WEEK 12 POST TEST - LEUKEMIA

1. Acute myeloid leukemia (AML) is a life threatening condition in which a subset of

blood cells quickly replace healthy cells in the bone marrow. People with AML become
anemic from having too few red blood cells because healthy blood cells are being
replaced by malignant cells. They are more prone to infection because they have
insufficient white blood cells to fight infections, and their blood clots poorly because they
have insufficient platelets. Which of the following additional symptoms of AML may be
caused by having too few white blood cells? 
Bruising easily
Having frequent nosebleeds
Running a fever
Tiring quickly

Answer: Running a fever

Rationale: Running a fever. White blood cells help prevent infection. A person with too
few white blood cells may develop infections easily and experience fevers and
excessive sweating.

2. AML can be diagnosed using a variety of diagnostic techniques, which can also be
used to evaluate whether the disease has progressed outside the bloodstream. Which
of the following is often used to confirm a diagnosis of AML? 
Bone marrow examination
Computed tomography (CT) of the chest
Magnetic resonance imagery (MRI) of the brain
Ultrasonography of the abdomen

Answer: Bone marrow examination

Rationale: Bone marrow examination. To diagnose AML, a complete blood count is

done first. This is often followed by a bone marrow examination to confirm the
diagnosis. Bone marrow examination also helps to distinguish AML from other types of
leukemia.
3. Chemotherapy is frequently used as the first phase of treatment for AML patients. As
many leukemia cells as feasible must be eliminated in order to bring the patient into
remission. Which of the following is a treatment that is sometimes given to people with
AML who are in remission but are considered to be at risk of relapse? 

Radiation therapy
Spleen transplantation
Stem cell transplantation
Surgery

Answer: Stem cell transplantation

Rationale: Stem cell transplantation. People with AML who are in remission but thought
to be at risk of relapse may be given a stem cell transplant. In this procedure, stem cells
from a person with compatible tissue type are transplanted into the patient. The donor is
usually, but not always, a sibling or another family member. Sometimes compatible
stem cells may come from an unrelated person.

4. A 34 year old woman has been identified as having thrombocytopenia as a result of

acute lymphocytic leukemia. She receives care at the hospital and is admitted. 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.

Answer: to a private room so she will not be infected by other patients and health care
workers.

Rationale: Lymphocytic leukemia, disease characterized by proliferation of immature

WBCs. Immature cells unable to fight infection as competently as mature white cells.
5. In formulating a nursing diagnosis of risk for infection for a patient with chronic
lymphoid leukemia (CLL), what nursing interventions should include? Select all that
apply.

Maintaining a clean technique for all invasive procedures.

Placing the client in protective isolation.
Limiting visitors who have colds and infections.
Ensuring meticulous handwashing by all persons coming in contact with the client.

Answer:

Placing the client in protective isolation.

Limiting visitors who have colds and infections.
Ensuring meticulous handwashing by all persons coming in contact with the client.

Rationale: Chronic lymphoid leukemia (CLL) is characterized by a proliferation and

accumulation of small, abnormal mature lymphocytes in bone marrow, peripheral blood,
and body tissues. Infections and fever are frequent complications of CLL.

6. A 32 year old patient diagnosed with leukemia has central nervous system
involvement. Which instructions should the nurse teach?

Sleep with the head of the bed elevated to prevent increased intracranial pressure.
Take an analgesic medication for pain only when the pain becomes severe.
Explain that radiation therapy to the head may result in permanent hair loss.
Discuss end-of-life decisions prior to cognitive deterioration.

Answer: Explain that radiation therapy to the head may result in permanent hair loss.

Rationale:

1. Sleeping with the head of the bed elevated might relieve some intracranial pressure,
but it will not prevent intracranial pressure from occurring.
2. Analgesic medications for clients with cancer are given on a scheduled basis with a
fast-acting analgesic administered PRN for break-through pain.
3. Radiation therapy to the head and scalp area is the treatment of choice for central
nervous system involvement of any cancer. If the radiation therapy destroys the hair
follicle, the hair will not grow back.
4. Cognitive deterioration does not usually occur.
7. A nurse examines the laboratory results of a 26 year old patient receiving
chemotherapy for leukemia. The nurse notes that the platelet count is 10,000/ul. Which
intervention will the nurse document in the plan of care, based on the laboratory result?

Monitor closely for signs of infection

Monitor the temperature every 4 hours
Initiate protective isolation precautions
Use soft small toothbrush for mouth care

Answer: Use soft small toothbrush for mouth care

Rationale: If a patient is severely thrombocytopenic and has a platelet count less than
20,000/ul, bleeding precautions need to be initiated because of increased risk of
bleeding or hemorrhage.

8. In the oncology unit, a 30 years old patient is admitted with acute leukemia. Which of

the following would be the nurse's most important question to ask? 

"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?”

Answer: "Have you had a respiratory infection in the last 6 months?"

Rationale: 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; therefore, answers A, C, and D are incorrect.

9. What nursing diagnosis is made when thrombocytopenia and acute lymphocytic

leukemia are present?

potential for injury

self-care deficit
potential for self harm
alteration in comfort

Answer: potential for injury

Rationale: 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.
10. Which of the following statements on the rate of cell growth in relation to
chemotherapy is true?

