Leukemia NCLEX questions NCLEX EXAM PREVIEW

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NCLEX EXAM PREVIEW

110 terms kandykat1012Preview Lung cancer questions 21 terms chelseatucker_ Preview Sickle Cell Anemia NCLEX QUESTIO...210 terms sundus_abdii Preview Lupus N 18 terms jane "In formulating a nursing diagnosis of risk for infection for a client with chronic lymphoid leukemia (CLL), nursing

measures should include: (Select all that apply.)

"A. 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."

"Correct Answers: B, C, D

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." "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 68-year-old woman is diagnosed with thrombocytopenia due to acute lymphocytic leukemia.She is admitted to the hospital for treatment. The nurse

should assign the patient:

"A. To a private room so she will not infect other patients and healthcare workers

• To a private room so she will not be infected by other

patients and healthcare 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"

"Correct Answer: B

• To a private room so she will not infect other patients and health care workers

— poses little or no threat

• To a private room so she will not be infected by other patients and health care

workers — CORRECT: protects patient from exogenous bacteria, risk for

developing infection from others due to depressed WBC count, alters ability to fight infection

• To a semiprivate room so she will have stimulation during her hospitalization —

should be placed in a room alone

• To a semiprivate room so she will have the opportunity to express her feelings

about her illness — ensure that patient is provided with opportunities to express feelings about illness" "A 33-year-old male is being evaluated for possible acute leukemia. Which of the following would the nurse inquire about as a part of the assessment?"a. 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 C is correct. Radiation treatment for other types of cancer can result in leukemia. Some hobbies and occupations involving chemicals are linked to leukemia, but not the ones in these answers; therefore, answers A and B are incorrect. Answer D is incorrect because the incidence of leukemia is higher in twins than in siblings."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"

"The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a suspected malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die.The most effective nursing intervention at this point is to

use this opportunity to:

"a. 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."

"Correct answer: D

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." 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."