Hinkle Ch. 30 - Adult Malignant Hematology
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? A. "In chronic leukemia, the minority of leukocytes are mature." B. "Chronic leukemia develops slowly." C. "Acute leukemia develops slowly." D. "In acute leukemia there are not many undifferentiated cells."
B. "Chronic leukemia develops slowly." Explanation: Chronic leukemia develops slowly, and the majority of leukocytes produced are mature. Acute leukemia develops quickly and the majority of leukocytes are undifferentiated cells.
A client is taking hydroxyurea as treatment for essential thrombocythemia. Which laboratory test will the nurse remind the client to have completed regularly? A. Complete blood count B. Uric acid level C. Serum potassium level D. Clotting factors
A. Complete blood count Explanation: Clients taking hydroxyurea should have the CBC monitored regularly because the dosage is adjusted based on the platelet and WBC count. Uric acid, clotting factors, and serum potassium level do not need to be monitored when taking hydroxyurea.
A nurse assesses a client who has been diagnosed with DIC. Which indicators are consistent with this diagnosis? Select all that apply. A. Cyanosis in the extremities B. Capillary fill time <3 seconds C. Polyuria D. Increased blood urea nitrogen (BUN) and creatinine E. Increased breath sounds F. Dyspnea and hypoxia
A. Cyanosis in the extremities D. Increased blood urea nitrogen (BUN) and creatinine F. Dyspnea and hypoxia Explanation: Urine output would be decreased in DIC, and capillary fill time would be more than 3 seconds; breath sounds would be decreased.
A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client is not appropriately dealing with spiritual distress? A. "I am going to call my clergy to pray with me." B. "I do not understand why this happened to me." C. "I know I am going to die. I want to say good-bye to my family." D. "I have resources within myself that I can depend on."
B. "I do not understand why this happened to me." Explanation: The statement "I do not understand why this happened to me" indicates that the client is not accepting of the consequences of his health problems and impending death. The other statements indicate the client has plans that would result in spiritual well-being or harmony.
The nurse instructs a client with polycythemia vera on actions to reduce the symptoms. Which statement indicates that client teaching was effective? A. "I will use an alcohol-based lotion after bathing." B. "I will shower in tepid water." C. "I will avoid caffeinated beverages." D. "I will take a multivitamin with iron every day."
B. "I will shower in tepid water." Explanation: A common symptom in clients with polycythemia vera is pruritus, described as strong itching, stinging, or burning. The exact etiology is not known but is thought to be related to pro-inflammatory cytokines. Pruritus can be triggered by contact with water of any temperature. Bathing in tepid water is recommended as a strategy to manage pruritus. Caffeinated beverages are recommended to help manage the feelings of fatigue. A multivitamin with iron should be avoided as the iron stimulates further red blood cell production. An alcohol-based lotion can dry the skin and aggravate pruritus.
A nurse is providing teaching to a client who will undergo chemotherapy and radiation prior to hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia (AML). What statement will the nurse use to describe the purpose of the chemotherapy and radiation? A. "These therapies decrease your immune system to decrease the risk of allergic reaction." B. "These therapies shrink your tumor to ensure the stem cell transplant is more effective." C. "These therapies destroy the ability of your body to produce blood cells inside your bone marrow." D. "These therapies destroy the bone marrow in an effort to shrink it and decrease your pain."
C. "These therapies destroy the ability of your body to produce blood cells inside your bone marrow." Explanation: The treatment goal of chemotherapy and radiation therapy is the destruction of hematopoietic function of the client's bone marrow. The client is then "rescued" with the infusion of the donor stem cells to reinitiate blood cell production. AML is a cancer of the blood and does not have a mass effect/tumor that other cancers may cause. Also, these therapies are not used to decrease a client's pain or to decrease the risk of allergic reaction.
The nurse is reviewing the treatment options with a client diagnosed with myelodysplastic syndromes (MDS). Which therapy will the nurse emphasize as the option to cure the condition? A. Blood transfusions B. Hypomethylating agents C. Allogeneic hematopoietic stem cell transplantation D. Erythropoiesis-stimulating agents
C. Allogeneic hematopoietic stem cell transplantation Explanation: Medical management strategies for MDS are based on risk stratification to determine stage of disease and prognosis. Allogeneic HSCT continues to be the only potential option of cure for MDS. Blood transfusions are used for those with low-risk disease. Hypomethylating agents are used to treat clients with low to intermediate-risk disease. Erythropoiesis-stimulating agents are used to treat clients with low risk disease.
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? A. "Intrathecal chemotherapy is used primarily as preventive therapy." B. "Treatment is simple and consists of single-drug therapy." C. "The goal of therapy is palliation." D. "Side effects are rare with therapy."
A. "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 clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? A. A general reduction in neutrophils and basophils B. Too many erythrocytes C. A general reduction in all white blood cells D. A decrease in granulocytes
A. A general reduction in neutrophils and basophils Explanation: Leukopenia is a general reduction in all WBCs. Leukopenia does not have anything to do with erythrocytes.
A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess? A. A leukocyte count >100,000/mm3 B. Increased number of blast cells C. Lymphadenopathy D. An enlarged liver
A. A leukocyte count >100,000/mm3 Explanation: Although there is an increase in the production of blast cells and the client may have an enlarged liver and tender spleen, it is the high leukocyte count that is diagnostic. Lymphadenopathy is rare.
After chemotherapy for AML, what interventions will best help to prevent renal complications? Select all that apply. A. Administer rasburicase. B. Encourage exercise. C. Increase hydration. D. Administer potassium therapy. E. Administer allopurinol.
