Hematologic Neoplasms
CHF (congestive heart failure)
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?
Assess the client's hemoglobin and platelets
A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention?
Neutropenia
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever?
leukopenia
less-than-normal amount of WBCs in circulation
white blood cell (WBC)
synonym: leukocyte
leukemia
uncontrolled proliferation of WBCs, often immature
reticulocytes
slightly immature RBCs, usually only 1% of total circulating RBCs
A
A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patients care plan? A) Protective isolation and vigilant use of standard precautions B) Provision of a high-calorie, low-texture diet and appropriate oral hygiene C) Including the family in planning the patients activities of daily living D) Monitoring and treating the patients pain
C
A patient with a myelodysplastic syndrome is being treated on the medical unit. What assessment finding should prompt the nurse to contact the patients primary care provider? A) The patient is experiencing a frontal lobe headache. B) The patient has an episode of urinary incontinence. C) The patient has an oral temperature of 37.5C (99.5F). D) The patients SpO2 is 91% on room air.
A
A patient with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the patient? A) Chew with care to avoid inadvertently biting the tongue. B) Use the oral anesthetic 1 hour prior to meal time. C) Brush teeth before and after eating. D) Swallow slowly and deliberately.
D
A patient with non-Hodgkins lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurses best response? A) Everyone should do these things because theyre health promotion activities that apply to everyone. B) You dont want to develop a second cancer, do you? C) You need to do this just to be on the safe side. D) Its important to reduce other factors that increase the risk of second cancers.
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
stem cell
primitive cell, capable of self-replication and differentiation into myeloid or lymphoid stem cell
blast cell
primitive leukocyte
phagocytosis
process of cellular ingestion and digestion of foreign bodies
apoptosis
programmed cell death
lymphocyte
type of WBC involved in immune functions
macrocytic anemia
A nurse cares for a client with myelodysplastic syndrome (MDS). Which assessment finding does the nurse recognize is the most common finding with this condition?
A
A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia? A) Monitoring for infection B) Monitoring nutritional status C) Monitor electrolyte levels D) Monitoring liver function
B
A patient diagnosed with acute myelogenous leukemia has just been admitted to the oncology unit. When writing this patients care plan, what potential complication should the nurse address? A) Pancreatitis B) Hemorrhage C) Arteritis D) Liver dysfunction
A
A nurse is caring for a patient with Hodgkin lymphoma at the oncology clinic. The nurse should be aware of what main goal of care? A) Cure of the disease B) Enhancing quality of life C) Controlling symptoms D) Palliation
A
Following an extensive diagnostic workup, an older adult patient has been diagnosed with a secondary myelodysplastic syndrome (MDS). What assessment question most directly addresses the potential etiology of this patients health problem? A) Were you ever exposed to toxic chemicals in any of the jobs that you held? B) When you were younger, did you tend to have recurrent infections of any kind? C) Have your parents or siblings had any disease like this? D) Would you say that youve had a lot of sun exposure in your lifetime?
C
A nurse at a long-term care facility is amending the care plan of a resident who has just been diagnosed with essential thrombocythemia (ET). The nurse should anticipate the administration of what medication? A) Dalteparin B) Allopurinol C) Hydroxyurea D) Hydrochlorothiazide
A
A patient has been found to have an indolent neoplasm. The nurse should recognize what implication of this condition? A) The patient faces a significant risk of malignancy. B) The patient has a myeloid form of leukemia. C) The patient has a lymphocytic form of leukemia. D) The patient has a major risk factor for hemophilia.
phlebotomy
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?
