406 e2 c42 hemolytic neoplasms
A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect? You Selected: Deficiency of neutrophils Correct response: Excess of immature leukocytes Explanation: The bone marrow biopsy of a client with acute myeloid leukemia will reveal an excess of immature leukocytes. Reference:
A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect? You Selected: Deficiency of neutrophils Correct response: Excess of immature leukocytes Explanation: The bone marrow biopsy of a client with acute myeloid leukemia will reveal an excess of immature leukocytes. Reference:
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? You Selected: The client with painful lymph nodes under the arm. Correct response: The client with enlarged lymph nodes in the neck. Explanation: Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? You Selected: The client with painful lymph nodes under the arm. Correct response: The client with enlarged lymph nodes in the neck. Explanation: Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? You Selected: Involvement of lymph nodes Correct response: Staging of disease Explanation: Treatment of Hodgkin lymphoma is based on the stage of the disease, not the histology of tissue, involvement of lymph nodes, or total blood cell count.
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? You Selected: Involvement of lymph nodes Correct response: Staging of disease Explanation: Treatment of Hodgkin lymphoma is based on the stage of the disease, not the histology of tissue, involvement of lymph nodes, or total blood cell count.
An otherwise healthy 33-year-old woman experienced debilitating and persistent fatigue over a period of several weeks and was subsequently diagnosed with acute myeloid leukemia (AML). The woman has been admitted to the hospital for treatment. The nurse who is providing care for this patient should prioritize which of the following assessments? You Selected: Assessing the woman for thrombosis and embolism Correct response: Assessing the woman for signs and symptoms of infection Explanation: Infection and bleeding present the greatest risks to patients with AML. As a result, nursing assessments related to these problems should be prioritized over cardiac status and fluid balance. The patient is at a low risk of thromboembolism.
An otherwise healthy 33-year-old woman experienced debilitating and persistent fatigue over a period of several weeks and was subsequently diagnosed with acute myeloid leukemia (AML). The woman has been admitted to the hospital for treatment. The nurse who is providing care for this patient should prioritize which of the following assessments? You Selected: Assessing the woman for thrombosis and embolism Correct response: Assessing the woman for signs and symptoms of infection Explanation: Infection and bleeding present the greatest risks to patients with AML. As a result, nursing assessments related to these problems should be prioritized over cardiac status and fluid balance. The patient is at a low risk of thromboembolism.
Which statement best describes the function of stem cells in the bone marrow? You Selected: They produce antibodies against foreign antigens. Correct response: They produce all blood cells. Explanation: All blood cells are produced from undifferentiated precursors called pluripotent stem cells in the bone marrow. Other cells produced from the pluripotent stem cells help defend against bacterial infection, produce antibodies against foreign antigens, and are active against hypersensitivity reactions.
Which statement best describes the function of stem cells in the bone marrow? You Selected: They produce antibodies against foreign antigens. Correct response: They produce all blood cells. Explanation: All blood cells are produced from undifferentiated precursors called pluripotent stem cells in the bone marrow. Other cells produced from the pluripotent stem cells help defend against bacterial infection, produce antibodies against foreign antigens, and are active against hypersensitivity reactions.
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? You Selected: "The goal of therapy is palliation." Correct response: "Intrathecal chemotherapy is used primarily as preventive therapy." Explanation: Intrathecal chemotherapy is a key part of the treatment plan to prevent invasion of the central nervous system. The therapy uses multiple drugs, with many side effects. The goal of therapy is remission.
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? You Selected: "The goal of therapy is palliation." Correct response: "Intrathecal chemotherapy is used primarily as preventive therapy." Explanation: Intrathecal chemotherapy is a key part of the treatment plan to prevent invasion of the central nervous system. The therapy uses multiple drugs, with many side effects. The goal of therapy is remission.
A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for? You Selected: Adventitious lung sounds Correct response: Diarrheal stools Explanation: Side effects of radiation therapy are limited to the area being irradiated. Clients who have abdominal radiation therapy may experience diarrhea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal edema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.
A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for? You Selected: Adventitious lung sounds Correct response: Diarrheal stools Explanation: Side effects of radiation therapy are limited to the area being irradiated. Clients who have abdominal radiation therapy may experience diarrhea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal edema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.
The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? You Selected: Hydroxyurea Correct response: Allopurinol Explanation: Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate are seen; this process is referred to as tumor lysis (cell destruction) syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Clients require a high fluid intake, and prophylaxis with allopurinol (Zyloprim) to prevent crystallization of uric acid and subsequent stone formation.