A. Administer rasburicase. C. Increase hydration. E. Administer allopurinol. Explanation: Increased uric acid and phosphorus concentrations after chemotherapy for AML can lead to renal calculi formation. Increasing hydration and administering allopurinol (a uricosuric) will help to eliminate the uric acid. Rasburicase is an enzyme that can also decrease uric acid. Administration of potassium is not indicated, as concentrations are elevated after chemotherapy. Exercise is not initially encouraged because the client could have weakness and cramping during this time.
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? A. Assess for signs of injury. B. Keep the feet cool. C. Elevate the client's legs. D. Encourage ambulation.
A. Assess for signs of injury Explanation: A client with hypoesthesia of the feet will have decreased sensation and numbness. The nurse should assess for signs of injury. If the client is injured, he or she will not be able to feel it; this could lead to the development of infection. Ambulation will not help the client, and elevating the legs may make the problem worse, as blood flow to the feet would be decreased. Keeping the feet cold will also decrease blood flow.
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? A. Assess renal function. B. Refer the client to a chiropractor. C. Place heating pads on the client's back. D. Administer pain medication, as ordered.
A. 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 with polycythemia vera presents to the primary care clinic for an annual physical. Which health care provider prescriptions does the nurse recognize as preventive measures to prevent thrombosis in the client? Select all that apply. A. Beta blocker therapy B. Iron therapy C. Anti-dysrhythmia therapy D. Statin therapy E. Nitrate therapy
A. Beta blocker therapy D. Statin therapy Explanation: Aggressive management of atherosclerosis, by treating hypertension and hyperlipidemia, is important in diminishing the risk of thrombosis in the client with polycythemia vera. Statin therapy decreases cholesterol levels while beta blockers decrease blood pressure. Iron therapy would make the client worse, not better. Nitrates and anti-dysrhythmia drugs are not primarily used in the treatment of polycythemia vera.
A nurse plans care for a client with multiple myeloma. Using the CRAB acronym for symptoms associated with this disease, which clinical features does the nurse expect to find upon assessment of the client? Select all that apply. A. Bone lesions B. Renal insufficiency C. Acidosis D. Hypercalcemia E. Anemia
A. Bone lesions B. Renal insufficiency D. Hypercalcemia E. Anemia Explanation: The acronym CRAB is used to describe the combined pathologic effects of multiple myeloma and include: calcium levels elevated (hypercalcemia), renal insufficiency, anemia, bone lesions. Acidosis is not part of the acronym used to describe the pathologic effects of the disease.
The nurse cares for a client with acute myeloid leukemia with severe bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain? A. Bone marrow expands. B. Lymph nodes expand. C. Abnormal blood cells deposit in small vessels. D. Abnormal blood cells crystalize.
A. Bone marrow expands Explanation: In acute myeloid leukemia, bone pain is caused when the bone marrow expands.
The nurse is caring for a client with chronic myeloid leukemia (CML). The nurse knows that which symptoms indicate the client is in the accelerated phase of the condition? Select all that apply. A. Bone pain B. Dyspnea C. Confusion D. Fatigue E. Splenomegaly
A. Bone pain B. Dyspnea D. Fatigue E. Splenomegaly Explanation: Chronic myeloid leukemia (CML) arises from a mutation in the myeloid stem cell. Normal myeloid cells continue to be produced, but there is a pathologic increase in the production of forms of blast cells. Therefore, a wide spectrum of cell types exists within the blood, from blast forms to mature neutrophils. Because there is an uncontrolled proliferation of cells, the marrow expands into the cavities of long bones, such as the femur, and cells are also formed in the liver and spleen, resulting in enlargement of these organs that is sometimes painful. The accelerated phase of CML marks the process of evolution to the acute form of leukemia. In this phase the client experiences fatigue, dyspnea, bone pain, and splenomegaly. Confusion is associated with the blast phase of CML because of a change in perfusion to the brain caused by leukostasis.
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? A. Bone pain in the back of the ribs B. Gradual muscle paralysis C. Severe thrombocytopenia D. Debilitating fatigue
A. Bone pain in the back of the ribs Explanation: Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; clients may report that they have less pain on awakening but the pain intensity increases during the day.
The nurse is caring for a client with chronic myeloid leukemia (CML) who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission? A. Chronic B. Transformation C. Blast crisis D. Accelerated
A. Chronic Explanation: Advances in understanding the pathology of CML at a molecular level have led to dramatic changes in treatment. An oral formulation of a tyrosine kinase inhibitor, imatinib mesylate (Gleevec), works by blocking signals within the leukemia cells that express the BCR-ABL protein, thus preventing a series of chemical reactions that cause the cell to grow and divide. Imatinib therapy appears to be most useful in the chronic phase of the illness. It can induce complete remission at the cellular and even molecular level.
A home care nurse is caring for a client with multiple myeloma. Which nursing interventions are appropriate for this client? Select all that apply. A. Delay position changes and bathing if the client is experiencing pain. B. Monitor renal function C. Assist with ambulation because exercise can worsen loss of calcium from the bone. D. Limit fluid intake. E. Instruct the client to avoid activities that may cause injury.
A. Delay position changes and bathing if the client is experiencing pain. B. Monitor renal function E. Instruct the client to avoid activities that may cause injury. Explanation: Pain can become quite severe. Delay position changes and bathing until analgesic has reached peak concentration level and the client is experiencing maximum pain relief. Safety is paramount because any injury, no matter how slight, can result in a fracture. The nurse assists the client with ambulation because immobility can worsen loss of calcium from the bone. The nurse provides up to 4000 mL of fluid to prevent renal damage from hypercalcemia and precipitation of protein in the renal tubules.
