FINAL EXAM- Hemophilia: Anemia: Leukemia: Lymphoma

S/S of Hodgkins Lymphoma

- Enlarged, painless mass, most often in the neck -Typically there are no other s/s

Treatments for lymphoma

-Chemotherapy -Radiation -Targeted drug therapy -Immunotherapy -Bone marrow transplant

Signs and Symptoms of Belomycin

-Darkening of the skin, and dark stripes on the skin - Itching of the skin -Skin rash -Skin redness and tenderness -Swelling of fingers -Severe lung injury -Pneumonitis -Pulmonary fibrosis -Nausea -Vomiting Loss of appetite

Treatments for Leukemia

-Irradiation -Antileukemic drugs -Bone marrow transplants

A nurse is providing preoperative teaching to a client who is scheduled for arthroplasty in the next month and may require a blood transfusion. The client expresses concern about the risk of acquiring an infection from the blood transfusion. Which of the following statements should the nurse share with the client?

A. "Ask your provider to prescribe epoetin before the surgery." B. "You should ask your provider about taking iron supplements prior to the surgery." C. "Ask a family member to donate blood for you." D. "Donate autologous blood before the surgery." D. "Donate autologous blood before the surgery." -Autologous blood transfusion is the collection and reinfusion of the client's blood. The blood is drawn from the client 3 to 5 weeks before an elective surgical procedure and stored for transfusion at the time of the surgery. Autologous blood is the safest form of blood transfusion

A nurse is providing teaching to a 12-year-old client who is recovering from an acute episode of hemophilia A. Which of the following statements should the nurse include in the teaching?

A. "Have your parent stretch and move your legs for you." B. "Apply heat to joints that become painful, stiff, and swollen." C. "Take aspirin at the first sign of a headache." D. "You will be able to participate in physical exercises." D. "You will be able to participate in physical exercises." -Physical exercise is important for the maintenance of joint mobility and muscle strengthening. Participation in non-contact sports and the use of protective equipment such as knee pads are encouraged, although high-impact athletic activities such as karate should be avoided.

A nurse is providing discharge teaching to a client who has aplastic anemia. Which of the following statements indicates that the client understands the instructions?

A. "I need to stay active to prevent blood clots in my legs." B. "If I have a bad headache, I can take aspirin to get rid of it." C. "I should eliminate uncooked foods from my diet for now." D. "I should eat more iron-fortified cereal to strengthen my blood." C. "I should eliminate uncooked foods from my diet for now." -Prevent infection by eating thoroughly cooked foods. Fresh fruit, vegetables, eggs, meat, and fish can harbor microorganisms that cooking destroys, so the client should avoid raw foods Clients who have aplastic anemia are not at particular risk for deep-vein thrombosis Although iron-fortified cereal is a component of a healthy diet, it is a specific recommendation for clients who have iron-deficiency anemia, not aplastic anemia.

A nurse is teaching the parents of a 10-year-old child who has iron-deficiency anemia. Which of the following statements by a parent indicates an understanding of the teaching?

A. "I will give my child an iron tablet once each day at bedtime." B. "I will administer the iron tablet with orange juice." C. "I will encourage my child to take an antacid with the iron tablet." D. "I will crush the iron tablet prior to giving it to my child." B. "I will administer the iron tablet with orange juice." -Citrus juice with the iron will increase the iron's absorption The parent should spread the iron doses throughout the day to prevent gastric upset. Antacids decrease the absorption of iron. Crushing the tablet interferes with absorption and distribution.

A nurse is caring for a client who is pregnant with a male child and expresses concern to the nurse about the possibility of the child having hemophilia. The client is a carrier of the gene mutation for this condition. Which of the following percentages represents the chance that the child will have this disorder?

A. 25% B. 50% C. 75% D. 100% B. 50% -Hemophilia A is an X-linked recessive inheritance disorder, which means that female clients who are carriers have a 50% chance of passing the gene mutation to their children. If the child is female, she will be a carrier. If the child is male, he will have the disorder. This is because male children inherit an X chromosome from their biological mothers and a Y chromosome from their biological fathers. If the male child has the gene mutation on 1 of his X chromosomes, it will cause the disorder even though it is on a copy of the gene.

A nurse in a provider's office is reviewing the medical records of a group of clients. Which of the following clients is at risk for iron deficiency? (Select all that apply.)

