Nurs 2300 Midterm1 Patients with hematologic neoplasms

A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for?

pathologic bone fractures. Explanation: Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.

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

"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.

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

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

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.

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 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

Which of the following are complications related to polycythemia vera (PV)? Select all that apply

CVA MI Ulcers Hematuria Explanation: Patients with PV are at increased risk for thromboses resulting in a CVA or myocardial infarction. Bleeding can be significant and can occur in the form of nosebleeds, ulcers, frank gastrointestinal bleeding, and intracranial hemorrhage. Splenomegaly is a clinical manifestation of PV, not a complication.

some adverse effects of dasatinib

Chills Fever Decreased urine output Prolonged QT interval on electrocardiogram

azathioprine

Imuran, or Azapress DMARD (disease modifying anti rheumatic drug. reduces activity of the immune system

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 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).

Dyphenoxylate/atropine

Lomotil (used to treat diarrhea)

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. Explanation: The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor.

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. Explanation: With platelets less than 10,000/mm³ there is a risk for spontaneous bleeding, including within the cranial vault. The nurse performs a neurologic examination to assess for this possibility. Though the client is receiving immunosuppressants, it is not necessary to use contact precautions with this client. Contact precautions are used with clients who have known or suspected transmittable illnesses. Diphenoxylate and atropine can cause constipation and inhibit accurate assessment of the client's gastrointestinal bleeding. If the client strains when having a bowel movement, the client could bleed even more. The client is not to floss vigorously; doing so can cause bleeding.

A client is awaiting test results to diagnose Hodgkin lymphoma. The nurse knows that which result is the hallmark for the diagnosis of this condition?

Reed-Sternberg cells Explanation: The malignant cell of Hodgkin lymphoma is the Reed-Sternberg cell, a gigantic tumor cell that is morphologically unique and thought to be of immature lymphoid origin. These cells arise from the B lymphocyte. They may have more than one nucleus and often have an owl-like appearance. The presence of Reed-Sternberg cells is the pathologic hallmark and essential diagnostic criterion. Basophils, platelets, or red blood cells are not used to diagnose Hodgkin lymphoma.

What type of medicine is dasatinib

TKI Tyrosine Kinase inhibitor

A client is diagnosed with low risk asymptomatic polycythemia vera. For which treatment will the nurse prepare teaching for this client?

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.

The nurse is caring for a patient who will begin taking long-term biphosphate therapy. Why is it important for the nurse to encourage the patient to receive a thorough evaluation of dentition, including panoramic dental x-rays?

The patient can develop osteonecrosis of the jaw. Explanation: Osteonecrosis of the jaw is an infrequent but serious complication that can arise in patients treated long-term with bisphosphonates; the mandible or maxilla are affected. Careful assessment for this complication should be conducted and a thorough evaluation of the patient's dentition should be performed prior to initiating bisphosphonate therapy, including panoramic dental x-rays.

allopurinol

decreases uric acid in the blood to prevent gout

lymph node enlargement hodgkins lymphoma

lymph node enlargement in lymphoma isn't painful

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.

Diplopia Dizziness Paresthesias 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.