MSN Exam for Acute Leukemia

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1) A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client’s chemotherapy regimen is to:

  1. Prevent metabolic breakdown of xanthine to uric acid
  2. Prevent uric acid from precipitating in the ureters
  3. Enhance the production of uric acid to ensure adequate excretion of urine
  4. Ensure that the chemotherapy doesn’t adversely affect the bone marrow

2) A nurse is caring for a patient with acute lymphoblastic leukemia (ALL). Which of the following is the most likely age range of the patient?

  1. 3-10 years.
  2. 25-35 years.
  3. 45-55 years.
  4. over 60 years.

3) The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). The nurse tells the client that the purpose if the allopurinol is to prevent:

  1. Nausea
  2. Alopecia
  3. Vomiting
  4. Hyperuricemia

4) An African American client is admitted with acute leukemia. The nurse is assessing for signs and symptoms of bleeding. Where is the best site for examining for the presence of petechiae?

  1. The abdomen
  2. The thorax
  3. The earlobes
  4. The soles of the feet

5) 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?

  1. The client collects stamps as a hobby.
  2. The client recently lost his job as a postal worker.
  3. The client had radiation for treatment of Hodgkin’s disease as a teenager.
  4. The client’s brother had leukemia as a child.

6) A client with acute leukemia is admitted to the oncology unit. Which of the following would be most important for the nurse to inquire?

  1. “Have you noticed a change in sleeping habits recently?”
  2. “Have you had a respiratory infection in the last 6 months?”
  3. “Have you lost weight recently?”
  4. “Have you noticed changes in your alertness?”

7) Francis with leukemia has neutropenia. Which of the following functions must frequently assessed?

  1. Blood pressure
  2. Bowel sounds
  3. Heart sounds
  4. Breath sounds

8) The treatment protocol for a client with acute lymphatic leukemia includes prednisone, methotrexate, and cimetadine. The purpose of the cimetadine is to:

  1. Decrease the secretion of pancreatic enzymes
  2. Enhance the effectiveness of methotrexate
  3. Promote peristalsis
  4. Prevent a common side effect of prednisone

9) A 4-year-old is admitted with acute leukemia. It will be most important to monitor the child for:

  1. Abdominal pain and anorexia
  2. Fatigue and bruising
  3. Bleeding and pallor
  4. Petechiae and mucosal ulcers

10) The nurse is reviewing the laboratory report of a client who underwent a bone marrow biopsy. The finding that would most strongly support a diagnosis of acute leukemia is the existence of a large number of immature:

  1. lymphocytes
  2. thrombocytes
  3. reticulocytes
  4. leukocytes

11) A leukemia patient has a relative who wants to donate blood for transfusion. Which of the following donor medical conditions would prevent this?

  1. A history of hepatitis C five years previously.
  2. Cholecystitis requiring cholecystectomy one year previously.
  3. Asymptomatic diverticulosis.
  4. Crohn’s disease in remission.

12) A patient with leukemia is receiving chemotherapy that is known to depress bone marrow. A CBC (complete blood count) reveals a platelet count of 25,000/microliter. Which of the following actions related specifically to the platelet count should be included on the nursing care plan?

  1. Monitor for fever every 4 hours.
  2. Require visitors to wear respiratory masks and protective clothing.
  3. Consider transfusion of packed red blood cells.
  4. Check for signs of bleeding, including examination of urine and stool for blood.

13) Which of the following would the nurse identify as the initial priority for a child with acute lymphocytic leukemia?

  1. Instituting infection control precautions
  2. Encouraging adequate intake of iron-rich foods
  3. Assisting with coping with chronic illness
  4. Administering medications via IM injections

14) A 22-year-old man is admitted to the hospital with complaints of fatigue and weight loss. Physical examination reveals pallor and multiple bruises on his arms and legs. The results of the patients tests reveal acute lymphocytic leukemia and thrombocytopenia. Which of the following nursing diagnoses MOST accurately reflects his condition?

  1. Potential for injury.
  2. Self-care deficit
  3. Potential for self-harm.
  4. Alteration in comfort.

15) Which of the following would be the priority nursing diagnosis for the adult client with acute leukemia?

  1. Oral mucous membrane, altered related to chemotherapy
  2. Risk for injury related to thrombocytopenia
  3. Fatigue related to the disease process
  4. Interrupted family processes related to life-threatening illness of a family member

16) The patient receiving mitoxantrone (Novantrone) for treatment of secondary progressive multiple sclerosis (MS) is closely monitored for

  1. leukopenia and cardiac toxicity.
  2. mood changes and fluid and electrolyte alterations.
  3. renal insufficiency.
  4. hypoxia.

