Hinkle Ch.30 PrepU
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? Osteopathic tumors destroy bone causing fractures. Osteoclasts break down bone cells so pathologic fractures occur. Osteosarcomas form producing pathologic fractures. Osteolytic activating factor weakens bones producing fractures.
Osteoclasts break down bone cells so pathologic fractures occur. Explanation: The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This, in turn, causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a "punched-out" or "honeycombed" appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. The other options are distractors for this question.
The nurse is teaching a client who is undergoing diagnostic tests for multiple myeloma. What clinical findings support the client's diagnosis of multiple myeloma? serum protein level 5.8 g/dL serum albumin level of 2.0 g/dL serum calcium level of 7.5 mg/dL serum creatinine level 0.5 mg/dL
serum albumin level of 2.0 g/dL Explanation: Albumin is a protein found in the blood and low levels can be seen in myeloma. Normal albumin level is 3.4 to 5.4 g/dL. Serum creatinine level may be increased (above 1.2 mg/dL in men and 0.9 mg/dL in women). Serum calcium levels exceed 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.
The nurse is assessing a client admitted with a deep vein thrombosis with an elevated red blood cell count. The admitting diagnosis is polycythemia vera. What is the hallmark clinical sign of PV? splenomegaly peripheral edema pale body color weight gain
splenomegaly Explanation: Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, weight loss, paresthesias, and blurred vision). Edema, pale body color, and weight gain are not classic symptoms of PV.
A client is being tested for acute myeloid leukemia (AML). The nurse knows that which diagnostic test will be used as the hallmark for the diagnosis? Clotting factors Bone marrow analysis Complete blood count Alkaline phosphatase level
Bone marrow analysis Explanation: To confirm the diagnosis of AML, laboratory studies need to be performed. A bone marrow analysis shows an excess or more than 20% of blast cells which is the hallmark of the diagnosis. Clotting factors are not used to diagnose AML. The complete blood count (CBC) commonly shows a decrease in both erythrocytes and platelets but is not as specific as the bone marrow analysis. The alkaline phosphatase level measures a liver enzyme.
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? Administer pain medication. Maintain nutrition. Address issues of negative body image. Place the client in reverse isolation.
Maintain nutrition. Explanation: Maintaining nutrition is the most important goal after induction therapy because the client experiences severe diarrhea and can easily become nutritionally deficient and develop fluid and electrolyte imbalance. The client is most likely not in pain at this point, and this is an intervention, not a goal.
The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has? Chronic myeloid leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Multiple myeloma
Multiple myeloma Explanation: Any older adult with unprovoked or unexplained back pain and increased protein in the serum should be assessed for multiple myeloma. Bone pain occurs because of bone breakdown and the malignant cells of multiple myeloma increase the serum protein levels.
Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. What is the most common complication of the pathology resulting from this process? Pathologic fractures Increased mobility Calcified bones Osteoporosis
Pathologic fractures Explanation: Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.
A client is awaiting test results to diagnose Hodgkin lymphoma. The nurse knows that which result is the hallmark for the diagnosis of this condition? Misshaped red blood cells Reed-Sternberg cells Increased basophils Elevated platelet count
Reed-Sternberg cells Explanation: The malignant cell of Hodgkin lymphoma is the Reed-Sternberg cell, a gigantic tumor cell that is morphologically unique and thought to be of immature lymphoid origin. These cells arise from the B lymphocyte. They may have more than one nucleus and often have an owl-like appearance. The presence of Reed-Sternberg cells is the pathologic hallmark and essential diagnostic criterion. Basophils, platelets, or red blood cells are not used to diagnose Hodgkin lymphoma.
A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? Acute pain Sensory-perception disturbance Impaired tissue integrity Risk for falls
Risk for falls Explanation: A client with paresthesia in the feet is at risk for falls due to impaired sensation. Acute pain, impaired tissue integrity, and sensory-perception disturbance are all nursing diagnoses that are appropriate for the client; however, risk for falls is priority.