The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? You Selected: Hydroxyurea Correct response: Allopurinol Explanation: Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate are seen; this process is referred to as tumor lysis (cell destruction) syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Clients require a high fluid intake, and prophylaxis with allopurinol (Zyloprim) to prevent crystallization of uric acid and subsequent stone formation.
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan? You Selected: "Consolidation of the lungs is an expected effect of induction therapy." Correct response: "Consolidation therapy is administered to reduce the chance of leukemia recurrence." Explanation: Consolidation therapy is administered to eliminate residual leukemia cells that are not clinically detectable and reduce the chance for recurrence. It is also termed post-remission therapy. It is not a side effect of chemotherapy, but the administration of chemotherapy.
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan? You Selected: "Consolidation of the lungs is an expected effect of induction therapy." Correct response: "Consolidation therapy is administered to reduce the chance of leukemia recurrence." Explanation: Consolidation therapy is administered to eliminate residual leukemia cells that are not clinically detectable and reduce the chance for recurrence. It is also termed post-remission therapy. It is not a side effect of chemotherapy, but the administration of chemotherapy.
A client with a diagnosis of thrombocytopenia has been admitted to your unit for IV corticosteroid treatment. As the nurse caring for this client, you would expect the physician's orders to include which of the following? You Selected: Small frequent meals throughout the day Correct response: A tapering course of solumedrol at discharge Explanation: If instituting corticosteroid therapy in thrombocytopenia, the nurse observes the client for adverse drug effects. The dose and frequency of steroid medication is tapered before discontinuing it to avoid adrenal insufficiency or crisis. When a client is on high dose steroid treatment, a sleeping medication might be ordered; also a medication for steroid headaches, but not oxycodone. Clients on steroids are often hungry throughout the day. However, what you would expect to find in the orders is a tapering course of the steroids.
A client with a diagnosis of thrombocytopenia has been admitted to your unit for IV corticosteroid treatment. As the nurse caring for this client, you would expect the physician's orders to include which of the following? You Selected: Small frequent meals throughout the day Correct response: A tapering course of solumedrol at discharge Explanation: If instituting corticosteroid therapy in thrombocytopenia, the nurse observes the client for adverse drug effects. The dose and frequency of steroid medication is tapered before discontinuing it to avoid adrenal insufficiency or crisis. When a client is on high dose steroid treatment, a sleeping medication might be ordered; also a medication for steroid headaches, but not oxycodone. Clients on steroids are often hungry throughout the day. However, what you would expect to find in the orders is a tapering course of the steroids.
The nurse is educating a client taking imatinib mesylate for treatment of leukemia. What should the nurse be sure to include when educating the client on the best way to take the medication to optimize absorption? You Selected: Take the medication with a source of vitamin C to enhance absorption. Correct response: Take antacids if needed for gastrointestinal (GI) upset 2 hours after taking imatinib mesylate. Explanation: Imatinib (Gleevec) is metabolized by the cytochrome P450 pathway, which means that drug drug interactions are common. In particular, antacids and grapefruit juice may limit drug absorption, and large doses of acetaminophen can cause hepatotoxicity.
The nurse is educating a client taking imatinib mesylate for treatment of leukemia. What should the nurse be sure to include when educating the client on the best way to take the medication to optimize absorption? You Selected: Take the medication with a source of vitamin C to enhance absorption. Correct response: Take antacids if needed for gastrointestinal (GI) upset 2 hours after taking imatinib mesylate. Explanation: Imatinib (Gleevec) is metabolized by the cytochrome P450 pathway, which means that drug drug interactions are common. In particular, antacids and grapefruit juice may limit drug absorption, and large doses of acetaminophen can cause hepatotoxicity.
A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? You Selected: Impaired tissue integrity Correct response: Risk for falls Explanation: A client with paresthesia in the feet is at risk for falls due to impaired sensation. Acute pain, impaired tissue integrity, and sensory-perception disturbance are all nursing diagnoses that are appropriate for the client; however, risk for falls is priority.
A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? You Selected: Impaired tissue integrity Correct response: Risk for falls Explanation: A client with paresthesia in the feet is at risk for falls due to impaired sensation. Acute pain, impaired tissue integrity, and sensory-perception disturbance are all nursing diagnoses that are appropriate for the client; however, risk for falls is priority.
