Ch. 30 : Mgmt of Pts w/ Hematologic Neoplasms - Exam 1

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 postremission therapy. It is not a side effect of chemotherapy, but the administration of chemotherapy.

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

"I will be in the hospital for several weeks." Explanation: Induction therapy involves high doses of several medications and the client is usually admitted to the hospital for several weeks. The treatment is started quickly and the goal is to cure or put the disease into remission.

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

"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.

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 client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess? An enlarged liver A leukocyte count >100,000/mm3 Lymphadenopathy Increased number of blast cells

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.

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.

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.

A client is receiving chemotherapy for acute myeloid leukemia and has poor nutritional intake. What is the first action the nurse should take? Ask, "Are you experiencing nausea?" Provide mouth care before each meal. Caution the client to chew carefully after administration of the prescribed lidocaine. Provide nutritional supplements in addition to a diet that has a soft texture and moderate temperature.

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 client presents with peripheral neuropathy and hypothesia 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 hypothesia 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? 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.

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. Assess skin and mucus membranes every shift. Auscultate lung sounds every shift and as needed. Place fresh flowers on a shelf on the opposite wall from the client. Encourage the client to take deep breaths every 4 hours while awake. Provide oral hygiene once daily.

Assess skin and mucus membranes every shift. Auscultate lung sounds every shift and as needed. Encourage the client to take deep breaths every 4 hours while awake. 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 AML has pale mucous membranes and bruises on the legs. What is the primarynursing 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.

An elderly client is hospitalized for induction of chemotherapy to treat leukemia. The client reports fatigue to the nurse. What nursing intervention would best address the client's fatigue? Have the client maintain complete bedrest. Assist the client to sit in a chair for meals. Talk to the family about not visiting so the client can obtain rest. Provide sedentary activities only, such as watching television.

Assist the client to sit in a chair for meals. Explanation: Fatigue is a common symptom with clients who have leukemia. Despite the fatigue, clients still need to maintain some physical activity. An example of physical activity is having the client sit in a chair for meals. The nurse does not want to encourage complete bedrest or sedentary activities, such as watching television, due to possible deconditioning. The nurse has not discussed with the client about limiting family visits. The client may want some family to visit.

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? Abnormal blood cells deposit in small vessels. Bone marrow expands. Lymph nodes expand. Abnormal blood cells crystalize.

Bone marrow expands. Explanation: In acute myeloid leukemia, bone pain is caused when the bone marrow expands.

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.

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 assesses a client who has been diagnosed with DIC. Which indicators are consistent with this diagnosis? Select all that apply. Cyanosis in the extremities Capillary fill time <3 seconds Dyspnea and hypoxia Increased breath sounds Increased blood urea nitrogen (BUN) and creatinine Polyuria

Cyanosis in the extremities Dyspnea and hypoxia Increased blood urea nitrogen (BUN) and creatinine 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 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? Adventitous 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 diarrhoea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal oedema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.

A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity? Do not lift more than 10 pounds. Stay in bed as much as possible. Limit activity to once a day. Limit fluids to prevent going to the bathroom.

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 clent 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.

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.

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

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 client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? Evaluate the client for potential infection. Administer an antitussive. Place a cooling blanket on the client. Medicate the client to relieve pain.

Evaluate the client for potential infection. Explanation: The client with leukemia has a lack of mature and normal granulocytes to fight infection. For this reason, the client is susceptible to infection. The primary nursing intervention is to evaluate for potential infection if the client has a cough and increased fatigue. Administering an antitussive would not be appropriate before determining the cause of the cough. A cooling blanket would not be needed if the client does not have a fever. Medicating the client to relieve pain would come after the assessment phase.

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

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 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? Excess of immature leukocytes Excess of immature erythrocytes Deficiency of neutrophils Deficiency of erythrocytes

Excess of immature leukocytes Explanation: The bone marrow biopsy of a client with acute myeloid leukemia will reveal an excess of immature leukocytes.

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? Diarrhea Excessive thirst Polyuria Fluid volume excess

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.

