You have the unfortunate task of explaining what leukemia is to a small group of parents whose children have been diagnosed with different forms of it.
Which of the following is the BEST teaching?
"Leukemia is a type of cancer that happens when the body produces white blood cells that don't help with the immune response, which is what they're supposed to do. Instead, these cells clone rapidly and leak into the bloodstream, where they replace the normal white blood cells."
"As the bad white blood cells fill the spongy stuff in some of your bones called your bone marrow, cells that produce other blood products get crowded out."
"Leukemias can be acute or chronic AND they can be lymphocytic or myeloid."
"Acute means they happen fast and progress fast, and chronic means they happen slowly and progress slowly. Additionally, lymphocytic means they happen in immature versions of a cell called 'lymphocytes', and myeloid means they involve cells called myeloid stem cells."
"There are also subtypes of both acute and chronic leukemia."
"Acute myeloid leukemia and chronic lymphocytic leukemia are the most common types of leukemia in children."
You are delivering teaching to parents of a child diagnosed with acute myeloid leukemia.
Which of the following statements shows that teaching has been received?
"This form of leukemia is characterized by uncontrolled division of cells called myeloblasts and enlargement of the bone marrow and spleen. It's quite uncommon for people under the age of 40 to get."
"This form of leukemia is characterized by abnormal division of all parts of the bone marrow, and it's associated with a chromosomal abnormality called the Philadelphia chromosome. It's very rarely seen in children."
"Most of the time, this leukemia results from a malformation in the Philadelphia chromosome. Most cases result from cancerous transformation of B-cells, causing them to reproduce quickly but not mature. This is the most common type in children."
"This type of leukemia is characterized by division and build-up of small, abnormal, mature lymphocytes, usually B-lymphocytes, in different parts of the body. It is rarely seen in children and adults under the age of 40."
You are delivering teaching to parents of a child diagnosed with chronic myeloid leukemia.
Which of the following shows that teaching has been received?
You are delivering teaching to parents of a child diagnosed with acute lymphocytic leukemia.
You are delivering teaching to parents of a child diagnosed with chronic lymphocytic leukemia.
Which of the following is NOT a manifestation of chronic lymphoid leukemia?
Fatigue and exercise intolerance r/t anemia
Bleeding
Lymphadenopathy and splenomegaly
Recurrent infections, pallor, edema, and thrombophlebitis
Which of the following is NOT a manifestation of acute myeloid leukemia?
Fatigue, weakness, fever, and headaches caused by anemia.
Bone and joint pain caused by bone infarctions or subperiosteal infiltrates.
Abnormal bleeding and bruising due to thrombocytopenia.
Recurrent infection due to neutropenia.
Lymphadenopathy, splenomegaly, and hepatomegaly.
Vomiting, visual disturbances, and seizures.
What stage of chronic myeloid leukemia is this?
The patient is largely asymptomatic.
Chronic
Accelerated
Acute
The patient has decreased appetite, weight loss, and fever.
Blast
The patient has decreased appetite, weight loss, fever, splenomegaly, bone damage, and an abnormal platelet count.
Acute phase
Accelerated phase
Chronic phase
Parents of a child diagnosed with acute lymphocytic leukemia asks you what this disorder is.
Select the correct teaching for these parents.
"ALL is the most common type of leukemia in children. It is often caused by a mutation called a translocation in a gene called the Philadelphia chromosome."
"Most cases are called by cancerous changes in white blood cells called B-cells. These cells don't function effectively enough to maintain immunity."
"Most cases are called by cancerous changes in white blood cells called T-cells. These cells don't function effectively enough to maintain immunity."
"The immature white blood cells, called lymphoblasts, build up in the bone marrow , lymph nodes, spleen, and circulating blood."
"Because the lymphoblasts divide so fast, the body doesn't produce normal blood cells; the lymph nodes and the liver enlarges; and the bones start to hurt."