Faster growing cells are less susceptible to chemotherapy.

Non-dividing cells are more susceptible to chemotherapy.
Faster growing cells are more susceptible to chemotherapy.
Slower growing cells are more susceptible to chemotherapy.

Answer: Faster growing cells are more susceptible to chemotherapy.

Rationale: The faster the cell grows, the more susceptible it is to chemotherapy and
radiation therapy. Slow-growing and non-dividing cells are less susceptible to
chemotherapy. Repeated cycles of chemotherapy are used to destroy non-dividing cells
as the begin active cell division.

11. A 28 year old patient with acute myeloid leukemia is being cared for by the nurse.
Which assessment results call for immediate action?

Temp 99, Pulse 102, RR 22, and BP 132/68

Hyperplasia of the gums
Weakness and fatigue
Pain in the left upper quadrant

Answer: Pain in the left upper quadrant

Rationale:
1. These vital signs are not alarming. The vital signs are slightly elevated and indicate
monitoring at intervals, but they do not indicate an immediate need.
2. Hyperplasia of the gums is a symptom of myeloid leukemia, but it is not an
emergency.
3. Weakness and fatigue are symptoms of the disease and are expected.
4. Pain is expected, but it is a priority, and pain control measures should be
implemented.

12. Which medications should not be taken by a patient with leukemia?

Bactrim, a sulfa antibiotic

Morphine, a narcotic analgesic
Epogen, a biologic response modifier
Gleevec, a genetic blocking agent

Answer: Epogen, a biologic response modifier

Rationale: Epogen is a biologic response modifier that stimulates the bone marrow to produce RBCs.
The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow would be generally
ineffective for the desired results and would have the potential to stimulate malignant growth.
13. Bone marrow transplantation are used to treat patients with leukemia. Which of the
following statements about bone marrow transplants 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.

Answer: The patient is under local anesthesia during the procedure.

Rationale: 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.
14. A 22 year old patient with leukemia is being treated with allopurinol (Myleran) and
busulfan (Zyloprim). The patient is informed by the nurse that allopurinol is used to
prevent?
Nausea
Alopecia
Vomiting
Hyperuricemia

Answer: Hyperuricemia

Rationale: 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.

15. A female patient, age 28, is being examined for possible acute leukemia. Which of
the following questions would the nurse ask as 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 Hodgkin’s disease as a teenager.
The client’s brother had leukemia as a child.

Answer: The client had radiation for treatment of Hodgkin’s disease as a teenager.

Rationale: Radiation treatment for other types of cancer can result in leukemia. Some
hobbies and occupations involving chemicals are linked to leukemia.
16. 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

Answer: Instituting infection control precautions

Rationale: 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.

17. A 32 year old leukemia patient is undergoing chemotherapy, which is known to

suppress bone marrow. The platelet count is 25,000/microliter based on a CBC
(complete blood count). Which of the following nursing 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.

Answer: Check for signs of bleeding, including examination of urine and stool for blood.

Rationale: 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.

18. Following Rose's acute lymphoid leukemia (ALL) diagnosis, treatment is started.
After receiving her chemotherapy, Rose is discharged from the hospital. Which of
Rose's mother's statement indicates that she understands when she will contact the
doctor?
“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”.

Answer: “I will call my doctor if Rose has persistent vomiting and diarrhea”.
Rationale: 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.

19. Gabriel experiences diarrhea with a "horse barn" smell, fever, and stomach pain
while receiving chemotherapy for lymphocytic leukemia. It would be important for the
nurse to advise to the doctor to order?

enzyme-linked immunosuppressant assay (ELISA) test.

electrolyte panel and hemogram.
stool for Clostridium difficile test.
flat plate X-ray of the abdomen.

Answer: stool for Clostridium difficile test.

Rationale: Immunosuppressed clients — for example, clients receiving chemotherapy,

are at risk for infection with C. difficile, which causes "horse barn" smelling diarrhea.

20. A nurse is worried about the patient's nutritional status and notices that a leukemia
patient is complaining of nausea. The nurse assumes that the sickness is due to the
chemotherapy regimen. The nurse would most appropriately offer which of the following
during this episode of nausea?

Cool, clear liquids

Low protein foods
Low-calorie foods
The patient's favorite food

Answer: Cool, clear liquids

Rationale: With nausea, cool and clear liquids are better tolerated. Do not offer foods
when the child is nauseated so he doesn't associate if with being sick. Support nutrition
with oral supplements and foods high in proteins and calories

21. A 40 year old woman who underwent surgery to remove a potentially cancerous
abdominal mass one day ago is being cared for by the nurse. The pathology report is
being awaited by the patient. She expresses fear of dying while crying. The most
effective nursing intervention at this point is to use this opportunity to?

Motivate change in unhealthy lifestyles.

Educate her about the seven warning signs of cancer.
Instruct her about healthy stress relief and coping practices.
Allow her to communicate about the meaning of this experience.

Answer: Allow her to communicate about the meaning of this experience.

