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Laboratory results of a client's blood after chemotherapy indicate bone marrow depression. What should the nurse encourage the client to do? Select all that apply. 1 Use a soft toothbrush. 2 Sleep with the head of the bed elevated. 3 increase activity levels and take frequent walks. 4 Drink more citrus juices and eat more citrus fruits. 5 Read the ingredients in over-the-counter drugs before taking them

ANS. 1,5 The gums are vascular tissue and prone to bleed easily if the platelet count is low. Drugs such as ibuprofen and salicylates in any analgesic or cold medicine should be avoided because they increase the risk of bleeding by inhibiting platelet function. With bone marrow depression, red blood cells are decreased and the oxygen-carrying capacity of the blood is decreased; raising the head of the bed will not increase the number of red blood cells. Rest should be encouraged. Citrus fruits and juices will not change the bone marrow depression; they should be avoided because they are acidic and aggravate stomatitis.

A client is receiving whole-body radiation for Hodgkin disease. Which side effect should the nurse expect as a result of this therapy? 1 Increased tendency to bleed 2 Increased tendency for fractures 3 Decreased number of erythrocytes 4 Decreased susceptibility to infection

ans. 3 Depression of the bone marrow interferes with hemopoiesis, resulting in anemia. A decrease in the number of cells occurs, and therefore there is an increase in blood viscosity and a more rapid clotting time. Pathologic fractures result from the disease, not from the treatment. Radiation causes increased susceptibility to infection as a result of the decreased number of white blood cells.

A nurse is teaching a client with Hodgkin disease about responses to whole-body radiation. Which clinical indicator increase should the nurse include in the teaching session? 1 Blood viscosity 2 Susceptibility to infection 3 Red blood cell (RBC) production 4 Tendency for pathologic fractures

ans 2 Radiation exposure may lead to depression of the bone marrow, with subsequent insufficient white blood cells (WBCs) to combat infection. There is no increase in the number of cells; therefore viscosity is not increased. RBC production is decreased by radiation. Pathologic fractures are not associated with radiation treatments.

A client is diagnosed with pancytopenia caused by chemotherapy. What should a nurse teach the client about this complication? 1 Begin a program of meticulous mouth care. 2 Avoid traumatic injury and exposure to infection. 3 Increase oral fluid intake to at least 3 L/day. 4 Report unusual muscle cramps or tingling sensations in the extremities.

ans. 2 Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase the susceptibility to infection. Beginning a program of meticulous mouth care is helpful for stomatitis, not pancytopenia; aggressive oral hygiene may precipitate bleeding from the gums. Although fluids may be increased to flush out the toxic byproducts of chemotherapy, this will have no effect on pancytopenia. Unusual muscle cramps or tingling sensations in the extremities are signs of hypocalcemia and do not apply to pancytopenia.

A client with multiple myeloma is scheduled to have a chest x-ray examination and a bone scan. For this client, what is the primary responsibility of the nurses and other members of the healthcare team? 1 Explain the procedure and its purpose. 2 Observe the client for the presence of pallor. 3 Provide for rest periods during the procedure. 4 Handle the client with supportive movements.

ANS. 4 Because of bone erosion, pathologic fractures are a common complication of multiple myeloma. Although explaining the procedure and its purpose is done, the priority is to prevent injury. Although observing the client for the presence of pallor is an adaptation to the associated anemia, it is not life threatening. Although providing for rest periods during the procedure is important, preventing pathologic fractures is the priority.

The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply. 1 .Monitor for signs of alopecia. 2 .Encourage an increase in fluids. 3 .Wash hands before entering the client's room. 4 .Advise use of a soft toothbrush for oral hygiene. 5 .Report an elevation in temperature immediately. 6 .Encourage the client to eat raw, fresh fruits and vegetables.

Ans. 3,4,5 It is essential to prevent infection in a client with severe bone marrow depression; thorough handwashing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the primary healthcare provider immediately because it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables and undercooked meat, eggs, and fish to prevent possible exposure to microbes.

