Adult Health Exam 3

a. Withhold the blood products and notify the health care provider. Competent adults have the right to make all health care decisions, including the right to refuse treatment based on their religious beliefs. The nurse should withhold the blood products in accordance with the patient's wishes. Contacting the ethics committee is not necessary since the patient's wishes are clear. Since the patient is competent, asking the family for permission to administer blood products would be unethical. Administration of blood products after the patient has confirmed not wanting a transfusion would be unethical.

A competent patient who reports being a Jehovah's Witness is hospitalized with hemorrhage and confirms not wanting to receive blood products. Which action by the nurse is best when the patient becomes unconscious and packed red blood cells are prescribed? a. Withhold the blood products and notify the health care provider. b. Contact the agency's ethics committee about whether to give blood. c. Contact the family for permission to administer blood products to the patient. d. Administer blood products with the intent of informing the patient after the procedure.

a. Tachycardia b. Heart failure d. Intermittent claudication The compensatory cardiac symptoms of severe anemia are tachycardia, heart failure, and intermittent claudication. The cardiac murmurs that occur in severe anemia are systolic, not diastolic, in nature. In severe anemia, there is an increase in pulse pressure.

A nurse mentor provides teaching to a group of nursing students about the cardiac manifestations of severe anemia. Which compensatory cardiac changes would the nurse include? Select all that apply. a. Tachycardia b. Heart failure c. Diastolic murmurs d. Intermittent claudication e. Decreased pulse pressure

a. Mild anemia In mild anemia, hemoglobin is in the range of 10-12 g/dL. In severe anemia, it is less than 6 g/dL. Aplastic anemia refers to a type of anemia caused by a decrease in red blood cell precursors. It does not refer to the severity of anemia. In moderate anemia, the hemoglobin it is in the range of 6-10 g/dL. Hemoglobin above 12 g/dL is considered normal (no anemia).

A patient has a hemoglobin level of 11 g/dL. The nurse determines that the patient has which level of severity of anemia? a. Mild anemia b. Severe anemia c. Aplastic anemia d. Moderate anemia

b. Four tablets Using ratio and proportion, multiply 250 by x and multiply 1000 × 1 to yield 250x = 1000. Divide 1000 by 250 to yield four tablets.

A patient is to receive cobalamin (vitamin B ) 1,000 mcg by mouth (PO). The pharmacy issues 250-mcg tablets. Which number of tablets would the nurse administer to the patient? a. Two tablets b. Four tablets c. Six tablets d. Eight tablets

b. Assist the patient in prioritizing activities. The nurse should teach and assist the patient and caregiver to assign priority to activities to accommodate energy levels and promote tolerance for important activities. The caregiver should limit the number of visitors so that the patient receives adequate rest. The patient should be asked to avoid activity immediately after meals to reduce competition for oxygen supply to vital functions. Activities should be alternated with rest periods throughout the day rather than completed in the morning.

A patient with anemia experiences fatigue when performing activities of daily living. Which nursing intervention is appropriate to include in the patient's plan of care? a. Encourage frequent visitors. b. Assist the patient in prioritizing activities. c. Assist the patient in walking immediately after meals. d. Ensure that all physical activities are completed in the morning.

c. "It is designed to minimize the spread of germs to you from sources outside your environment." The primary purpose of protective, or reverse, isolation is to reduce transmission of organisms to the patient from sources outside the patient's environment. The use of special techniques to destroy discharge or handle the patient's linen and personal items and preventing the spread from the patient to others are not the purpose of protective isolation.

A patient with neutropenia asks how the prescribed protective (reverse) isolation helps prevent the spread of organisms. Which response by the nurse is appropriate? a. "It is designed to use special techniques to decrease discharge from your body." b. "It is designed to use special techniques to handle your linens and personal items." c. "It is designed to minimize the spread of germs to you from sources outside your environment." d. "It is designed to minimize the spread of germs from you to health care personnel, visitors, and other patients."

a. Acute lymphocytic leukemia (ALL) Patients with ALL have a high probability of having leukemic infiltration of the CNS. The spread of leukemia to the CNS is not expected in CLL. AML does not typically infiltrate the CNS. CML is not associated with leukemic spread to the CNS.

A patient with which type of leukemia is likely to experience central nervous system (CNS) manifestations of the disease? a. Acute lymphocytic leukemia (ALL) b. Chronic lymphocytic leukemia (CLL) c. Acute myelogenous leukemia (AML) d. Chronic myelogenous leukemia (CML)

b. Palpitations An Hgb range of 10 to 12 g/dL indicates mild anemia. Therefore the patient with an Hgb of 11 g/dL may experience palpitations. Glossitis is one of the manifestations of severe anemia in which the patient would have an Hgb level below 6 g/dL. Exertional dyspnea is seen in patients with mild anemia. However, dyspnea at rest is a manifestation of severe anemia. Roaring in the ears is seen in patients with moderate anemia whose Hgb values range between 6 and 10 g/dL.

A patient's laboratory report reveals a hemoglobin (Hgb) level of 11 g/dL. The nurse expects to observe which clinical manifestation? a. Glossitis b. Palpitations c. Dyspnea at rest d. Roaring in the ears

c. Combination chemotherapy The initial treatment for AML will be combination chemotherapy. If the white blood cell count is higher than 100,000/µL, then leukapheresis may be needed, but there is no indication that leukapheresis is needed currently. Total body radiation may be done prior to hematopoietic stem cell transplantation (HSCT), but remission will be achieved with chemotherapy first. HSCT may be an option, but remission with chemotherapy will be achieved prior to considering HSCT.

After a patient is diagnosed with acute myelogenous leukemia (AML), which topic will the nurse plan to teach first? a. Leukapheresis b. Total body radiation c. Combination chemotherapy d. Hematopoietic stem cell transplant

d. "In stage II, there is an involvement of two or more lymph nodes on both sides of the diaphragm." In stage II of Hodgkin's disease and non-Hodgkin's disease, there is an involvement of two or more lymph nodes on one side of the diaphragm but not both sides of diaphragm. In stage I, there is an involvement of a single lymph node, generally the cervical node. In stage IV, there is involvement of other organs besides lymph nodes, such as the liver or bone marrow. In stage III, there is lymph node involvement above and below the diaphragm.

After the nurse educator has discussed the staging of Hodgkin's lymphoma with students, which statement made by a student indicates a need for more teaching? a. "In stage I, there is an involvement of a single lymph node." b. "In stage IV, there is an involvement outside the lymph nodes." c. "In stage III, there is lymph node involvement above and below the diaphragm." d. "In stage II, there is an involvement of two or more lymph nodes on both sides of the diaphragm."

a. Partial remission In partial remission, there will be a lack of symptoms, and the peripheral blood smear will appear to be normal; however, evidence of disease in the bone marrow can be observed. In complete remission, there will be a lack of symptoms and no evidence of disease in the bone marrow. In molecular remission, all molecular studies are negative for residual leukemia. In minimal residual disease, tumor cells are not detected by morphologic examination but can be identified by molecular testing.

After treatment for leukemia, a patient no longer experiences symptoms, and the peripheral blood smear is normal, although there are abnormal cells in the bone marrow. The patient is in which stage of remission? a. Partial remission b. Complete remission c. Molecular remission d. Minimal residual disease

c. Petechiae Petechiae are minute hemorrhages into the skin that are seen in patients with bleeding disorders, such as thrombocytopenia. Purpura are larger discolored areas of bleeding that may occur when multiple petechiae coalesce. Bruises are larger areas of bleeding into the skin that occur with thrombocytopenia and might also be noted by the nurse in this patient. Ecchymoses are also larger areas of bleeding seen under the skin in patients with thrombocytopenia or other bleeding disorders.

How will the nurse document the finding after noting multiple 1-mm red macules when assessing the skin of a patient with leukemia and thrombocytopenia? a. Purpura b. Bruising c. Petechiae d. Ecchymosis

b. 1045 The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank, which would be at 1045. 1030, 1100, and 1115 are not consistent with this policy.

If a unit of packed red blood cells is picked up from the laboratory at 1015, the nurse would plan to hang the unit to begin infusion no later than which time? a. 1030 b. 1045 c. 1100 d. 1115

a. Pallor The integumentary finding of pallor is associated with severe anemia. Gastrointestinal diarrhea is not associated with anemia. Cardiovascular palpitations are associated with mild anemia. Pulmonary exertional dyspnea is associated with mild anemia.

