CH 30: Management of Patients with Hematologic Neoplasms

Which of the following are complications related to polycythemia vera (PV)? Select all that apply. A) Hematuria B) Ulcers C) MI D) Splenomegaly E) CVA

A, B, C, and E

A client is being tested for acute myeloid leukemia (AML). The nurse knows that which diagnostic test will be used as the hallmark for the diagnosis? A) Alkaline phosphatase level B) Complete blood count C) Bone marrow analysis D) Clotting factors

C

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

A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? A) Assess for signs of injury. B) Encourage ambulation. C) Keep the feet cool. D) Elevate the client's legs.

A

A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect? A) Excess of immature leukocytes B) Excess of immature erythrocytes C) Deficiency of neutrophils D) Deficiency of erythrocytes

A

Which term refers to a form of white blood cell involved in immune response? A) Thrombocyte B) Spherocyte C) Lymphocyte D) Granulocyte

C

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) Assist with ambulation because exercise can worsen loss of calcium from the bone. C) Monitor renal function D) Instruct the client to avoid activities that may cause injury. E) Limit fluid intake.

A, D, and C

A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? A) Restricting fluid intake B) Monitoring respiratory status C) Preventing bone injury D) Balancing rest and activity

C

A client with acute myeloid leukemia (AML) is scheduled to begin induction therapy. Which treatments will the nurse expect to be prescribed to prevent life-threatening effects of this therapy? Select all that apply. A) Granulocytic growth factors B) Packed red blood cells C) Hematopoietic stem cell transplant D) Platelets E) Antibiotics

A, B, D, and E

Place the pathophysiology of multiple myeloma in the correct order. A) Break down and removal of bone cells B) Proliferation of abnormal plasma cells C) Release of osteoclast-activating factor D) Increased blood calcium levels

B, C, A, then D

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? A) Creatinine level of 1.0 mg/dL B) WBC count of 4,200 cells/uL C) Platelet count of 9,000/mm3 D) Hematocrit of 38%

C

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) Severe thrombocytopenia B) Debilitating fatigue C) Gradual muscle paralysis D) Bone pain in the back of the ribs

D

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 acetaminophen as prescribed. B) Apply ice packs to the groin. C) Change bed clothes frequently. D) Provide a warm beverage before bedtime. E) Sponge with cool water.

A, C, and E

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) Supportive therapy C) Antimicrobial therapy D) Induction therapy

D

The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has? A) Chronic myeloid leukemia B) Hodgkin lymphoma C) Non-Hodgkin lymphoma D) Multiple myeloma

D

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) Gradual muscle paralysis B) Severe thrombocytopenia C) Debilitating fatigue D) Bone pain in the back of the ribs

D

A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? A) Keep the client on bed rest. B) Evaluate the client's INR. C) Evaluate the client's platelet count. D) Ask the client whether they have recently fallen.

C

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A) A 24-year-old female taking oral contraceptives B) A 52-year-old patient with acute kidney injury C) A 72-year-old patient with a history of cancer D) A 40-year-old patient with a history of hypertension

C

Which statement best describes the function of stem cells in the bone marrow? A) They produce all blood cells. B) They are active against hypersensitivity reactions. C) They defend against bacterial infection. D) They produce antibodies against foreign antigens.

A

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) Abnormal blood cells crystalize. B) Lymph nodes expand. C) Bone marrow expands. D) Abnormal blood cells deposit in small vessels.

C

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) Magnesium levels C) Iron levels D) Potassium levels

C

The nurse is assessing a client with leukemia. How would the nurse assess for enlargement and tenderness over the liver and spleen? A) By looking for evidence of bruising B) By calculating the absolute neutrophil count C) By palpating the abdomen D) By reviewing laboratory test results

C

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) Jaundice skin and sclera B) Bronze skin tone C) Ruddy complexion D) Pale skin and mucous membranes

C

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 is the term used when a client does not tolerate chemotherapy." C) "Consolidation of the lungs is an expected effect of induction therapy." D) "Consolidation therapy is administered to reduce the chance of leukemia recurrence."

D

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) Decreased urine output B) Prolonged QT interval on electrocardiogram C) Hypoactive bowel sounds D) Chills E) Fever

A, B, D, and E

A client is diagnosed with primary myelofibrosis. Which assessment findings will the nurse expect to assess in this client? Select all that apply. A) Weight loss B) Ruddy complexion C) Abdominal discomfort D) Bone pain E) Early satiety

A, C, D, and E

Which statement indicates the client understands teaching about induction therapy for leukemia? A) "I will be in the hospital for several weeks." B) "I know I can never be cured." C) "I will start slowly with medication treatment." D) "I will need to come every week for treatment."

A

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) pale body color B) splenomegaly C) weight gain D) peripheral edema

B

The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? A) "Side effects are rare with therapy." B) "Intrathecal chemotherapy is used primarily as preventive therapy." C) "Treatment is simple and consists of single-drug therapy." D) "The goal of therapy is palliation."