C
A young adult patient has received the news that her treatment for Hodgkin lymphoma has been deemed successful and that no further treatment is necessary at this time. The care team should ensure that the patient receives regular health assessments in the future due to the risk of what complication? A) Iron-deficiency anemia B) Hemophilia C) Hematologic cancers D) Genitourinary cancers
Multiple Myeloma Treatment
Steroids, Thalidomide, chemotherapy, autologous, marrow transplant, Bortezomib
Neutrophil and platelet counts within normal limits
What assessment finding best indicates that the client has recovered from induction therapy?
pancytopenia
abnormal decrease in WBCs, RBCs, and platelets
hematopoiesis
complex process of the formation and maturation of blood cells
D
A home health nurse is caring for a patient with multiple myeloma. Which of the following interventions should the nurse prioritize when addressing the patients severe bone pain? A) Implementing distraction techniques B) Educating the patient about the effective use of hot and cold packs C) Teaching the patient to use NSAIDs effectively D) Helping the patient manage the opioid analgesic regimen
B Renal function must be monitored closely in the patient with multiple myeloma. Excessive weight-bearing can cause pathologic fractures. There is no direct indication for anticoagulation or supplementary oxygen.
A patient has a diagnosis of multiple myeloma and the nurse is preparing health education in preparation for discharge from the hospital. What action should the nurse promote? A) Daily performance of weight-bearing exercise to prevent muscle atrophy B) Close monitoring of urine output and kidney function C) Daily administration of warfarin (Coumadin) as ordered D) Safe use of supplementary oxygen in the home setting
D
Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult patient who is otherwise healthy. The patient and the care team have collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient for which of the following? A) Daily treatment with targeted therapy medications B) Radiation therapy on a daily basis C) Hematopoietic stem cell transplantation D) An aggressive course of chemotherapy
Proliferation of abnormal plasma cells Release of osteoclast-activating factor Break down and removal of bone cells Increased blood calcium levels
Place the pathophysiology of multiple myeloma in the correct order.
C
The clinical nurse educator is presenting health promotion education to a patient who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions? A) Avoiding direct sun exposure in excess of 15 minutes daily B) Avoiding grapefruit juice and fresh grapefruit C) Avoiding highly crowded public places D) Using an electric shaver rather than a razor
Hypercalcemia
What lab would nurse caring for multiple myleoma pt expect to see?
Pantocytopenia
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets?
absolute neutrophil count (ANC)
a calculation of the number of circulating neutrophils, derived from the total white blood cells (WBCs) and the percentage of neutrophils counted in a microscope's visual field
polycythemia vera
general increase in red blood cells (erythremia)
thrombocytosis
higher-than-normal platelet count
B
A nurse is caring for a patient who has been diagnosed with leukemia. The nurses most recent assessment reveals the presence of ecchymoseson the patients sacral area and petechiae in her forearms. In addition to informing the patients primary care provider, the nurse should perform what action? A) Initiate measures to prevent venous thromboembolism (VTE). B) Check the patients most recent platelet level. C) Place the patient on protective isolation. D) Ambulate the patient to promote circulatory function.
C
A nurse is planning the care of a patient who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the patients care plan, the nurse has identified a diagnosis of Risk for Injury. What pathophysiologic effect of multiple myeloma most contributes to this risk? A) Labyrinthitis B) Left ventricular hypertrophy C) Decreased bone density D) Hypercoagulation
A
A nurse is planning the care of a patient who has been diagnosed with essential thrombocythemia (ET). What nursing diagnosis should the nurse prioritize when choosing interventions? A) Risk for Ineffective Tissue Perfusion B) Risk for Imbalanced Fluid Volume C) Risk for Ineffective Breathing Pattern D) Risk for Ineffective Thermoregulation
C
After receiving a diagnosis of acute lymphocytic leukemia, a patient is visibly distraught, stating, I have no idea where to go from here. How should the nurse prepare to meet this patients psychosocial needs? A) Assess the patients previous experience with the health care system. B) Reassure the patient that treatment will be challenging but successful. C) Assess the patients specific needs for education and support. D) Identify the patients plan of medical care.
Reduce exposure to excessive sunlight Smoking cessation Decrease alcohol intake
The nurse is caring for a patient with Hodgkin lymphoma in the hospital and preparing discharge planning education. Knowing that this patient is at risk for the development of a second malignancy, what education would be beneficial to reduce the risk factors? (Select all that apply.)
multiple myeloma
malignant neoplasm of bone marrow
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])
lymphoid
pertaining to lymphocytes
D A significant toxicity associated with the use of bortezomib for multiple myeloma is peripheral neuropathy. Stomatitis, cognitive changes, and nephropathy are not noted to be adverse effects of this medication.