17) Marie with acute lymphocytic leukemia suffers from nausea and headache. These clinical manifestations may indicate all of the following except

  1. effects of radiation
  2. chemotherapy side effects
  3. meningeal irritation
  4. gastric distension

18) Situation: Stacy is diagnosed with acute lymphoid leukemia (ALL) and beginning chemotherapy. Stacy is discharged from the hospital following her chemotherapy treatments. Which statement of Stacy’s mother indicated that she understands when she will contact the physician?

  1. “I should contact the physician if Stacy has difficulty in sleeping”.
  2. “I will call my doctor if Stacy has persistent vomiting and diarrhea”.
  3. “My physician should be called if Stacy is irritable and unhappy”.
  4. “Should Stacy have continued hair loss, I need to call the doctor”.

19) A patient is undergoing the induction stage of treatment for leukemia. The nurse teaches family members about infectious precautions. Which of the following statements by family members indicates that the family needs more education?

  1. We will bring in books and magazines for entertainment.
  2. We will bring in personal care items for comfort.
  3. We will bring in fresh flowers to brighten the room.
  4. We will bring in family pictures and get well cards.

20) A child with leukemia is being discharged after beginning chemotherapy. What instructions will the nurse include in the teaching plan for the parents of this child?

  1. Provide a diet low in protein and high in carbohydrates
  2. Avoid fresh vegetables that are not cooked or peeled
  3. Notify the M.D. if the child’s temperature exceeds 101F (39C)
  4. Increase the use of humidifiers throughout the house

21) The treatment for patients with leukemia is bone marrow transplantation. Which statement about bone marrow transplantation is not correct?

  1. The patient is under local anesthesia during the procedure
  2. The aspirated bone marrow is mixed with heparin.
  3. The aspiration site is the posterior or anterior iliac crest.
  4. The recipient receives cyclophosphamide (Cytoxan) for 4 consecutive days before the procedure.

22) What is the peak age range in acquiring acute lymphocytic leukemia (ALL)?

  1. 4 to 12 years.
  2. 20 to 30 years
  3. 40 to 50 years
  4. 60 to 70 years

23) A client jokes about his leukemia even though he is becoming sicker and weaker. The nurse’s most therapeutic response would be:

  1. “Your laugher is a cover for your fear.”
  2. “He who laughs on the outside, cries on the inside.”
  3. “Why are you always laughing?”
  4. “Does it help you to joke about your illness?”

24) The laboratory results of the client with leukemia indicate bone marrow depression. The nurse should encourage the client to:

  1. Increase his activity level and ambulate frequently
  2. Sleep with the head of his bed slightly elevated
  3. Drink citrus juices frequently for nourishment
  4. Use a soft toothbrush and electric razor

25) During chemotherapy for lymphocytic leukemia, Mathew develops abdominal pain, fever, and “horse barn” smelling diarrhea. It would be most important for the nurse to advise the physician to order:

  1. enzyme-linked immunosuppressant assay (ELISA) test.
  2. electrolyte panel and hemogram.
  3. stool for Clostridium difficile test.
  4. flat plate X-ray of the abdomen.

