Exemplar 2.5 Leukemia
1) A pediatric client is receiving chemotherapy for acute lymphocytic leukemia. The nurse
recognizes that a potential oncological emergency for this client would be tumor lysis syndrome.
For which manifestations should the nurse monitor this client?
Select all that apply.
A) Thrombocytopenia
B) Altered levels of consciousness
C) Respiratory distress
D) Oliguria
E) Upper-extremity edema
Answer: B, D
Explanation: A) Tumor lysis causes a metabolic emergency. Because of electrolyte imbalance,
the signs can be oliguria and altered levels of consciousness. Thrombocytopenia occurs with a
hematological emergency. Space-occupying lesions can cause respiratory distress and upper-
extremity edema.
B) Tumor lysis causes a metabolic emergency. Because of electrolyte imbalance, the signs can be
oliguria and altered levels of consciousness. Thrombocytopenia occurs with a hematological
emergency. Space-occupying lesions can cause respiratory distress and upper-extremity edema.
C) Tumor lysis causes a metabolic emergency. Because of electrolyte imbalance, the signs can be
oliguria and altered levels of consciousness. Thrombocytopenia occurs with a hematological
emergency. Space-occupying lesions can cause respiratory distress and upper-extremity edema.
D) Tumor lysis causes a metabolic emergency. Because of electrolyte imbalance, the signs can be
oliguria and altered levels of consciousness. Thrombocytopenia occurs with a hematological
emergency. Space-occupying lesions can cause respiratory distress and upper-extremity edema.
E) Tumor lysis causes a metabolic emergency. Because of electrolyte imbalance, the signs can be
oliguria and altered levels of consciousness. Thrombocytopenia occurs with a hematological
emergency. Space-occupying lesions can cause respiratory distress and upper-extremity edema.
Page Ref: 101
Cognitive Level: Applying
Client Need: Physiological Integrity
Nursing Process: Assessment
Learning Outcome: 6. Plan evidence-based care for an individual with leukemia and his or her
family in collaboration with other members of the healthcare team.
,2) A 51-year-old client reports to the nurse an inability to tolerate usual exercise and the feeling
of fatigue. The client states that these symptoms have been gradual over time. Which physical
assessment findings, along with the client's verbal complaints, would indicate chronic
lymphocytic leukemia (CML)?
Select all that apply.
A) Joint pain
B) Pallor
C) Splenomegaly
D) Abnormal bleeding
E) Edema
Answer: B, C, E
Explanation: A) The symptoms for CML are insidious and occur over time, affecting older
adults. The client may exhibit splenomegaly, pallor, edema, and lymphadenopathy. Bone and
joint pain with abnormal bleeding are characteristics of AML, which also occurs in older clients.
B) The symptoms for CML are insidious and occur over time, affecting older adults. The client
may exhibit splenomegaly, pallor, edema, and lymphadenopathy. Bone and joint pain with
abnormal bleeding are characteristics of AML, which also occurs in older clients.
C) The symptoms for CML are insidious and occur over time, affecting older adults. The client
may exhibit splenomegaly, pallor, edema, and lymphadenopathy. Bone and joint pain with
abnormal bleeding are characteristics of AML, which also occurs in older clients.
D) The symptoms for CML are insidious and occur over time, affecting older adults. The client
may exhibit splenomegaly, pallor, edema, and lymphadenopathy. Bone and joint pain with
abnormal bleeding are characteristics of AML, which also occurs in older clients.
E) The symptoms for CML are insidious and occur over time, affecting older adults. The client
may exhibit splenomegaly, pallor, edema, and lymphadenopathy. Bone and joint pain with
abnormal bleeding are characteristics of AML, which also occurs in older clients.
Page Ref: 93
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Nursing Process: Assessment
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct
and indirect causes of leukemia.
, 3) The nurse is teaching a class at a local community center about decreasing risk factors for
cancer. Which risk factors should the nurse include in the teaching regarding leukemia?
Select all that apply.
A) Alkylating agents
B) Diets low in fat
C) Exposure to infectious agents
D) Bloom syndrome
E) Decreased exercise
Answer: A, C, D
Explanation: A) A higher incidence of leukemia associated with chromosomal defects such as
Bloom syndrome, exposure to infectious agents, and chemical agents used to treat previous
cancer, such as alkylating agents. Low-fat diets are not a risk factor for leukemia, and neither is
lack of exercise.
B) A higher incidence of leukemia associated with chromosomal defects such as Bloom
syndrome, exposure to infectious agents, and chemical agents used to treat previous cancer, such
as alkylating agents. Low-fat diets are not a risk factor for leukemia, and neither is lack of
exercise.
C) A higher incidence of leukemia associated with chromosomal defects such as Bloom
syndrome, exposure to infectious agents, and chemical agents used to treat previous cancer, such
as alkylating agents. Low-fat diets are not a risk factor for leukemia, and neither is lack of
exercise.
D) A higher incidence of leukemia associated with chromosomal defects such as Bloom
syndrome, exposure to infectious agents, and chemical agents used to treat previous cancer, such
as alkylating agents. Low-fat diets are not a risk factor for leukemia, and neither is lack of
exercise.
E) A higher incidence of leukemia associated with chromosomal defects such as Bloom
syndrome, exposure to infectious agents, and chemical agents used to treat previous cancer, such
as alkylating agents. Low-fat diets are not a risk factor for leukemia, and neither is lack of
exercise.
Page Ref: 95
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 2. Identify risk factors and prevention methods associated with leukemia.