Ch 34 Hematologic Neoplasms
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? a) Stroke b) Tissue infarction c) Pulmonary embolus d) Congestive heart failure
Congestive heart failure 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.
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? a) Hypernatremia b) Hypercalcemia c) Hypermagnesemia d) Hyperkalemia
Hypercalcemia Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.
Which nursing intervention is most appropriate for a client with multiple myeloma? a) Balancing rest and activity b) Restricting fluid intake c) Preventing bone injury d) Monitoring respiratory status
Preventing bone injury 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 his fluid intake.
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) Hemolytic anemia c) Leukemia d) Polycythemia vera
Multiple myeloma 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 nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: a) pathologic bone fractures. b) acute heart failure. c) hypoxemia. d) chronic liver failure.
pathologic bone fractures. 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.
What assessment findings best indicate that the patient has recovered from induction therapy? a) Neutrophil and platelet counts within normal limits b) Vital signs within normal ranges c) Absence of bone pain d) No evidence of oedema
Neutrophil and platelet counts within normal limits 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 oedema, and absence of pain are not indicative of recovery from induction therapy.
Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a) Myeloid stem cell b) Monocyte c) Neutrophil d) Lymphoid stem cell
Myeloid stem cell The myeloid stem cell is responsible not only for all nonlymphoid white blood cells (WBC), but also for the production of RBCs and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.
After chemotherapy for AML, what interventions will best help to prevent renal complications? Select all that apply. a) Increase hydration. b) Administer rasburicase (Elitek). c) Administer potassium therapy. d) Administer allopurinol (Zyloprim). e) Encourage exercise.
• Increase hydration. • Administer allopurinol (Zyloprim). • Administer rasburicase (Elitek). Increased uric acid and phosphorus levels after chemotherapy for AML can lead to renal calculi formation. Increasing hydration and administering allopurinol (a uricosuric) will help to eliminate the uric acid. Elitek is an enzyme that can also decrease uric acid. Administration of potassium is not indicated as levels are elevated after chemotherapy. Exercise is not initially encouraged because the patient could have weakness and cramping during this time.
A home care nurse is caring for a client with multiple myeloma. Which of the following nursing interventions are appropriate for this client? Select all that apply. a) The nurse limits the client's ambulation because exercise can worsen loss of calcium from the bone. b) The nurse instructs the client to avoid activities that may cause injury. c) The nurse limits fluid intake. d) The nurse delays position changes and bathing if the client is experiencing pain.
• The nurse delays position changes and bathing if the client is experiencing pain. • The nurse instructs the client to avoid activities that may cause injury. Pain can become quite severe. Delay position changes and bathing until analgesic has reached its peak concentration level and the client is experiencing maximum pain relief. Safety is paramount because any injury, no matter how slight, can result in a fracture. The nurse assists the client with ambulation because immobility can worsen loss of calcium from the bone. He or she provides up to 4000 mL of fluid to prevent renal damage from hypercalcemia and precipitation of protein in the renal tubules.
A patient presents with peripheral neuropathy and hypothesia of the feet. What is the best nursing intervention? a) Keep the feet cool. b) Have the client elevate his legs. c) Encourage ambulation. d) Assess for signs of injury.
Assess for signs of injury. A patient with hypothesia of the feet will have decreased sensation and numbness. The nurse should assess for signs of injury. If the patient has injured himself, he will not be able to feel it and this could lead to the development of infection. Ambulation will not help the patient and elevation of 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 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? a) Hemoglobin and hematocrit b) Leukocyte and platelet count c) Blood urea nitrogen (BUN) and creatinine levels d) Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels
Leukocyte and platelet count 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 of the following is the only curative treatment for chronic myeloid leukaemia (CML)? a) Idarubicin b) Imatinib c) Cytarabine d) Allogeneic stem cell transplant
Allogeneic stem cell transplant Allogeneic stem cell transplantation remains the only curative treatment for CML. The efficacy of Imatinib as first-line treatment and the treatment-related mortality of stem cell transplant limits use of transplant to patients with high risk or relapsed disease, or in those patients who did not respond to therapy with TKI. Cytarabine and idarubicin are part of induction therapy for acute myeloid leukemia (AML).
