In a patient with chronic myelogenous leukemia (CML), which manifestation(s) would the nurse expect to find caused by splenomegaly?
A) Excessive sweating and night sweats
B) Joint pain with joint splinting
C) Weakness and fatigue
D) Abdominal pain referred to the left shoulder
D) Abdominal pain referred to the left shoulder
Explanation: A) The degree of pancytopenia that is seen in CML depends on the degree of marrow overcrowding. Infection related to neutropenia, weakness and fatigue related to anemia, and bleeding related to thrombocytopenia may be present on diagnosis. Symptoms can also include excessive sweating or night sweats. However, these manifestations of illness are not due to splenomegaly.
B) Acute gouty arthritis manifested as joint pain may also present in CML, caused by an overproduction of uric acid. However, these manifestations of illness are not due to splenomegaly.
C) The degree of pancytopenia that is seen in CML depends on the degree of marrow overcrowding. Infection related to neutropenia, weakness and fatigue related to anemia, and bleeding related to thrombocytopenia may be present on diagnosis. Symptoms can also include excessive sweating or night sweats. However, these manifestations of illness are not due to splenomegaly.
D) Infiltration of the abnormal cells in the spleen can cause splenomegaly with abdominal pain, discomfort, early satiety, and upper left quadrant pain that is sometimes referred to the left shoulder.
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