Which of the types of leukemias may not require immediate treatment?
Acute myeloid leukemia
Chronic myeloid leukemia
Acute lymphocytic leukemia
Chronic lymphocytic leukemia
Most cases of leukemia are in children.
Select the pediatric patients that are at risk for developing acute lymphoid leukemia.
A 5-year-old boy recently diagnosed with a disease causing immunodeficiency.
A 2-year-old girl diagnosed with Downs syndrome.
A 10-year-old girl who was exposed to radiation following the Fukushima Daiichi nuclear disaster in 2011.
An 8-year-old whose parents smoke.
A 15-year-old diagnosed with human papilloma virus.
A 12-year-old who underwent treatment for a brain tumor as a child.
Which of the following individuals are NOT at risk of developing acute myeloid leukemia?
A 50-year-old female who spent the last 34 years as a smoker.
A 65-year-old female who lived close to the blast site when the Chernobyl disaster happened.
A 5-year-old diagnosed with Kleinfelter syndrome.
A 30-year-old who underwent treatment for ALL as a child.
The only proven risk factor for chronic myeloid leukemia is exposure to high-dose radiation.
Chronic lymphocytic leukemia has no known solid risk factors.
How can nurses prevent adverse effects related to infection in patients with leukemia?
Implement transmission-based precautions.
Perform careful hand hygiene and make sure all visitors do the same.
Take vital signs every 4 hours and report manifestations of infection.
Provide oral hygiene after every meal.
Document manifestations of infection.
Take vital signs at the beginning and end of every shift to minimize contact with patient.
Which of the following findings would you NOT report to the physician when caring for a child with leukemia?
Fever, chills, and temperature spikes.
Chest pain, painful urination, and burning in vaginal or rectal area.
Coughing.
Purulent drainage.
Tachypnea, tachycardia, changes in PaO2, and hypotension.
Neutrophil level at 2,600/mm3
Which of the following orders would you QUESTION on a leukemic child receiving IV chemotherapy.
Administer morphine 0.2 mg/kg IV push q6 hr.
TPR q4 hr, or more frequently if signs of infection are found.
Insert urinary catheter and closely monitor I & O.
Monitor IV site hourly; report to physician if bleeding and/or purulent discharge is present.
Initiate neutropenic precautions.
Infection is the second most common cause of death in people with leukemia, next to bleeding.
Select the children that are at SEVERE relative risk for infection.
Neutrophils at 2000/mm3
Neutrophils at 1,650/mm3
Neutrophils at 800/mm3
Neutrophils at 1,200/mm3
Neutrophils at 450/mm3
Neutrophils at 286/mm3
What interventions would you enact to assess for bleeding in a patient with leukemia?
Assess vital signs and skin for pallor and diaphoresis every 4 hours.
Assess all body systems, including the gums and nasal membranes, for bleeding every shift.
Assess pain hourly, specifically asking about abdominal and head pain.
Instruct the patient to vomit, urinate, and defecate into provided receptacles, and to call nursing personnel when these things occur.
Assess saline locked IVs once a shift and running IVs every 4 hours.
Apply pressure to injection sites for 1 minute.
You are receiving report on a patient with leukemia. The patient's platelet count is 40,000 cmm, and the neutrophil count is 670/mm3.
Which of the following statements would make you want to call the physician?
"The patient is scheduled for a bone marrow aspiration at 1300 today."
"The patient has been spiking fevers, so we've been taking vitals every 2 hours and assessing him for signs of infection during his hourly safety checks. "
"The patient is on both neutropenic and radiation precautions. His mom is currently in the room wearing PPE, but his dad can't visit because he has a cold."
"We've given him some Miralax because his mom reports that he's straining while pooping."
What lab values would you want to monitor and promptly report in a leukemia patient with thrombocytopenia?
Electrolytes
Uric acid
Urea nitrogen
Creatinine.
Hemoglobin
Hematocrit