The nurse notes that a client with essential thrombocythemia has a headache and a platelet count of 1 million/mm3 (1 million/ ×109/L). Which additional neurologic findings will the nurse expect to assess in this client? Select all that apply. A. Dizziness B. Diplopia C. Facial paralysis D. Paresthesias E. Transient ischemic attacks
A. Dizziness B. Diplopia D. Paresthesias E. Transient ischemic attacks Explanation: Essential thrombocythemia, also called primary thrombocythemia, is a rare, chronic, Philadelphia chromosome-negative myeloproliferative disorder characterized by an increased production of megakaryocytes. A marked increase in platelet production occurs. One of the most common neurologic symptoms of essential thrombocythemia is headaches. Other neurological manifestations that may be related to compromised blood flow include diplopia, dizziness, paresthesias, and transient ischemic attacks. Facial paralysis is not a symptom of essential thrombocytopenia.
A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity? A. Do not lift more than 10 pounds. B. Stay in bed as much as possible. C. Limit activity to once a day. D. Limit fluids to prevent going to the bathroom.
A. Do not lift more than 10 pounds Explanation: The client with multiple myeloma needs education about activity instructions, such as lifting no more than 10 pounds and using proper body mechanics. Braces may be needed. The client should be active and would not be instructed to stay in bed or limit activity, as he or she would become very stiff. Limiting fluids would be contraindicated; the client needs to remain well hydrated.
Acute myeloid leukemia (AML) results from a defect in the hematopoietic stem cell that differentiates into which of the following myeloid cells? Select all that apply. A. Erythrocytes B. Platelets C. Granulocytes D. Islet cells E. Monocytes
A. Erythrocytes B. Platelets C. Granulocytes E. Monocytes Explanation: AML results from a defect in the hematopoietic stem cell that differentiates into all myeloid cells: monocytes, granulocytes, erythrocytes, and platelets. Islet cells are associated with the pancreas.
A nurse cares for a client with multiple myeloma who reports severe back pain that worsens throughout the day. What additional clinical symptoms will the nurse associate with the pathophysiology of the client's disease? A. Excessive thirst B. Polyuria C. Fluid volume excess D. Diarrhea
A. Excessive thirst Explanation: Bone pain in multiple myeloma results from bone breakdown. As a result of the breakdown, ionized calcium is released into the blood causing hypercalcemia. Symptoms of hypercalcemia include excessive thirst, dehydration, and constipation.
When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? A. Health history, such as bleeding, fatigue, or fainting B. Age and gender C. Lifestyle assessments, such as exercise routines D. Menstrual history
A. Health history, such as bleeding, fatigue, or fainting Explanation: When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.
A client receiving treatment for acute myeloid leukemia (AML) develops elevated potassium, uric acid, and phosphate levels. Which treatments will the nurse anticipate being prescribed to reduce this client's risk for kidney stone formation? Select all that apply. A. Intravenous fluids B. Anticoagulants C. Antibiotics D. Allopurinol E. Acetaminophen
A. Intravenous fluids D. Allopurinol Explanation: Massive leukemic cell destruction from chemotherapy in the treatment of AML results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate indicate the development of tumor lysis syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute kidney injury. Clients require a high fluid intake, and prophylaxis with allopurinol to prevent crystallization of uric acid and subsequent stone formation. Antibiotics, anticoagulants, and acetaminophen are not used to reduce the risk for the formation of kidney stones in the client being treated for AML.
What assessment finding best indicates that the client has recovered from induction therapy? A. Neutrophil and platelet counts within normal limits B. No evidence of edema C. Absence of bone pain D. Vital signs within normal ranges
A. Neutrophil and platelet counts within normal limitis Explanation: Recovery from induction therapy is indicated when the neutrophil and platelet counts have returned to normal and any infection has resolved. Stable vital signs, lack of edema, and absence of pain are not indicative of recovery from induction therapy.
Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. What is the most common complication of the pathology resulting from this process? A. Pathologic fractures B. Calcified bones C. Increased mobility D. Osteoporosis
A. Pathologic fractures Explanation: Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.
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? A. Perform a neurologic assessment with vital signs. B. Use contact precautions with this client. C. Teach the client to vigorously floss the teeth to prevent infections. D. Request a prescription of diphenoxylate and atropine for loose stools.
A. 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.
Which assessment findings support the client's diagnosis of acute myeloid leukemia? Select all that apply. A. Petechiae B. Enlarged lymph nodes C. Enlarged heart D. Bone pain E. Weakness and fatigue
A. Petechiae B. Enlarged lymph nodes D. Bone pain E. Weakness and fatigue Explanation: Clients with AML may present with petechiae, enlarged lymph nodes, weakness, fatigue, and bone pain. An enlarged heart is not a typical finding with this disorder.
A patient with polycythemia vera has a high red blood cell (RBC) count and is at risk for the development of thrombosis. What treatment is important to reduce blood viscosity and to deplete the patient's iron stores? A. Phlebotomy B. Chelation therapy C. Blood transfusions D. Radiation
A. Phlebotomy Explanation: The objective of management is to reduce the high RBC count and reduce the risk of thrombosis. Phlebotomy is an important part of therapy (Fig. 34-5). It involves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete the patient's iron stores, thereby rendering the patient iron deficient and consequently unable to continue to manufacture hemoglobin excessively.