A. A client who is postmenopausal B. A client who is a vegetarian C. A middle adult male client D. A client who is pregnant E. A toddler who is overweight B. A client who is a vegetarian D. A client who is pregnant E. A toddler who is overweight -Vegetarians might require additional iron because the availability of iron in vegetable's are limited -During pregnancy, maternal blood volume increases, and the fetus requires additional iron -Toddlers who are overweight may get most of their calories from milk and foods that are not considered healthy, which increases their risk for iron-deficiency anemia

A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take?

A. Administer a small test dose before giving the full dose. B. Infuse the medication over 30 seconds. C. Monitor the client closely for hypertension after the infusion. D. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs. A. Administer a small test dose before giving the full dose -Adverse effect of iron dextran is anaphylaxis caused by hypersensitivity to the medication. A small test dose should be administered over 5 minutes before giving the full dose. The client should be monitored carefully for an allergic reaction during and for a period of time following IV bolus dose should be administered over at least 1 minute, and an IV infusion dose should be given over 10 to 15 minutes Monitor the client for hypotension and other manifestations of anaphylaxis

A nurse is caring for a school-aged child who has hemophilia and fell on the playground. The child reports a pain level of 4 on a scale of 0 to 10. Which of the following actions should the nurse take?

A. Administer an NSAID B. Perform passive range-of-motion exercises on the joint C. Administer cryoprecipitate D. Apply an ice pack to the joint D. Apply an ice pack to the joint -Immediately following an injury, a joint should be rested, elevated, and have ice applied to minimize bleeding into the joint. Passive range-of-motion exercises should never be performed on a client with hemophilia. Over-stretching and tearing could inadvertently occur, resulting in further joint bleeding. Cryoprecipitate is no longer used to treat clients with hemophilia due to the inability to remove hepatitis and HIV completely from the product. Hemophilia is currently treated with factor VIII replacement products or a synthetic form of vasopressin.

A nurse is planning care for a client who has pernicious anemia. Which of the following interventions should the nurse include in the plan?

A. Administer ferrous sulfate supplementation B. Increase dietary intake of folic acid C. Initiate weekly injections of vitamin B12 D. Initiate a blood transfusion C. Initiate weekly injections of vitamin B12 -The nurse should initiate weekly injections of vitamin B12 for a client who has pernicious anemia and then decrease the injections to a monthly schedule.

A nurse is caring for a child who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following actions should the nurse take?

A. Administer ibuprofen B. Limit daily fluid intake C. Apply cold compresses to painful joints D. Withhold live virus immunizations A. Administer ibuprofen -Administer ibuprofen or acetaminophen for mild to moderate pain. If pain is not relieved, the nurse should administer an opioid analgesic Ensure the child receives all immunizations to prevent infection. Infection is a major cause of death in children who have sickle cell anemia.

A home health nurse is developing a plan of care a toddler who has hemophilia. Which of the following instructions for the parents should the nurse include in the plan?

A. Administer low-dose aspirin for pain B. Inspect the toddler's toys for sharp edges C. Perform passive range-of-motion of the affected joint during a bleeding episode D. Avoid contact with people who have respiratory infections. B. Inspect the toddler's toys for sharp edges -The nurse should instruct the parents to inspect the toddler's toys for sharp edges or parts to decrease the risk of injury and bleeding to the toddler.

A nurse is planning care for an adolescent who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following interventions should the nurse include in the plan?

A. Apply cold compresses to the child's extremities B. Administer meperidine every 4 hr until the crisis has resolved C. Maintain the child on bed rest D. Decrease the child's fluid intake for 8 hr C. Maintain the child on bed rest -Maintain bed rest for this child who is experiencing a vaso-occlusive crisis to minimize energy expenditure and avoid additional oxygen needs

A nurse is caring for an 8-year-old child who has sickle cell anemia. Which of the following actions should the nurse take?

A. Apply cool compresses to the painful area B. Initiate contact isolation precautions C. Give the child flavored popsicles D. Administer phytonadione C. Give the child flavored popsicles -Maintaining hydration with a child who has sickle cell anemia is important to prevent sickling.

A nurse is teaching a client who has iron-deficiency anemia. The nurse should encourage the client to increase consumption of which of the following foods?

A. Beef liver B. Oranges C. Turnips D. Whole milk A. Beef liver -Iron-rich foods, including meat, fish, and poultry. A 3 oz serving of beef liver contains 4.17 mg of iron

A nurse in an oncology clinic is assessing a client who has early stage Hodgkin's lymphoma. Which of the following findings should the nurse expect?

