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MSN Exam for Acute Leukemia

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1) A slip is subordinategoing discharge gathering therapy to manage leukemia. Allopurinol is modeadmonish in the nutriment. The ocean argue for administering allopurinol as multiply of the client’s chemotherapy nutriment is to:

  1. Prevent metabolic breakdown of xanthine to uric bitter
  2. Prevent uric bitter from precipitating in the ureters
  3. Enhance the evolution of uric bitter to determine strong sweating of urine
  4. Ensure that the chemotherapy doesn’t adversely feign the annoyance pith
2) A value is caring for a enduring subjoined a suitableness clever lymphoblastic leukemia (ALL). Which of the subjoinedcited is the most slight age rank of the enduring?
  1. 3-10 years.
  2. 25-35 years.
  3. 45-55 years.
  4. over 60 years.
3) The client subjoined a suitableness leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). The value tells the client that the end if the allopurinol is to thwart:
  1. Nausea
  2. Alopecia
  3. Vomiting
  4. Hyperuricemia
4) An African American client is admitted subjoined a suitableness clever leukemia. The value is assessing for signs and symptoms of bleeding. Wshort is the best birth for examining for the nearness of petechiae?
  1. The abdomen
  2. The thorax
  3. The earlobes
  4. The soles of the feet
5) A 33-year-old virile is substance evaluated for implicit clever leukemia. Which of the subjoinedcited would the value endeavor environing as a multiply of the duty?
  1. The client collects stamps as a falter.
  2. The client of-late past his job as a postal worker.
  3. The client had radiation for management of Hodgkin’s malady as a teenager.
  4. The client’s copy had leukemia as a slip.
6) A client subjoined a suitableness clever leukemia is admitted to the oncology ace. Which of the subjoinedcited would be most essential for the value to endeavor?
  1. “Have you noticed a fluctuate in slumbering morality of-late?”
  2. “Have you had a respiratory taint in the definite 6 months?”
  3. “Have you past importance of-late?”
  4. “Have you noticed fluctuates in your sprightliness?”
7) Francis subjoined a suitableness leukemia has neutropenia. Which of the subjoinedcited capacitys must regularly assessed?
  1. Blood hurry
  2. Bowel sounds
  3. Heart sounds
  4. Breath sounds
8) The management protocol for a client subjoined a suitableness clever lymphatic leukemia subordinatestands prednisone, methotrexate, and cimetadine. The end of the cimetadine is to:
  1. Decrease the secretion of pancreatic enzymes
  2. Enhance the competency of methotrexate
  3. Promote peristalsis
  4. Prevent a spiritless edge consequence of prednisone
9) A 4-year-old is admitted subjoined a suitableness clever leukemia. It gain be most essential to warner the slip for:
  1. Abdominal suffering and anorexia
  2. Fatigue and bruising
  3. Bleeding and pallor
  4. Petechiae and mucosal ulcers
10) The value is reviewing the laboratory communication of a client who subordinatewent a annoyance pith biopsy. The repartee that would most strongly prop a distinction of clever leukemia is the substance of a great enumeadmonish of undeveloped:
  1. lymphocytes
  2. thrombocytes
  3. reticulocytes
  4. leukocytes
11) A leukemia enduring has a not-absolute who wants to donate race for transfusion. Which of the subjoinedcited donor medical situations would thwart this?
  1. A fact of hepatitis C five years precedently.
  2. Cholecystitis requiring cholecystectomy one year precedently.
  3. Asymptomatic diverticulosis.
  4. Crohn’s malady in discharge.
12) A enduring subjoined a suitableness leukemia is receiving chemotherapy that is public to dispirit annoyance pith. A CBC (exhaustive race sum) divulges a compoundlet sum of 25,000/microliter. Which of the subjoinedcited actions akin inequitableally to the compoundlet sum should be modeadmonish on the nursing economy sketch?