Which assessment finding would the nurse associate with severe anemia? a. Pallor b. Diarrhea c. Palpitations d. Exertional dyspnea

a. Vertigo b. Dyspnea at rest d. Jaundice and pruritus e. Glossitis and smooth tongue In severe anemia (Hgb less than 6 g/dL [60 g/L]), the patient has many clinical manifestations involving multiple body systems, including vertigo, dyspnea at rest, jaundice and pruritus, and glossitis and smooth tongue. The patient will not have sensitivity to heat, but rather a sensitivity to cold.

The nurse assesses a patient who has severe anemia and expects to find which manifestations? Select all that apply. a. Vertigo b. Dyspnea at rest c. Sensitivity to heat d. Jaundice and pruritus e. Glossitis and smooth tongue

d. Red, beefy tongue The decreased absorption of vitamin B resulting from a lack of intrinsic factor causes a decrease in hemoglobin, hematocrit, and red blood cells. A smooth, red, enlarged or "beefy" appearance of the tongue may also be seen. Intrinsic factor is produced by the parietal cells of the stomach lining and is required to absorb vitamin B from the intestines. Causes of decreased intrinsic factor production include surgical alterations such as gastrectomy and autoimmune disease. Diarrhea, indigestion, and flushed skin appearance are not signs specifically associated with pernicious anemia.

The nurse assesses a patient with pernicious anemia and expects to find which classic sign of this condition? a. Diarrhea b. Indigestion c. Flushed skin d. Red, beefy tongue

a. Air hunger b. Clammy skin e. Decreased central venous pressure Air hunger, clammy skin, and a decreased central venous pressure are the clinical manifestations seen in a patient who has sustained 2000 mL of acute blood loss. Lactic acidosis may occur in cases of 2500 mL of acute blood loss. Rare vasovagal syncope may occur if 500 mL of acute blood loss occurs.

The nurse expects to observe which manifestations in a patient who experienced an acute blood loss of 2000 mL? Select all that apply. a. Air hunger b. Clammy skin c. Lactic acidosis d. Vasovagal syncope e. Decreased central venous pressure

a. Orthopnea b. Tachypnea c. Dyspnea at rest The compensatory respiratory changes that occur in severe anemia are orthopnea, tachypnea, and dyspnea at rest. Impaired thought process is a neurologic symptom associated with severe anemia. Dyspnea on exertion is seen in mild anemia.

The nurse is caring for a patient with severe anemia. The nurse expects which compensatory respiratory changes? Select all that apply. a. Orthopnea b. Tachypnea c. Dyspnea at rest d. Dyspnea on exertion e. Impaired thought process

d. "Now that the blood loss is controlled and as your blood volume is replaced, the anemia generally corrects itself, so no long-term treatment is needed." Anemia caused by acute blood loss generally resolves itself once the source of the bleeding is identified and controlled and blood/fluid volume is replaced. It is incorrect to tell the patient he or she will need supplements for the rest of his or her life, that dietary changes will be necessary for the next year or two, or that several supplements are necessary to prevent recurrence.

The nurse is providing discharge instructions to a patient who has anemia secondary to acute blood loss. Which instruction would the nurse include in the discharge teaching? a. "You will need to take an iron supplement for the rest of your life to make sure the anemia does not return." b. "You will need to make dietary changes to help support the production of red blood cells for the next one to two years." c. "It would be best to take several supplements to prevent the anemia from recurring, including folic acid, niacin, and riboflavin." d. "Now that the blood loss is controlled and as your blood volume is replaced, the anemia generally corrects itself, so no long-term treatment is needed."

a. Report 1 Uptake noted in a single cervical lymph node aligns with stage I lymphoma because a single node is positive. Uptake noted in cervical and mediastinal lymph is stage II lymphoma because multiple nodes on one side of the diaphragm are positive. Uptake noted in cervical and mesenteric lymph nodes align with stage III lymphoma because multiple nodes are involved on both sides of the diaphragm. Uptake noted in cervical, mediastinal, mesenteric, and hepatic areas aligns with stage IV lymphoma because multiple nodes are involved on both sides of the diaphragm and outside the diaphragm in the hepatic area.

The nurse is reviewing imaging results on lymphoma patients. Which report reflects nodal involvement at stage I? a. Report 1 b. Report 2 c. Report 3 d. Report 4

b. Report 2 Uptake noted in cervical and mediastinal lymph is stage II lymphoma because multiple nodes on one side of the diaphragm are positive. Uptake noted in a single cervical lymph node aligns with stage I lymphoma because a single node is positive. Uptake noted in cervical and mesenteric lymph nodes align with stage III lymphoma because multiple nodes are involved on both sides of the diaphragm. Uptake noted in cervical, mediastinal, mesenteric, and hepatic areas aligns with stage IV lymphoma because multiple nodes are involved on both sides of the diaphragm and outside the diaphragm in the hepatic area.

The nurse is reviewing imaging results on lymphoma patients. Which report reflects nodal involvement at stage II? a. Report 1 b. Report 2 c. Report 3 d. Report 4

c. Avocados d. Red meat Avocado contains niacin, which is required for the maturation of RBC. Red meat is rich in cobalamin (vitamin B ). Cobalamin is an essential nutrient that plays an important role in erythropoiesis by enhancing the RBC maturation. Therefore the nurse would expect these two food sources to promote red blood cell (RBC) maturation. Shellfish contains copper, which is an essential nutrient useful for mobilization of iron from tissues to plasma. Bananas and cornmeal are rich in pyridoxine (vitamin B ), which is essential for hemoglobin synthesis.

The nurse provides dietary teaching to a patient with anemia and would include which food sources to promote red blood cell (RBC) maturation? Select all that apply. a. Shellfish b. Bananas c. Avocados d. Red meat e. Cornmeal

a. "I should avoid high altitudes." e. "I should start screening for retinopathy at age 10." Patients with SCD should avoid crises by avoiding activities that cause hypoxia. High altitudes can increase the risk for the development of hypoxia. Regular screenings for retinopathy are recommended. The patient should not drink orange juice too often because orange juice is rich in vitamin C. Eating uncooked seafood increases the risk of infection; this type of product is rich in iron and should be avoided. The pneumococcal injection is recommended to prevent infection.

The nurse provides discharge teaching to a patient with sickle cell disease (SCD). Which statements made by the patient indicate understanding of the teaching? Select all that apply. a. "I should avoid high altitudes." b. "I should drink orange juice quite often." c. "I can safely consume uncooked seafood." d. "I shouldn't receive the pneumococcal injection." e. "I should start screening for retinopathy at age 10."

a. Infectious agent Infectious agents, such as malaria, are extrinsic factors that can lead to acquired hemolytic anemias. Abnormal hemoglobin, such as sickle cell disease, and enzyme deficiencies are intrinsic factors that lead to hereditary (intrinsic) hemolytic anemias. Membrane abnormalities, such as paroxysmal nocturnal hemoglobinuria, cause increased red blood cell (RBC) destruction and are hereditary (intrinsic) factors.

The nurse recalls that hemolytic anemia can be caused by which extrinsic factors? a. Infectious agent b. Enzyme deficiency c. Sickle cell disease d. Membrane abnormalities

d. Heparin-induced thrombocytopenia (HIT) With HIT, heparin causes decreased platelet counts and increases the risk for hemorrhage. Patients who have had HIT should never be given heparin or low-molecular-weight heparin (LMWH). This should be clearly marked in the patient's medical record. Splenomegaly is an enlarged spleen; this often occurs with anemia and autoimmune disorders. Thromboembolism is another term for blood clot; heparin is used to treat clots and would not cause them. Hepatic encephalopathy occurs in alcoholic patients when brain tissue is destroyed due to decreased thiamine.

The nurse recalls that heparin should not be given to a patient with a history of which condition? a. Splenomegaly b. Thromboembolism c. Hepatic encephalopathy d. Heparin-induced thrombocytopenia (HIT)

c. That competent and compassionate care is provided to all patients The standard of care for pain includes providing competent and compassionate care for all patients. The patient's pain assessment is not based on nursing judgment; it is based on the patient's self-report. The standard of care for pain includes providing the best possible relief under the circumstances. Notifying the health care provider regarding the effects of the pain medication should occur if the medication is not providing adequate pain relief for the patient.