A nurse is caring for an asymptomatic client with acute myelogenous leukemia. The client has a total white blood cell (WBC) count of 0, a platelet count of 3,000 mm2, and a hemoglobin level of 9 mg/dl. The client has a single lumen central venous catheter in place and the health care provider has ordered the nurse to administer imipenem cilastatin 500 mg every 8 hours, transfuse 1 unit packed red blood cells (RBCs), give amphotericin B 40 mg I.V. over 4 hours, and transfuse 2 pheresis units of platelets. In what order should the nurse infuse these medications and blood products? A. Platelets, imipenem cilastatin, amphotericin B, packed RBCs B. Packed RBCs, amphotericin B, imipenem cilastatin, platelets C. Packed RBCs, platelets, imipenem cilastatin, amphotericin B D. Amphotericin B, imipenem cilastatin, platelets, packed RBCs
A. Platelets, imipenem cilastatin, amphotericin B, packed RBCs Explanation: Although the client is currently asymptomatic, a platelet count of 3,000 mm2 puts the client at risk for spontaneous hemorrhage. A WBC count of 0 clearly indicates neutropenia; the client needs an antibiotic and antifungal therapy to prevent infection. Although the client is anemic, the client currently asymptomatic. The absence of clinical manifestations makes the need for a transfusion less urgent.
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? A. Polycythemia vera B. Sickle cell disease C. Aplastic anemia D. Pernicious anemia
A. Polycythemia vera Explanation: Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow. In sickle cell disease, HbS causes RBCs to assume a sickled shape under hypoxic conditions. Aplastic anemia has a deficiency of erythrocytes. The other options do not have the characteristics of erythrocytosis.
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? A. Practice vigilant handwashing. B. Maintain contact precautions. C. Monitor the client's temperature every shift. D. Encourage increased fluid consumption.
A. Practice vigilant handwashing Explanation: Infection prevention is best handled by vigilant handwashing. Monitoring the client's temperature once a shift is not often enough. The client will take precautions, but precautions are enough to prevent infections. Encouraging increased fluid consumption will not prevent infection.
A client receiving treatment for leukemia is experiencing stomatitis. Which interventions will the nurse implement to improve the client's nutritional status? Select all that apply. A. Suggest foods that are soft in texture. B. Provide foods that are hot in temperature. C. Administer pain medication before meals. D. Encourage small frequent meals. E. Provide mouth care before and after meals.
A. Suggest foods that are soft in texture. C. Administer pain medication before meals. D. Encourage small frequent meals. E. Provide mouth care before and after meals. Explanation: In leukemia, nutritional intake is often reduced because of pain and discomfort from stomatitis. Actions to improve the client's nutritional intake include small, frequent meals that are soft in texture and moderate in temperature. Hot foods can be irritating to the stomach. Pain medication should be provided before meals to reduce discomfort. Mouth care should be provided before and after meals to help improve oral intake.
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. A. Suggest support for household maintenance. B. Suggest the prescription of antianxiety medications. C. Suggest the family go to church more often. D. Allow family members to express feelings. E. Educate the family about medications and side effects.
A. Suggest support for household maintenance. D. Allow family members to express feelings. E. Educate the family about medications and side effects.
The nurse assesses a patient for late-stage chronic lymphocytic leukemia (CLL) by looking for what? A. Thrombocytopenia. B. Splenomegaly. C. Hepatomegaly. D. Lymphadenopathy.
A. Thrombocytopenia. Explanation: Anemia and thrombocytopenia are late-stage indicators of CLL. The others are early-stage signs.
The nurse in the oncology clinic is caring for a 42-year-old female client receiving chemotherapy with fludarabine for acute myeloid leukemia who has developed petechiae, epistaxis, and ecchymosis. Complete the following sentence by choosing from the lists of options. The nurse anticipates that the client has developed __A__ and that the laboratory results will reveal __B__. A. DVT, hyperkalemia, hemorrhage, or infection B. electrolyte imbalance, leukocytosis, thrombocytopenia, abnormal renal function tests
A. hemorrhage B. thrombocytopenia Explanation: This client has manifestations of hemorrhage, including petechiae (pinpoint bleeding in the skin), epistaxis (nosebleeds), and ecchymosis (bruises) due to a low platelet count (thrombocytopenia) secondary to chemotherapy. Chemotherapy with fludarabine may cause bone marrow suppression with neutropenia (low neutrophil count) and thrombocytopenia (low platelet count). When the platelet count is low, the client is at risk for hemorrhage as evidenced by petechiae, epistaxis, and ecchymosis. Chemotherapy with fludarabine may cause bone marrow suppression, leading to thrombocytopenia (low platelet count) and hemorrhage. Although the client is at risk for infection, the assessment findings of petechiae, epistaxis, and ecchymoses are indicators of a low platelet count. The assessment findings do not support a diagnosis of deep vein thrombosis (DVT). Manifestations of DVT include calf pain, leg swelling, and warmth, and pain over the thrombosis. Hyperkalemia does not cause signs and symptoms of hemorrhage. Leukocytosis (a low white count) may occur following treatment with fludarabine, but it does not cause petechiae, epistaxis, and ecchymosis. Electrolyte imbalances and abnormal renal function also do not cause petechiae, epistaxis, and ecchymosis.
A nurse is teaching a client with multiple myeloma about the therapeutic benefits of radiation therapy. Which statements will the nurse include in the teaching? Select all that apply. A. "It decreases excess calcium." B. "It helps to strengthen the bone." C. "It decreases the bone malignancy." D. "It helps to decrease bone pain." E. "It helps to activate an immune response."
B. "It helps to strengthen the bone." D. "It helps to decrease bone pain." Explanation: Radiation therapy is useful in strengthening the bone at a specific lesion, particularly a bone at risk for fracture or spinal cord compression. It is also extremely useful in relieving bone pain. Radiation therapy is not effective in decreasing bone malignancy, decreasing excess calcium, or activating an immune response.