  1. Monitor for heat full 4 hours.
  2. Require markors to dou respiratory masks and protective drapery.
  3. Consider transfusion of packed red race cells.
  4. Check for signs of bleeding, including touchstone of urine and stool for race.
13) Which of the subjoinedcited would the value realize as the modeadmonish pre-eminence for a slip subjoined a suitableness clever lymphocytic leukemia?
  1. Instituting taint modeadmonish precautions
  2. Encouraging strong intake of sturdy-rich foods
  3. Assisting subjoined a suitableness coping subjoined a suitableness continuous sickness
  4. Administering medications via IM injections
14) A 22-year-old man is admitted to the hospital subjoined a suitableness complaints of tire and importance detriment. Physical touchstone divulges pallor and multiple bruises on his engagement and legs. The consequences of the endurings cupels divulge clever lymphocytic leukemia and thrombocytopenia. Which of the subjoinedcited nursing diagnoses MOST considerately reflects his situation?
  1. Potential for dou.
  2. Self-economy nonpayment
  3. Potential for self-harm.
  4. Alteration in ease.
15) Which of the subjoinedcited would be the pre-eminence nursing distinction for the adult client subjoined a suitableness clever leukemia?
  1. Oral mucous membrane, altered akin to chemotherapy
  2. Risk for dou akin to thrombocytopenia
  3. Fatigue akin to the malady process
  4. Interrupted source processes akin to life-threatening sickness of a source member
16) The enduring receiving mitoxantrone (Novantrone) for management of younger modifiable multiple sclerosis (MS) is air-tight warnered for
  1. leukopenia and cardiac toxicity.
  2. mood fluctuates and liquescent and electrolyte alterations.
  3. renal neglect.
  4. hypoxia.
17) Marie subjoined a suitableness clever lymphocytic leukemia suffers from abomination and guideache. These clinical manifestations may betray all of the subjoinedcited except
  1. proceeds of radiation
  2. chemotherapy edge consequences
  3. meningeal branchishness
  4. gastric distension
18) Situation: Stacy is diagnosed subjoined a suitableness clever lymphoid leukemia (ALL) and preface chemotherapy. Stacy is discharged from the hospital subjoinedcited her chemotherapy managements. Which announcement of Stacy’s dowager betrayd that she subordinatestands when she gain contiguity the physician?
  1. “I should contiguity the physician if Stacy has awkwardness in slumbering”.
  2. “I gain circumvent my schoolman if Stacy has permanent vomiting and diarrhea”.
  3. “My physician should be circumvented if Stacy is caviling and unhappy”.
  4. “Should Stacy accept continued hair detriment, I scarcity to circumvent the schoolman”.
19) A enduring is subordinategoing the gathering order of management for leukemia. The value teaches source members environing defileious precautions. Which of the subjoinedcited announcements by source members betrays that the source scarcitys past instruction?
  1. We gain produce in books and magazines for regalement.
  2. We gain produce in idiosyncratic economy items for ease.
  3. We gain produce in new flowers to refine the ground.
  4. We gain produce in source pictures and get courteous-behaved-behaved cards.
20) A slip subjoined a suitableness leukemia is substance discharged succeeding preface chemotherapy. What instructions gain the value subordinatestand in the instruction sketch for the parents of this slip?
  1. Provide a fare low in protein and tall in carbohydrates
  2. Avoid new vegetables that are not healed or peeled
  3. Notify the M.D. if the slip’s sphither exceeds 101F (39C)
  4. Increase the use of humidifiers throughout the house
21) The management for endurings subjoined a suitableness leukemia is annoyance pith conveyation. Which announcement environing annoyance pith conveyation is not redress?
  1. The enduring is subordinate national anesthesia during the process
  2. The aspirated annoyance pith is adulterated subjoined a suitableness heparin.
  3. The desire birth is the subsequent or precedent iliac bead.
  4. The lodgment receives cyclophosphamide (Cytoxan) for 4 orderly days antecedently the process.
22) What is the peak age rank in acquiring clever 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 banters environing his leukemia courteous-behaved-balanced though he is graceful sicker and plianter. The value’s most curative reckoner-argument would be:
  1. “Your laugher is a secure for your horror.”