26) 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

  1. to a private room so she will not infect other patients and health care workers.
  2. to a private room so she will not be infected by other patients and health care workers.
  3. to a semiprivate room so she will have stimulation during her hospitalization.
  4. to a semiprivate room so she will have the opportunity to express her feelings about her illness.
Answers and Rationales
  1. A. Prevent metabolic breakdown of xanthine to uric acid . The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk by preventing the breakdown of xanthine to uric acid. Allopurinol doesn’t act in the manner described in the other options.
  2. A. 3-10 years. The peak incidence of ALL is at 4 years (range 3-10). It is uncommon after the mid-teen years. The peak incidence of chronic myelogenous leukemia (CML) is 45-55 years. The peak incidence of acute myelogenous leukemia (AML) occurs at 60 years. Two-thirds of cases of chronic lymphocytic leukemia (CLL) occur after 60 years.
  3. D. Hyperuricemia . 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. Allopurinol is not used to prevent alopecia, nausea, or vomiting.
  4. D. The soles of the feet . Petechiae are not usually visualized on dark skin. The soles of the feet and palms of the hand provide a lighter surface for assessing the client for petichiae.
  5. C. The client had radiation for treatment of Hodgkin’s disease as a teenager. 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.
  6. B. “Have you had a respiratory infection in the last 6 months?”  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
  7. D. Breath sounds . Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent assessment of respiratory rate and breath sounds is required. Although assessing blood pressure, bowel sounds, and heart sounds is important, it won’t help detect pneumonia.
  8. D. Prevent a common side effect of prednisone . A common side effect of prednisone is gastric ulcers. Cimetadine is given to help prevent the development of ulcers.
  9. C. Bleeding and pallor . The child with leukemia has low platelet counts, which contribute to spontaneous bleeding.
  10. D. leukocytes . Leukemia is manifested by an abnormal overpopulation of immature leukocytes in the bone marrow.
  11. A. A history of hepatitis C five years previously. Hepatitis C is a viral infection transmitted through bodily fluids, such as blood, causing inflammation of the liver. Patients with hepatitis C may not donate blood for transfusion due to the high risk of infection in the recipient. Cholecystitis (gall bladder disease), diverticulosis, and history of Crohn’s disease do not preclude blood donation.
  12. D. Check for signs of bleeding, including examination of urine and stool for blood. 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. Monitoring for fever and requiring protective clothing are indicated to prevent infection if white blood cells are decreased. Transfusion of red cells is indicated for severe anemia.
  13. A. Instituting infection control precautions . 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. Iron-rich foods help with anemia, but dietary iron is not an initial intervention. The prognosis of ALL usually is good. However, later on, the nurse may need to assist the child and family with coping since death and dying may still be an issue in need of discussion. Injections should be discouraged, owing to increased risk from bleeding due to thrombocytopenia.
  14. A. Potential for injury. Question: What nursing diagnosis is seen with acute lymphocytic leukemia and thromocytopenia? Needed Info: Thromocytopenia: decreased platelet count increases the patient’s risk for injury, normal count: 200,000-400,000 per mm3. Leukemia: group of malignant disorders involving overproduction of immature leukocytes in bone marrow. This shuts down normal bone marrow production of erythrocytes, platelets, normal leukocytes. Causes anemia, leukopenia, and thrombocytopenia leading to infection and hemorrhage. Symptoms: pallor of nail beds and conjunctiva, petechiae (small hemorrhagic spot on skin), tachycardia, dyspnea, weight loss, fatigue. Treatment: chemotherapy, antibiotics, blood transfusions, bone marrow transplantation. Nursing responsibilities: private room, no raw fruits or vegs, small frequent meals, O2, good skin care.
    • Potential for injury — CORRECT: 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.
    • Self-care deficit — may feel weak, doesn’t address condition
    • Potential for self-harm — implies risk for purposeful self-injury, not given any info, assumption
    • Alteration in comfort — patient is not comfortable, and comfort measures would address problem
  15. B. Risk for injury related to thrombocytopenia . The client with acute leukemia has bleeding tendencies due to decreased platelet counts, and any injury would exacerbate the problem.
  16. A. leukopenia and cardiac toxicity. Mitoxantrone is an antineoplastic agent used primarily to treat leukemia and lyphoma but is also used to treat secondary progressive MS. Patients need to have laboratory tests ordered and the results closely monitored due to the potential for leukopenia and cardiac toxicity.
  17. D. gastric distension . Acute Lymphocytic Leukemia (ALL) does not cause gastric distention. It does invade the central nervous system, and clients experience headaches and vomiting from meningeal irritation.
  18. B. “I will call my doctor if Stacy has persistent vomiting and diarrhea”. 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. C. We will bring in fresh flowers to brighten the room. During induction chemotherapy, the leukemia patient is severely immunocompromised and at risk of serious infection. Fresh flowers, fruit, and plants can carry microbes and should be avoided. Books, pictures, and other personal items can be cleaned with antimicrobials before being brought into the room to minimize the risk of contamination.
  20. B. Avoid fresh vegetables that are not cooked or peeled 
  21. A. The patient is under local anesthesia during the procedure . 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.
  22. A. 4 to 12 years. The peak incidence of Acute Lymphocytic Leukemia (ALL) is 4 years of age. It is uncommon after 15 years of age.
  23. D. “Does it help you to joke about your illness?” This non-judgmentally on the part of the nurse points out the client’s behavior.
  24. D. Use a soft toothbrush and electric razor . Suppression of red bone marrow increases bleeding susceptibility associated with thrombocytopenia, decreased platelets. Anemia and leucopenia are the two other problems noted with bone marrow depression.
  25. C. stool for Clostridium difficile test. Immunosuppressed clients — for example, clients receiving chemotherapy, — are at risk for infection with C. difficile, which causes “horse barn” smelling diarrhea. Successful treatment begins with an accurate diagnosis, which includes a stool test. The ELISA test is diagnostic for human immunodeficiency virus (HIV) and isn’t indicated in this case. An electrolyte panel and hemogram may be useful in the overall evaluation of a client but aren’t diagnostic for specific causes of diarrhea. A flat plate of the abdomen may provide useful information about bowel function but isn’t indicated in the case of “horse barn” smelling diarrhea.
  26. B. to a private room so she will not be infected by other patients and health care workers. 
    • Question: What are the needs of the patient with acute lymphocytic leukemia and thrombocytopenia?
    • Needed Info: Lymphocytic leukemia, disease characterized by proliferation of immature WBCs. Immature cells unable to fight infection as competently as mature white cells. Treatment: chemotherapy, antibiotics, blood transfusions, bone marrow transplantation.
    • Nursing responsibilities: private room, no raw fruits or vegs, small frequent meals, O2, good skin care.
      • 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

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