A. Bone and joint pain B. Enlarged lymph nodes C. Intermittent hematuria D. Productive cough B. Enlarged lymph nodes -The first manifestation of this cancer is often an enlarged painless lymph node (or nodes) that appears without a known cause. Other early manifestations include night sweats, unexplained weight loss, fevers, and pruritus

A nurse is teaching a client who has pernicious anemia. The nurse should encourage the client to increase consumption of which of the following foods?

A. Eggs B. Squash C. Kale D. Tofu A. Eggs -Foods rich in vitamin B12, such as dairy products, animal protein, poultry, shellfish, and eggs

A nurse is providing teaching about home care to the guardian of an adolescent who has hemophilia. Which of the following pieces of information should the nurse provide?

A. Encourage the adolescent to participate in non-contact sports B. Provide the adolescent with a firm-bristled toothbrush C. Administer aspirin to the adolescent for episodes of pain D. Provide disposable razors to the adolescent for shaving A. Encourage the adolescent to participate in non-contact sports -Adolescent should be allowed to participate in non-contact sports such as walking, bowling, and golf. Contact sports may be allowed if the adolescent wears protective gear and receives routine recombinant factor VIII infusions.

A nurse is caring for an adolescent who has sickle cell anemia. Which of the following manifestations is/are the result of chronic vaso-occlusive phenomena? (Select all that apply.)

A. Enlarged heart B. Enuresis C. Leg ulcers D. Extrahepatic cholestasis E. Retinal detachment A. Enlarged heart B. Enuresis C. Leg ulcers E. Retinal detachment -Chronic vaso-occlusive phenomena result from the obstruction of organs by red blood cells, leading to stasis and enlargement of the organs, infarction due to ischemia, and scarring

A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. An increase in which of the following values indicates a therapeutic effect of this medication?

A. Erythrocyte count B. Neutrophil count C. Lymphocyte count D. Thrombocyte count B. Neutrophil count -Filgrastim increases neutrophil production. It is given to treat neutropenia and reduce the risk of infection in clients who are receiving chemotherapy for cancer or who have undergone bone marrow transplant.

A nurse is reviewing the laboratory results of a client who has end-stage renal disease and reports fatigue. The client's hemoglobin level is 8 g/dL. The nurse should expect a prescription for which of the following medications?

A. Erythropoietin B. Erythromycin C. Filgrastim D. Calcitriol A. Erythropoietin -Erythropoietin stimulates the production of RBCs and is used to treat anemia associated with chronic renal failure.

A nurse is caring for a client who has a new diagnosis of pernicious anemia. The nurse should expect the client's provider to prescribe which of the following medications for this client?

A. Ferrous sulfate B. Epoetin alfa C. Vitamin B12 D. Folic acid C. Vitamin B12

A home health nurse is visiting an older adult client who has anemia. Which of the following foods should the nurse recommend to increase the client's iron intake?

A. Greek yogurt B. Bran muffin C. Peanut butter sandwich D. Dried fruit D. Dried fruit

A nurse is preparing to transfuse a unit of packed red blood cells (RBCs) for a client who has anemia. Which of the following actions should the nurse take first?

A. Hang an IV infusion of 0.9% sodium chloride with the blood B. Compare the client's identification number with the number on the blood C. Witness the informed consent document D. Obtain pretransfusion vital signs C. Witness the informed consent document

A nurse is providing teaching to a client who has anemia and a new prescription for epoetin alfa. Which of the following pieces of information should the nurse include in the teaching?

A. Hospitalization is required when administering each treatment B. The maximum effect of the medication will occur in 6 months C. Hypertension is a common adverse effect of this medication D. Blood transfusions are needed with each treatment C. Hypertension is a common adverse effect of this medication -Common adverse effect of epoetin alfa is hypertension because of the rise in the production of erythrocytes and other blood cell types

A nurse is reviewing laboratory values for an adult client who has sickle cell anemia and a history of receiving blood transfusions. For which of the following complications should the nurse monitor?

A. Hypokalemia B. Lead poisoning C. Hypercalcemia D. Iron toxicity D. Iron toxicity -Client who has received several blood transfusions is at risk of hemosiderosis, which is the excess storage of iron in the body. Excessive iron can come from overuse of supplements or from receiving frequent blood transfusions

A nurse is creating a plan of care for a child who has aplastic anemia. Which of the following interventions should the nurse include?