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? A. Hydroxyurea B. Allopurinol C. Filgrastim D. Asparaginase
B. 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. Patients require a high fluid intake, and prophylaxis with allopurinol or rasburicase to prevent crystallization of uric acid and subsequent stone formation
A client receiving treatment for acute myeloid leukemia (AML) develops elevated potassium, uric acid, and phosphate levels. Which treatments will the nurse anticipate being prescribed to reduce this client's risk for kidney stone formation? Select all that apply. A. Antibiotics B. Allopurinol C. Intravenous fluids D. Acetaminophen E. Anticoagulants
B. Allopurinol C. IV fluids Explanation: Massive leukemic cell destruction from chemotherapy in the treatment of AML results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate indicate the development of tumor lysis syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute kidney injury. Clients require a high fluid intake, and prophylaxis with allopurinol to prevent crystallization of uric acid and subsequent stone formation. Antibiotics, anticoagulants, and acetaminophen are not used to reduce the risk for the formation of kidney stones in the client being treated for AML.
A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? A. Check the client's history. B. Assess the client's hemoglobin and platelets. C. Assess the client's pulse and blood pressure. D. Assess the client's skin.
B. Assess the client's hemoglobin and platelets. Explanation: Clients with AML may develop pallor from anemia and a tendency to bleed because of a low platelet count. Assessing the client's hemoglobin and platelets will help to determine whether this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.
A client with a new onset of rib and spine pain is being evaluated for multiple myeloma. For which manifestations will the nurse assess this client? Select all that apply. A. Lymph enlargement B. Bone destructions C. Renal dysfunction D. Hypercalcemia E. Anemia
B. Bone destructions C. Renal dysfunction D. Hypercalcemia E. Anemia Explanation: Clinical manifestations of multiple myeloma result not only from the malignant cells themselves, but also from the abnormal protein they produce. The classic clinical manifestations of multiple myeloma are referred to as the CRAB features and include anemia, hypercalcemia, renal dysfunction, and bone destruction. Lymph enlargement is associated with lymphomas, but not with multiple myeloma.
The nurse is assessing a client with leukemia. How would the nurse assess for enlargement and tenderness over the liver and spleen? A. By calculating the absolute neutrophil count B. By palpating the abdomen C. By reviewing laboratory test results D. By looking for evidence of bruising
B. By palpating the abdomen Explanation: In a client with leukemia, the nurse palpates the abdomen to detect enlargement and tenderness over the liver and spleen. The nurse reviews laboratory test results to note the number and types of blood cells. The nurse may calculate the absolute neutrophil count to determine the client's potential for infection.
A client with acute myeloid leukemia (AML) receiving chemotherapy is treated for an acute renal injury. What is the nurse's best understanding of the pathophysiological reason behind the client's injury? A. The majority of the disease process occurs in the vessels of the kidneys. B. Chemotherapy causes an increase in kidney stone formation. C. Chemotherapy causes destruction of the nephrons in the kidney. D. The majority of the disease process occurs in the tissue of the kidneys.
B. Chemotherapy causes an increase in kidney stone formation. Explanation: Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. This causes an increase in uric acid levels, potassium, and phosphate (also known as tumor lysis). The increase in uric acid predisposes the client to the development of kidney stones and increases the risk for renal injury.
A client has multiple myeloma. Prior to starting treatment with thalidomide, what it is most important action for the nurse to take? A. Instruct the client about signs and symptoms of hypercalcemia. B. Contract with the client regarding birth-control methods. C. Assess the client's BUN and creatinine levels frequently. D. Encourage the client to drink at least 3000 mL of fluids per day.
B. Contract with the client regarding birth-control methods. Explanation: Thalidomide (Thalomid) may cause birth defects. Prior to taking this drug, the client must agree to use approved methods of birth control. The question is asking about thalidomide and not multiple myeloma. The other options relate to the effects of multiple myeloma.
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? A. Adventitious lung sounds B. Diarrheal stools C. Hair loss D. Laryngeal edema
B. 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 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. A. Warn client to avoid extremes in temperatures B. Encourage hydration C. Warn client to avoid abrupt position change D. Encourage ambulation E. Encourage range of motion exercises
B. Encourage hydration D. Encourage ambulation Explanation: Muscle cramping can be alleviated or reduced by encouraging hydration and ambulation. Warning the client to avoid abrupt position change best supports the client with postural hypotension. Paresthesias (tingling) can best be mediated with range of motion exercises. Clients experiencing hypoesthesia should be warned to avoid extremes in temperatures.
What interventions are most appropriate for the nurse to include in the plan of care for a client at risk for infection? Select all that apply. A. Place fresh flowers on a shelf on the opposite wall from the client. B. Encourage the client to take deep breaths every 4 hours while awake. C. Provide oral hygiene once daily. D. Auscultate lung sounds every shift and as needed. E. Assess skin and mucus membranes every shift.
B. Encourage the client to take deep breaths every 4 hours while awake. D. Auscultate lung sounds every shift and as needed. E. Assess skin and mucus membranes every shift. Explanation: Interventions for risk for infection include assessing skin and mucus membranes every shift, auscultating lung sounds every shift and as needed, and encouraging deep breaths every 4 hours while the client is awake. No fresh flowers are allowed in the room because of germs found in stagnant water. Oral hygiene should be provided after meals and every 4 hours while the client is awake.
A client with chronic lymphocytic leukemia (CLL) wants to have treatment for the condition. Which medication will the nurse question for this client? A. Ipilimumab B. Heparin C. Vincristine D. Dexamethasone
B. Heparin Explanation: Commonly prescribed pharmacological therapies for chronic lymphocytic leukemia (CLL) include immunotherapy agents (ipilimumab), corticosteroids (dexamethasone), and chemotherapeutic agents (vincristine). Clients with CLL are at risk of bleeding, and therefore the use of anticoagulants (heparin) is contraindicated.
