Unit 6- Chapter 34 w/ rationales
Which of the following are complications related to polycythemia vera (PV)? Select all that apply. CVA MI Ulcers Hematuria Splenomegaly
CVA MI Ulcers Hematuria Explanation: Patients with PV are at increased risk for thromboses resulting in: - a CVA or MI. - 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.
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A 24-year-old female taking oral contraceptives A 40-year-old patient with a history of hypertension A 52-year-old patient with acute kidney injury A 72-year-old patient with a history of cancer
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.
The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? Too many erythrocytes A decrease in granulocytes A general reduction in all white blood cells A general reduction in neutrophils and basophils
A general reduction in all white blood cells Explanation: Leukopenia is a general reduction in all WBCs. Leukopenia does not have anything to do with erythrocytes.
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? Axillary Cervical Inguinal Popliteal
Cervical Explanation: Non painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.
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. Hypercalcemia Renal insufficiency Anemia Bone lesions Acidosis
Hypercalcemia Renal insufficiency Anemia Bone lesions 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.
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Pancytopenia Thrombocytopenia Anemia Neutropenia
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.
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Pancytopenia Thrombocytopenia Anemia Neutropenia
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.
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? Adventitious lung sounds Hair loss Diarrheal stools Laryngeal edema
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 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? Stroke Tissue infarction Congestive heart failure Pulmonary embolus
Congestive heart failure Explanation: The symptoms exhibited by this client are indicative of congestive heart failure. Complications include: hypertension, congestive heart failure, stroke, tissue and organ infarction, and hemorrhage. Stroke would present with headache, aphasia, and/or numbness in extremities. Tissue infarction would involve extremity discoloration or an organ failure. Pulmonary embolism would be associated with chest pain. Google: polycythemia vera= rare blood disorder in which there is an increase in all blood cells, particularly red blood cells
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "Acute leukemia develops slowly." "Chronic leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature." "In acute leukemia there are not many undifferentiated cells."
"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.
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan? "Consolidation therapy is administered to reduce the chance of leukemia recurrence." "Consolidation occurs as a side effect of chemotherapy." "Consolidation of the lungs is an expected effect of induction therapy." "Consolidation is the term used when a client does not tolerate chemotherapy."
"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.
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 Filgrastim Hydroxyurea Asparaginase
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. Clients require a high fluid intake, and prophylaxis with allopurinol (Zyloprim) to prevent crystallization of uric acid and subsequent stone formation.
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? Elevate the client's legs. Encourage ambulation. Assess for signs of injury. Keep the feet cool.
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. hypoesthesia=decrease in normal sensation
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? Refer the client to a chiropractor. Place heating pads on the client's back. Administer pain medication, as ordered. Assess renal function.
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 AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? Assess the client's skin. Assess the client's hemoglobin and platelets. Assess the client's pulse and blood pressure. Check the client's history.
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 chronic lymphocytic leukemia (CLL) wants to have treatment for the condition. Which medication will the nurse question for this client? Heparin Ipilimumab Dexamethasone Vincristine
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 with primary myelofibrosis is diagnosed with splenomegaly. Which medications will the nurse prepare teaching for this client? Select all that apply. Anagrelide Hydroxyurea Thalidomide Pomalidomide Interferon-alfa
Hydroxyurea Thalidomide Pomalidomide Explanation: Primary myelofibrosis is characterized by extramedullary hematopoiesis [hematopoiesis occurring outside of the medulla of the bone (bone marrow)](body produces blood cells and blood plasma) that involves the spleen causing splenomegaly. Pharmacologic agents can be used to diminish splenomegaly and include hydroxyurea, thalidomide, and pomalidomide. Anagrelide and interferon-alfa are not used to treat splenomegaly caused by primary myelofibrosis.
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? Hypercalcemia Hyperkalemia Hypernatremia Hypermagnesemia
Hypercalcemia Explanation: Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.
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? Creatinine and blood urea nitrogen (BUN) levels Iron levels Magnesium levels Potassium levels
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 an abnormal decrease in white blood cells, red blood cells, and platelets? Pancytopenia Anemia Leukopenia Thrombocytopenia
Pancytopenia Explanation: Pancytopenia may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.
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? Pathologic fractures Osteoporosis Calcified bones Increased mobility
Pathologic fractures Explanation: Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.