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? Jaundice skin and sclera Bronze skin tone Pale skin and mucous membranes Ruddy complexion
Ruddy complexion Explanation: Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? Involvement of lymph nodes Total blood cell count Staging of disease Histology of tissue
Staging of disease Explanation: Treatment of Hodgkin lymphoma is based on the stage of the disease, not the histology of tissue, involvement of lymph nodes, or total blood cell count.
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? The client with painful lymph nodes under the arm. The client with enlarged lymph nodes in the neck. The client with painful lymph nodes in the groin. The client with a painful sore throat.
The client with enlarged lymph nodes in the neck. Explanation: Lymph node enlargement in Hodgkin lymphoma is not painful. The client 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.
A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? Restricting fluid intake Monitoring respiratory status Preventing bone injury Balancing rest and activity
Preventing bone injury Explanation: When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict fluid intake.
The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing intervention to help prevent fractures in the client? -Promote safety. -Provide adequate hydration. -Encourage adequate nutrition. -Increase mobility.
Promote safety. Explanation: Safety is paramount because any injury, no matter how slight, can result in a fracture. Mobility, hydration, and nutrition are important, but will not prevent fractures.
A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess? Increased number of blast cells A leukocyte count >100,000/mm3 An enlarged liver Lymphadenopathy
A leukocyte count >100,000/mm3 Explanation: Although there is an increase in the production of blast cells and the client may have an enlarged liver and tender spleen, it is the high leukocyte count that is diagnostic. Lymphadenopathy is rare.
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "In chronic leukemia, the minority of leukocytes are mature." "Chronic leukemia develops slowly." "In acute leukemia there are not many undifferentiated cells." "Acute leukemia develops slowly."
"Chronic leukemia develops slowly." Explanation: Chronic leukemia develops slowly, and the majority of leukocytes produced are mature. Acute leukemia develops quickly and the majority of leukocytes are undifferentiated cells.
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan? "Consolidation of the lungs is an expected effect of induction therapy." "Consolidation therapy is administered to reduce the chance of leukemia recurrence." "Consolidation occurs as a side effect of chemotherapy." "Consolidation is the term used when a client does not tolerate chemotherapy."
"Consolidation therapy is administered to reduce the chance of leukemia recurrence." Explanation: Consolidation therapy is administered to eliminate residual leukemia cells that are not clinically detectable and reduce the chance for recurrence. It is also termed post-remission therapy. It is not a side effect of chemotherapy, but the administration of chemotherapy.
Which statement indicates the client understands teaching about induction therapy for leukemia? "I know I can never be cured." "I will need to come every week for treatment." "I will start slowly with medication treatment." "I will be in the hospital for several weeks."
"I will be in the hospital for several weeks." Explanation: Induction therapy involves high doses of several medications and the client is usually admitted to the hospital for several weeks. The treatment is started quickly and the goal is to cure or put the disease into remission.
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care?' "Intrathecal chemotherapy is used primarily as preventive therapy." "The goal of therapy is palliation." "Side effects are rare with therapy." "Treatment is simple and consists of single-drug therapy."
"Intrathecal chemotherapy is used primarily as preventive therapy." Explanation: Intrathecal chemotherapy is a key part of the treatment plan to prevent invasion of the central nervous system. The therapy uses multiple drugs, with many side effects. The goal of therapy is remission.
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? Blast crisis Accelerated Transformation Chronic
Chronic Explanation: Advances in understanding the pathology of CML at a molecular level have led to dramatic changes in treatment. An oral formulation of a tyrosine kinase inhibitor, imatinib mesylate (Gleevec), works by blocking signals within the leukemia cells that express the BCR-ABL protein, thus preventing a series of chemical reactions that cause the cell to grow and divide. Imatinib therapy appears to be most useful in the chronic phase of the illness. It can induce complete remission at the cellular and even molecular level.