The nurse recalls that the standard of care for pain includes which component? a. That the pain assessment is based on nursing judgment b. The minimal amount of intervention required to address pain c. That competent and compassionate care is provided to all patients d. Notifying the health care provider regarding the effects of the pain medication

c. Sore throat Sore throat is an assessment finding related to cognitive-perceptual health patterns in a patient with leukemia. Nausea comes under the nutritional-metabolic health pattern. Epistaxis is an assessment finding related to activity-exercise. Easy bruising also comes under the nutritional-metabolic health pattern.

The nurse recognizes that which assessment finding is related to cognitive-perceptual health patterns in a patient with leukemia? a. Nausea b. Epistaxis c. Sore throat d. Easy bruising

b. Hemochromatosis The normal range of total body iron is 2 to 6 g, and its concentration exceeds 50 g in case of hemochromatosis. Fatigue, arthralgia, abdominal pain, weight loss, and enlarged liver and spleen are the clinical manifestations of hemochromatosis. Polycythemia is characterized by laboratory manifestations such as elevated hemoglobin and red blood cell (RBC) count, low to normal erythropoietin, elevated white blood cell (WBC) count, platelet, uric acid, and cobalamin levels. The clinical manifestations include headaches, vertigo, dizziness, tinnitus, and visual disturbances. In patients with sickle cell disease, the peripheral blood smear will show sickled cells and abnormal reticulocytes. The patient may have elevated serum bilirubin levels and bone and joint deformities. In patients with iron-deficiency anemia, the laboratory findings indicate a low total body iron and hemoglobin levels along with clinical manifestations such as glossitis, cheilitis, and pallor.

The nurse reviews a patient's assessment findings, which include arthralgia, liver enlargement, and total body iron level of 70 g. The nurse would anticipate providing care related to which condition? a. Polycythemia b. Hemochromatosis c. Sickle cell disease d. Iron-deficiency anemia

d. Hyperpigmentation Common integumentary changes observed in anemia include pallor, pruritus, and jaundice. Pallor results from reduced amounts of hemoglobin and reduced blood flow to the skin. Pruritus occurs because of increased serum and skin bile salt concentration. Jaundice occurs when hemolysis of red blood cells (RBCs) results in an increased concentration of serum bilirubin. Hyperpigmentation is usually not associated with anemia.

The nurse reviews documentation of assessment findings of a patient with severe anemia. Which assessment finding would the nurse question? a. Pallor b. Pruritus c. Jaundice d. Hyperpigmentation

a. Increased cobalamin levels c. Increased hemoglobin levels d. Increased red blood cell levels f. Increased white blood cell levels Polycythemia vera has increased cobalamin and hemoglobin levels, as well as the presence of increased red blood cell and white blood cell levels. Elevated levels of histamine and blood platelet count are seen in patients with polycythemia vera.

The nurse suspects that a patient has polycythemia vera based on which findings in the patient' s laboratory reports? Select all that apply. a. Increased cobalamin levels b. Decreased histamine levels c. Increased hemoglobin levels d. Increased red blood cell levels e. Decreased blood platelet levels f. Increased white blood cell levels

c. Lungs With repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially the spleen, lungs, kidneys, and brain. Organs that have a need for large amounts of O , like the lungs, are most often affected and form the basis for many of the complications of sickle cell disease (SCD). Although the liver, heart, and stomach may be affected, they are less so when compared to the lungs.

The nurse understands that with repeated episodes of sickling, which organ is most affected? a. Liver b. Heart c. Lungs d. Stomach

b. 1045 As part of standard procedure, the nurse remains with the patient for the first 15 minutes after hanging a blood transfusion. Patients who are likely to have a transfusion reaction more often will exhibit signs within the first 15 minutes that the blood is infusing. Ten minutes is not enough time to evaluate for adverse reactions; unless the patient is having an adverse reaction, it is not necessary to remain at the bedside for longer than 15 minutes.

The nurse will begin a patient's transfusion of packed red blood cells at 1030. The nurse would plan to stay in the patient's room until which time? a. 1040 b. 1045 c. 1050 d. 1055

c. Another registered nurse (RN) Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. If there is not another nurse available, a health care provider could check the blood with the nurse. The unit secretary, physician's assistant, and UAP are not licensed to perform this duty.

The nurse would ask which health care team member to assist when checking a unit of packed red blood cells before administration? a. The unit secretary b. The physician's assistant c. Another registered nurse (RN) d. The unlicensed assistive personnel (UAP)

c. Heartburn d. Black stools e. Constipation Because the gastrointestinal (GI) tract excretes excess iron, the primary side effects of oral iron preparations are heartburn, black stools, and constipation. Anorexia is not an expected side effect. Red stool is not a side effect of iron preparation but can be caused by the presence of fresh blood in the stools due to bleeding from hemorrhoids or irritable bowel syndrome.

The nurse would instruct the patient about which side effects of oral iron supplements? Select all that apply. a. Anorexia b. Red stools c. Heartburn d. Black stools e. Constipation

d. Have a second registered nurse check the identifying information on the unit of blood against the identification bracelet and blood-bank identification bracelet. The patient's identifying information (name, date of birth, medical record number) on the identification bracelet should match exactly the information on the blood-bank tag that has been placed on the unit of blood. A second registered nurse should perform this check. If any information does not match, the transfusion should not be hung because of possible error and risk to the patient. Blood tubing, not primary tubing, is needed for blood transfusion and should not be administered as a secondary infusion. The nurse should remain with the patient for 15 minutes following initiation of transfusion.

The nurse would take which action to ensure patient safety when administering a unit of packed red blood cells (PRBCs)? a. Add the blood transfusion as a secondary line to the existing IV and infuse over 60 minutes or less. b. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of transfusion reaction. c. Select a new primary IV tubing to use for the administration and piggyback with 500 mL of normal saline. d. Have a second registered nurse check the identifying information on the unit of blood against the identification bracelet and blood-bank identification bracelet.

d. Taking the tablet with orange juice e. Taking the tablet an hour before meals Taking iron tablets an hour before food ensures maximum absorption because iron will not get bound to food. When iron binds with food, absorption of iron falls. Orange juice and ascorbic acid enhance iron absorption. Taking iron tablets with food can reduce iron absorption. Taking iron tablets before or after exercise does not affect absorption.

When a patient is prescribed iron tablets for the treatment of anemia, which measures ensure maximum absorption? Select all that apply. a. Taking the tablet with food b. Taking the tablet after exercise c. Taking the tablet before exercise d. Taking the tablet with orange juice e. Taking the tablet an hour before meals

c. Proliferation of immature white blood cells (WBCs) d. Replacement of bone marrow with blast cells a. Reduction in erythrocyte, leukocyte, and platelet count b. Occurrence of anemia, pallor, and infection In leukemia, immature white blood cells, such as malignant and blast cells, proliferate. Blast cells replace bone marrow resulting in bone marrow failure, which causes a decrease in red blood cells (RBCs), WBCs, and platelets. Anemia and pallor occur due to reduction in RBC count. The decrease in WBC count leads to immunosuppression, resulting in infection.

The steps involved in the pathophysiology of leukemia occur in which chronologic order? a. Reduction in erythrocyte, leukocyte, and platelet count b. Occurrence of anemia, pallor, and infection c. Proliferation of immature white blood cells (WBCs) d. Replacement of bone marrow with blast cells

a. Lumbar puncture e. CT Lumbar puncture and CT are used to detect leukemic cells outside of the blood and bone marrow. Morphologic study, histochemical study, and cytogenetic method are used to identify leukemic cell type and help in choice of chemotherapy regimen and other treatments.

To determine whether a patient's leukemia has affected other organs besides bone marrow and blood, which diagnostic studies will be prescribed? Select all that apply. a. Lumbar puncture b. Morphologic study c. Histochemical study d. Cytogenetic method e. CT

a. Monitor the patient for liver problems. c. Evaluate the patient's response to the therapy. e. Continue the supplementation for two to three months after hemoglobin levels return to normal. Long-term iron supplementation can cause liver dysfunction; therefore the patient should be evaluated for liver function abnormalities. While undergoing therapy, the nurse should evaluate the improvement in hemoglobin levels during every visit and should take necessary steps if hemoglobin levels do not improve. Iron therapy should be continued for two to three months after hemoglobin levels return to normal to replenish the iron stores in the body. Iron therapy is not associated with psychologic problems; hence, there is no need to monitor for psychologic changes. Iron supplementation should not be stopped once hemoglobin levels are back to normal.