B

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) Pancytopenia B) Anemia C) Thrombocytopenia D) Neutropenia

D

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? A) Leukopenia B) Thrombocytopenia C) Anemia D) Pancytopenia

D

A client with suspected multiple myeloma is reporting back pain. What is the priority nursing action? A) Send the client for a spinal x-ray study. B) Have the client lie on a hard surface. C) Have the client rest. D) Encourage ambulation.

A

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? A) polycythemia vera B) sickle cell disease C) aplastic anemia D) pernicious anemia

A

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 intake of antipyretic medications such as acetaminophen B) Smoking cessation C) Decrease alcohol intake D) Decrease fat intake E) Reduce exposure to excessive sunlight

B, C, and E

What assessment finding best indicates that the client has recovered from induction therapy? A) No evidence of edema B) Absence of bone pain C) Neutrophil and platelet counts within normal limits D) Vital signs within normal ranges

C

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? A) Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. B) Put on a mask, gown, and gloves when entering the client's room. C) Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. D) Provide a clear liquid, low-sodium diet.

A

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) Limit activity to once a day. C) Stay in bed as much as possible. D) Limit fluids to prevent going to the bathroom.

A

A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? A) acute heart failure. B) chronic liver failure. C) hypoxemia. D) pathologic bone fractures.

D

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? A) Hypernatremia B) Hyperkalemia C) Hypermagnesemia D) Hypercalcemia

D

A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? A) Acute pain B) Risk for falls C) Impaired tissue integrity D) Sensory-perception disturbance

B

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) Excess red blood cells cause vascular injury in the joints. B) The dead red blood cells release excess uric acid. C) Excess red blood cells produce extracellular toxins that build up. D) The dead red blood cells occlude the small vessels in the joints.

B

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 skin. C) Assess the client's hemoglobin and platelets. D) Assess the client's pulse and blood pressure.

C

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? A) Maintain nutrition. B) Place the client in reverse isolation. C) Address issues of negative body image. D) Administer pain medication.

A

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? A) Reed-Sternberg cells B) Elevated platelet count C) Misshaped red blood cells D) Increased basophils

A

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

A

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) Place heating pads on the client's back. C) Refer the client to a chiropractor. D) Administer pain medication, as ordered.

A

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) Cervical B) Inguinal C) Axillary D) Popliteal

A

For a client with Hodgkin lymphoma, who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse places the client in a high Fowler's position to A) increase lung expansion. B) anticipate the need for airway management. C) detect compromised ventilation. D) reduce deficits in the blood oxygen concentration.

A

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? A) A general reduction in all white blood cells B) A decrease in granulocytes C) A general reduction in neutrophils and basophils D) Too many erythrocytes

A

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) Allopurinol B) Asparaginase C) Filgrastim D) Hydroxyurea

A

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? A) Osteoclasts break down bone cells so pathologic fractures occur. B) Osteosarcomas form producing pathologic fractures. C) Osteolytic activating factor weakens bones producing fractures. D) Osteopathic tumors destroy bone causing fractures.

A

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

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) Calcified bones B) Pathologic fractures C) Osteoporosis D) Increased mobility

B

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) Use contact precautions with this client. B) Perform a neurologic assessment with vital signs. C) Teach the client to vigorously floss the teeth to prevent infections. D) Request a prescription of diphenoxylate and atropine for loose stools.

B

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? A) The patient can develop loosening of the teeth. B) The patient can develop osteonecrosis of the jaw. C) The patient is at risk for tooth decay. D) The patient will develop gingival hyperplasia.

B

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) Monitor the client's temperature every shift. B) Practice vigilant handwashing. C) Maintain contact precautions. D) Encourage increased fluid consumption.

B

The nurse is caring for a client at high risk for thrombocythemia. Which treatments will the nurse anticipate being prescribed for this client? Select all that apply. A) Diphenhydramine B) Aspirin C) Anagrelide D) Hydroxyurea E) Interferon-alfa

B, C, D, and E

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 the family go to church more often. B) Allow family members to express feelings. C) Suggest the prescription of antianxiety medications. D) Educate the family about medications and side effects. E) Suggest support for household maintenance.

B, D, and E

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) Hemoglobin of 9.8 g/dl B) Serum sodium level of 133 mEq/L C) Serum calcium level 13.8 mg/dl D) Platelet count 300,000/mm3

C

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? A) The client with painful lymph nodes under the arm. B) The client with painful lymph nodes in the groin. C) The client with enlarged lymph nodes in the neck. D) The client with a painful sore throat.

C

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? A) "In acute leukemia there are not many undifferentiated cells." B) "In chronic leukemia, the minority of leukocytes are mature." C) "Acute leukemia develops slowly." D) "Chronic leukemia develops slowly."

D