Rationale: While the patient is waiting for diagnostic study results, the nurse should be
available to actively listen to the patient's concerns and should be skilled in techniques
that can engage the patient and the family members or significant others in a discussion
about their cancer-related fears.
22. The patient being looked after by the nurse has anorexia brought on by
chemotherapy. Which of the following strategies would the nurse use to increase the
patient's food intake be most effective?

Increase intake of liquids at mealtime to stimulate the appetite.

Serve three large meals per day plus snacks between each meal.
Avoid the use of liquid protein supplements to encourage eating at mealtime.
Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

Answer: Add items such as skim milk powder, cheese, honey, or peanut butter to
selected foods.

Rationale: The nurse can increase the nutritional density of foods by adding items high
in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or
brown sugar) to the foods that a patient will eat.

23. In a bone marrow transplantation unit, the nurse and the unlicensed assistance
people (UAP) are providing patient care. Which nursing task should the nurse delegate?

Take the hourly vital signs on a client receiving blood transfusions.

Monitor the infusion of anti-neoplastic medications.
Transcribe the HCP's orders onto the Medication Administration Record.
Determine the client's reponse to the therapy.

Answer: Take the hourly vital signs on a client receiving blood transfusions.

Rationale: After the first 15 minutes during which the client tolerates the blood
transfusion, it is appropriate to ask the UAP to take the vital signs as long as the UAP
has been given specific parameters for the vital signs. Any vital sign outside the normal
parameters must have an intervention by the nurse.

24. Which of the following the most common signs and symptoms of leukemia related to
bone marrow involvement? 

Petechiae, fever, fatigue

Headache, papilledema, irritability
Muscle wasting, weight loss, fatigue
Decreased intracranial pressure, psychosis, confusion

Answer: Petechiae, fever, fatigue

Rationale: Signs of infiltration of the bone marrow are petechiae from lowered platelet
count, fever related to infection from the depressed number of effective leukocytes, and
fatigue from the anemia.

25. The patient is admitted to the hospital for treatment of hemolytic anemia after
receiving a diagnosis of chronic lymphocytic leukemia. Which of the following actions
would best meet the patient's needs if they were included in the nursing care plan?

Encourage activities with other patients in the day room.

Isolate him from visitors and patients to avoid infection.
Provide a diet high in Vitamin C
Provide a quiet environment to promote adequate rest.

Answer: Provide a quiet environment to promote adequate rest.

Rationale: Primary problem activity intolerance due to fatigue.

26. A laboratory test reveals that a patient who has been diagnosed with acute
lymphocytic leukemia and admitted to the medical ward is neutropenic. The nurse
should perform which of the following?

Advise the client to rest and avoid exertion

Prevent client exposure of infections
Monitor the blood pressure frequently
Observe for increased bruising

Answer: Prevent client exposure of infections

Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are
responsible for the body's defense against infection.  

27. For a patient with leukemia who has undergone chemotherapy and radiation
treatment, the nurse documents a nursing problem of "altered nutrition." Which nursing
intervention should be implemented?

Administer an anti-diarrheal medication prior to meals

Monitor the client's serum albumin levels
Assess for signs and symptoms of infection
Provide skin care to irradiated areas

Answer: Monitor the client's serum albumin levels

Rationale: Serum albumin is a measure of the protein content in the blood that is
derived from food eaten; albumin monitors nutritional status.
28. A 37 year old African American woman with sickle cell anemia is admitted. Every
two hours, the nurse intends to check the lower extremities' circulation. Which of the
following outcome criteria would the nurse use?

Body temperature of 99°F or less

Toes moved in active range of motion
Sensation reported when soles of feet are touched
Capillary refill of < 3 seconds

Answer: Capillary refill of < 3 seconds

Rationale: It is important to assess the extremities for blood vessel occlusion in the
client with sickle cell anemia because a change in capillary refill would indicate a
change in circulation. 

29. Abdominal pain prompts a 15 year old admission. The patient has been overly
exhausted, pale, and prone to bruising. Hepatosplenomegaly and lymphadenopathy are
discovered during a physical examination. The patient is undergoing diagnostic tests
because acute lymphocytic leukemia is thought to be the reason. Which diagnostic
study would confirm this diagnosis? 

Platelet count
Lumbar puncture
Bone marrow biopsy
WBC count

Answer: Bone marrow biopsy

Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an

immature stage, in the bone marrow. The confirmatory test is microscopic exam of bone
marrow obtained by bone marrow aspirate and biopsy.
30. Which of the following is a nursing consideration for the administration of
chemotherapeutic drugs?

Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells.
Infiltration will not occur unless superficial veins are used for the intravenous infusion.
Many chemotherapeutic agents are vesicants that can cause severe cellular damage if
drug infiltrates.
Good hand washing is essential when handling chemotherapeutic drugs, but gloves are
not necessary.

Answer: Many chemotherapeutic agents are vesicants that can cause severe cellular
damage if drug infiltrates.

Rationale: Chemotherapeutic agents can be extremely damaging to cells. Nurses

experienced with the administration of vesicant drugs should be responsible for giving
these drugs and be prepared to treat extravasations if necessary.