Chapter 30

Question 1

Malignancy in which the mechanism that controls production is affected and the production of these cells are disrupted is known as?

Answer 1

Hematopoetic malignancies

Question 2

____ is a neoplastic proliferation of a particular cell type. The defect originates in the hematopoietic stem cells.

Answer 2

Leukemia

Question 3

____ are neoplasms of lymphoid tissue, usually derived from B lymphocytes.

Answer 3

Lymphomas

Question 4

____ ____ is a malignancy of the most mature form of B lymphocyte–the plasma cell.

Answer 4

Multiple myeloma

Question 5

___ ____ ___ ____ is when some hematologic neoplasms develop, hematopoietic control mechanisms may be in place to continue to produce adequate numbers of normal blood cells which are referred to as ___ neoplasms.
*this is when the control mechanism fails

Answer 5

clonal stem cell disorder
indolent

Question 6

____ ___ are slow growing cancers that often remains localized and carry few symptoms.

Answer 6

Indolent neoplasms

Question 7

Indolent neoplasms have increased numbers of cells produced from a culprit clone all have the SAME ____.

Answer 7

genotype

Question 8

_____ ____ are slow growing hematologic neoplasms that are clones normal cells.
**VERY FEW SYMPTOMS

Answer 8

Simplified neoplasms

Question 9

TRUE OR FALSE.
ALL indolent neoplasms will eventually evolve into a malignancy.

Answer 9

FALSE, not all

Question 10

Do all malignancies arise from an indolent neoplasm?

Answer 10

NO
They may evolve directly from changed in the stem cell.

Question 11

____ refers to an increased level of leukocytes in the circulation which can result in elevation of total leukocytes count.

Answer 11

Leukocytosis

Question 12

What is a proliferation of cells in the liver and spleen that leads to enlargement of organs?

Answer 12

extra medullary hematopoiesis

Question 13

What are leukemia risk factors?

Answer 13

exposure to radiation or chemicals, certain genetic disorders, and viral infections

Question 14

____ refers to stem cells that produce lymphocytes
___refers to stem cells that produce non lymphoid blood cells

Answer 14

Lymphoid
Myeloid

Question 15

Acute leukemia characteristics:
- ___ onset often occurring within a few weeks
- leukocyte development is halted at the ___ phase and thus most leukocytes are _____ cells or blasts
- can progress ____ with death occurring within weeks to months ____ aggressive treatment
- more common in ____ and young adults

Answer 15

Abrupt
blast, undifferentiated
rapidly, without
children

Question 16

Chronic leukemia characteristics:
- symptoms evolve over a period of ___ to ____ and the majority of leukocytes produced are mature
- progresses more ____; the disease trajectory can extend for years
- more common between ages ___ and ____

Answer 16

months, years
slowly
25, 60

Question 17

What is the most common non-lymphocytic leukemia?

Answer 17

Acute myeloid leukemia

Question 18

___ ____ ____ is a defect in stem cells that differentiate into all myeloid cells: monocytes, granulocytes, erythrocytes, and platelets.

Answer 18

Acute myeloid leukemia

Question 19

What are S/S of AML?

Answer 19

fever and infection, muscle weakness, fatigue, dyspnea on exertion, pallor, petechiae, ecchymosis, bone pain, enlarged spleen and liver, hyperplasia of gums

Question 20

___ ___ analysis that shows an excess of immature leukocytes (blast cells) is a hallmark sign of AML.

Answer 20

Bone marrow

Question 21

What are the treatment options for AML?

Answer 21

aggressive chemotherapy and/or hematopoietic stem cell transplantation
*GOAL IS COMPLETE REMISSON

Question 22

What are some complications of AML treatment?

Answer 22

significant risk for infection and graft-versus-host disease

Question 23

What are some complications of AML?

Answer 23

bleeding (GI, pulmonary, vaginal, intracranial), DIC, high WBC

Question 24

True or false.
Bleeding and infection are the major causes of death.

Answer 24

True

Question 25

____ ____ ___ is massive leukemic cell =destruction from chemotherapy resulting in the release of intracellular electrolytes and fluids into the systemic circulation. Increase uric acid levels, potassium, and phosphate

Answer 25

Tumor lysis syndrome

Question 26

AML affects all ages with peak incidence at age ___.

Answer 26

67

Question 27

____ ____ ____ is a mutation in myeloid stem cells with uncontrolled proliferation.

Answer 27

Chronic myeloid leukemia

Question 28

What are the stages of chronic myeloid leukemia?

Answer 28

chronic phase, transformational phase, blast crisis

Question 29

What is the cause of CML?