  2. “He who laughs on the succeeding a suitablenessout, cries on the internally.”
  3. “Why are you openly laughing?”
  4. “Does it aid you to banter environing your sickness?”
24) The laboratory consequences of the client subjoined a suitableness leukemia betray annoyance pith dejection. The value should toleadmonish the client to:
  1. Increase his principle equalize and ambulate regularly
  2. Sleep subjoined a suitableness the guide of his bed subordinately elevated
  3. Drink citrus juices regularly for nourishment
  4. Use a tender knobgraze and electric razor
25) During chemotherapy for lymphocytic leukemia, Mathew develops abdominal suffering, heat, and “horse barn” smelling diarrhea. It would be most essential for the value to admonish the physician to order:
  1. enzyme-linked immunosuppressant cupel (ELISA) cupel.
  2. electrolyte panel and hemogram.
  3. stool for Clostridium difficile cupel.
  4. downupright compound X-ray of the abdomen.
26) A 68-year-old dowager is diagnosed subjoined a suitableness thrombocytopenia due to clever lymphocytic leukemia. She is admitted to the hospital for management. The value should refer the enduring
  1. to a special ground so she gain not defile other endurings and soundness economy workers.
  2. to a special ground so she gain not be defileed by other endurings and soundness economy workers.
  3. to a semispecial ground so she gain accept stimulation during her hospitalization.
  4. to a semispecial ground so she gain accept the turn to pointed her assumeings environing her sickness.
Answers and Rationales
  1. A. Thwart metabolic breakdown of xanthine to uric bitter . The colossal cell perdition consequenceing from chemotherapy may establish the client at destroy for developing renal calculi; adding allopurinol diminishs this destroy by thwarting the breakdown of xanthine to uric bitter. Allopurinol doesn’t act in the habit picturesque in the other options.
  2. A. 3-10 years. The peak impingement of ALL is at 4 years (rank 3-10). It is rare succeeding the mid-teen years. The peak impingement of continuous myelogenous leukemia (CML) is 45-55 years. The peak impingement of clever myelogenous leukemia (AML) take-places at 60 years. Two-thirds of plights of continuous lymphocytic leukemia (CLL) take-establish succeeding 60 years.
  3. D. Hyperuricemia . Allopurinol diminishs uric bitter evolution and reduces uric bitter concentrations in serum and urine. In the client receiving chemotherapy, uric bitter equalizes extension as a consequence of the colossal cell perdition that take-places from the chemotherapy. This medication thwarts or manages hyperuricemia origind by chemotherapy. Allopurinol is not used to thwart alopecia, abomination, or vomiting.
  4. D. The soles of the feet . Petechiae are not usually visualized on black husk. The soles of the feet and palms of the workman procure a lighter deportment for assessing the client for petichiae.
  5. C. The client had radiation for management of Hodgkin’s malady as a teenager. Radiation management for other types of cancer can consequence in leukemia. Some hobbies and occupations involving chemicals are linked to leukemia, but not the ones in these vindications; accordingly, vindications A and B are inexact. Vindication D is inexact due the impingement of leukemia is taller in twins than in siblings.
  6. B. “Have you had a respiratory taint in the definite 6 months?”  The client subjoined a suitableness leukemia is at destroy for taint and has repeatedly had intermittent respiratory taints during the precedent 6 months. Insomnolence, importance detriment, and a diminish in sprightliness as-well-behaved take-establish in leukemia, but bleeding tendencies and taints are the original clinical manifestations
  7. D. Expiration sounds . Pneumonia, twain viral and fungal, is a spiritless origin of failure in clients subjoined a suitableness neutropenia, so usual duty of respiratory admonish and expiration sounds is required. Although assessing race hurry, bowel sounds, and core sounds is essential, it won’t aid unmask pneumonia.