To ensure maximum effectiveness of lifelong iron supplementation therapy, which intervention would the nurse include in the patient's plan of care? Select all that apply. a. Monitor the patient for liver problems. b. Assess the patient for psychologic problems. c. Evaluate the patient's response to the therapy. d. Discontinue the therapy after hemoglobin levels return to normal. e. Continue the supplementation for two to three months after hemoglobin levels return to normal.

d. 0.9% normal saline The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure that the patient receives blood that is left in the tubing when the bag is empty. 3% normal saline, Lactated Ringer's and 5% dextrose in water, are not compatible with blood products.

To prepare for a patient's transfusion of packed red blood cells, the nurse would select which IV solution to use for the procedure? a. 3% normal saline b. Lactated Ringer's c. 5% dextrose in water d. 0.9% normal saline

b. Stop the blood transfusion. Itching and hives indicate that the patient is experiencing a blood transfusion reaction. The transfusion should be discontinued immediately and disconnected in order to minimize complications of the transfusion reaction. An infusion of normal saline may be started after the blood transfusion has been discontinued and disconnected. After the transfusion has been stopped, the nurse will assess the patient, including assessing BP and then notifying the health care provider. The antihistamine may be given to relieve itching and hives after the blood is discontinued and disconnected.

When a patient receiving a transfusion of packed red blood cells reports itching and develops hives on the chest and abdomen, which action will the nurse take first? a. Infuse normal saline. b. Stop the blood transfusion. c. Take the patient's BP. d. Give the prescribed antihistamine.

c. Molecular remission Molecular remission is the condition in which all molecular studies are negative for residual leukemia. Partial remission is the condition in which there is a lack of symptoms of the disease and a normal peripheral blood smear but evidence of disease in the bone marrow. Complete remission is the condition in which the bone marrow and the peripheral blood appear normal. Minimal residual disease refers to the tumor cells that cannot be detected by morphologic examination but can be detected by molecular testing.

When a leukemia patient's post-chemotherapy molecular studies are negative for residual leukemia, which type of remission has the patient achieved? a. Partial remission b. Complete remission c. Molecular remission d. Minimal residual disease

b. Hypercalcemia c. Hypoalbuminemia d. Reed-Sternberg cells Blood studies may show hypercalcemia from bone involvement and hypoalbuminemia if there is liver involvement for a patient with Hodgkin's lymphoma. Reed-Sternberg cells are giant lymphocytes that are characteristic of Hodgkin's lymphoma. Anemia is sometimes seen in Hodgkin's lymphoma, but polycythemia would not be expected. Bence Jones proteins are characteristic of multiple myeloma.

When a patient has Hodgkin's lymphoma that involves the bone and the liver, which diagnostic findings will the nurse expect? Select all that apply. a. Polycythemia b. Hypercalcemia c. Hypoalbuminemia d. Reed-Sternberg cells e. Bence Jones protein

c. MRI An MRI scan is useful in NHL to determine whether there is CNS involvement. Peripheral blood analysis might be used to check for complications such as anemia, thrombocytopenia, or liver involvement but would not be useful in detecting CNS involvement. Bone marrow aspiration might be done to detect bone marrow involvement but would not help to detect CNS involvement. A PET scan with CT is used to stage NHL and to assess the response to therapy.

When a patient has been diagnosed with non-Hodgkin's lymphoma (NHL), which diagnostic test will be used to assess for central nervous system (CNS) involvement? a. Peripheral blood analysis b. Bone marrow aspiration c. MRI d. Positron emission tomography (PET) scan

a. Partial remission Partial remission is a condition in which there is a lack of symptoms of the disease and a normal peripheral blood smear but evidence of the disease in the bone marrow. Complete remission refers to the condition in which the bone marrow and the peripheral blood appear normal. Molecular remission is the condition in which all molecular studies are negative for residual leukemia. Minimal residual disease refers to the tumor cells that cannot be detected by morphologic examination but can be detected by molecular testing.

When a patient with leukemia has completed induction therapy with resolution of leukemia symptoms, normal peripheral blood smear testing, and some leukemic cells in the bone marrow testing, how will the patient's status be described? a. Partial remission b. Complete remission c. Molecular remission d. Minimal residual disease

a. Acute lymphocytic leukemia (ALL) Acute lymphocytic leukemia is associated with hypercellular bone marrow with lymphoblasts (immature lymphocytes). Acute myelogenous leukemia is characterized by an increase in the number of myeloblasts (immature myelocytes). Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes. Chronic myelogenous leukemia occurs as a result of the excessive development of mature granulocytes in the bone marrow.

When diagnostic testing shows hypercellular bone marrow with lymphoblasts, the nurse expects the patient to be diagnosed with which type of leukemia? a. Acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)

d. Hematopoietic stem cell transplantation (HSCT) HSCT may be used to achieve a cure for Hodgkin's lymphoma once chemotherapy has achieved a remission. Corticosteroids may be part of the chemotherapy regimen but are not used alone to treat lymphoma or as maintenance therapy after remission is achieved. Targeted radiation therapy may be part of the initial treatment but is not needed once remission has been received. Maintenance chemotherapy does not contribute to survival once remission has been achieved for Hodgkin's lymphoma.

When initial treatment for stage III Hodgkin's lymphoma has been successful and the patient is in remission, the nurse anticipates that which type of therapy may be prescribed to follow the initial treatment? a. Corticosteroids b. Targeted radiation c. Maintenance chemotherapy d. Hematopoietic stem cell transplantation (HSCT)

a. "Have you experienced numbness or tingling of the feet?" Assessment of the cognitive-perceptual functional health pattern will include sensory data, such as numbness of the feet. The other questions also will help collect important data but are not directed toward sensory, cognitive, or perceptual patient information. Past health history of chemotherapy may help to determine whether the patient is having a relapse of leukemia. Knowledge about gum bleeding or oral pain is collected as part of the nutritional-metabolic functional health pattern and will help the nurse plan diet and oral care for this patient. Family history of leukemia or cancer may help to determine what type of leukemia the patient has and what treatment will be best and falls in the health perception-health management functional health pattern.

When interviewing a patient with leukemia, which question would the nurse ask to obtain information about the patient's cognitive-perceptual functional health pattern? a. "Have you experienced numbness or tingling of the feet?" b. "Do you have any past history of chemotherapy for cancer?" c. "Have you noticed any gum bleeding or oral pain recently?" d. "Is there any family history of leukemia or other cancers?"

b. Complete remission In complete remission, the bone marrow and the peripheral blood appear normal. The patient does not show any evidence of disease upon physical examination. Partial remission is a condition characterized by a lack of disease symptoms and a normal peripheral blood smear, but evidence of disease remains in the bone marrow. Molecular remission is the condition in which all molecular studies are negative for residual leukemia. Minimal residual disease indicates that tumor cells cannot be detected by morphologic examination but can be detected by molecular testing.

When the posttreatment diagnostic studies for a patient with leukemia indicate normal bone marrow and peripheral blood, and the physical examination does not show any evidence of disease, which term will be used to describe the patient's status? a. Partial remission b. Complete remission c. Molecular remission d. Minimal residual disease

a. Carefully monitor intake and output measurements. Tumor lysis syndrome is a common complication of chemotherapy for Burkitt's NHL, and the nurse will plan to administer IV fluids and monitor intake and output carefully to prevent and detect this complication. Antibiotic therapy will not be administered for Burkitt's NHL unless the patient develops an infection. There is no need to assess grip strength or neurologic status more frequently. Although Hodgkin's lymphoma has an 80% long-term survival level with treatment, NHL has a much poorer prognosis.

Which action would the nurse plan to take when a patient is being treated with chemotherapy for Burkitt's non-Hodgkin's lymphoma (NHL)? a. Carefully monitor intake and output measurements. b. Administer concurrent IV antibiotics. c. Check grip strength and orientation more frequently. d. Teach the patient that there is an 80% chance of survival.

c. Jaundice ALL can affect organs such as the liver and the spleen. When leukemic cells infiltrate the liver, it can cause impaired function and jaundice, as bilirubin metabolism is impaired. Fever and bone pain are related to increased lymphocyte production. Pallor is related to decreased red blood cell production.

