NCLEX Questions about NHL

#1 A patient who was recently diagnosed with nonHodgkin Lymphoma that is Stage I would have enlarged
lymph nodes most prominently in which part of the body?
o A. Abdomen
o B. Axillary
o C. Neck
o D. Groin

Non-Hodgkin Lymphoma (2014, August 26). In The American

Cancer Society. Retrieved February 26, 2015.

Answer = C

#2 Which of the following pathogens is most commonly

associated with the development of non-Hodgkin
Lymphoma?
o A. Epstein Bar Virus
o B. HIV/AIDS
o C. Reed-Sternberg Cells
o D. Radiation
Answer = A

References

Explanation of Disease

Etiology Neoplasia is caused by a single mutated cell.

Ackley, B. J., & Ladwig, G. B. (2008). Nursing diagnosis

handbook: An evidence-based guide to planning care (8th
ed.). St. Louis, MO: Mosby Elsevier.

Malignant transformation of B cells starts the disease of NonHodgkin Lymphoma (NHL). This may be related to the Epstein
Bar Virus or exposure to radiation.
Incidence Each year, approx. 71, 850 people will be

Bishop, R. (2015). PowerPoint: Neoplasia

diagnosed with NHL and approx. 19,790 people will die from
this cancer. Risk for developing NHL is approx. 1:50.
Risk factors Overall, the general risk factors for Non-

Braun, C. A., & Anderson, C. M. (2010). Pathophysiology: A

clinical approach (2nd ed.). Baltimore, MD: Lippincott
Williams & Wilkins.

Hodgkin Lymphoma include:

o Age/Gender- Men over the age of 50 are generally the
most common population who develops NHL. Women of

o
o

all ages and children also

receive diagnoses of NHL, but
this happens less frequently
Ethnicity Whites are most
likely to develop NHL
Environment People exposed
to harsh chemicals and
radiation are at an increased
risk for NHL
Immune system/infection
both immune system
deficiencies and certain
infections (EBV) can help B
cells transform to malignant
cells

Pathophysiology Non-Hodgkin
lymphoma starts with an exposure to
risk factors, then there is a malignant
transformation of B, T, and Natural
Killer cellular genes, and finally there
is a loss of control of proliferation and
cell growth.

Clinical Manifestations & Potential

Complications

Expected clinical manifestation

There are 6 main clinical
manifestations that are generally
involved in neoplasia. These include:
Pain, Fatigue, Cachexia, Anemia,
Infection, and
Leukopenia/Thrombocytopenia.
Specifically in NHL, common clinical
manifestations include: Enlarged
Lymph Nodes (usually cervical lymph
nodes in early stages), Swollen
abdomen, Cachexia (more common in
children), Chest
pain/pressure/shortness of breath,
Fever, Weight loss, Night Sweats,
Fatigue, Low RBC count, and

increased WBC count and lymphocyte

count.
Potential complications
Complications with NHL could
happen if the patient has other
infections occurring at the same time
as NHL. This could affect the plan of
treatment and increase the chances of
death from the disease. H. pylori,
Epstein Bar Virus, and HIV/AIDS are
common infections that are seen with
NHL and can cause a decreased
response to treatment because of
immunocompromisation.

Lifespan & Cultural Considerations

Children Children and adolescents

have an increased risk of contracting
the disease when they have been
exposed to the Epstein Bar Virus
because this tends to make them
extremely immunocompromised and
the B cell has an opportunity to
become malignant. Children often
suffer from very high fever and
cachexia when diagnosed with NHL.
Adults Adults over the age of 50 are
the most common population who
hear a diagnosis of NHL. At this age,
the body can still work well to fight off
NHL with the assistance of
Chemotherapy & Radiation. If the
disease is well progressed, the patient
may suffer especially from weight loss,
night sweats& fatigue.
Older Adults As an adult gets
older, the more harm NHL will do to
their body and the prognosis will
decline. This population usually has
a decreased immune system which

also makes the disease harder to

treat. Fatigue will be especially
common in this population.
Ethnic Groups Caucasian people
are most likely to be affected by NHL,
with African Americans and Asian
Americans following as the next most
common population to be diagnosed
with NHL. NHL is most commonly
diagnosed in developed countries.
The U.S. and Europe have the highest
rates of diagnoses.

Nursing Diagnoses

#1 Activity intolerance related to

side effects of treatment as evidenced
by fatigue, tiredness, and fever.
Patient will demonstrate increased
tolerance to activity within 2 days.
#2 Disturbed body image related to
side effects of treatment and clinical
manifestations of disease (enlarged
lymph nodes, cachexia) as evidenced
by social withdrawal. Patient will
utilize strategies to enhance
appearance one week after treatment.
#3 Fear related to serious threat to
well-being as evidenced by emotional
tendencies and fearful statements
made by the patient. Patient will
verbalize fears at the time of
diagnosis

Significance to Nursing
Legal/ethical responsibilities of
the nurse The legal responsibilities
of the nurse would include all of the
same standards of practice as with
any other patient with any other
disease. NHL does not have any
special implications legally.

As incidence , impact on nursing

is As the incidence rate of NHL
increases, the nursing population who
of nurses who are knowledgeable
about the disease and how to care for
a patient receiving treatment for NHL
should grow. There are many
hospitals and oncology clinics that
need to have an increased number of
specially trained nurses who
specialize in this field to give patients
the best care possible. Nurses will
also need to have an increased
knowledge about NHL therapies and
treatments in order to serve their
patients with the most
comprehensive care and holistic
approach possible.
Other healthcare providers
involved Other healthcare workers
involved with a patient with NHL
would include:
o Physician The patients
doctor would be working with
the patient to first diagnose
the disease. This is done by
way of a few possible tests,
such as biopsy, lab tests on
biopsy samples, blood tests,
and imaging tests. Doctors
then can treat NHL with the
most appropriate treatment for
the specifications of the patient
and get the patient to a point
of remission and eventually
freed of the disease.
o Pharmacist A pharmacist
would be responsible for
preparing any drugs that the
patient would be taking

before/during/after their course

of treatment.
UAP If hospitalized, the
patient would have

interactions with a UAP who

would help them to do their
ADLs.