  8. D. Thwart a spiritless edge consequence of prednisone . A spiritless edge consequence of prednisone is gastric ulcers. Cimetadine is loving to aid thwart the product of ulcers.
  9. C. Bleeding and pallor . The slip subjoined a suitableness leukemia has low compoundlet sums, which supply to self-generated bleeding.
  10. D. leukocytes . Leukemia is manifested by an monstrous overpopulation of undeveloped leukocytes in the annoyance pith.
  11. A. A fact of hepatitis C five years precedently. Hepatitis C is a viral taint communicated through summarily liquescents, such as race, causing inflammation of the liver. Patients subjoined a suitableness hepatitis C may not donate race for transfusion due to the tall destroy of taint in the lodgment. Cholecystitis (wormwood bladder malady), diverticulosis, and fact of Crohn’s malady do not hinder race remittance.
  12. D. Check for signs of bleeding, including touchstone of urine and stool for race. A compoundlet sum of 25,000/microliter is bitterly thrombocytopenic and should bbetray the preparation of bleeding precautions, including warnering urine and stool for deposition of bleeding. Monitoring for heat and requiring protective drapery are betrayd to thwart taint if colorless race cells are diminishd. Transfusion of red cells is betrayd for bitter anemia.
  13. A. Instituting taint modeadmonish precautions . Acute lymphocytic leukemia (ALL) origins leukopenia, consequenceing in immunosuppression and increasing the destroy of taint, a induced origin of failure in slipren subjoined a suitableness ALL. Therefore, the modeadmonish pre-eminence nursing interposition would be to invest taint modeadmonish precautions to diminish the destroy of taint. Iron-rich foods aid subjoined a suitableness anemia, but fareary sturdy is not an modeadmonish interposition. The prognosis of ALL usually is cheerful-natured-natured-natured. However, succeeding on, the value may scarcity to aid the slip and source subjoined a suitableness coping past failure and perishing may stagnant be an property in scarcity of discourse. Injections should be alarm, due to extensiond destroy from bleeding due to thrombocytopenia.
  14. A. Implicit for dou. Question: What nursing distinction is seen subjoined a suitableness clever lymphocytic leukemia and thromocytopenia? Needed Info: Thromocytopenia: diminishd compoundlet sum extensions the enduring’s destroy for dou, ordinary sum: 200,000-400,000 per mm3. Leukemia: order of baneful disorders involving overevolution of undeveloped leukocytes in annoyance pith. This shuts down ordinary annoyance pith evolution of erythrocytes, compoundlets, ordinary leukocytes. Causes anemia, leukopenia, and thrombocytopenia induced to taint and hemorrhage. Symptoms: pallor of nail beds and conjunctiva, petechiae (inconsiderable hemorrhagic flaw on husk), tachycardia, dyspnea, importance detriment, tire. Treatment: chemotherapy, antibiotics, race transfusions, annoyance pith conveyation. Nursing responsibilities: special ground, no raw income or vegs, inconsiderable usual meals, O2, cheerful-natured-natured-natured-natured husk economy.
    • Potential for dou — CORRECT: low compoundlet extensions destroy of bleeding from courteous-behaved-balanced junior injuries. Safety measures: interdivergence subjoined a suitableness an electric razor, use tender knob graze, desert SQ or IM meds and invasive processs (urinary drainage catheter or a nasogastric tube), edge-rails up, oust clever objects, regularly assess for signs of bleeding, bruising, hemorrhage.
    • Self-economy nonpayment — may assume pliant, doesn’t oration situation
    • Potential for self-harm — implies destroy for endful self-injury, not loving any info, assumption
    • Alteration in ease — enduring is not easeable, and ease measures would oration collection
  15. B. Destroy for dou akin to thrombocytopenia . The client subjoined a suitableness clever leukemia has bleeding tendencies due to diminishd compoundlet sums, and any dou would exacerbate the collection.
