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.
The nurse identifies a concept of hematologic regulation for a client diagnosed with leukemia. Which clinical manifestations support the concept?
- A. The client has petechiae on the trunk and extremities.
- B. The client complains of pain and swelling in the joints.
- C. The client has an Hbg of 9.7 and Hct of 32%.
- D. The client complains of a headache and slurred speech.
Correct Answer: A,C
Rationale: Petechiae (A) and low Hb/Hct (C) reflect leukemia’s impact on hematologic regulation (thrombocytopenia, anemia). Joint pain (B) is less common, and headache/slurred speech (D) suggest stroke.
Ferrous sulfate is prescribed for a client. She returns to the clinic in two weeks. Which assessment by the nurse indicates that she has NOT been taking iron as ordered?
- A. The client's cheeks are flushed.
- B. The client reports having more energy.
- C. The client complains of nausea.
- D. The client's stools are light brown.
Correct Answer: D
Rationale: Iron turns stool black. Light brown stools indicate the client has not been taking iron as prescribed. Flushed cheeks, increased energy, and nausea can be associated with iron therapy compliance.
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.
The client has a blood type of B negative. The client’s family asks if they can donate blood for the client. The nurse informs the family that they would need to be of which blood type to be considered for a directed donation of RBCs for this client?
- A. Type A positive
- B. Type B positive
- C. Type B negative
- D. Type O positive
- E. Type O negative
- F. Type AB positive
Correct Answer: C, E, A
Rationale: Blood type A positive has the D antigen on the RBC, making it incompatible with blood type B negative. B. Blood type B positive has the D antigen on the RBC, making it incompatible with blood type B negative. C. The client with B negative blood type has B antigen on the RBC and does not have an Rh (or D) antigen on the cell. Because the client can receive RBCs of the same blood type, a person with type B negative blood could be considered for a directed donation. D. Blood type O positive has the D antigen, making it incompatible with blood type B negative. E. Type O negative has no antigens on the RBC so a directed donation from a person with type O negative blood could also be considered. F. Blood type AB positive has the D antigen on the RBC, making it incompatible with blood type B negative.