The hospitalized client is experiencing gastrointestinal bleeding with a platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take? You Selected: Use contact precautions with this client. Correct response: Perform a neurologic assessment with vital signs. Explanation: With platelets less than 10,000/mm³ there is a risk for spontaneous bleeding, including within the cranial vault. The nurse performs a neurologic examination to assess for this possibility. Though the client is receiving immunosuppressants, it is not necessary to use contact precautions with this client. Contact precautions are used with clients who have known or suspected transmittable illnesses. Diphenoxylate and atropine can cause constipation and inhibit accurate assessment of the client's gastrointestinal bleeding. If the client strains when having a bowel movement, the client could bleed even more. The client is not to floss vigorously; doing so can cause bleeding.
The hospitalized client is experiencing gastrointestinal bleeding with a platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take? You Selected: Use contact precautions with this client. Correct response: Perform a neurologic assessment with vital signs. Explanation: With platelets less than 10,000/mm³ there is a risk for spontaneous bleeding, including within the cranial vault. The nurse performs a neurologic examination to assess for this possibility. Though the client is receiving immunosuppressants, it is not necessary to use contact precautions with this client. Contact precautions are used with clients who have known or suspected transmittable illnesses. Diphenoxylate and atropine can cause constipation and inhibit accurate assessment of the client's gastrointestinal bleeding. If the client strains when having a bowel movement, the client could bleed even more. The client is not to floss vigorously; doing so can cause bleeding.
A 63-year-old woman has been diagnosed with polycythemia vera (PV) after undergoing a series of diagnostic tests. When the woman's nurse is providing health education, what subject should the nurse prioritize? You Selected: Nutritional modifications necessary for maintaining a low-iron diet Correct response: Lifestyle modifications and techniques for preventing thromboembolism Explanation: The increased blood volume and viscosity that are the hallmarks of PV create a significant risk of thromboembolism. A vascular access device is not necessary for the treatment of PV, and a low-iron diet does not resolve the disease. Patients may experience fatigue, but this risk is superseded by that of thromboembolism.
A 63-year-old woman has been diagnosed with polycythemia vera (PV) after undergoing a series of diagnostic tests. When the woman's nurse is providing health education, what subject should the nurse prioritize? You Selected: Nutritional modifications necessary for maintaining a low-iron diet Correct response: Lifestyle modifications and techniques for preventing thromboembolism Explanation: The increased blood volume and viscosity that are the hallmarks of PV create a significant risk of thromboembolism. A vascular access device is not necessary for the treatment of PV, and a low-iron diet does not resolve the disease. Patients may experience fatigue, but this risk is superseded by that of thromboembolism.
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? You Selected: Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. Correct response: Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. Explanation: Neutropenia occurs when the absolute neutrophil count falls below 1,000/mm3, reflecting a severe risk of infection. The nurse should provide a low-bacterial diet, which means eliminating fresh fruits and vegetables, avoiding invasive procedures such as enemas, and practicing frequent hand washing. Using a soft toothbrush, avoiding straight-edged razors and enemas, and monitoring for bleeding are precautions for clients with thrombocytopenia. Putting on a mask, gown, and gloves when entering the client's room are reverse isolation measures. A neutropenic client doesn't need a clear liquid diet or sodium restrictions.
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? You Selected: Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. Correct response: Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. Explanation: Neutropenia occurs when the absolute neutrophil count falls below 1,000/mm3, reflecting a severe risk of infection. The nurse should provide a low-bacterial diet, which means eliminating fresh fruits and vegetables, avoiding invasive procedures such as enemas, and practicing frequent hand washing. Using a soft toothbrush, avoiding straight-edged razors and enemas, and monitoring for bleeding are precautions for clients with thrombocytopenia. Putting on a mask, gown, and gloves when entering the client's room are reverse isolation measures. A neutropenic client doesn't need a clear liquid diet or sodium restrictions.
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? You Selected: Administer pain medication, as ordered. Correct response: Assess renal function. Explanation: Chemotherapy results in the destruction of cells and tumor lysis syndrome. Uric acid and phosphorus concentrations increase, and the client is susceptible to renal failure. The nurse should assess renal function if the client complains of low-back pain, as this could be indicative of kidney stone formation. Heating pads, pain medication, and referrals could be instituted once the cause of the pain is determined. The priority is further assessment to rule out important problems.
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? You Selected: Administer pain medication, as ordered. Correct response: Assess renal function. Explanation: Chemotherapy results in the destruction of cells and tumor lysis syndrome. Uric acid and phosphorus concentrations increase, and the client is susceptible to renal failure. The nurse should assess renal function if the client complains of low-back pain, as this could be indicative of kidney stone formation. Heating pads, pain medication, and referrals could be instituted once the cause of the pain is determined. The priority is further assessment to rule out important problems.