A client has been diagnosed with multiple myeloma. Which of the following laboratory values should the nurse expect to find in a client with multiple myeloma? A. Decreased serum protein B. Increased urinary protein C. Decreased calcium level D. Polycythemia vera
B. Increased urinary protein Explanation: A characteristic finding in multiple myeloma is protein in the urine. Other laboratory findings include increased serum protein, hypercalcemia, anemia, and hyperuricemia. Polycythemia vera is not found in multiple myeloma.
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? A. Creatinine and blood urea nitrogen (BUN) levels B. Iron levels C. Magnesium levels D. Potassium levels
B. Iron levels Explanation: For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).
Which term refers to a form of white blood cell involved in immune response? A. Granulocyte B. Lymphocyte C. Thrombocyte D. Spherocyte
B. Lymphocyte Explanation: Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? A. Anemia B. Neutropenia C. Pancytopenia D. Thrombocytopenia
B. Neutropenia Explanation: Fever and infection result from a decrease in neutrophils (neutropenia). Decreased red blood cells (anemia) cause weakness, fatigue, dyspnea on exertion, and pallor in AML. Pancytopenia, an overall decrease in all blood components, is not cause of fever in clients with AML. Decreased platelet count (thrombocytopenia) causes petechiae and bruising in AML.
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? A. Osteolytic activating factor weakens bones producing fractures. B. Osteoclasts break down bone cells so pathologic fractures occur. C. Osteosarcomas form producing pathologic fractures. D. Osteopathic tumors destroy bone causing fractures.
B. Osteoclasts break down bone cells so pathologic fractures occur. Explanation: The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This, in turn, causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a "punched-out" or "honeycombed" appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. The other options are distractors for this question.
A client is taking dasatinib as prescribed. Which findings indicate to the nurse the client is experiencing adverse effects from this medication? Select all that apply. A. Hypoactive bowel sounds B. Prolonged QT interval on electrocardiogram C. Decreased urine output D. Fever E. Chills
B. Prolonged QT interval on electrocardiogram C. Decreased urine output D. Fever E. Chills Explanation: Most TKIs are oral agents whose effectiveness depends upon the client's ability and motivation to adhere to the prescribed treatment regimen. These drugs may cause side effects that the client may find difficult to manage. Adverse effects of these medications include signs of myelosuppression to include chills and fever. Decreased urine output and a prolonged QT interval are additional adverse effects of TKIs. Hypoactive bowel sounds are not identified as adverse effects of TKIs.
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.) A. Decrease fat intake B. Reduce exposure to excessive sunlight C. Smoking cessation D. Decrease alcohol intake E. Decrease intake of antipyretic medications such as acetaminophen
B. Reduce exposure to excessive sunlight C. Smoking cessation D. Decrease alcohol intake Explanation: The potential development of a second malignancy should be addressed with the patient when initial treatment decisions are made. However, patients should also be told that Hodgkin lymphoma is often curable. The nurse should encourage patients to reduce other factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and exposure to environmental carcinogens and excessive sunlight.
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? A. Platelet count 300,000/mm3 B. Serum calcium level 13.8 mg/dl C. Hemoglobin of 9.8 g/dl D. Serum sodium level of 133 mEq/L
B. Serum calcium level 13.8 mg/dl Explanation: Excessive thirst, constipation, dehydration, confusion, and altered mental state are possible signs of hypercalcemia. Hypercalcemia is common in multiple myeloma because of the increased bone destruction. A platelet count of 300,000/mm3 is normal and wouldn't cause the client's symptoms. A sodium level of 133 mEq/L is slightly decreased but wouldn't cause confusion and excessive thirst. A hemoglobin of 9.8 g/dl level is slightly low but isn't likely responsible for the client's symptoms.
The nurse is teaching a client who is undergoing diagnostic tests for multiple myeloma. What clinical findings support the client's diagnosis of multiple myeloma? A. serum creatinine level 0.5 mg/dL B. serum albumin level of 2.0 g/dL C. serum calcium level of 7.5 mg/dL D. serum protein level 5.8 g/dL
B. serum albumin level of 2.0 g/dL Explanation: Albumin is a protein found in the blood and low levels can be seen in myeloma. Normal albumin level is 3.4 to 5.4 g/dL. Serum creatinine level may be increased (above 1.2 mg/dL in men and 0.9 mg/dL in women). Serum calcium levels exceed 10.2 mg/dL in multiple myeloma because calcium is lost from the bone and reabsorbed in the serum. The serum protein level is increased in multiple myeloma, not decreased.
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? A. peripheral edema B. splenomegaly C. pale body color D. weight gain
B. splenomegaly Explanation: Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, weight loss, paresthesias, and blurred vision). Edema, pale body color, and weight gain are not classic symptoms of PV.
A client with chronic lymphocytic leukemia (CLL) experiences frequent bacterial infections. Which medication will the nurse anticipate being prescribed for this client? A. Clotrimazole B. Dasatinib C. Asceniv D. Acyclovir
C. Asceniv Explanation: Virtually all clients with CLL have reduced levels of immunoglobulins, and bacterial infections are common, independent of treatment. Intravenous treatment with immunoglobulin (IVIG), such as ascenivc, may be given to clients with recurrent infection. Antivirals (acyclovir) and antifungals (clotrimazole) would be used if the client develops a viral or fungal infection. Tyrosine kinase inhibitors (dasatinib) are targeted therapies to treat certain types of cancer, and not to treat bacterial infection.