The nurse is caring for a patient 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) Hydroxyurea (Myleran) b) Allopurinol (Zyloprim) c) Asparaginase (Elspar) d) Filgrastim (Neupogen)
Allopurinol (Zyloprim) 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 (see Chapter 15). The increased uric acid and phosphorus levels make the patient vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Patients require a high fluid intake, and prophylaxis with allopurinol (Zyloprim) to prevent crystallization of uric acid and subsequent stone formation.
Which of the following nursing interventions should be incorporated into the plan of care to manage the delayed clotting process in a patient with leukemia? a) Implement neutropenic precautions. b) Monitor temperature at least once per shift. c) Eliminate direct contact with others who are infectious. d) Apply prolonged pressure to needle sites or other sources of external bleeding.
Apply prolonged pressure to needle sites or other sources of external bleeding. For a patient 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 patient who is undergoing chemotherapy for AML complains of pain in his lower back. What is the nurse's first action? a) Administer pain medication, as ordered. b) Assess renal function. c) Refer the client to a chiropractor. d) Place heating pads on the patient's back.
Assess renal function. Chemotherapy results in the destruction of cells and tumor lysis syndrome. There is an increase in uric acid and phosphorus levels and the patient is susceptible to renal failure. The nurse should assess renal function if the patient complains of lower back pain as this could be indicative of a 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 priority problems.
A patient with AML has pale mucous membranes and bruises on his legs. What is the primary nursing intervention? a) Assess the patient's pulses and blood pressure. b) Assess the patient's hemoglobin and platelets. c) Assess the patient's skin. d) Check the patient's history.
Assess the patient's hemoglobin and platelets. Patients with AML may develop pallor from anemia and bleeding tendencies from low platelet counts. Assessing the patient's hemoglobin and platelets will help to determine if this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.
A client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include: a) Bence Jones protein in the urine b) Serum protein level 5.8 g/dl c) Serum calcium level of 7.5 mg/dl d) Serum creatinine level 0.5 mg/dl
Bence Jones protein in the urine Presence of Bence Jones protein in the urine almost always confirms multiple myeloma; however, absence of the protein doesn't rule out the disease. Serum creatinine level may be increased (above 1.2 mg/dl in men and 0.9 mg/dl in women). Serum calcium levels are above 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 multiple myeloma is complaining about pain. What instructions will the nurse give the patient to help to reduce pain during activity? a) Stay in bed as much as possible. b) Do not lift more than 10 pounds. c) Limit activity to once a day. d) Limit fluids to prevent going to the bathroom.
Do not lift more than 10 pounds. The patient 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 patient should have activity 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 patient needs to remain well hydrated.
A patient is scheduled for a test to help confirm the diagnosis of acute myeloid leukemia (AML). Which of the following is the result that the nurse knows is consistent with the diagnosis? a) Excess of immature blast cells b) Neutrophil reading of 60% c) Platelet count of 300,000/mm3 d) Erythrocyte count of 5.8 m/?L
Excess of immature blast cells
A client has been diagnosed with multiple myeloma. Which of the following laboratory values should the nurse expect to find in a client with multiple myeloma? a) Polycythaemia vera b) Decreased calcium level c) Decreased serum protein d) Increased urinary protein
Increased urinary protein A characteristic finding in multiple myeloma is protein in the urine. Other laboratory findings include increased serum protein, hypercalcaemia, anaemia, and hyperuricemia. Polycythaemia vera is not found in multiple myeloma.
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) Magnesium levels b) Potassium levels c) Iron levels d) Creatinine and blood urea nitrogen (BUN) levels
Iron levels 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 of the following terms refers to a form of white blood cell involved in immune response? a) Thrombocyte b) Granulocyte c) Spherocyte d) Lymphocyte
Lymphocyte 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 patient with polycythemia vera has a high red blood cell (RBC) count and is at risk for the development of thrombosis. What treatment is important to reduce blood viscosity and to deplete the patient's iron stores? a) Phlebotomy b) Radiation c) Blood transfusions d) Chelation therapy
Phlebotomy The objective of management is to reduce the high RBC count and reduce the risk of thrombosis. Phlebotomy is an important part of therapy (Fig. 34-5). It involves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete the patient's iron stores, thereby rendering the patient iron deficient and consequently unable to continue to manufacture hemoglobin excessively.