A. Initiate protective-environment isolation for the child B. Apply pressure for 1-2 min at the puncture site following blood specimen collection C. Mix the child's ferrous sulfate elixir twice per day into a glass of milk for administration D. Check the child's blood glucose level every 4 hr A. Initiate protective-environment isolation for the child -Private room with positive air pressure and no live flowers; nurses must don a respirator mask, gloves, and gown prior to entering the child's room. A child who has aplastic anemia has decreased RBCs, platelets, and WBCs, causing immune suppression and increasing susceptibility to infection Apply pressure to peripheral puncture sites for a minimum of 5 minutes to prevent bleeding following blood specimen collection

A nurse is caring for a client who has pernicious anemia. Which of the following factors should the nurse identify with this condition?

A. Iron deficiency B. Hemolytic blood loss C. Folic acid deficiency D. Vitamin B12 deficiency D. Vitamin B12 deficiency -Pernicious anemia is deficient in vitamin B12 due to a deficiency in an intrinsic factor normally supplied by the gastric mucosa that is essential for the absorption of vitamin B12

A nurse is teaching a client who has iron-deficiency anemia. The nurse should encourage the client to increase her consumption of which of the following foods?

A. Lentils B. Avocados C. Cabbage D. Broccoli A. Lentils -Iron-rich foods, including meat, fish, poultry, and dried beans and peas. A 1-cup serving of lentils contains 3.6 mg of iron Rest of above answers only contain <0.9mg of iron

A nurse is caring for a client who has acute lymphocytic leukemia and reports a fever, chills, fatigue, and pallor over the past week. When checking the client's laboratory results, which of the following values should the nurse identify as contributing to the client's fatigue and pallor?

A. Magnesium 2.0 mEq/L B. Hgb 6.5 g/dL C. WBC count 9.6/mm3 D. Creatinine 0.8 mg/dL -reference range of Hgb is 14 to 18 g/dL for men and 12 to 16 g/dL for women. Therefore, a client who has an Hgb level of 6.5 g/dL has anemia. Typical manifestations of a low Hgb level include fatigue, headaches, pallor, dizziness, and tachycardia Due to the overproduction of cancerous WBC's, it causes underproduction of RBC's, PLT's, and NORMAL WBC's

A nurse is creating a plan of care for a child who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following interventions is the priority for the nurse to include?

A. Monitor the child's oxygen saturation level B. Administer prescribed antibiotics to the child C. Increase the child's fluid intake D. Apply warm compresses to the child's affected joints A. Monitor the child's oxygen saturation level -Airway, breathing, and circulation (ABC) approach to client care, the priority intervention is to monitor the child's oxygen saturation level

A nurse is caring for a client who has hemophilia. The client reports pain and swelling in a joint following an injury. Which of the following actions should the nurse take?

A. Obtain blood samples to test platelet function B. Prepare for replacement of the missing clotting factor C. Administer aspirin for the client's pain D. Place the bleeding joint in the dependent position B. Prepare for replacement of the missing clotting factor -Aggressive factor replacement is initiated to prevent hemarthrosis, which can result in a long-term loss of range of motion in repeatedly affected joints. The affected joint should be elevated to allow the blood to drain away from the joint.

A nurse is assessing the hematologic system of an older adult client. The nurse should report which of the following findings to the provider as a possible indication of a hematologic disorder?

A. Pallor B. Jaundice C. Absence of hair on the legs D. Poor nailbed capillary refill C. Absence of hair on the legs -Thinning or absence of hair on the extremities indicates poor arterial circulation to that area. The nurse should look for further indications of arterial insufficiency Pallor is an unreliable indicator of anemia for an older adult Yellowing of the skin is common with aging. Jaundice is an unreliable indicator of hyperbilirubinemia for an older adult Thickening and discoloration of the nails are common with aging and are not a reliable indicator of arterial insufficiency for an older adult client

A nurse is reviewing the laboratory report of a toddler who is receiving chemotherapy for leukemia. Which of the following laboratory values should the nurse report to the provider?

A. Platelets 150,000/mm^3 B. Hgb 6 g/dL C. WBC 6,000/mm^3 D. Potassium 4.5 mEq/L B. Hgb 6 g/dL

A nurse is assessing a client for manifestations of aplastic anemia. Which of the following findings should the nurse expect?

A. Plethoric appearance of facial skin B. Glossitis and weight loss C. Jaundice with an enlarged liver D. Petechiae and ecchymosis D. Petechiae and ecchymosis -Dyspnea on exertion also can be present. In aplastic anemia, all 3 major blood components (red blood cells, white blood cells, and platelets) are reduced or absent

A nurse is caring for a school-aged child who has sickle cell anemia. Which of the following actions should the nurse plan to take to help decrease the risk of a vaso-occlusive crisis?