Answer 29

a chromosomal translocation where a section of DNA is shifted from chromosome 22 on the BCR gene to chromosome 9 on ABL gene, they fuse and produce an abnormal protein that causes leukocytes to divide rapidly

Question 30

True or False. The BCR-ABL gene AKA the Philadelphia translocation is present in virtually all patients with this disease.

Answer 30

TRUE

Question 31

S/S of CML?

Answer 31

SOB, confusion, tender spleen, malaise, anorexia, weight loss **Infection and bleeding are RARE

Question 32

What is the treatment of CML?

Answer 32

imatinib mesylate (Gleevec) blocks signals in leukemic cells that express BCR-ABL protein, chemotherapy, HSCT

Question 33

____ ____ ____ is uncontrolled proliferation of immature cells from lymphoid stem cells

Answer 33

acute lymphocytic leukemia

Question 34

What population is acute lymphocytic leukemia most popular among?

Answer 34

young children, boys more often than girls

Question 35

True or False. Acute lymphocytic leukemia is very responsive to treatment.

Answer 35

TRUE

Question 36

This CNS is frequently a site for ___ cells; thus, patients may exhibit cranial nerve palsies or headache and vomiting because _____ involvement.

Answer 36

leukemic meningeal

Question 37

What is the treatment plan for a patient with acute lymphocytic leukemia?

Answer 37

chemotherapy, HSCT, monoclonal antibody therapy, corticosteroids

Question 38

____. is using different combinations and dosages of the drugs used in induction therapy to improve outcomes in those patients at high risk for relapse.

Answer 38

Consolidation

Question 39

___ ___ is an intense combination of chemotherapy with purpose to achieve a rapid, complete remission. *Life threatening side effects, prolonged hospitalization

Answer 39

Induction therapy

Question 40

___ ___ is started after remission is achieved.

Answer 40

Consolidation therapy

Question 41

____ ____ is lower doses of the drug that the patient received in consolidation therapy Q3-Q4 weeks for months to years.

Answer 41

maintenance therapy

Question 42

What is the goal of maintenance therapy?

Answer 42

to maintain remission

Question 43

A hematopoietic stem cell transplant is when ____ to ____ mL of bone marrow is aspirated from donor (stem cell obtainment)

Answer 43

500-1000

Question 44

What assessments should the nurse complete in a patient with leukemia?

Answer 44

health hx S/S labs

Question 45

Potential complications of leukemia?

Answer 45

infection bleeding/DIC renal dysfunction tumor lysis syndrome nutritional depletion mucositis depression

Question 46

What are some goals for a patient with leukemia?

Answer 46

-absence of complications and pain -attainment of adequate nutrition -activity tolerance -ability to cope -positive body image -understanding of the disease

Question 47

What are some interventions related to risk of infection and bleeding in a patient with leukemia?

Answer 47

Q4 VS report fever monitor WBC count avoid ppl with known infection

Question 48

What are some interventions related to mucositis in a patient with leukemia?

Answer 48

-frequent, gentle oral hygiene -soft toothbrush or sponge tipped applicators when counts are low -rinse only with NS -perineal and rectal care

Question 49

Ways to improve nutritional intake in a patient with leukemia?

Answer 49

-oral care before and after meals -administer analgesics before meals -appropriate treatment of nausea -small, frequent feedings -soft foods that are moderate in temperature -low-microbial diet -nutritional supplements

Question 50

Ways to ease pain and discomfort in a patient with leukemia?

Answer 50

-Tylenol for fever and myalgias -cool water sponging -frequent bedding changes -gentle massage -relaxations techniques

Question 51

____ ____ is a group of clonal disorders of the myeloid stem cell that cause dysplasia in one or more types of cell lines

Answer 51

Myelodysplastic syndromes (MDS)

Question 52

How will patients with MDS present?

Answer 52

asymptomatic or with fatigue or illness

Question 53

In MDS, overtime, the bone marrow fails and the patient has ____.

Answer 53

pancytopenia

Question 54

The only way to cure MDS is with a _____. Otherwise treat with bone marrow stimulating agents, blood products, chelation therapy, or myeloid growth factors.

Answer 54

HSCT

Question 55

What are the different types of myeloproliferative neoplasms?

Answer 55

Polycythemia vera Essential thrombocythemia primary myelofobrosis

Question 56

What is polycythemia vera?

Answer 56

bone marrow is hypercellular with increased erythrocytes and blood volume

Question 57

What is essential thrombocythemia?

Answer 57

stem cell disorder within bone marrow that causes elevated PLT count

Question 58

What is primary myelofibrosis?