Which assessment finding indicates possible hepatic involvement in a patient newly diagnosed with acute lymphocytic leukemia (ALL)? a. Fever b. Pallor c. Jaundice d. Bone pain

c. Blast cells remaining in the bone marrow In partial remission, symptoms are absent and the blood smear is normal, but abnormal cells remain in the bone marrow. A patient who reports ongoing chronic fatigue would not meet the criteria for partial remission since ongoing fatigue is a symptom of leukemia. A patient with abnormalities in the peripheral blood smear would not meet the criteria for partial remission since peripheral blood smears are normal in partial remission. A patient with negative molecular studies for residual leukemia would more likely be in complete remission since these studies indicate that no evidence of leukemic cells remains.

Which assessment finding would the nurse expect when caring for a patient who has achieved partial remission after the initial prescribed chemotherapy for acute leukemia? a. Patient report of chronic fatigue b. Abnormalities in the peripheral blood smear c. Blast cells remaining in the bone marrow d. Negative molecular studies for residual leukemia

b. Bleomycin The most common chemotherapeutic regimen prescribed for early stage Hodgkin's lymphoma is doxorubicin ( Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD regimen). Rituximab is used in treatment of non-Hodgkin's lymphoma and multiple other hematologic disorders but is not used to treat Hodgkin's lymphoma. Fludarabine is a chemotherapeutic agent used in non-Hodgkin's lymphoma and leukemia. Ibritumomab tiuxetan is used in treatment of non-Hodgkin's lymphoma.

Which chemotherapeutic medication will the nurse anticipate administering for a patient with stage IA Hodgkin ' s lymphoma? a. Rituximab b. Bleomycin c. Fludarabine d. Ibritumomab tiuxetan

b. Stage IIIB Because lymph nodes both above and below the diaphragm are involved, the patient is in stage III of the disease. The letter A indicates the absence of systemic symptoms, and the letter B indicates their presence. Because the patient presents with systemic symptoms, such as fever, night sweats, and weight loss, the patient is in stage IIIB. If the patient did not have any systemic symptoms, the stage of the disease would have been stage IIIA. In stage IVA, other internal organs such as the liver would be involved but the patient would not be experiencing fever, night sweats, and weight loss. In stage IVB, internal organs such as the liver would be involved and the patient would report the B symptoms of fever, night sweats, and weight loss.

Which clinical stage of lymphoma will the nurse suspect for a patient who has enlarged mediastinal and retroperitoneal lymph nodes and reports fever, night sweats, and weight loss? a. Stage IIIA b. Stage IIIB c. Stage IVA d. Stage IVB

d. Renal failure High levels of calcium and uric acid caused by tumor lysis syndrome may lead to acute kidney injury (acute renal failure) in patients with NHL. Jaundice may occur with NHL due to spread to the liver but is not caused by tumor lysis syndrome. Bone pain may occur with NHL if there is bone involvement but is not related to tumor lysis syndrome. Paraplegia may occur in NHL if enlarged lymph tissue pushes on the spinal cord but is not caused by tumor lysis syndrome.

Which complication will the nurse monitor for when a patient with non-Hodgkin's lymphoma (NHL) develops tumor lysis syndrome? a. Jaundice b. Bone pain c. Paraplegia d. Renal failure

c. Sickle cell disease Sickle cell disease is characterized by the presence of a high percentage of Hgb S in the erythrocytes. Thalassemia occurs due to the absence of reduced globulin protein. Aplastic anemia is a disease characterized by pancytopenia in which all the blood cell types decrease. Acquired hemolytic anemia results from hemolysis of red blood cells (RBCs) from extrinsic factors. It is characterized by increased mean corpuscular volume (MCV), reticulocytes, and bilirubin.

Which condition is characterized by the presence of a high percentage of hemoglobin S (Hgb S) in the erythrocytes? a. Thalassemia b. Aplastic anemia c. Sickle cell disease d. Acquired hemolytic anemia

c. Folic acid deficiency Folic acid deficiency can cause the synthesis of defective DNA and result in anemia. A decreased number of red blood cell precursors results in anemia in patients with myelodysplasia and Fanconi syndrome. Increased red blood cell destruction can result in anemia in patients with G6PD enzyme deficiency.

Which condition results in anemia due to synthesis of defective deoxyribonucleic acid (DNA) in the body? a. Myelodysplasia b. Fanconi syndrome c. Folic acid deficiency d. G6PD enzyme deficiency

c. Hodgkin's lymphoma Hodgkin's lymphoma is a malignant condition characterized by proliferation of abnormal giant, multinucleated cells called Reed-Sternberg cells, which are located in the lymph nodes. Polycythemia is characterized by an increased number of red blood cells. Multiple myeloma is characterized by the presence of Bence Jones protein in blood and urine. The presence of Reed-Sternberg cells helps to differentiate Hodgkin's lymphoma from non-Hodgkin's lymphoma.

Which diagnosis is confirmed by a biopsy showing Reed-Sternberg cells? a. Polycythemia b. Multiple myeloma c. Hodgkin's lymphoma d. Non-Hodgkin's lymphoma

c. Presence of Philadelphia chromosome The Philadelphia chromosome is present in 90% to 95% of patients with CML and is a diagnostic hallmark of CML. Thrombocytopenia may occur with CML, but thrombocytosis would not be expected. Since CML is characterized by abnormal myelocytes (not abnormal lymphocytes) and does not typically invade the central nervous system, lymphoblasts in the cerebrospinal fluid are not an expected finding. In CML, the bone marrow would contain abnormal but mature myelocytes.

Which diagnostic finding is a hallmark of chronic myelogenous leukemia (CML)? a. Thrombocytosis b. Lymphoblasts in cerebrospinal fluid c. Presence of Philadelphia chromosome d. Hypercellular bone marrow with lymphoblasts

d. Positron emission tomography (PET) PET is helpful to define all sites and determine the clinical stage of Hodgkin's lymphoma. Barium enemas would be used to help determine the impact of Hodgkin's lymphoma on lower gastrointestinal tract function. An upper endoscopy would be used to assess for the effect of lymphoma on upper gastrointestinal tract function. A CBC would be helpful in determining whether lymphoma has infiltrated the bone marrow.

Which diagnostic study is helpful in determining the clinical stage of Hodgkin's lymphoma? a. Barium enema b. Upper endoscopy c. Complete blood count (CBC) d. Positron emission tomography (PET)

b. Bone marrow biopsy A bone marrow biopsy provides a sample to determine the presence of leukemic cells. Blood cultures are done to detect the presence of microorganisms, such as bacteria or fungi, in the blood. Blood cultures will not detect leukemic cells. An MRI creates a detailed image of the organs and tissues in the body but does not identify specific cell types. A Wood's lamp examination is usually done on the surface of the skin and can detect the presence of bacterial or fungal skin infections.

Which diagnostic test allows the health care provider to directly visualize the presence of leukemic cells? a. Blood culture b. Bone marrow biopsy c. MRI d. Wood's lamp examination

b. Reed-Sternberg cells in the lymph node The presence of Reed-Sternberg cells in a lymph node biopsy specimen is the main diagnostic feature in Hodgkin's lymphoma disease. Lymphoblasts in the cerebrospinal fluid indicate acute lymphocytic leukemia. Hypercellular bone marrow with myeloblasts is a diagnostic finding of acute myelogenous leukemia. The Philadelphia chromosome is a sign of chronic myelogenous leukemia.

Which diagnostic test result indicates a diagnosis of Hodgkin's lymphoma? a. Lymphoblasts in the cerebrospinal fluid b. Reed-Sternberg cells in the lymph node c. Hypercellular bone marrow with myeloblasts d. Philadelphia chromosome in the bone marrow cells

b. Decreased platelets and red blood cells (RBCs) Since bone marrow proliferation of abnormal lymphocytes leads to decreased RBCs and thrombocyte production, the nurse will expect low numbers of RBCs and platelets. Low leukocyte alkaline phosphatase is associated with chronic myelogenous leukemia. Acute myelogenous leukemia is characterized by hypercellular bone marrow with myeloblasts. Increased numbers of immature myelocytes are found in patients with acute myelogenous leukemia.

