Deck 79: Management of Clients with Leukemia and Lymphoma

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?

A) A sandwich
B) Cold applesauce
C) Hot soup
D) Vanilla milkshake

Answer 1

Hot soup

Question 2

The nurse explains that acute leukemia is caused by

A) accumulation of immature blast cells.
B) excessively rapid mitosis of leukemic cells.
C) proliferation of neutrophils.
D) undifferentiated blast cells entering bone marrow.

Answer 2

accumulation of immature blast 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

A) a drastic decrease in monocytes.
B) a hemoglobin drop to 9 g/dl.
C) myeloid cell precursors >20%.
D) thrombocytic proliferation.

Answer 3

myeloid cell precursors >20%.

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

A) can frequently produce a remission after only 1 cycle.
B) negates the need for radiation therapy.
C) prevents hypercalcemia.
D) reduces the risk 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

A) BMT or stem cell transplantation.
B) immunosuppressants.
C) more chemotherapy.
D) systemic steroids.

Question 6

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

A) allow no plants or live flowers in the room.
B) allow no visitors at this time.
C) ensure strict adherence to hand-washing protocol.
D) place the client on protective isolation.
E) restrict the client's access to raw fruits and vegetables.

Question 7

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

A) are nodes on both sides of the diaphragm with para-aorta involvement.
B) are nodes on both sides of the diaphragm with portal involvement.
C) is involvement of a single lymphoid structure.
D) might be a single node on one side of the diaphragm.

Question 8

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

A) graft-versus-host disease.
B) hemorrhage.
C) pulmonary complications.
D) Sjögren's syndrome.

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)

A) describing the physical changes that may occur with chemotherapy affecting sexuality.
B) explaining that because of fatigue or other causes, libido may be decreased during chemotherapy.
C) informing the client and partner that you will call a social worker who can address their concerns.
D) informing the client about some reproductive alternatives such as sperm banking and egg harvesting.
E) offering information on alternative sexual positioning and techniques the client can try.

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

A) acute lymphoblastic leukemia.
B) chronic lymphocytic leukemia.
C) Hodgkin's disease.
D) severe bone marrow depression.

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?

A) Anorexia
B) Bleeding
C) Hypoglycemia
D) Infection

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.)

A) Allopurinol (Zyloprim)
B) Increased IV fluids
C) Rasburicase (Elitek)
D) Urine acidifiers

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

A) decrease the number of monocytes.
B) induce complete remission.
C) reduce long bone pain and splenomegaly.
D) "shock" the marrow into producing normal cells.

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

A) is likely to prevent successful engraftment.
B) may prevent leukemic relapse.
C) is treatable with steroids.
D) is usually fatal very quickly.

Question 15

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

A) cellular components of the blood are reduced.
B) platelets are immature and dividing rapidly.
C) red cells have become polymorphic.
D) white cells are poorly undifferentiated.

Question 16

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

A) encourage iron-rich foods.
B) increase fluid intake.
C) institute bleeding precautions.
D) place the client in protective isolation.