Answer 58

chronic marrow fibrosis/scarring, extramedullary hematopoiesis in liver and spleen, leukocytosis, thrombocytosis, anemia

Question 59

What are the S/S of polycythemia vera?

Answer 59

ruddy complexion and splenomegaly from increased blood volume and viscosity of blood, elevated BP, generalized pruritis

Question 60

What are the risks of polycythemia vera?

Answer 60

thrombosis complications (CVA, MI) and bleeding from dysfunctional platelets

Question 61

What is the treatment of polycythemia vera?

Answer 61

-therapeutic phlebotomy -chemotherapeutic agents to suppress bone marrow function -aggressive management of atherosclerosis -allopurinol to prevent gout -aspirin for pain -platelet aggregation inhibitors -interferon-alfa

Question 62

Patient education for a patient with polycythemia vera?

Answer 62

REDUCE RISK OF THROMBOTIC COMPLICATIONS -stop smoking -lose weight -control hypertension and diabetes -reduce risk for DVT -avoid high-dose aspirin -avoid iron supplements -cool baths for pruitis

Question 63

Does essential/primary thrombocytopenia affect men or women more?

Answer 63

women

Question 64

What are S/S of essential thrombocytopenia?

Answer 64

symptoms usually occur from vascular occlusion headache, enlarged spleen, and hemorrhage

Question 65

Medical management of essential thrombocytopenia depends on?

Answer 65

risk for developing thrombosis or hemorrhage and the presence of symptoms

Question 66

What are S/S of primary myelofibrosis?

Answer 66

enlarged spleen, fatigue, pruritus, bone pain, wight loss, infection, bleeding, and cachexia

Question 67

What is the treatment of primary myelofibrosis?

Answer 67

**based on reducing the burden of the disease -blood transfusions -erythroid stimulating agents -HSCT in younger people -splenectomy

Question 68

Where does lymphoma typically originate?

Answer 68

lymph nodes but can evolve to lymphoid tissue in spleen, GI tract, Liver, or bone marrow

Question 69

_____ lymphoma starts in a single lymph node and may have a viral etiology; cure rate high, especially in stage 1

Answer 69

Hodgkin

Question 70

____ ____ ____ is when malignant cells arise from single clone of lymphocytes. Affects mainly B cells, but could affect T cells.

Answer 70

Non-hodgkins lymphoma

Question 71

What does stage 1 lymphoma mean?

Answer 71

involvement of single lymph node

Question 72

What does stage II lymphoma mean?

Answer 72

2 or more on the same side of diaphragm

Question 73

What does stage III lymphoma mean?

Answer 73

above and below diaphragm

Question 74

What does stage 4 lymphoma mean?

Answer 74

outside diaphragm, liver, and spleen

Question 75

____ ___ is a relatively rare malignancy that has a high cure rate

Answer 75

hodgkin disease

Question 76

What are some risk factors of Hodgkins disease?

Answer 76

men > women, first-degree relative, its receiving chronic immunosuppressive therapy, veterans exposed to agent orange

Question 77

Pathophis of Hodgkins disease: Initiated in a ____ node that is large, hard, non-painful, and then spreads by _____ extension along the ____ system.

Answer 77

single contiguous lymphatic

Question 78

What is the hallmark sign of Hodgkins disease?

Answer 78

Reed-Sternberg cell

Question 79

What is the most common signs of Hodgkins disease?

Answer 79

enlargement of one or more lymph nodes on one side of the neck that are painless and firm but NOT hard

Question 80

Patient education for Hodgkins disease?

Answer 80

- encourage to reduce risk factors - No tobacco or alcohol usage - be careful of environmental carcinogens - no excessive sunlight - screening for late effects of treatment IS necessary

Question 81

In contrast to Hodgkin lymphoma, the lymphoid tissues involved are largely infiltrated with malignant lymphoid cells from multiple sites in _____ ____ ____

Answer 81

Non-hodgkins lymphoma

Question 82

Non-hodgkins lymphoma is the ____ most common type of cancer diagnosed in the US

Answer 82

sixth

Question 83

What is the treatment for NHL?

Answer 83

determined by type and stage of disease and may include, interferon, chemo, radiation, HSCT

Question 84

___ ___ is a malignant disease of the most mature form of B lymphocyte with destruction of bone

Answer 84

Multiple myeloma

Question 85

What is the treatment of multiple myeloma?

Answer 85

*NO CURE auto HSCT, chemo, radiation, corticosteroids NEW: imunomodulatory drugs, thalidomide analogs, monoclonal antibody

Question 86

What are the clinical manifestations of multiple myeloma?

Answer 86

bone pain, osteoporosis, fractures, elevated serum protein, renal failure, anemia, fatigue, weakness, increased serum viscosity