A client with leukemia is experiencing recurrent fevers. Which actions will the nurse take to improve this client's comfort? Select all that apply. A. Provide a warm beverage before bedtime. B. Apply ice packs to the groin. C. Change bed clothes frequently. D. Provide acetaminophen as prescribed. E. Sponge with cool water.
C. Change bed clothes frequently. D. Provide acetaminophen as prescribed. E. Sponge with cool water. Explanation: Recurrent fevers are common in acute leukemia. Treatment for this symptom includes sponging with cool water and changing the bed clothes frequently. Acetaminophen should be provided as prescribed. Ice packs should be avoided because the heat cannot dissipate from the constricted blood vessels. A warm beverage before bedtime may encourage sweating and is not identified as an action to improve comfort.
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? A. Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. B. Put on a mask, gown, and gloves when entering the client's room. C. Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. D. Provide a clear liquid, low-sodium diet.
C. 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 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? A. Standard therapy B. Antimicrobial therapy C. Induction therapy D. Supportive therapy
C. Induction therapy Explanation: Despite advances in understanding of the biology of AML, substantive advances in treatment response rates and survival rates have not occurred for decades, with the exception of advances made in treating APL (see later discussion). Even for patients with subtypes that have not benefited from advances in treatment, cure is still possible. The overall objective of treatment is to achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow. Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks.
A nurse caring for a client with myeloma prepares to administer dexamethasone to the client. What is the nurse's best understanding of how this medication is an effective treatment option for this client? A. It kills affected bone marrow. B. It decreases immune response. C. It kills affected cells. D. It decreases tumor necrosis factor.
C. It kills affected cells. Explanation: Dexamethasone is used to induce myeloma apoptosis and cell death and to reduce bone pain.
A nurse cares for a client with myelodysplastic syndrome (MDS). Which assessment finding does the nurse recognize is the most common finding with this condition? A. Hemolytic anemia B. Proliferative anemia C. Macrocytic anemia D. Microcytic anemia
C. Macrocytic anemia Explanation: Macrocytic anemia is the most common symptom of MDS.
Which laboratory test results indicate to the nurse that the client is experiencing symptoms of acute lymphocytic leukemia (ALL)? Select all that apply. A. Blastocyte count 94 B. Hemoglobin 16 C. Platelet count of 20,000 D. Erythocyte count 2.5 E. Granulocyte count 0.8
C. Platelet count of 20,000 D. Erythocyte count 2.5 E. Granulocyte count 0.8 Explanation: Acute lymphocytic leukemia (ALL) results from an uncontrolled proliferation of immature cells (lymphoblasts) derived from the lymphoid stem cell. Immature lymphocytes proliferate in the marrow and impede the development of normal myeloid cells. As a result, normal hematopoiesis is inhibited, resulting in reduced numbers of platelets, granulocytes, and erythrocytes. ALL does not cause an increase in blastocytes or elevate the hemoglobin level.
Place the pathophysiology of multiple myeloma in the correct order. A. Increased blood calcium levels B. Break down and removal of bone cells C. Proliferation of abnormal plasma cells D. Release of osteoclast-activating factor
C. Proliferation of abnormal plasma cells D. Release of osteoclast-activating factor B. Break down and removal of bone cells A. Increased blood calcium levels Explanation: The pathophysiology of multiple myeloma is as follows: Proliferation of abnormal plasma cells, release of osteoclast-activating factor, break down and removal of bone cells, increased blood calcium levels.
A client with polycythemia vera reports severe itching. What triggers does the nurse know can cause this distressing symptom? Select all that apply. A. Allergic reaction to the red blood cell increase B. Aspirin C. Temperature change D. Alcohol consumption E. Exposure to water of any temperature
C. Temperature change D. Alcohol consumption E. Exposure to water of any temperature Explanation: Pruritus is very common, occurring in up to 70% of clients with polycythemia vera (Saini, Patnaik & Tefferi, 2010) and is one of the most distressing symptoms of this disease. It is triggered by contact with temperature change, alcohol consumption, or, more typically, exposure to water of any temperature but seems to be worse with exposure to hot water.
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan? A. "Consolidation occurs as a side effect of chemotherapy." B. "Consolidation of the lungs is an expected effect of induction therapy." C. "Consolidation is the term used when a client does not tolerate chemotherapy." D. "Consolidation therapy is administered to reduce the chance of leukemia recurrence."
D. "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 being treated for non-Hodgkin lymphoma asks the nurse why they need to be monitored for additional forms of leukemia. Which is the nurse's best response? A. "You don't want to develop a second cancer, do you?" B. "These screening are health promotion activities that apply to everyone." C. "You need to do this just to be on the safe side." D. "These are seen among survivors like yourself."
D. "These are seen among survivors like yourself." Explanation: Many lymphomas can be cured with current treatments. However, as survival rates increase, the incidence of secondary malignancies, particularly acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS), also increases. Therefore, survivors should be screened regularly for the development of second malignancies. The nurse should encourage clients to reduce other factors that increase the risk of developing second cancers. The other options do not answer the client's question, and also seem insensitive to the client's question.
The nurse is providing teaching to a client diagnosed with chronic myeloid leukemia (CML). Which statement will the nurse include in the teaching on the pathophysiology of the disease? A. "Abnormally-shaped blood cells cause thickening of the vessels and leads to necrosis of tissue." B. "Uncontrolled growth of blood cells causes occlusion in the vessels and tissues." C. "Abnormally-shaped blood cells cause malfunction of the marrow." D. "Uncontrolled growth of blood cells causes the marrow to expand to organs."
D. "Uncontrolled growth of blood cells causes the marrow to expand to organs." Explanation: Because there is an uncontrolled proliferation of cells, the marrow expands into the cavities of long bones, such as the femur, and cells are also formed in the liver and spleen (extramedullary hematopoiesis), resulting in enlargement of these organs that is sometimes painful.