A client is suspected of having leukemia and is having a series of laboratory and diagnostic studies performed. What does the nurse recognize as the hallmark signs of leukemia? Select all that apply. Diarrhea Nausea and vomiting Frequent infections Fatigue from anemia Easy bruising

Frequent infections Fatigue from anemia Easy bruising Explanation: Infections, fatigue from anemia, and easy bruising are hallmarks of leukemia. At the onset of leukemia, particularly in acute lymphocytic leukemia (ALL), a fever is present, the spleen and lymph nodes enlarge, and internal or external bleeding develops. Diarrhea and nausea and vomiting are not the hallmark signs of leukemia and can be indicators in many illnesses and gastrointestinal disorders.

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.

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? Age and gender Lifestyle assessments, such as exercise routines Health history, such as bleeding, fatigue, or fainting Menstrual history

Health history, such as bleeding, fatigue, or fainting Rationale: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 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.

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.

The nurse suspects a client's diagnosis of acute myeloid leukemia (AML) will be confirmed. What laboratory result is consistent with the medical diagnosis? Erythrocyte count of 5.8 m/L Platelet count of 300,000/mm3 Neutrophil reading of 60% Immature blast cells greater than 20%

Immature blast cells greater than 20% Explanation: Most clients with AML have too many white blood cells, not enough red blood cells, and not enough platelets. An excess of blast cells of greater than 20% is common with AML. The erythrocyte count of 5.8 m/L is normal. The platelet count of 300,000mm3 is normal. The neutrophil reading of 60% is normal.

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 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).

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? It kills affected cells. It decreases immune response. It decreases tumor necrosis factor. It kills affected bone marrow.

It kills affected cells. Explanation: Dexamethasone is used to induce myeloma apoptosis and cell death and to reduce bone pain.

A patient is taking hydroxyurea for the treatment of primary myelofibrosis. While the patient is taking this medication, what will the nurse monitor to determine effectiveness? Leukocyte and platelet count Blood urea nitrogen (BUN) and creatinine levels Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels Hemoglobin and hematocrit

Leukocyte and platelet count Explanation: Hydroxyurea is often used in patients with primary myelofibrosis to control high leukocyte and platelet counts and to reduce the size of the spleen.

Which term refers to a form of white blood cell involved in immune response? Granulocyte Lymphocyte Spherocyte Thrombocyte

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 has been diagnosed with polycythemia vera. What is the best instruction for the nurse to give to this client? Take a daily multivitamin with iron supplement Maintain adequate blood pressure control Drink alcohol to decrease blood viscosity Bath in tepid or cool water to control itching

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

Multiple myeloma Explanation: Any older adult with unprovoked or unexplained back pain and increased protein in the serum should be assessed for multiple myeloma. Bone pain occurs because of bone breakdown and the malignant cells of multiple myeloma increase the serum protein levels.

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? Hemolytic anemia Polycythemia vera Leukemia Multiple myeloma

Multiple myeloma Explanation: The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

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.

What assessment findingbest 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.

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

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.

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/mcL 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.

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.

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. Encouarge 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. Encouarging increased fluid consumption will not prevent infection.

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

Preventing bone injury Explanation: When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict fluid intake.

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? Acute pain Risk for falls Impaired tissue integrity Sensory-perception disturbance

Risk for falls Explanation: A client with parathesia in the feet is at risk for falls due to impaired sensation. Acute pain, impaired tissue integrity, and sensory-perception disturbance are all nursing diagnoses that are appropriate for the client; however, risk for falls is priority.

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

Send the client for a spinal x-ray study. Rationale:The client with myeloma can have bone pain, especially in the back and ribs. The pain will decrease with rest and increase with activity. Lying on a hard surface will not relieve the pain. The priority action is to make certain the client does not have a fractured spine, as the bone destruction in this disease is sufficiently severe to cause vertebral collapse.

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 gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom? The dead red blood cells release excess uric acid. The dead red blood cells occlude the small vessels in the joints. Excess red blood cells produce extracellular toxins that build up. Excess red blood cells cause vascular injury in the joints.

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.

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 is at risk for tooth decay. The patient will develop gingival hyperplasia. The patient can develop osteonecrosis of the jaw. The patient can develop loosening of the teeth.

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.

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.

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

a)Keep the client on bed rest. 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 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 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 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.

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? splenomegaly weight gain peripheral edema pale body color

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.