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) Aplastic anemia b) Polycythemia vera c) Sickle cell disease d) Pernicious anemia
Polycythemia vera 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. Options B, C, and D do not have the characteristics of erythrocytosis.
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) Bronze skin tone b) Pale skin and mucous membranes c) Jaundice skin and sclera d) Ruddy complexion
Ruddy complexion 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.
Which of the following is the hallmark of polycythaemia vera (PV)? a) Headache b) Ruddy complexion c) Splenomegaly d) Blurred vision
Splenomegaly Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, paresthesias, and blurred vision).
The nurse is assessing several patients. Which patient does the nurse determine is most likely to have Hodgkin lymphoma? a) The patient with a painful sore throat. b) The patent with painful lymph nodes under the arm. c) The patient with painful lymph nodes in the groin. d) The patient with enlarged lymph nodes in the neck.
The patient with enlarged lymph nodes in the neck. Lymph node enlargement in Hodgkin lymphoma is not painful. The patient 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.
Which of the following statements best describes the function of stem cells in the bone marrow? a) They defend against bacterial infection. b) They produce antibodies against foreign antigens. c) They are active against hypersensitivity reactions. d) They produce all blood cells.
They produce all blood cells. All blood cells are produced from undifferentiated precursors called pluripotential stem cells in the bone marrow. Other cells produced from the pluripotential stem cells help defend against bacterial infection, produce antibodies against foreign antigens, and are active against hypersensitivity reactions.
The nurse is aware that chronic lymphocytic leukemia (CLL), a common malignancy in those older than 60, has an early stage and a late stage. The nurse assesses a patient for late stage CLL by looking for: a) Lymphadenopathy. b) Thrombocytopenia. c) Hepatomegaly. d) Splenomegaly.
Thrombocytopenia. Anemia and thrombocytopenia are late-stage indicators of CLL. The others are early-stage signs.
A patient is being evaluated for a diagnosis of chronic myeloid leukemia (CML). The nurse understands that a diagnostic indicator is: a) Increased number of blast cells. b) A leukocyte count >100,000/mm3. c) An enlarged liver. d) Lymphadenopathy.
A leukocyte count >100,000/mm3. Although there is an increase in the production of blast cells, and the patient may have an enlarged liver and tender spleen, it is the high leukocyte count that is diagnostic. Lymphadenopathy is rare.
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 40-year-old patient with a history of hypertension c) A 52-year-old patient with acute kidney injury d) A 72-year-old patient with a history of cancer
A 72-year-old patient with a history of cancer 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 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 will develop gingival hyperplasia. b) The patient is at risk for tooth decay. c) The patient can develop osteonecrosis of the jaw. d) The patient can develop loosening of the teeth.
The patient can develop osteonecrosis of the jaw. 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.
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. a) Fatigue from anemia b) Nausea and vomiting c) Easy bruising d) Diarrhea e) Frequent infections
• Fatigue from anemia • Frequent infections • Easy bruising 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? a) Graft-versus-host disease b) Bone marrow depression c) Remission d) Acute respiratory distress syndrome
Graft-versus-host disease 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.
A client has been diagnosed with polycythaemia vera. It is most important for the nurse to teach the client about a) Drinking alcohol to decrease blood viscosity b) Taking a daily multivitamin with iron supplement c) Maintaining adequate blood pressure control d) Bathing in tepid or cool water to control itching
Maintaining adequate blood pressure control The client with polycythaemia vera needs to control blood pressure, because of the increased risk for thrombosis or haemorrhage. 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 haemorrhage.
