the first-line treatment for these symptoms.

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Question 13:

(Select all that apply):
A nurse is caring for a patient with lymphoma and is monitoring for complications.
Which interventions are appropriate for preventing infection and managing bleeding in this patient? (Select three.)

A. "Administer antibiotics as prescribed.” B. "Administer platelet transfusions as prescribed.” C. "Teach the patient to avoid hand hygiene.” D. "Administer antivirals as prescribed.” E. "Teach the patient to report signs of bleeding such as bruising.”

Answer and Explanation

Choice A:

Administer antibiotics as prescribed. Patients with lymphoma often have compromised immune systems due to their disease and its treatment, making them susceptible to infections. Administering antibiotics as prescribed is appropriate to prevent and treat infections in these patients. It helps in reducing the risk of complications associated with infections, such as sepsis.

Choice B:

Administer platelet transfusions as prescribed. Lymphoma patients may experience bleeding tendencies, including thrombocytopenia, which can result from the disease itself or its treatment. Platelet transfusions can help manage bleeding and prevent hemorrhage in these patients by increasing their platelet counts.

Choice C:

Teach the patient to avoid hand hygiene. Avoiding hand hygiene is not an appropriate intervention for a patient with lymphoma. Hand hygiene is crucial in preventing infections in healthcare settings. Encouraging patients to practice proper hand hygiene is essential for infection control. Therefore, this choice is incorrect in this context.

Choice D:

Administer antivirals as prescribed. Administering antivirals is not a standard intervention for all lymphoma patients. The use of antivirals would depend on specific indications or infections. It is not a routine preventive measure in lymphoma care, so this choice is not appropriate.

Choice E:

Teach the patient to report signs of bleeding such as bruising. Educating the patient to report signs of bleeding, such as bruising, is essential in lymphoma care. Early detection and intervention can prevent complications associated with bleeding disorders. This proactive approach allows healthcare providers to assess and manage the patient's condition promptly.

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Question 14:

A client with lymphoma is experiencing weight loss and weakness.
What nutritional support measures should the nurse implement?

A. "Monitor the patient's dietary intake.” B. "Administer intravenous fluids as prescribed.” C. "Advise the patient to eat spicy and fatty foods.” D. "Recommend avoiding high-calorie foods.”

Answer and Explanation

Choice A:

Monitor the patient's dietary intake. Lymphoma patients often experience weight loss and weakness due to the effects of the disease and its treatment, including anorexia and nausea. Monitoring the patient's dietary intake is essential to assess nutritional status, identify any deficiencies, and develop an appropriate nutritional plan. It helps ensure that the patient receives adequate nutrients and calories to support their healing process.

Choice B:

Administer intravenous fluids as prescribed. While hydration is important, administering intravenous fluids should not be the first-line intervention for weight loss and weakness in a lymphoma patient. Intravenous fluids may be necessary in cases of dehydration, but they do not address the underlying nutritional issues. Other interventions, such as dietary modifications and supplements, should be considered first.

Choice C:

Advise the patient to eat spicy and fatty foods. Advising the patient to eat spicy and fatty foods is not appropriate for a patient with lymphoma who is experiencing weight loss and weakness. Such foods can exacerbate gastrointestinal symptoms, leading to discomfort and further decreased food intake. The focus should be on providing a balanced and nutritious diet.

Choice D:

Recommend avoiding high-calorie foods. Avoiding high-calorie foods is not advisable for a lymphoma patient experiencing weight loss and weakness. These patients often require extra calories to combat weight loss and support their energy needs during treatment. Encouraging a healthy intake of calories from nutritious sources is more appropriate.

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Question 15:

A nurse is promoting fluid and electrolyte balance in a patient with lymphoma.
What interventions are appropriate for this purpose?

A. "Administer intravenous fluids as prescribed.” B. "Encourage the patient to consume caffeine and alcohol.” C. "Teach the patient to report signs of imbalance.” D. "Administer diuretics as prescribed.”

Answer and Explanation

Choice A:

Administer intravenous fluids as prescribed. Lymphoma patients may experience fluid and electrolyte imbalances due to factors such as nausea, vomiting, and treatment-related side effects. Administering intravenous fluids as prescribed can help maintain hydration and electrolyte balance, especially if the patient is unable to tolerate oral intake.

Choice B:

Encourage the patient to consume caffeine and alcohol. Encouraging the consumption of caffeine and alcohol is not appropriate for a patient with lymphoma who needs to maintain fluid and electrolyte balance. Both caffeine and alcohol can have diuretic effects and may worsen dehydration and electrolyte imbalances.

Choice C:

Teach the patient to report signs of imbalance. Educating the patient to report signs of fluid and electrolyte imbalance is important for early detection and intervention. However, this alone is not sufficient as an intervention. Actual measures to address the imbalance, such as administering fluids or adjusting the treatment plan, should be implemented based on the patient's condition.

Choice D:

Administer diuretics as prescribed. Administering diuretics should not be the first-line intervention for a patient with lymphoma who is at risk of fluid and electrolyte imbalance. Diuretics can exacerbate these imbalances and should only be used when medically necessary and under the guidance of a healthcare provider.

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Lymphoma

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