Which diagnostic test result will the nurse expect for a patient who has been diagnosed with acute lymphocytic leukemia? a. Low leukocyte alkaline phosphatase b. Decreased platelets and red blood cells (RBCs) c. Hypercellular bone marrow with myeloblasts d. Elevated numbers of immature myelocytes

b. ALL is initially treated with both IV and intrathecal chemotherapy drugs. ALL is characterized by a proliferation of immature white blood cells and frequently infiltrates the central nervous system (CNS); it is treated initially with IV combination chemotherapy and intrathecal chemotherapy to prevent CNS involvement. ALL is rapidly progressive, and patients deteriorate quickly without treatment. Affected lymphocytes in ALL are immature and poorly differentiated; radiation is not an initial treatment. ALL is not infectious in nature, and antibiotics are not used to treat ALL.

Which explanation would the nurse give when a patient with acute lymphocytic leukemia (ALL) asks for clarification about the disease and expected treatment? a. ALL is frequently slowly progressive and may not need treatment immediately. b. ALL is initially treated with both IV and intrathecal chemotherapy drugs. c. ALL is characterized by well differentiated lymphocytes and may be initially treated with radiation. d. ALL is caused by an infectious agent and usually is initially treated with multiple antibiotics.

b. Smooth, beefy-red tongue Pernicious anemia is characterized by the presence of abdominal pain and a smooth, beefy-red tongue. Platelet function is reduced in the patient with leukemia; therefore bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron-deficiency anemia.

Which finding supports the nurse's conclusion that a patient has pernicious anemia? a. Bleeding of the gums b. Smooth, beefy-red tongue c. Spoon-shaped concave nails d. Fissures in corners of the mouth

b. Enlarged lymph nodes Enlarged lymph nodes are the most common initial finding in Hodgkin's lymphoma. Skeletal pain might occur with bone involvement, but this would occur in later stages of the disease. T-cell blasts in the lymph nodes occur with some types of non-Hodgkin's lymphoma but are not found in Hodgkin's lymphoma, which is a lymphoma of B lymphocytes. Lymphoblasts in the cerebrospinal fluid are a diagnostic finding of acute lymphocytic lymphoma and would not be found in stage I Hodgkin's lymphoma.

Which finding will the nurse expect in a patient who is hospitalized with stage I Hodgkin's lymphoma? a. Skeletal pain b. Enlarged lymph nodes c. T-cell blasts in the lymph node d. Lymphoblasts in the cerebrospinal fluid

a. Legumes b. Dried fruits e. Dark-green, leafy vegetables Legumes, dried fruits, and dark-green, leafy vegetables contain iron, which supports hemoglobin synthesis. Milk products contain riboflavin and amino acids but do not support hemoglobin synthesis. Strawberries provide vitamin C, which converts folic to its active forms and aids iron absorption but not hemoglobin synthesis.

Which foods would the nurse encourage the patient to eat in order to provide nutritional support for hemoglobin synthesis? Select all that apply. a. Legumes b. Dried fruits c. Strawberries d. Milk products e. Dark-green, leafy vegetables

a. Farm workers Pesticide exposure increases risk for leukemia and non-Hodgkin's lymphomas, and farm workers are more likely to develop these illnesses than the general population. Office managers are not at higher risk for cell changes that may lead to cancer. Police officers are not at higher risk for development of leukemia or lymphoma. College professors are not at higher risk for leukemia or lymphoma.

Which group of people is at high risk for developing leukemia and non-Hodgkin's lymphoma? a. Farm workers b. Office managers c. Police officers d. College professors

a. It interferes with the regulation of cell proliferation. The protein that is encoded by the newly created BCR-ABL gene on the Philadelphia chromosome interferes with normal cell cycle events such as the regulation of cell proliferation. Absence of the Philadelphia chromosome is an expected marker for remission in leukemia; if the Philadelphia chromosome persists, the patient is not in remission. The Philadelphia chromosome occurs most frequently in chronic myelogenous leukemia but is sometimes found in acute lymphocytic leukemia and occasionally in acute myelogenous leukemia. It is not found with chronic leukocytic leukemia. The Philadelphia chromosome is not a congenital defect but occurs later in life because of exposure to factors such as oncogenes, environment, and viruses.

Which information about the Philadelphia chromosome in leukemia is accurate? a. It interferes with the regulation of cell proliferation. b. It persists even after leukemia is in complete remission. c. It occurs most frequently in chronic leukocytic leukemia. d. It presents as a congenital defect in children who develop leukemia.

b. Treatment includes chemotherapy. d. Long-term survival exceeds 80% for all stages. e. Fever, drenching night sweats, and weight loss are common. Chemotherapy is the initial treatment for Hodgkin's lymphoma, and long-term survival exceeds 80%. B symptoms, such as fever, night sweats, and weight loss, indicate a worse prognosis and are common. Hodgkin's lymphoma usually starts in a single node but can spread diffusely and infiltrate other organs. Anemia may occur because of decreased red blood cell production and increased red blood cell destruction, but polycythemia is not a complication of Hodgkin's lymphoma.

Which information is accurate about Hodgkin's lymphoma? Select all that apply. a. Extranodal spread does not occur. b. Treatment includes chemotherapy. c. Polycythemia is frequently a complication. d. Long-term survival exceeds 80% for all stages. e. Fever, drenching night sweats, and weight loss are common.

b. Exposure to chemical toxins The subjective data category includes information taken from the patient, such as the patient reporting exposure to chemical toxins. The objective data category includes information regarding diagnostic findings, such as Philadelphia chromosome. The observed information related to the integumentary findings, like reddish-brown cutaneous filtrates, is documented in the objective data section. Bleeding gums would be noted by the nurse and documented in the objective data section.

Which information obtained by the nurse during the admission of a patient with leukemia would be documented under the subjective data section? a. Gingival bleeding b. Exposure to chemical toxins c. Presence of Philadelphia chromosome d. Presence of reddish-brown cutaneous infiltrates

d. Graft-versus-host disease is a complication of allogenic HSCT. Graft-versus-host disease is a common complication following allogenic HSCT as the donor cells attack the patient's own cells, causing symptoms such as rashes, diarrhea, and jaundice. Because HSCT involves eradication of the patient's own hematopoietic stem cells and causes severe immune suppression, risk for life-threatening infection is high. Relapse may occur even with HSCT. Autologous HSCT involves using the patient's own stem cells, while allogenic HSCT is done using donor cells.

Which information will the nurse include when teaching a patient about allogenic hematopoietic stem cell transplantation (HSCT) therapy as treatment for leukemia? a. Infection risk is low with allogenic HSCT. b. Relapse is rare after allogenic HSCT treatment. c. Allogenic HSCT involves use of the patient's own stem cells. d. Graft-versus-host disease is a complication of allogenic HSCT.

c. "Prevention and early detection of infection are important during leukemia treatment." Since neutropenia is a common adverse effect of leukemia chemotherapy, education about how to prevent infection and clinical manifestations of infection is important to include in patient education. While leukemia treatment does have severe side effects, the side effects resolve when treatment is stopped. There is no indication that the patient needs assistance when getting out of bed for safety reasons, and insisting that assistance is needed will encourage over-dependence and may cause depression. While feeling isolated is a common consequence of leukemia and leukemia treatment, the nurse will plan ways to help the patient to avoid feeling isolated rather than stating that feelings of isolation are inevitable.

Which information will the nurse include when teaching a patient who is receiving chemotherapy for leukemia? a. "The treatment has severe side effects, some of which will be permanent." b. "You need to use your call light to ask for help every time you get out of bed." c. "Prevention and early detection of infection are important during leukemia treatment." d. "Feeling isolated is a common and unavoidable consequence of leukemia treatment."

b. Chemotherapy is given every three to four weeks for a prolonged period. In maintenance therapy, treatment is provided every three to four weeks for a prolonged period with lower doses of the drugs. Intensification therapy is the highdose treatment given immediately after induction therapy. Intensification and consolidation are the terms used to describe post-induction or post-remission therapy. Maintenance chemotherapy is given at lower doses and longer intervals and is better tolerated by patients; severe bone marrow depression and critical illness are not expected.

