Chapter 34: Management of Patients With Hematologic Neoplasms - N266 Sp2019

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

"Chronic leukemia develops slowly."

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

A 72-year-old patient with a history of cancer

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has?

A general reduction in all white blood cells

Hematopoiesis

complex process of the formation and maturation of blood cells

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal?

Maintain nutrition.

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?

Multiple myeloma

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever?

Neutropenia

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?

Platelet count of 9,000/mm3

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?

Serum calcium level 13.8 mg/dl

Thrombocytopenia

lower-than-normal platelet count

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

pathologic bone fractures.

Lymphoid

pertaining to lymphocytes

Stem cell

primitive cell, capable of self-replication and differentiation into myeloid or lymphoid stem cell

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?

Congestive heart failure

A home care nurse is caring for a client with multiple myeloma. Which nursing interventions are appropriate for this client? Select all that apply.

Delay position changes and bathing if the client is experiencing pain. Instruct the client to avoid activities that may cause injury. Monitor renal function

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.

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia?

Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing

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?

Bone marrow expands.

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 Dyspnea and hypoxia Increased blood urea nitrogen (BUN) and creatinine

Which term refers to a form of white blood cell involved in immune response?

Lymphocyte

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

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?

Apply prolonged pressure to needle sites or other sources of external bleeding.

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

Assess the client's hemoglobin and platelets.

The nurse is assessing a client with leukemia. How would the nurse assess for enlargement and tenderness over the liver and spleen?

By palpating the abdomen

A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action?

Evaluate the client's platelet count.

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets?

Pancytopenia

A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client?

Preventing bone injury

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma?

The client with enlarged lymph nodes in the neck.

Erythrocyte sedimentation rate (ESR)

laboratory test that measures the rate of settling of red blood cells (RBCs); elevation is indicative of inflammation; also called the sed rate

Monocyte

large WBC that becomes a macrophage when it leaves the circulation and moves into body tissues

Leukopenia

less-than-normal amount of WBCs in circulation

White blood cell (WBC): synonym

leukocyte

Neutropenia

lower-than-normal number of neutrophils

A nurse is teaching a client with multiple myeloma about the therapeutic benefits of radiation therapy. Which statements will the nurse include in the teaching? Select all that apply.

"It helps to strengthen the bone." "It helps to decrease bone pain."

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?

Cervical

The nurse is caring for a client with chronic myeloid leukemia (CML) who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission?

Chronic

A client has multiple myeloma. Prior to starting treatment with thalidomide, what it is most important action for the nurse to take?

Contract with the client regarding birth-control methods.

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.

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

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?

Excessive thirst

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?

Graft-versus-host disease

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

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

The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions?

Iron levels

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

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?

Multiple myeloma

What assessment findingbest indicates that the client has recovered from induction therapy?

Neutrophil and platelet counts within normal limits

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures?

Osteoclasts break down bone cells so pathologic fractures occur.

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

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?

Risk for falls

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

The patient can develop osteonecrosis of the jaw.

Which statement best describes the function of stem cells in the bone marrow?

They produce all blood cells.

The nurse assesses a patient for late-stage chronic lymphocytic leukemia (CLL) by looking for what?

Thrombocytopenia.

Absolute Neutrophil Count (ANC)

a calculation of the number of circulating neutrophils, derived from the total white blood cells

Red blood cell (RBC)

a cellular component of blood involved in the transport of oxygen and carbon dioxide (synonym: erythrocyte)

Indolent neoplasm

a slow-growing cancer that often remains localized or causes few symptoms

Pancytopenia

abnormal decrease in WBCs, RBCs, and platelets

lysis

destruction of cells

Lymphadenopathy

enlargement of a lymph node or lymph nodes

Splenomegaly

enlargement of the spleen

Angiogenesis

formation of new blood vessels

Neutrophil

fully mature WBC capable of phagocytosis; primary defense against bacterial infection

Granulocyte

granulated WBC (neutrophil, eosinophil, basophil); term sometimes used as synonymous with neutrophil

Thrombocytosis

higher-than-normal platelet count

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

increase lung expansion.

Blast cell

primitive leukocyte

Phagocytosis

process of cellular ingestion and digestion of foreign bodies

Apoptosis

programmed cell death

Clone

proliferation from same cell of origin so that descendent cells are identical to the cell of origin

Cytokines

proteins produced by leukocytes that are vital to regulation of hematopoiesis, apoptosis, and immune responses

Reticulocytes

slightly immature RBCs, usually only 1% of total circulating RBCs

Petechiae

tiny capillary hemorrhages

Lymphocyte

type of WBC involved in immune functions

Leukemia

uncontrolled proliferation of WBCs, often immature

The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient?

Ruddy complexion

A nurse reviews the laboratory results of a client with polycythemia vera. Which findings will the nurse find? Select all that apply.

Decreased erythropoietin Increased hemoglobin

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.

Frequent infections Fatigue from anemia Easy bruising

A nurse prepares teaching for a group of clients with chronic myeloid leukemia (CML). When planning the teaching on medication adherence, which factors associated with lower oral therapy adherence will the nurse keep in mind? Select all that apply.

Living alone Low socioeconomic status Not participating in a clinical trial Taking medication independent of meals

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?

Assist the client to sit in a chair for meals.

A client with suspected multiple myeloma is reporting back pain. What is the priority nursing action?

Send the client for a spinal x-ray study.

Myeloid

pertaining to nonlymphoid blood cells that differentiate into RBCs, platelets, macrophages, mast cells, and various WBCs

Which statement indicates the client understands teaching about induction therapy for leukemia?

"I will be in the hospital for several weeks."

The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care?

"Intrathecal chemotherapy is used primarily as preventive therapy."

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?"

A client presents with peripheral neuropathy and hypothesia of the feet. What is the best nursing intervention?

Assess for signs of injury.

A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action?

Assess renal function.

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?

Hypercalcemia

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

The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for?

Bone pain in the back of the ribs

Leukocyte

one of several cellular components of blood involved in defense of the body; subtypes include neutrophils, eosinophils, basophils, monocytes, and lymphocytes (synonym: white blood cell [WBC])