A nurse is caring for patient whose diagnosis of multiple myeloma is being treated with bortezomib. The nurse should assess for what adverse effect of this treatment? A) Stomatitis B) Nephropathy C) Cognitive changes D) Peripheral neuropathy
"It helps to strengthen the bone." "It helps to decrease bone pain."
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.
A B C E
A nurse is writing the care plan of a patient who has been diagnosed with myelofibrosis. What nursing diagnoses should the nurse address? Select all that apply. A) Disturbed Body Image B) Impaired Mobility C) Imbalanced Nutrition: Less than Body Requirements D) Acute Confusion E) Risk for Infection
Multiple Myeloma
What condition would be related to bone pain/fractures questions?
petechiae
tiny capillary hemorrhages
C
7. A 77-year-old male is admitted to a unit with a suspected diagnosis of acute myeloid leukemia (AML). When planning this patients care, the nurse should be aware of what epidemiologic fact? A) Early diagnosis is associated with good outcomes. B) Five-year survival for older adults is approximately 50%. C) Five-year survival for patients over 75 years old is less than 2%. D) Survival rates are wholly dependent on the patients pre-illness level of health.
The dead red blood cells release excess uric acid.
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?
Pathologic bone fractures
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for?
B
A nurse practitioner is assessing a patient who has a fever, malaise, and a white blood cell count that is elevated. Which of the following principles should guide the nurses management of the patients care? A) There is a need for the patient to be assessed for lymphoma. B) Infection is the most likely cause of the patients change in health status. C) The patient is exhibiting signs and symptoms of leukemia. D) The patient should undergo diagnostic testing for multiple myeloma.
C
A patient with advanced leukemia is responding poorly to treatment. The nurse finds the patient tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurses most appropriate action? A) Tell him that you will give him privacy and leave the room. B) Offer to call pastoral care. C) Ask if he would like you to sit with him while he collects his thoughts. D) Tell him that you can understand how hes feeling.
risk for falls
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?
polycythemia vera
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?
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
myeloid
pertaining to nonlymphoid blood cells that differentiate into RBCs, platelets, macrophages, mast cells, and various WBCs
A
1. An oncology nurse is providing health education for a patient who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia? A) The different leukemias all involve unregulated proliferation of white blood cells. B) The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function. C) The different leukemias all result in a decrease in the production of white blood cells. D) The different leukemias all involve the development of cancer in the lymphatic system.
D
A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what? A) AML B) CML C) MDS D) ALL
Chronic lymphocytic leukemia
A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia?
increased urinary protien
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?
staging of disease
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept?
Frequent infections Fatigue from anemia Easy bruising
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.
D
A clinic nurse is working with a patient who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the patients disease? A) Document the color of the patients palms and face during each visit. B) Follow the patients erythrocyte sedimentation rate over time. C) Document the patients response to erythropoietin injections. D) Follow the trends of the patients hematocrit.
D
A clinic patient is being treated for polycythemia vera and the nurse is providing health education. What practice should the nurse recommend in order to prevent the complications of this health problem? A) Avoiding natural sources of vitamin K B) Avoiding altitudes of 1500 feet (457 meters) C) Performing active range of motion exercises daily D) Avoiding tight and restrictive clothing on the legs
B
An adult patient has presented to the health clinic with a complaint of a firm, painless cervical lymph node. The patient denies any recent infectious diseases. What is the nurses most appropriate response to the patients complaint? A) Call 911. B) Promptly refer the patient for medical assessment. C) Facilitate a radiograph of the patients neck and have the results forwarded to the patients primary care provider. D) Encourage the patient to track the size of the lymph node and seek care in 1 week.
