Chapter 34

T or F- Hematopoiesis is characterized by a slow, continuous process of the formation and maturation of blood cells.

False

A nurse cares for a client with early Hodgkin lymphoma. While assessing the client, the nurse will most likely find painless enlargement of which lymph node?

Cervical

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)?

A 72-year-old patient with a history of cancer

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has?

A general reduction in all white blood cells

A client diagnosed with polycythemia vera has come into the clinic because he has developed a nighttime cough, fatigue, and shortness of breath. What complication would you suspect in this client?

Congestive heart failure

T or F- Polycythemia vera is a condition that places the patient at risk for increased infection.

False

A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host?

Graft-versus-host disease

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal?

Maintain nutrition.

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms?

Multiple myeloma

The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has?

Multiple myeloma

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever?

Neutropenia

What assessment finding best indicates that the client has recovered from induction therapy?

Neutrophil and platelet counts within normal limits

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures?

Osteoclasts break down bone cells so pathologic fractures occur.

The diagnosis of Hodgkin lymphoma is made by means of an excisional lymph node biopsy and the finding of the __________________ cell.

Reed--Sternberg

The nurse is assessing a client admitted with a deep vein thrombosis with an elevated red blood cell count. The admitting diagnosis is polycythemia vera. What is the hallmark clinical sign of PV?

splenomegaly

Which term refers to a form of white blood cell involved in immune response?

Lymphocyte

Common symptoms seen in polycythemia vera include a ruddy complexion and ____________ from increased blood volume and viscosity.

splenomegaly

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

The nurse assesses a patient for late-stage chronic lymphocytic leukemia (CLL) by looking for what?

Thrombocytopenia

A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention?

Assess for signs of injury.

The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply.

Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance.

A client with multiple myeloma reports uncomfortable muscle cramping. Which nursing interventions will the nurse implement in response to the client's report of symptoms? Select all that apply.

Encourage hydration Encourage ambulation

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma?

The client with enlarged lymph nodes in the neck.

T or F- A primary nursing diagnosis for a patient with acute leukemia is impaired nutritional intake due to the pain and discomfort associated with mucositis and stomatitis.

True

T or F- Chronic lymphocytic leukemia the most common form of leukemia and may require no treatment in the early stages.

True

T or F- Multiple myeloma is a malignant disease of plasma cells in bone marrow.

True

An older adult with a chief complaint of ______________ and an elevated total protein level should be evaluated for multiple myeloma.

back pain

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?

Apply prolonged pressure to needle sites or other sources of external bleeding.

A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive?

Induction Therapy

The nurse is caring for a patient with Hodgkin lymphoma in the hospital and preparing discharge planning education. Knowing that this patient is at risk for the development of a second malignancy, what education would be beneficial to reduce the risk factors? (Select all that apply.)

Reduce exposure to excessive sunlight Smoking cessation Decrease alcohol intake

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan?

"Chronic leukemia develops slowly."

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention?

Assess the client's hemoglobin and platelets.

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?

Excess of immature leukocytes

The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis?

Polycythemia vera

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?

Allopurinol

A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action?

Assess renal function

The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for?

Bone pain in the back of the ribs

A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action?

Evaluate the client's platelet count.

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?

Hypercalcemia

The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions?

Iron levels

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets?

Pancytopenia

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?

Perform a neurologic assessment with vital signs.

A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client?

Preventing bone injury

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?

Risk for falls

A client with multiple myeloma presents to the emergency department and reports excessive thirst and constipation. Family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms?

Serum calcium level 13.8 mg/dl

A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept?

Staging of disease

Nursing interventions for the patient with acute leukemia should focus on assisting the patient to establish a balance between ___________ and _______ because fatigue and deconditioning are common symptoms of the disease.

activity, rest

Two primary complications seen in acute myeloid leukemia (AML), bleeding and __________, are the major causes of death for these patients.

infection

The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis?

polycythemia vera

A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia?

Chronic lymphocytic leukemia

Which statement best describes the function of stem cells in the bone marrow?

They produce all blood cells.

The nurse recognizes the clinical assessment of a patient with acute myeloid leukemia (AML) includes observing for signs of infection early. What nursing action will most likely help prevent infection?

Practice vigilant handwashing.