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 Sickle cell disease Aplastic anemia Pernicious anemia
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. Polycythaemia, also known as erythrocytosis= having a high concentration of red blood cells in your blood
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? Pale skin and mucous membranes Bronze skin tone Ruddy complexion Jaundice skin and sclera
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 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? Platelet count 300,000/mm3 Serum calcium level 13.8 mg/dl Serum sodium level of 133 mEq/L Hemoglobin of 9.8 g/dl
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.
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? Histology of tissue Staging of disease Involvement of lymph nodes Total blood cell count
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.
A client with polycythemia vera reports severe itching. What triggers does the nurse know can cause this distressing symptom? Select all that apply. Temperature change Allergic reaction to the red blood cell increase Alcohol consumption Exposure to water of any temperature Aspirin
Temperature change Alcohol consumption 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.
Which statement best describes the function of stem cells in the bone marrow? They are active against hypersensitivity reactions. They defend against bacterial infection. They produce all blood cells. They produce antibodies against foreign antigens.
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.
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 sickle cell disease aplastic anemia pernicious anemia
polycythemia vera Explanation: Polycythemia vera is associated with a rapid proliferation (rapid increase in numbers.)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. Sickle cell disease and the anemias do not have the characteristics of erythrocytosis.
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? Address issues of negative body image. Place the client in reverse isolation. Administer pain medication. Maintain nutrition.
Maintain nutrition. Explanation: Maintaining nutrition is the most important goal after induction therapy because the client experiences severe diarrhea and can easily become nutritionally deficient and develop fluid and electrolyte imbalance. The client is most likely not in pain at this point, and this is an intervention, not a goal.
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? The client with painful lymph nodes under the arm. The client with painful lymph nodes in the groin. The client with enlarged lymph nodes in the neck. The client with a painful sore throat.
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.
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? Use contact precautions with this client. Perform a neurologic assessment with vital signs. Request a prescription of diphenoxylate and atropine for loose stools. Teach the client to vigorously floss the teeth to prevent infections.
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.
The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? WBC count of 4,200 cells/uL Hematocrit of 38% Platelet count of 9,000/mm3 Creatinine level of 1.0 mg/dL
Platelet count of 9,000/mm3 Explanation: Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? chronic liver failure. acute heart failure. pathologic bone fractures. hypoxemia.
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 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? Monitor the client's temperature every shift. Maintain contact precautions. Encourage increased fluid consumption. Practice vigilant handwashing.
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 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? Acute respiratory distress syndrome Graft-versus-host disease Remission Bone marrow depression
Graft-versus-host disease Explanation: Patients who undergo HSCT have a significant risk of infection, graft-versus host disease (in which the donor's lymphocytes [graft] recognize the patient's body as "foreign" and set up reactions to attack the foreign host), and other complications.
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? serum creatinine level 0.5 mg/dL serum calcium level of 7.5 mg/dL serum albumin level of 2.0 g/dL serum protein level 5.8 g/dL
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.
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 Supportive therapy Antimicrobial therapy Standard therapy
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.
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? Use contact precautions with this client. Perform a neurologic assessment with vital signs. Request a prescription of diphenoxylate and atropine for loose stools. Teach the client to vigorously floss the teeth to prevent infections.
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? Increased basophils Reed-Sternberg cells Elevated platelet count Misshaped red blood cells
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.
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? Debilitating fatigue Bone pain in the back of the ribs Gradual muscle paralysis Severe thrombocytopenia
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 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. Suggest the prescription of antianxiety medications. Suggest the family go to church more often.
Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance. Explanation: Family members benefit from increased education on what to expect. Allowing family members to express their feelings has also been shown to relieve stress. Supporting the caregiver and family with help in household duties will also help the overburdened family. Antianxiety medications and church attendance have not been shown to reduce caregiver stress.
What assessment finding best indicates that the client has recovered from induction therapy? Neutrophil and platelet counts within normal limits Vital signs within normal ranges No evidence of edema Absence of bone pain
Neutrophil and platelet counts within normal limits 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.
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? Implement neutropenic precautions. Eliminate direct contact with others who are infectious. Apply prolonged pressure to needle sites or other sources of external bleeding. Monitor temperature at least once per shift.
Apply prolonged pressure to needle sites or other sources of external bleeding. Explanation: For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.