A. Provide adequate fluid intake throughout the day B. Provide oxygen at 2 L/min via nasal cannula C. Administer a blood transfusion D. Give ibuprofen to manage pain -Maintaining adequate hydration can reduce the risk of sickle cell formation

A nurse is caring for a client who is receiving bleomycin IV to treat lymphoma. Which of the following assessments is the nurse's priority?

A. Pulmonary function B. CBC C. Urinary output D. Peripheral edema A. Pulmonary function -Bleomycin can cause severe lung injury, including pneumonitis and pulmonary fibrosis, which affects a significant percentage of clients receiving this medication; therefore, pulmonary function is the priority assessment. Also remember ABC's

A nurse is reviewing recent laboratory values during a prenatal visit for a client who is pregnant. the nurse notes a hemoglobin level of 10 g/dl. which of the following actions should the nurse take?

A. Review the medical record for a history of gastric bypass surgery B. Advise the client to start iron and vitamin C supplementation C. Review the medication list to determine if the client is taking an anticonvulsant D. Request an order for sickle cell anemia screening B. Advise the client to start iron and vitamin C supplementation -Anemia during pregnancy is defined by hemoglobin levels less than 10.5 to 11 g/dL, depending on the client's gestational age. Iron-deficiency anemia is characteristically microcytic. It is treated with iron supplementation with added vitamin C to aid in iron absorption.

A nurse is caring for a school-aged child who has sickle cell anemia and was admitted for a vaso-occlusive crisis. Which of the following findings should the nurse report to the provider immediately?

A. Slurred speech B. Hemoglobin level of 9 g/dL C. Hematuria D. Pain level of 7 on FACES scale A. Slurred speech -Slurred speech in a child who has sickle cell anemia is an indication of a stroke

A nurse is assessing a client who has pernicious anemia. Which of the following findings should the nurse expect?

A. Thick, white coating on the client's tongue B. Decreased pulse rate C. Paresthesias in the hands and feet D. Joint pain in the extremities -Other manifestations include weight loss, tachycardia, glossitis, beefy-red tongue, and fatigue

A nurse documents the presence of clubbing of the fingernails for a client who has emphysema. Which of the following is the underlying cause of this finding?

A. Trauma B. Severe infection C. Iron-deficiency anemia D. Chronic hypoxemia D. Chronic hypoxemia -Result of chronic hypoxemia (low oxygen supply) such as with COPD

A nurse is caring for a client who is at 16 weeks gestation and has severe iron-deficiency anemia. The provider prescribes an injection of iron dextran IM. Which of the following methods should the nurse use to administer the medication?

A. Use a 20-gauge needle and administer the medication using the Z-track method B. Use a 22-gauge needle and administer the medication deep into the thigh C. Use a 25-gauge needle and administer the medication into the deltoid muscle D. Use an 18-gauge needle and administer the medication into the rectus femoris muscle A. Use a 20-gauge needle and administer the medication using the Z-track method -Administer iron using the Z-track method to prevent staining of tissue. A 20-gauge needle is the correct size.

The parents of a child with phenylketonuria (PKU) ask the nurse if their second unborn child could have the same condition. The nurse should base the response on which of the following inheritance patterns responsible for PKU?

A. X-linked recessive B. X-linked dominant C. Autosomal recessive D. Autosomal dominant C. Autosomal recessive -PKU is inherited by autosomal-recessive gene patterns. In these types of disorders, neither parent may actually have the disorder, but both mother and father must carry and contribute a variant gene for it to occur. Other autosomal-recessive disorders are cystic fibrosis and sickle cell anemia.

What class of drug is Bleomycin?

Chemotherapy (Cytotoxic Chemotherapy)

S/S of Non-Hodgkin's Lymphoma

Enlarged lymph nodes Fever Night sweats Weight loss Bleeding Infection Red skin & generalized itching of unknown etiology

Hematocrit levels rise when a patient has received too much fluids [ T or F ]

FALSE An increased hematocrit level indicates dehydration. Hematocrit levels rise when blood volume is decreased during dehydration.

Which Lymphoma [ Hodgkins or Non-Hodgkins ] has the Reed-Sternberg cells

Hodgkins Lymphoma

Which type of lymphoma is 1 of the most curable cancers?

Hodgkins Lymphoma

Which type of lymphoma spreads eratically?

Non-Hodgkins