The nurse practitioner suspects that a patient has multiple myeloma based on his major presenting symptom and the analysis of his laboratory results. Select the classic symptom for this disease. a) Debilitating fatigue b) Bone pain in the back of the ribs c) Gradual muscle paralysis d) Severe thrombocytopenia
Bone pain in the back of the ribs 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; patients may report that they have less pain on awakening but the pain intensity increases during the day.
You are caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? a) Osteolytic activating factor weakens bones producing fractures. b) Osteoclasts break down bone cells so pathologic fractures occur. c) Osteopathic tumors destroy bone causing fractures. d) Osteosarcomas form producing pathologic fractures.
Osteoclasts break down bone cells so pathologic fractures occur. 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.
A client with multiple myeloma presents to the emergency department complaining of excessive thirst and constipation. His family members report that he has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? a) Platelet count 300,000/mm3 b) Serum calcium level 13.8 mg/dl c) Hemoglobin of 9.8 g/dl d) Serum sodium level of 133 mEq/L
Serum calcium level 13.8 mg/dl 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.
The nurse is teaching the patient about consolidation. What statement should be included in the teaching plan? a) "Consolidation occurs as a side effect of chemotherapy." b) "Consolidation therapy is administered to reduce the chance of leukaemia recurrence." c) "Consolidation is the term for when a patient does not tolerate chemotherapy." d) "Consolidation of the lungs is an expected effect of induction therapy."
"Consolidation therapy is administered to reduce the chance of leukaemia recurrence." Consolidation therapy is administered to eliminate residual leukaemia 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.
For a patient with Hodgkin disease, who is at a risk for an ineffective airway clearance and an impaired gas exchange, the nurse places the patient in a high Fowler's position to do which of the following? a) Increase the lung expansion. b) Anticipate the need for the airway management. c) Detect compromised ventilation. d) Reduce the deficits in the blood oxygen level.
Increase the lung expansion. For a patient with Hodgkin disease who is at a risk for an ineffective airway clearance and an impaired gas exchange, the nurse keeps the neck in midline and places the patient in a high Fowler's position if respiratory distress develops. Avoiding unnecessary pressure on the trachea and positioning for an increased lung expansion improve the air exchange. The nurse administers oxygen as per the physician's orders to reduce the deficits in the blood oxygen level. The nurse assesses the respiratory status in each shift to detect compromised ventilation. The nurse places an endotracheal tube, a laryngoscope, and a bag-valve mask at the bedside for intubation if the need for the airway management arises.
A patient with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? a) Administer an antitussive. b) Medicate the patient for pain. c) Place a cooling blanket on the patient. d) Evaluate the patient for potential infection.
Evaluate the patient for potential infection. The patient with leukemia has a lack of mature and normal granulocytes for fighting infection. For this reason, the patient is susceptible to infection. The primary nursing intervention is to evaluate the patient for potential infection if he or she 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 patient does not have a fever. Medicating the patient for pain would come after the assessment phase.
A patient with polycythemia vera is complaining of severe itching. What triggers does the nurse know can cause this distressing symptom? (Select all that apply.) a) Allergic reaction to the red blood cell increase b) Aspirin c) Temperature change d) Alcohol consumption e) Exposure to water of any temperature
• Temperature change • Alcohol consumption • Exposure to water of any temperature Pruritus is very common, occurring in up to 70% of patients 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.
The hospitalized client is experiencing gastrointestinal bleeding. Laboratory test results show that the client's platelets are 9000/mm³. The client is receiving prednisone and azathioprine (Imuran). The nurse a) Teaches the client to vigorously floss the teeth to prevent infections b) Requests a prescription of diphenoxylate/atropine (Lomotil) for loose stools c) Uses contact precautions with this client d) Performs a neurologic assessment with vital signs
Performs a neurologic assessment with vital signs 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/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.
When assessing a female patient with a disorder of the hematopoietic or the lymphatic system, which of the following assessments is most essential? a) Age and gender b) Lifestyle assessments, such as exercise routines c) Menstrual history d) Health history, such as bleeding, fatigue, or fainting
Health history, such as bleeding, fatigue, or fainting When assessing a patient with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the patient'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.