Nokea
The new nurse requests information about chronic lymphocytic leukemia (CLL). Which statements should an experienced nurse include?
- A. CLL is a malignancy of activated B lymphocytes.
- B. CLL is the most common malignancy of older adults.
- C. CLL is unresponsive to chemotherapy treatment.
- D. Clients are monitored in its early stages and often not treated.
- E. In CLL immature lymphocytes accumulate in the bone marrow.
- F. Clients with CLL often have no symptoms of the disorder.
Correct Answer: A, B, D, F
Rationale: CLL derives from a malignant clone of B lymphocytes. T-lymphocytic CLL is rare. B. Two-thirds of all persons with CLL are older than 60 years at diagnosis. C. Treatment for CLL includes chemotherapy with fludarabine (Fludara), but a major side effect is prolonged bone marrow suppression. D. Clients with CLL are monitored, and treatment is initiated when symptoms are severe (night sweats, painful lymphadenopathy) or the disease progresses to later stages. E. In CLL there is an accumulation of mature-appearing but functionally inactive lymphocytes, and not immature lymphocytes. Excessive accumulation of immature lymphocytes occurs in ALL. F. Because many persons are asymptomatic, it is often diagnosed during a routine physical or during treatment for another condition.
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Which client would be most at risk for developing disseminated intravascular coagulation (DIC)?
- A. A 35-year-old pregnant client with placenta previa.
- B. A 42-year-old client with a pulmonary embolus.
- C. A 60-year-old client receiving hemodialysis three (3) days a week.
- D. A 78-year-old client diagnosed with septicemia.
Correct Answer: D
Rationale: Septicemia (D) is a major DIC trigger due to systemic inflammation/coagulation. Placenta previa (A), PE (B), and dialysis (C) are lower risk.
A 5-year-old boy is admitted because he bled profusely when he lost his first baby tooth. After a workup, he is diagnosed as having classic hemophilia. His mother asks the nurse if his two younger sisters will also develop hemophilia. What is the best answer for the nurse to give?
- A. They will not develop the disease.'
- B. Statistically, one of them is likely to develop the disease.'
- C. They are not likely to get the disease, but they may be carriers.'
- D. If it doesn't show up by the time they start school, they are unlikely to develop the condition.'
Correct Answer: C
Rationale: Hemophilia is an X-linked recessive disorder. Females are unlikely to develop the disease but may be carriers, especially if the mother is a carrier.
The nurse is caring for the client placed on neutropenic precautions. Which interventions should the nurse implement?
- A. Apply pressure for at least 5 minutes to any site that is bleeding.
- B. Prevent anyone from bringing fresh flowers into the client’s room.
- C. Teach the client to avoid eating unwashed fruit and vegetables.
- D. Perform hand hygiene before touching any of the client’s belongings.
- E. Inform the client that fresh water will be delivered every hour.
- F. Stop visitors from entering the room if observed to be coughing.
Correct Answer: B, C, D, F, A.
Rationale: Pressure should be applied to an area that is bleeding when the client has thrombocytopenia, not neutropenia. B. Fresh flowers harbor microorganisms that can cause an infection. C. Unwashed fruits and vegetables have been found to be colonized with various bacteria, particularly gram-negative enteric organisms, as well as pseudomonas and fungi. Recent research indicates that well-washed fresh fruits and vegetables may be eaten. D. Hand hygiene reduces microbial counts on hands and helps to prevent the transmission of microorganisms to the client’s belongings. E. The client should not consume any liquids that have been standing at room temperature for longer than an hour due to risk of microbial colonization. F. Visitors with a transmittable infection place the client at a high risk for becoming infected due to the client’s depressed immune system.
Which of the following would be the best lunch for a client with folic acid deficiency anemia?
- A. Bologna sandwich and vegetable soup
- B. Grilled cheese sandwich and tomato soup
- C. Coleslaw and cream of mushroom soup
- D. Spinach salad and bean soup
Correct Answer: D
Rationale: Spinach and beans are rich in folate, making this lunch ideal for folic acid deficiency anemia.
A child who is being treated for leukemia develops stomatitis. Which of the following nursing care measures is essential?
- A. Using dental floss to clean the teeth
- B. Frequent cleaning of the mouth with an astringent mouthwash
- C. Use of an overbed cradle
- D. Swabbing the mouth with moistened cotton swabs
Correct Answer: D
Rationale: Swabbing the mouth with moistened cotton swabs gently cleans the mouth without irritating stomatitis. Flossing or astringent mouthwash may worsen irritation, and an overbed cradle is unrelated.