Which information will the nurse include when teaching a patient with leukemia about maintenance chemotherapy? a. It is the high-dose treatment given immediately after induction therapy. b. Chemotherapy is given every three to four weeks for a prolonged period. c. Intensification and consolidation are other terms used to describe this therapy. d. Severe bone marrow depression and critical illness are common complications.

d. NHL is a broad group of malignant neoplasms with a variety of presentations NHLs are a heterogeneous group of malignant neoplasms of primarily B-cell, T-cell, or natural killer (NK) cell origin. NHL is frequently disseminated and affects nonlymphatic organs, such as the brain or liver. While B symptoms such as fever, night sweats, and weight loss can occur, they are uncommon in NHL. NHL can affect persons of any age while Hodgkin's lymphoma has a bimodal peak incidence at ages 15 to 30 and over 55 years old.

Which information would the nursing instructor include when teaching about non-Hodgkin's lymphoma (NHL)? a. NHL is confined to the regional lymph nodes and lymphatic tissues. b. Night sweats, fever, and weight loss are common associated symptoms. c. Incidence is most frequent at ages 15 to 30 years or over 55 years of age. d. NHL is a broad group of malignant neoplasms with a variety of presentations

c. Take the iron with orange juice one hour before meals. With microcytic, hypochromic anemia, there may be an iron, B , or copper deficiency; thalassemia; or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals, as it is absorbed best in an acid environment. Enteric-coated capsules would not be used because iron is best absorbed in an acidic environment. Megaloblastic anemias occur with cobalamin (vitamin B ) and folic acid deficiencies. Vitamin B may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green, leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider.

Which instruction would the nurse include in the teaching plan for a patient newly diagnosed with microcytic hypochromic anemia? a. Take enteric-coated iron with each meal. b. Take cobalamin with green, leafy vegetables. c. Take the iron with orange juice one hour before meals. d. Decrease the intake of the antiseizure medications to improve.

b. Dilute the liquid iron and ingest it through a straw. Undiluted liquid iron may stain the patient's teeth; therefore liquid iron should be diluted and ingested through a straw. Iron is best absorbed as ferrous sulfate (Fe ) in an acidic environment. Therefore iron supplements should be taken about an hour before meals when the duodenal mucosa is acidic. Orange juice contains vitamin C (ascorbic acid), which enhances iron absorption. Therefore it is advisable to take vitamin C supplements along with iron. Constipation may commonly occur in patients who are prescribed iron therapy. Therefore it is advisable to take laxatives and stool softeners when receiving iron therapy.

Which instruction would the nurse include when teaching a patient about the administration of an iron supplement? a. Take the iron supplement with food. b. Dilute the liquid iron and ingest it through a straw. c. Refrain from drinking orange juice when taking iron. d. Refrain from the use of laxatives when on iron therapy.

c. "Take it one hour before breakfast, with orange juice." Iron is absorbed best as ferrous sulfate in an acidic environment. For this reason, and to avoid binding the iron with food, iron should be taken about an hour before meals, when the duodenal mucosa is most acidic. Taking iron with vitamin C (ascorbic acid) or orange juice, which contains ascorbic acid, enhances iron absorption. Gastric side effects, however, may necessitate ingesting iron with meals.

Which instruction would the nurse include when teaching a patient about the administration of an oral iron substitute? a. "Take it with meals." b. "Take it one hour after eating." c. "Take it one hour before breakfast, with orange juice." d. "Take it on an empty stomach with a full glass of water."

d. Thrombocytopenia AML leads to decreased production of platelets (thrombocytopenia), which increases bleeding time and leads to bruising. Neutropenia frequently occurs as a complication of chemotherapy and would increase risk for infection but would not be typical in untreated AML and would not be associated with increased bruising. Since bone marrow production of red blood cells is reduced in leukemia, anemia rather than polycythemia would be expected. Lymphocytosis may occur with acute lymphocytic leukemia but would not be expected in a patient with AML.

Which laboratory finding will the nurse expect after assessing a patient with acute myelogenous leukemia (AML) who has multiple bruises? a. Neutropenia b. Polycythemia c. Lymphocytosis d. Thrombocytopenia

a. Increased bilirubin levels b. Increased serum iron levels c. Increased reticulocyte level Thalassemia major is characterized by the presence of increased bilirubin levels, serum iron levels, and reticulocyte level. Thalassemia major is also characterized by the presence of decreased mean corpuscular volume and total iron-binding capacity.

Which laboratory report findings support the nurse's conclusion that a patient has thalassemia major? Select all that apply. a. Increased bilirubin levels b. Increased serum iron levels c. Increased reticulocyte level d. Increased mean corpuscular volume e. Increased total iron-binding capacity

b. Presence of lymphoblasts in cerebrospinal fluid c. Presence of hypercellular bone marrow with lymphoblasts Acute lymphocytic leukemia is characterized by lymphoblasts in cerebrospinal fluid and hypercellular bone marrow with lymphoblasts. Acute myelogenous leukemia is characterized by an increase in the number of myeloblasts. Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes. Chronic myelogenous leukemia occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow.

Which laboratory test results are consistent with a patient's diagnosis of acute lymphocytic leukemia (ALL)? Select all that apply. a. Presence of increased number of myeloblasts b. Presence of lymphoblasts in cerebrospinal fluid c. Presence of hypercellular bone marrow with lymphoblasts d. Presence of accumulated small, mature-appearing lymphocytes e. Excessive development of mature neoplastic granulocytes in the bone marrow

a. Acute lymphocytic leukemia (ALL) ALL is most commonly seen in children. AML is more commonly seen in adults. CLL is commonly seen in older adults. CML is most commonly seen in older adults.

Which leukemia is most commonly seen in children? a. Acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)

c. Cervical Hodgkin's lymphoma originates in cervical lymph nodes in 60% to 70% of patients. The mediastinal lymph nodes are the second most common location for Hodgkin's lymphoma. Hodgkin's lymphoma also may occur in the axillary and inguinal lymph nodes.

Which lymph nodes are most commonly affected in Hodgkin's lymphoma? a. Axillary b. Inguinal c. Cervical d. Mediastinal

c. Rapid destruction of a large volume of cancer cells following chemotherapy TLS is due to massive cancer cell destruction following chemotherapy. When the cells are killed, they release their intracellular contents including uric acid, potassium, and phosphorus. This is also often accompanied by an increase in circulating white blood cells. Poor nutritional intake and anorexia, immunocompromise and risk for infection, and fluid and electrolyte imbalance are also complications of chemotherapy, but are not the mechanisms for TLS.

Which mechanism is responsible for tumor lysis syndrome (TLS) in a patient with Burkitt's lymphoma who just began treatment? a. Poor nutritional intake related to chemotherapy-induced anorexia b. Immunocompromised state due to chemotherapy-induced leukopenia c. Rapid destruction of a large volume of cancer cells following chemotherapy d. Fluid and electrolyte imbalances due to side effects of chemotherapy

c. Targets BCR-ABL protein Imatinib is a newer therapeutic agent used as targeted therapy. It acts by targeting BCR-ABL protein and killing the abnormal CML cells without damaging normal cells. Other chemotherapeutic medications treat leukemia by inhibiting angiogenesis, inhibiting cell proliferation, and causing DNA fragmentation.

Which mechanism of action for imatinib makes it effective in treating chronic myelogenous leukemia (CML)? a. Inhibits angiogenesis b. Inhibits cell proliferation c. Targets BCR-ABL protein d. Causes deoxyribonucleic acid (DNA) fragmentation

a. Prednisone Prednisone is included in combination chemotherapy for advanced-stage Hodgkin's lymphoma. Methotrexate is used for treatment of some leukemias and non-Hodgkin's lymphoma. Mitoxantrone is used for treatment of some leukemias and for non-Hodgkin's lymphoma. Fludarabine is used to treat some leukemias and for non-Hodgkin's lymphoma.

Which medication may be included in the chemotherapy regimen for a patient with advanced-stage Hodgkin's disease? a. Prednisone b. Methotrexate c. Mitoxantrone d. Fludarabine

a. Patient A Cranial radiation therapy is given to a patient when the leukemia involves the central nervous system (CNS). This is commonly observed in patients who have acute lymphocytic leukemia, such as patient A. Acute myelogenous leukemia does not typically invade the CNS, and cranial radiation would not be anticipated for patient B. Chronic lymphocytic leukemia does not involve the CNS, and patient C will not require cranial radiation. Chronic myelogenous leukemia does not invade the CNS, so patient D will not need cranial radiation.