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A. A 40-year-old patient with a history of hypertension B. A 24-year-old female taking oral contraceptives C. A 52-year-old patient with acute kidney injury D. A 72-year-old patient with a history of cancer
D. A 72-year-old patient with a history of cancer Explanation: Primary MDS tends to be a disease of people older than 70 years. Because the initial findings are so subtle, the disease may not be diagnosed until later in the illness trajectory, if at all. Thus, the actual incidence of MDS is not known.
A client is receiving chemotherapy for acute myeloid leukemia and has poor nutritional intake. What is the first action the nurse should take? A. Provide mouth care before each meal. B. Caution the client to chew carefully after administration of the prescribed lidocaine. C. Provide nutritional supplements in addition to a diet that has a soft texture and moderate temperature. D. Ask, "Are you experiencing nausea?"
D. Ask, "Are you experiencing nausea?" Explanation: All these options are things the nurse can do to assist the client to obtain better nutrition. The nurse first needs to assess the reason for poor nutritional intake. It could be because of nausea, in which case the nurse would implement interventions to address the client's nausea.
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? A. Axillary B. Inguinal C. Popliteal D. Cervical
D. Cervical Explanation: Non painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.
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? A. Acute myelogenous leukemia B. Acute lymphocytic leukemia C. Chronic myelogenous leukemia D. Chronic lymphocytic leukemia
D. Chronic lymphocytic leukemia Explanation: Clients with CLL are typically older than 40 years of age, have increased immature lymphocytes, normal or decreased granulocytes, but erythrocyte and platelet counts may be normal or low. Clients with ALL are younger than 5 years of age; uncommon after 15 years of age. Clients with AML have a decrease in all myeloid formed cells: monocytes, granulocytes, erythrocytes, and platelets. Clients with CML are similar to those with AML but greater number of normal cells than in acute form.
A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? A. Ask the client whether they have recently fallen. B. Evaluate the client's INR. C. Keep the client on bed rest. D. Evaluate the client's platelet count.
D. Evaluate the client's platelet count. Explanation: Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3. The bleeding is usually unrelated to falling. Keeping the client on bed rest will not prevent bleeding when the client has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.
A client has been diagnosed with polycythemia vera. What is the best instruction for the nurse to give to this client? A. Drink alcohol to decrease blood viscosity B. Bath in tepid or cool water to control itching C. Take a daily multivitamin with iron supplement D. Maintain adequate blood pressure control
D. Maintain adequate blood pressure control Explanation: The client with polycythemia vera needs to control blood pressure, because of the increased risk for thrombosis or hemorrhage. Iron supplements can stimulate red blood cell production. Ingestion of alcohol may cause bleeding. Bathing in cool or tepid water may control itching, but this is not as high a priority as preventing thrombosis or hemorrhage.
A client is diagnosed with low risk asymptomatic polycythemia vera. For which treatment will the nurse prepare teaching for this client? A. Ruxolitinib B. Interferon-alfa C. Hydroxyurea D. Phlebotomy
D. Phlebotomy Explanation: The objectives of management in polycythemia vera are to reduce the risk of thrombosis without increasing the risk of bleeding, reduce the risk of evolution to myelofibrosis or AML, and ameliorate symptoms associated with the disease. Phlebotomy is considered the mainstay of therapy and is used to maintain the hematocrit level at less than 45%. It involves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete iron stores, thereby rendering the patient iron deficient and consequently unable to continue to manufacture excessive RBCs. Ruxolitinib is a JAK2 inhibitor and is used in clients who are unable to tolerate other treatment approaches. Cytoreductive therapy should be considered in clients at low-risk who are symptomatic due to progressive splenomegaly, leukocytosis, thrombocytosis, or have poor tolerance to phlebotomy. This type of therapy is accomplished through the use of hydroxyurea or interferon-alpha.
Place the pathophysiology of multiple myeloma in the correct order. A. Increased blood calcium levels B. Release of osteoclast-activating factor C. Breakdown and removal of bone cells D. Proliferation of abnormal plasma cells
D. Proliferation of abnormal plasma cells B. Release of osteoclast-activating factor C. Break down and removal of bone cells A. Increased blood calcium levels Explanation: The pathophysiology of multiple myeloma is as follows: Proliferation of abnormal plasma cells, release of osteoclast-activating factor, break down and removal of bone cells, increased blood calcium levels.
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? A. Pale skin and mucous membranes B. Jaundice skin and sclera C. Bronze skin tone D. Ruddy complexion
D. Ruddy complexion Explanation: Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? A. Total blood cell count B. Histology of tissue C. Involvement of lymph nodes D. Staging of disease
D. 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.
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? A. The client with a painful sore throat. B. The client with painful lymph nodes in the groin. C. The client with painful lymph nodes under the arm. D. The client with enlarged lymph nodes in the neck.
D. 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 with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom? A. The dead red blood cells occlude the small vessels in the joints. B. Excess red blood cells cause vascular injury in the joints. C. Excess red blood cells produce extracellular toxins that build up. D. The dead red blood cells release excess uric acid.
D. The dead red blood cells release excess uric acid. Explanation: There is a rapid proliferation of red blood cells from the marrow in polycythemia vera. However, these red blood cells die sooner than normal and the dead red blood cells release potassium and uric acid. This build up of uric acid in the blood leads to gouty arthritis symptoms.
Which statement best describes the function of stem cells in the bone marrow? A. They produce antibodies against foreign antigens. B. They are active against hypersensitivity reactions. C. They defend against bacterial infection. D. They produce all blood cells.
D. 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.