When receiving chemotherapy for non-Hodgkin lymphoma, a client states, "I get so sick to my stomach. The medication is useless." What is the best response by the nurse that uses the technique of paraphrasing? 1 "You get sick to your stomach." 2 "Tell me more about how you feel." 3 "I'll get a prescription for an antiemetic." 4"You don't think the medication is helping you."

ans. 4 Rewording of the client's statement is paraphrasing that promotes further verbalization. The response "You get sick to your stomach" is not paraphrasing; this repeats the client's exact words. The response "Tell me more about how you feel" is clarifying, a therapeutic technique; it is not paraphrasing. The response "I'll get a prescription for an antiemetic" is not an interviewing technique; it does not address the theme in the client's statement, and it cuts off communication.

A client's discouragement with the diagnosis of nodular, poorly differentiated lymphocytic lymphoma continues during radiation therapy because of the long time required for treatment and its side effects. What should the nurse emphasize when assisting the client to plan for the future? 1 Antidepressant medication may be prescribed. 2 Positive beliefs can influence the outcome of therapy. 3 Expected feelings of discouragement will lessen with time. 4 Prognosis for this disease is more favorable than for other cancers.

ans. 4 The true statement that the prognosis for this disease is more favorable than for other cancers can be the foundation for developing a positive mental outlook. There is no indication that the client needs drugs to combat depression. Although the statement that positive beliefs can influence the outcome of therapy is probably true, this response belittles the client's actual concern and physical discomfort. Stating that the expected feelings of discouragement will lessen with time is a patronizing response that does not recognize the despair.

A client has a right upper lobectomy to remove a cancerous lesion. After the surgery, the nurse monitors the client for the most life-threatening complication, which is what? A. Hemothorax caused by decreased thoracic drainage b. Dyspnea caused by increased intrathoracic pressure c. Decreased cardiac output because of mediastinal shift d. Pneumothorax caused by increased abdominal pressure

C If a closed chest drainage tube becomes obstructed, there is increased intrathoracic pressure that pushes the heart to the opposite side, thereby reducing venous return and cardiac output. Although a hemothorax is serious, it is not as life threatening as a mediastinal shift, which compromises cardiac output. Dyspnea may develop but is not life threatening. A pneumothorax is unrelated to abdominal pressure and is not as life threatening as a mediastinal shift.

A primary healthcare provider decides to omit a treatment that was part of a course of chemotherapy for a client because the client demonstrates myelosuppression. What information would be appropriate for the nurse to give to the client regarding myelosuppression? 1 Calcium carbonate and vitamin D must be increased in the diet because of the effects of myelosuppression. 2 Eating a balanced diet, resting, and trying to prevent bleeding and infections are appropriate at this time. 3 The development of myelosuppression explains why the client has nausea, vomiting, anorexia, and alopecia. 4 Frequent testing for restlessness, muscle control, and pupillary response is necessary because the meninges may be irritable.

ans. 2 Myelosuppression involves a decreased number of red blood cells (anemia), resulting in a reduced oxygen-carrying capacity of the blood and fatigue. A decreased number of white blood cells (leukopenia) results in a potential for infection. A decreased number of platelets (thrombocytopenia) results in a potential for bleeding. Myelosuppression is not related directly to calcium carbonate and vitamin D; myelosuppression, a reduction in bone marrow activity, results in decreased numbers of red blood cells (RBCs), white blood cells (WBCs), and platelets. Myelosuppression is not related to nausea, vomiting, anorexia, or alopecia. Myelosuppression is related to bone marrow activity, not the nervous system.

A client who has bone pain of insidious onset is suspected of having multiple myeloma. The nurse expects which diagnostic finding specific for multiple myeloma? 1 Occult blood in the stool 2 Low serum calcium levels 3 Bence Jones protein in the urine 4 Positive bacterial culture of sputum

ans. 3 Bence Jones protein (globulin) results from tumor cell metabolites. It is present in clients with multiple myeloma. Occult blood in the stool is not specific for the diagnosis of multiple myeloma; it is a late complication of multiple myeloma related to coagulation defects. Hypercalcemia, not hypocalcemia, occurs with multiple myeloma because of bone erosion. Multiple myeloma is not caused by a bacterial infection.