NUR 2356 CORE MAIN QUESTIONS AND
ANSWERS SET A+
✔✔A nursing instructor asks a group of nursing students to explain how leukemia
occurs. What would their answer be? - ✔✔-stem cells in the bone marrow produce
immature WBCs that cannot function normally
-these cells proliferate rapidly causing the bone marrow to fill with these abnormal
WBCs
-the abnormal cells replace the normally functioning WBCs in the circulatory system
-This makes the patient vulnerable to infections
-The malignant WBCs rapidly fill the bone marrow, replacing stem cells that produces
erythrocytes (RBCs) and other blood products such as platelets
✔✔What lab and diagnostic tests should the nurse anticipate being ordered for a child
with possible leukemia? and what would the indicated tests show?
-CBC
-Peripheral blood smear
-Bone marrow aspiration
-Lumbar puncture - ✔✔All of them!
-CBC - low hemoglobin and hematocrit, decreased RBC count, decreased platelet
count, and elevated/normal/or decreased WBC count
-Peripheral blood smear may reveal blasts
-Bone marrow aspiration - will show >25% lymphoblasts
-Lumbar puncture - assess for CNS involvement andCSF analysis for blast cells
, ✔✔What are the 2 forms of bone marrow aspiration? - ✔✔-Immunophenotyping =
identifies lymphoid vs myeloid cell type
- Cytogenic analysis = determines abnormalities in chromosome number and structure
✔✔Which leukemia affects the lymphoid progenerator resulting in an alteration in
lymphocyte production?
(Proliferation of lymphoblastic cells) - ✔✔ALL
✔✔How does ALL happen? (3 points) - ✔✔-abnormal lymphoblasts abound in blood
forming tissue
- the lymphoblasts are fragile and immature, and lack the infection fighting capabilities
of the normal WBC
-The growth of lymphoblasts is excessive and replace the normal cells in the bone
marrow
✔✔True or false
the closer the WBC count is to normal (5-10,000) at time of diagnosis, the better the
prognosis for ALL - ✔✔true
✔✔A child presents to the hospital with a fever (persistent or recurrent with unknown
cause), recurrent infection, fatigue/malaise/listless, pallor, unusual bleeding or bruising,
abdominal/bone pain, nausea/vomiting, and headache. What could the child have? -
✔✔Acute lymphoblastic leukemia (ALL)
✔✔What treatments could the nurse anticipate being ordered for ALL? - ✔✔-Radiation
-Chemotherapy
-Hematopoietic stem cell transplant
✔✔Why would CNS prophylaxis or intrathecal chemo be ordered for ALL? - ✔✔-Reduce
the risk of developing CNS disease
-included and essential to each phase
✔✔What are the 3 phases of chemo treatment? - ✔✔-Induction = rapid induction of
remission from disease (want them to get into remission)
-Consolidation = strengthen remission, reduce leukemic cell burden before the
emergence of drug resistance
ANSWERS SET A+
✔✔A nursing instructor asks a group of nursing students to explain how leukemia
occurs. What would their answer be? - ✔✔-stem cells in the bone marrow produce
immature WBCs that cannot function normally
-these cells proliferate rapidly causing the bone marrow to fill with these abnormal
WBCs
-the abnormal cells replace the normally functioning WBCs in the circulatory system
-This makes the patient vulnerable to infections
-The malignant WBCs rapidly fill the bone marrow, replacing stem cells that produces
erythrocytes (RBCs) and other blood products such as platelets
✔✔What lab and diagnostic tests should the nurse anticipate being ordered for a child
with possible leukemia? and what would the indicated tests show?
-CBC
-Peripheral blood smear
-Bone marrow aspiration
-Lumbar puncture - ✔✔All of them!
-CBC - low hemoglobin and hematocrit, decreased RBC count, decreased platelet
count, and elevated/normal/or decreased WBC count
-Peripheral blood smear may reveal blasts
-Bone marrow aspiration - will show >25% lymphoblasts
-Lumbar puncture - assess for CNS involvement andCSF analysis for blast cells
, ✔✔What are the 2 forms of bone marrow aspiration? - ✔✔-Immunophenotyping =
identifies lymphoid vs myeloid cell type
- Cytogenic analysis = determines abnormalities in chromosome number and structure
✔✔Which leukemia affects the lymphoid progenerator resulting in an alteration in
lymphocyte production?
(Proliferation of lymphoblastic cells) - ✔✔ALL
✔✔How does ALL happen? (3 points) - ✔✔-abnormal lymphoblasts abound in blood
forming tissue
- the lymphoblasts are fragile and immature, and lack the infection fighting capabilities
of the normal WBC
-The growth of lymphoblasts is excessive and replace the normal cells in the bone
marrow
✔✔True or false
the closer the WBC count is to normal (5-10,000) at time of diagnosis, the better the
prognosis for ALL - ✔✔true
✔✔A child presents to the hospital with a fever (persistent or recurrent with unknown
cause), recurrent infection, fatigue/malaise/listless, pallor, unusual bleeding or bruising,
abdominal/bone pain, nausea/vomiting, and headache. What could the child have? -
✔✔Acute lymphoblastic leukemia (ALL)
✔✔What treatments could the nurse anticipate being ordered for ALL? - ✔✔-Radiation
-Chemotherapy
-Hematopoietic stem cell transplant
✔✔Why would CNS prophylaxis or intrathecal chemo be ordered for ALL? - ✔✔-Reduce
the risk of developing CNS disease
-included and essential to each phase
✔✔What are the 3 phases of chemo treatment? - ✔✔-Induction = rapid induction of
remission from disease (want them to get into remission)
-Consolidation = strengthen remission, reduce leukemic cell burden before the
emergence of drug resistance