B
An adult patients abnormal complete blood count (CBC) and physical assessment have prompted the primary care provider to order a diagnostic workup for Hodgkin lymphoma. The presence of what assessment finding is considered diagnostic of the disease? A) Schwann cells B) Reed-Sternberg cells C) Lewy bodies D) Loops of Henle
C
An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem? A) Hodgkin disease B) Non-Hodgkin lymphoma C) Multiple myeloma D) Acute thrombocythemia
Multiple Myeloma
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?
splenomegaly
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?
Take antacids if needed for gastrointestinal (GI) upset 2 hours after taking imatinib mesylate.
The nurse is educating a client taking imatinib mesylate for treatment of leukemia. What should the nurse be sure to include when educating the client on the best way to take the medication to optimize absorption?
Platelet count 9,000
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?
chronic leukemia develops slowly
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan?
"Intrathecal chemotherapy is used primarily as preventive therapy.
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care?
"Consolidation therapy is administered to reduce the chance of leukemia recurrence."
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan?
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
neutropenia
lower-than-normal number of neutrophils
thrombocytopenia
lower-than-normal platelet count
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
polycythemia vera treatment
relies primarily on phlebotomy to reduce hematocrit - bleed them/ drain them (usually 1 or so a week or monthly)
B
A nursing student is caring for a patient with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnoses? A) Activity Intolerance B) Risk for Infection C) Acute Confusion D) Risk for Spiritual Distress
D
A patient has completed the full course of treatment for acute lymphocytic leukemia and has failed to respond appreciably. When preparing for the patients subsequent care, the nurse should perform what action? A) Arrange a meeting between the patients family and the hospital chaplain. B) Assess the factors underlying the patients failure to adhere to the treatment regimen. C) Encourage the patient to vigorously pursue complementary and alternative medicine (CAM). D) Identify the patients specific wishes around end-of-life care.
B
A patient who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this patients needs for physical activity? A) Teach the patient about the risks of immobility and the benefits of exercise. B) Assist the patient to a chair during awake times, as tolerated. C) Collaborate with the physical therapist to arrange for stair exercises. D) Teach the patient to perform deep breathing and coughing exercises.
C
A nurse is caring for a patient who is being treated for leukemia in the hospital. The patient was able to maintain her nutritional status for the first few weeks following her diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement what intervention? A) Arrange for total parenteral nutrition (TPN). B) Facilitate placement of a percutaneous endoscopic gastrostomy (PEG) tube. C) Provide the patient with several small, soft-textured meals each day. D) Assign responsibility for the patients nutrition to the patients friends and family.
B
A nurse is preparing health education for a patient who has received a diagnosis of myelodysplastic syndrome (MDS). Which of the following topics should the nurse prioritize? A) Techniques for energy conservation and activity management B) Emergency management of bleeding episodes C) Technique for the administration of bronchodilators by metered-dose inhaler D) Techniques for self-palpation of the lymph nodes
Hypercalcemia Renal insufficiency Anemia Bone lesions
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.
Excess of immature leukocytes
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?
lysis
destruction of cells
B
An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL? A) Increased numbers of blast cells B) Increased lymphocyte levels C) Intractable bone pain D) Thrombocytopenia with no evidence of bleeding
A
An oncology nurse is caring for a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patients most recent blood tests, the nurse should anticipate what imbalance? A) Hypercalcemia B) Hyperproteinemia C) Elevated serum viscosity D) Elevated RBC count
A C D E
An oncology nurse recognizes a patients risk for fluid imbalance while the patient is undergoing treatment for leukemia. What relevant assessments should the nurse include in the patients plan of care? Select all that apply. A) Monitoring the patients electrolyte levels B) Monitoring the patients hepatic function C) Measuring the patients weight on a daily basis D) Measuring and recording the patients intake and output E) Auscultating the patients lungs frequently
A
A 60-year-old patient with chronic myeloid leukemia will be treated in the home setting and the nurse is preparing appropriate health education. What topic should the nurse emphasize? A) The importance of adhering to the prescribed drug regimen B) The need to ensure that vaccinations are up to date C) The importance of daily physical activity D) The need to avoid shellfish and raw foods
