Leukemia NCLEX questions

Leukemia NCLEX questions

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nh1 "The client diagnosed with leukemia has central nervous system involvement. Whichinstructions should the nurse teach?"1.Sleep with the head of the bed elevated to prevent increased intracranial pressure.

2.Take an analgesic medication for pain only when the pain becomes severe.

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

4.Discuss end-of-life decisions prior to cognitive deterioration"

"Correct: 3

1.Sleeping with the head of the bed elevatedmight 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" The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy . The nurse notes that the platelet count is 20,000/ul. Based on the laboratry result, which intervention will the nurse document in the plan of care?

• Mointor closely for signs of infection 2. Mointor the

temperature every 4hours 3. Initate prptective isolation precautions 4. Use soft small toothbrush for mouth care Correct Ans 4 If a child is severely thrombocytopenic and has a platelet count less than 20,000/ul, bleeding precautions need to be initated because of increased risk of bleeding or hemorrhage. Options 1,2,3 are related to the prevention of infection rather than bleeding

"A client with acute leukemia is admitted to the oncology unit. Which of the following would be most important for the nurse to inquire?"a. ""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 B is correct. 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."What nursing diagnosis is seen with acute lymphocytic leukemia and thromocytopenia?"A. potential for injury

• self-care deficit
• potential for self harm
• alteration in comfort"

"Answer: A potential for injury

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. " "When caring for a client with a diagnosis of

thrombocytopenia, the nurse should plan to:

"a.Discourage the use of stool softeners b.Assess temperature readings every six hours c.Avoid invasive procedures d.Encourage the use of a hard, brittle toothbrush "

"Answer: C

Rationale:

Thrombocytopenia is a deficiency of platelets, and leaves the patient more prone to hemmorrhage. For this reason, avoiding invasive procedures will limit the risk of hemorrhage. Stool softeners should be encouraged, while hard brittle toothbrushes should be avoided. Temperature is not the most important vital to track in this patient" "Which statement is correct about the rate of cell growth in relation to chemotherapy?"1. Faster growing cells are less susceptible to chemotherapy.

• Nondividing cells are more susceptible to

chemotherapy.

• Faster growing cells are more susceptible to

chemotherapy.

• Slower growing cells are more susceptible to

chemotherapy." "Answer 3 The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Slow-growing and nondividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to destroy nondividing cells as the begin active cell division." "The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assess-ment data warrant immediate intervention?

1.T 99, P 102, R 22, and BP 132/68.

2.Hyperplasia of the gums.

3.Weakness and fatigue.

4.Pain in the left upper quadrant."

"Correct: 4

1.These vital signs are not alarming. The vitalsigns are slightly elevated and indicate moni-toring at intervals, but they do not indicate animmediate 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 thedisease and are expected.

4.Pain is expected, but it is a priority, andpain control measures should be imple- mented."

"Which medication is contraindicated for a client diagnosed with leukemia?

• Bactrim, a sulfa antibiotic
• Morphine, a narcotic analgesic
• Epogen, a biologic response modifier
• Gleevec, a genetic blocking agent"

"Correct: C

• Because of the ineffective or nonexistent WBCs characteristic of leukemia, the

body cannot fight infections, and antibiotics are given to treat infections.

• Leukemic infiltrations into the organs or the CNS cause pain. Morphine is the

drug of choice for most clients with cancer.

• 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.

• Gleevec is a drug that specifically works in leukemic cells to block the

expression of the BCR-ABL protein, preventing the cells from growing and dividing." "A child with leukemia is complaining of nausea. A nurse suspects that the nausea is related to the chemotherapy regimen. The nurse, concerned about the child's nutritional status, most appropriately would offer which of the following during this episode of nausea?"1. Cool, clear liquids

• Low protein foods
• Low-calorie foods
• The child's favorite food"

"Correct: 1.

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" Which of the following laboratory values could indicate that a child has leukemia?"1. WBCs 32,000/mm3

• Platelets 300,000/mm3
• Hemoglobin 15g/dL
• Blood pH of 7.35"

"Correct: 1.

• YES! - A normal WBC count is approximately 4.5 mm3 - 11.0 mm3. In leukemia a

high WBC count is diagnostic and is usually confirmed by a blood smear.2-4. None of these indicate leukemia," The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the patient's nutritional intake?"A. 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."

"Correct Answer: D

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.Other Rationales: Increasing liquids at meals can cause a patient to feel full faster, leading to eating fewer calories.Eating three large meals isn't possible for a patient on chemotherapy due to the decreased taste sensation.Liquid protein supplements should when needed but they lead to less eating during mealtimes due to feeling of satiation."

A client has developed oral mucositis as a result of radiation to the head and neck. The nurse shouls teach the client to incorporate which of the following measures in his or her daily home care routine?

• oral hygiene should be performed in the morning and

evening

• high-protein foods, such as peanut butter, should be

incorporated in the diet

• a glass of wine per day will not pose any further harm

to the oral cavity

• a combination of a weak saline and water solution

should be used to rinse the mouth before and after each meal" "2) D Oral mucositis (irritation, inflammation, and/or ulceration of the mucosa) commonly occurs in clients receiving radiation to the head and neck. Measures need to be taken to soothe the mucosa as well as provide effective cleansing of the oral cavity. A combination of a weak saline and water solution is an effective cleansing agent." "The nurse and the unlicensed assistive personnel (UAP) are caring for clients in a bone marrow transplantation unit. Which nursing task should the nurse delegate?"A. Take the hourly vital signs on a client receiving blood transfusions.

• Monitor the infusion of antineoplastic medications.
• Transcribe the HCP's orders onto the Medication

Administration Record.

• Determine the client's reponse to the therapy."

"Correct: A.

Explanation:

• 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.

• Antineoplastic medication infusions must be monitored by a chemotherapy-

certified, competent nurse.

• This is the responsibility of the word secretary or the nurse, not the unlicensed

personnel.

• This represents the evaluation portion of the nursing process and cannot be

delegated." "The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following?"A. Petechiae, fever, fatigue

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

"Answer A is Correct.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." "A client, diagnosed with chronic lymphocytic leukemia, is admitted to the hospital for treatment of hemolytic anemia. Which of the following measures, if incorporated into the nursing care plan, would best address the patient's needs?"1. 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."

"Correct: D.

• does not meet need for rest
• no info given about WBC or reverse isolation, on reverse isolation if neutrophil

count is less than 500/mm3

• needed for wound healing and resistance to infection, not best choice
• primary problem activity intolerance due to fatigue. Correct"