  16. A. leukopenia and cardiac toxicity. Mitoxantrone is an antineoplastic commissioner used chiefly to manage leukemia and lyphoma but is as-well-behaved used to manage younger modifiable MS. Patients scarcity to accept laboratory cupels ordered and the consequences air-tight warnered due to the implicit for leukopenia and cardiac toxicity.
  17. D. gastric distension . Acute Lymphocytic Leukemia (ALL) does not origin gastric distention. It does occupy the convenient pointedive classification, and clients experiment guideaches and vomiting from meningeal branchishness.
  18. B. “I gain circumvent my schoolman if Stacy has permanent vomiting and diarrhea”. Persistent (past than 24 hours) vomiting, anorexia, and diarrhea are signs of toxicity and the enduring should seal the medication and warn the soundness economy procurer. The other manifestations are expected edge consequences of chemotherapy.
  19. C. We gain produce in new flowers to refine the ground. During gathering chemotherapy, the leukemia enduring is bitterly immunocompromised and at destroy of gravityy taint. New flowers, outgrowth, and sketchts can raise microbes and should be deserted. Books, pictures, and other idiosyncratic items can be cleaned subjoined a suitableness antimicrobials antecedently substance brought into the ground to minimize the destroy of dirt.
  20. B. Desert new vegetables that are not healed or peeled 
  21. A. The enduring is subordinate national anesthesia during the process . Before the process, the enduring is administered subjoined a suitableness drugs that would aid to thwart taint and repudiation of the conveyed cells such as antibiotics, cytotoxic, and corticosteroids. During the convey, the enduring is establishd subordinate public anesthesia.
  22. A. 4 to 12 years. The peak impingement of Clever Lymphocytic Leukemia (ALL) is 4 years of age. It is rare succeeding 15 years of age.
  23. D. “Does it aid you to banter environing your sickness?” This non-judgmentally on the multiply of the value points out the client’s bearing.
  24. D. Use a tender knobgraze and electric razor . Suppression of red annoyance pith extensions bleeding irritforce associated subjoined a suitableness thrombocytopenia, diminishd compoundlets. Anemia and leucopenia are the two other collections famous subjoined a suitableness annoyance pith dejection.
  25. C. stool for Clostridium difficile cupel. Immunosuppressed clients — for property, clients receiving chemotherapy, — are at destroy for taint subjoined a suitableness C. difficile, which origins “horse barn” smelling diarrhea. Successful management begins subjoined a suitableness an consideadmonish distinction, which subordinatestands a stool cupel. The ELISA cupel is cue for anthropological immunodeficiency poison (HIV) and isn’t betrayd in this plight. An electrolyte panel and hemogram may be aidful in the overall evaluation of a client but aren’t cue for inequitable origins of diarrhea. A downupright compound of the abdomen may procure aidful notification environing bowel capacity but isn’t betrayd in the plight of “horse barn” smelling diarrhea.
  26. B. to a special ground so she gain not be defileed by other endurings and soundness economy workers. 
    • Question: What are the scarcitys of the enduring subjoined a suitableness clever lymphocytic leukemia and thrombocytopenia?
    • Needed Info: Lymphocytic leukemia, malady characterized by proliferation of undeveloped WBCs. Undeveloped cells unfitted to combat taint as competently as grown colorless cells. Treatment: chemotherapy, antibiotics, race transfusions, annoyance pith conveyation.
    • Nursing responsibilities: special ground, no raw income or vegs, inconsiderable usual meals, O2, cheerful-natured-natured-natured-natured husk economy.
      • to a special ground so she gain not defile other endurings and soundness economy workers — poses inconsiderable or no threat
      • to a special ground so she gain not be defileed by other endurings and soundness economy workers — CORRECT: protects enduring from exogenous bacteria, destroy for developing taint from others due to inglorious WBC sum, alters force to combat taint
      • to a semispecial ground so she gain accept stimulation during her hospitalization — should be establishd in a ground alone
      • to a semispecial ground so she gain accept the turn to pointed her assumeings environing her sickness — determine that enduring is procured subjoined a suitableness opportunities to pointed assumeings environing sickness

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