A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for? Laryngeal edema Adventitious lung sounds Diarrheal stools Hair loss
Diarrheal stools Explanation: Side effects of radiation therapy are limited to the area being irradiated. Clients who have abdominal radiation therapy may experience diarrhea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal edema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.
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? Antimicrobial therapy Supportive therapy Induction therapy Standard therapy
Induction therapy Explanation: Despite advances in understanding of the biology of AML, substantive advances in treatment response rates and survival rates have not occurred for decades, with the exception of advances made in treating APL (see later discussion). Even for patients with subtypes that have not benefited from advances in treatment, cure is still possible. The overall objective of treatment is to achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow. Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks.
Which term refers to a form of white blood cell involved in immune response? Granulocyte Lymphocyte Spherocyte Thrombocyte
Lymphocyte Explanation: Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.
The nurse is reviewing the treatment options with a client diagnosed with myelodysplastic syndromes (MDS). Which therapy will the nurse emphasize as the option to cure the condition? Erythropoiesis-stimulating agents Blood transfusions Hypomethylating agents Allogeneic hematopoietic stem cell transplantation
Allogeneic hematopoietic stem cell transplantation
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? Refer the client to a chiropractor. Assess renal function. Administer pain medication, as ordered. Place heating pads on the client's back.
Assess renal function. Explanation: Chemotherapy results in the destruction of cells and tumor lysis syndrome. Uric acid and phosphorus concentrations increase, and the client is susceptible to renal failure. The nurse should assess renal function if the client complains of low-back pain, as this could be indicative of kidney stone formation. Heating pads, pain medication, and referrals could be instituted once the cause of the pain is determined. The priority is further assessment to rule out important problems.
A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? Assess the client's skin. Check the client's history. Assess the client's hemoglobin and platelets. Assess the client's pulse and blood pressure.
Assess the client's hemoglobin and platelets. Explanation: Clients with AML may develop pallor from anemia and a tendency to bleed because of a low platelet count. Assessing the client's hemoglobin and platelets will help to determine whether this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.
An elderly client is hospitalized for induction of chemotherapy to treat leukemia. The client reports fatigue to the nurse. What nursing intervention would best address the client's fatigue? Provide sedentary activities only, such as watching television. Talk to the family about not visiting so the client can obtain rest. Have the client maintain complete bedrest. Assist the client to sit in a chair for meals.
Assist the client to sit in a chair for meals. Explanation: Fatigue is a common symptom with clients who have leukemia. Despite the fatigue, clients still need to maintain some physical activity. An example of physical activity is having the client sit in a chair for meals. The nurse does not want to encourage complete bedrest or sedentary activities, such as watching television, due to possible deconditioning. The nurse has not discussed with the client about limiting family visits. The client may want some family to visit.
The nurse cares for a client with acute myeloid leukemia with severe bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain? Abnormal blood cells crystalize. Bone marrow expands. Abnormal blood cells deposit in small vessels. Lymph nodes expand.
Bone marrow expands. Explanation: In acute myeloid leukemia, bone pain is caused when the bone marrow expands.
A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? Keep the client on bed rest. Evaluate the client's platelet count. Evaluate the client's INR. Ask the client whether they have recently fallen.
Evaluate the client's platelet count. Explanation: Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3. The bleeding is usually unrelated to falling. Keeping the client on bed rest will not prevent bleeding when the client has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.
A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect? Excess of immature leukocytes Excess of immature erythrocytes Deficiency of neutrophils Deficiency of erythrocytes
Excess of immature leukocytes Explanation: The bone marrow biopsy of a client with acute myeloid leukemia will reveal an excess of immature leukocytes.
A nurse cares for a client with multiple myeloma who reports severe back pain that worsens throughout the day. What additional clinical symptoms will the nurse associate with the pathophysiology of the client's disease? Excessive thirst Diarrhea Fluid volume excess Polyuria
Excessive thirst Explanation: Bone pain in multiple myeloma results from bone breakdown. As a result of the breakdown, ionized calcium is released into the blood causing hypercalcemia. Symptoms of hypercalcemia include excessive thirst, dehydration, and constipation.
