Walkthrough: Physiological Adaptation Q4 – NCLEX-RN®

00:01 The nurse is assessing a client with a diagnosis of leukemia.

00:05 Which problem does the nurse recognize to be associated with this condition? Select all that apply. Okay. Again, before you look at the answer choices, let's walk through this.

00:16 So I'm assessing someone who I know has leukemia.

00:19 Now, which problem do I expect to be associated with the condition which is leukemia? So I might see some things on here that are not cool.

00:29 Like, I wouldn't want them for my patient, but they're trying to see if I recognize what's directly associated with leukemia.

00:37 So you ready? Think about that diagnosis, what do you know about leukemia? What do you remember from your reading? Jot yourself some quick notes now to kind of focus your brain.

00:45 Then we'll bring in the answer choices.

00:48 Make sure that you pause the video and walk through the process of treating this as five separate questions and say, would this option be associated with leukemia? Yes or no? In or out? Would this symptom be associated with leukemia? Yes or no? In or out? And work your way through all the answers.

01:07 Okay, we're going to bring the answers for you.

01:09 Make sure you pause the video and work through it on your own.

01:13 Then I'll come back and do all the rationales with you.

01:23 Welcome back. Okay. I hope you're starting to feel a little more confident with these select all that apply or multiple response items.

01:31 So I know I'm looking for conditions that are associated with a diagnosis of leukemia.

01:36 Is increased risk of bleeding associated with leukemia? Well, risk of bleeding would be caused by some kind of problem with my platelets.

01:47 Is that associated with leukemia? Yes, it is.

01:50 So I would circle number one on my scratch paper and move on to the second part of the question.

01:56 Is weakness and fatigue associated with leukemia? Yes, absolutely, it is.

02:05 So I would also circle number two. Number three, pain and pressure sensation in the chest.

02:14 Is that associated with leukemia? It's really not.

02:18 Pain and pressure sensation in the chest is really more characteristic of lymphoma more than leukemia.

02:26 So if a patient has that symptom, it's likely caused from a lymphoma.

02:31 Now, we're not saying they have lymphoma and leukemia.

02:33 Because remember, we're in this artificial NCLEX world question.

02:38 They're just trying to recognize, do you know that this is not a normal characteristic of leukemia? And they're just trying to set you up to know like, oh, do you remember that's lymphoma and not leukemia? End up with in lymphoma, remember, you end up with those lymph nodes, they get really big, and they can cause obstruction and pressure.

02:56 And that's where they're having the pain.

02:58 So, so far, we've selected number one, number two, and we are not selecting number three.

03:06 You've crossed through that.

03:08 Now, number four, is a risk of infection associated with a diagnosis of leukemia? What did you pick? Okay. Let's go and look at the rationale.

03:19 So risk of infection, what connection is there in leukemia or is there one to a risk of infection? Oh, there is. So I know that sometimes when if you look at the lab values, sometimes their white cell counts are way off in leukemia.

03:35 Why is that? I mean, if they have so many white blood cells, why are they at a risk of infection? Well, they have quantity. Like, they have a high quantity of white blood cells, but they do not have quality. The white blood cells that are involved in leukemia are usually immature.

03:54 They just don't work, right? There's only a small percentage of those white blood cells when someone has leukemia that actually work and function like they're intended to.

04:04 So that's why they can't fight off infection, because only a small percentage of their white blood cells are actually working.

04:12 All right. So we've selected number one, number two, and number four.

04:18 We did not select number three. We've got one more option left, number five.

04:23 Severe focal bone pain. Okay. Is that something I would expect with leukemia? The answer is no, because this type of focal bone pain, that's really specific.

04:36 That's associated with multiple myeloma.

04:39 See, multiple myeloma has this abnormal build-up of plasma cells in the bone marrow.

04:45 That's why they have that pain. That build-up of plasma cells causes really intense bone pain.

04:52 I mean, it is - it's really heartbreaking if you're helping a patient through this type of diagnosis.

04:58 So you can have bone pain in leukemia, but it won't be focal.

05:03 So remember, those descriptor words are really, really important.

05:08 The bone pain in leukemia will be more generalized, kind of spread out because of the cells that are proliferating.

05:14 But in what we're talking about here is multiple myeloma.

05:18 This is why you did not select it, is because the focal part, that was the key indicator for you to recognize that this is not leukemia, but is more symptomatic of multiple myeloma.

05:30 So look back and review, how did you do? Now, one more thing before we go.

05:35 I wanted to show you some pictures of white blood cells.

05:38 On the left you see, that's what normal white blood cells look like.

05:42 Those guys are functioning. On the right, you see what white blood cells look like in leukemia.

05:48 Yeah, they're very, very different.

05:51 Keep in mind, the white cell count will go high in leukemia at a higher quantity, but they are not high quality.

06:00 They just don't function to help protect the patient from infection.

06:03 So one, two, and four are the correct answers for this select all that apply question.

06:10 That's it. You're ready to move on to the next question.