Which of these four patients is most likely to need teaching about cranial radiation therapy? a. Patient A b. Patient B c. Patient C d. Patient D

c. Laboratory finding of low platelet count Objective data includes diagnostic findings, such as a low platelet count. A patient report of impotence would be included in subjective data since this information is not objectively verified by the nurse. Patient descriptions of symptoms, such as prolonged menstrual cycles, are included in subjective data. Since family history is obtained from the patient and not observed or verified by the nurse, this information is documented as subjective.

Which patient information will be included when documenting objective data after the nurse has done the admission assessment for a patient with leukemia? a. Patient report of impotence b. Patient history of prolonged menses c. Laboratory finding of low platelet count d. Family history of Klinefelter syndrome

c. Patient C The Philadelphia chromosome is present in over 90% of patients with chronic myelogenous leukemia. It is considered an important indicator of continuing or recurrent chronic myelogenous leukemia after treatment. Hypercellular bone marrow with lymphoblasts indicates acute lymphocytic leukemia. Chronic myelogenous leukemia is characterized by anemia with low red blood cell count, hemoglobin, and hematocrit. Acute myelogenous leukemia is associated with high lactic dehydrogenase (LDH) levels.

Which patient's diagnostic findings are consistent with chronic myelogenous leukemia (CML)? a. Patient A b. Patient B c. Patient C d. Patient D

d. Patient D The condition in which tumor cells cannot be detected by morphologic study but can be identified by molecular testing is known as minimal residual disease. If the molecular studies of a patient are negative for residual leukemia, then it indicates molecular remission. Partial remission occurs when there is a normal peripheral blood smear, but there is evidence of disease in the bone marrow. Complete remission is characterized by normal bone marrow and peripheral blood smear, with no evidence of disease upon physical examination.

Which patient's diagnostic follow-up studies after treatment for leukemia indicate minimal residual disease? a. Patient A b. Patient B c. Patient C d. Patient D

b. Constipation Iron supplements, such as ferrous gluconate, reduce peristalsis and result in constipation. Ferrous gluconate does not reduce BP and does not result in hypotension. Ferrous gluconate can cause gastrointestinal bleeding and black, tarry stools. Ferrous gluconate does not cause fluid accumulation in the peritoneal cavity or abdominal swelling.

Which potential side effect would the nurse include when teaching a patient about the administration of ferrous gluconate? a. Hypotension b. Constipation c. Clay-colored stool d. Abdominal swelling

a. To prevent infiltration of ALL into the brain ALL is commonly associated with infiltration of leukemic cells into the central nervous system (CNS), and intrathecal chemotherapy is used to reduce the chance of CNS involvement. Pain may occur with ALL but is not treated with intrathecal chemotherapy. Immune modulators may be given as part of treatment for leukemia but are not administered through the intrathecal route. Intrathecal chemotherapy does not decrease infection risk while patients are being treated for ALL.

Which response will the nurse make when a patient who is being treated for acute lymphocytic leukemia (ALL) asks, "Why do I need intrathecal chemotherapy?" a. To prevent infiltration of ALL into the brain b. To assist with management of pain caused by ALL c. To help boost immune response during ALL treatment d. To decrease the risk of infection during ALL treatment

b. Promotes red blood cell (RBC) maturation Folic acid promotes maturation of RBCs. Ascorbic acid aids in the absorption of iron. Iron and pyridoxine promote hemoglobin synthesis. Copper helps to mobilize iron from tissue to plasma.

Which role does folic acid play in erythropoiesis? a. Aids in absorption of iron b. Promotes red blood cell (RBC) maturation c. Promotes hemoglobin synthesis d. Aids in mobilization of iron from tissue to plasma

c. "With lymphoma, there are fewer circulating abnormal cells." Abnormal lymphocytes are found mostly in the lymph nodes and tissues in a patient with lymphoma, and there are fewer abnormal cells in the circulation. Abnormal lymphocytes are more likely to be found in the peripheral circulation with lymphocytic leukemias than with lymphoma. A defining characteristic of lymphoma is proliferation of abnormal lymphocytes in the nodes, leading to enlargement of the nodes. Granulocyte proliferation leads to myelogenous leukemias but not to lymphoma.

Which statement about lymphoma will the nurse make when a patient asks about the difference between lymphocytic leukemia and lymphoma? a. "Lymphoma involves mostly peripheral lymphocytosis." b. "With lymphoma, there is very minimal nodal involvement." c. "With lymphoma, there are fewer circulating abnormal cells." d. "Lymphoma involves proliferation of granulocytes or their precursors."

d. There is a lack of symptoms and a normal peripheral blood smear, but evidence of the disease is still present in bone marrow. Partial remission is characterized by a lack of symptoms and a normal peripheral blood smear, but evidence of disease in the bone marrow. Molecular remission indicates that all molecular studies are negative for residual leukemia. Minimal residual disease is defined as tumor cells that cannot be detected by morphologic examination but can be identified by molecular testing. In complete remission, there is no evidence of overt disease on physical examination, and the bone marrow and peripheral blood appear normal.

Which statement does the nurse identify as being true about partial remission after leukemia treatment? a. All molecular studies for residual leukemia are negative. b. Tumor cells cannot be detected by morphologic examination, but they are present in molecular testing. c. There is no evidence of overt disease on examination, and the bone marrow and peripheral blood are normal. d. There is a lack of symptoms and a normal peripheral blood smear, but evidence of the disease is still present in bone marrow.

a. Rituximab c. External beam irradiation d. Single-agent chemotherapy e. Combination chemotherapy Indolent NHL may be treated with the monoclonal antibody rituximab, external beam irradiation, and with either single-agent or combination chemotherapy. Thalidomide would not be typically used for NHL, although it is a treatment for multiple myeloma.

Which treatment options will the nurse anticipate when caring for a patient with a newly diagnosed stage I indolent (low-grade) non-Hodgkin's lymphoma (NHL)? Select all that apply. a. Rituximab b. Thalidomide c. External beam irradiation d. Single-agent chemotherapy e. Combination chemotherapy

b. Acute myelogenous leukemia (AML) AML accounts for 15% to 20% of acute leukemia in children and 80% in adults. ALL is most frequently seen in children, with a mean age of 15 years at diagnosis. CLL is a chronic leukemia seen mostly in older adults but is not an acute leukemia. CML is a chronic, rather than acute, leukemia seen mostly in older adults.

Which type of leukemia accounts for the majority of acute leukemia in adults? a. Acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)

a. Acute lymphocytic leukemia (ALL) ALL is characterized by the presence of an excessive number of immature small lymphocytes in the bone marrow. AML is characterized by an increase in the number of myeloblasts. CLL is characterized by the accumulation of small, mature-appearing lymphocytes. CML occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow.

Which type of leukemia is characterized by the proliferation of immature small lymphocytes in the bone marrow? a. Acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)

b. Antibiotic therapy Antibiotics are included in the treatment for Helicobacter pylori gastric lymphoma because the bacteria contribute to the development of lymphoma. Phototherapy would be used to treat more superficial lymphomas such as cutaneous T-lymphoma. Radiation therapy might be used to treat resistant or refractory lymphoma but is not an initial treatment for Helicobacter pylori gastric lymphoma. Topical chemotherapy would be used for superficial lesions such as in cutaneous T-cell lymphoma.

Which type of therapy will the nurse anticipate administering to a patient who has newly diagnosed Helicobacter pylori gastric lymphoma? a. Phototherapy b. Antibiotic therapy c. Radiation therapy d. Topical chemotherapy

d. "It prevents staining of the teeth." An undiluted iron preparation causes staining of the teeth if consumed without using a straw. Such preparations should therefore be taken using a straw. Compared to drinking undiluted liquid iron without a straw, consuming it with a straw does not boost iron absorption, reduce iron absorption, or reduce allergic reactions.

While taking undiluted liquid iron that was prescribed, a patient asks the nurse why it must be drunk through a straw. Which response by the nurse is appropriate? a. "It reduces iron absorption." b. "It increases iron absorption." c. "It reduces allergic reactions." d. "It prevents staining of the teeth."