When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? Age and gender Health history, such as bleeding, fatigue, or fainting Menstrual history Lifestyle assessments, such as exercise routines
Health history, such as bleeding, fatigue, or fainting Explanation: When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? Hypercalcemia Hypermagnesemia Hyperkalemia Hypernatremia
Hypercalcemia Explanation: Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.
A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? Multiple myeloma Hemolytic anemia Polycythemia vera Leukemia
Multiple myeloma Explanation: The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Neutropenia Anemia Thrombocytopenia Pancytopenia
Neutropenia Explanation: Fever and infection result from a decrease in neutrophils (neutropenia). Decreased red blood cells (anemia) cause weakness, fatigue, dyspnea on exertion, and pallor in AML. Pancytopenia, an overall decrease in all blood components, is not cause of fever in clients with AML. Decreased platelet count (thrombocytopenia) causes petechiae and bruising in AML.
What assessment finding best indicates that the client has recovered from induction therapy? Neutrophil and platelet counts within normal limits No evidence of edema Absence of bone pain Vital signs within normal ranges
Neutrophil and platelet counts within normal limits Explanation: Recovery from induction therapy is indicated when the neutrophil and platelet counts have returned to normal and any infection has resolved. Stable vital signs, lack of edema, and absence of pain are not indicative of recovery from induction therapy.
The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? WBC count of 4,200 cells/uL Hematocrit of 38% Creatinine level of 1.0 mg/dL Platelet count of 9,000/mm3
Platelet count of 9,000/mm3 Explanation: Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.
The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis? Polycythemia vera Sickle cell disease Pernicious anemia Aplastic anemia
Polycythemia vera Explanation: Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow. In sickle cell disease, HbS causes RBCs to assume a sickled shape under hypoxic conditions. Aplastic anemia has a deficiency of erythrocytes. The other options do not have the characteristics of erythrocytosis.
The nurse recognizes the clinical assessment of a patient with acute myeloid leukemia (AML) includes observing for signs of infection early. What nursing action will most likely help prevent infection? Monitor the client's temperature every shift. Encourage increased fluid consumption. Practice vigilant handwashing. Maintain contact precautions.
Practice vigilant handwashing. Explanation: Infection prevention is best handled by vigilant handwashing. Monitoring the client's temperature once a shift is not often enough. The client will take precautions, but precautions are enough to prevent infections. Encouraging increased fluid consumption will not prevent infection.
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? -Excess red blood cells produce extracellular toxins that build up. -The dead red blood cells occlude the small vessels in the joints. -The dead red blood cells release excess uric acid. -Excess red blood cells cause vascular injury in the joints.
The dead red blood cells release excess uric acid. Explanation: There is a rapid proliferation of red blood cells from the marrow in polycythemia vera. However, these red blood cells die sooner than normal and the dead red blood cells release potassium and uric acid. This build up of uric acid in the blood leads to gouty arthritis symptoms.
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? chronic liver failure. hypoxemia. pathologic bone fractures. acute heart failure.
pathologic bone fractures. Explanation: Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.
The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis? -polycythemia vera -sickle cell disease -aplastic anemia -pernicious anemia
polycythemia vera Explanation: Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow. In sickle cell disease, HbS causes RBCs to assume a sickled shape under hypoxic conditions. Aplastic anemia has a deficiency of erythrocytes. Sickle cell disease and the anemias do not have the characteristics of erythrocytosis.
A nurse cares for a client with early Hodgkin lymphoma. While assessing the client, the nurse will most likely find painless enlargement of which lymph node? Axillary Cervical Popliteal Inguinal
Cervical Explanation: Non painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.
Which statement best describes the function of stem cells in the bone marrow? They are active against hypersensitivity reactions. They produce all blood cells. They defend against bacterial infection. They produce antibodies against foreign antigens.
They produce all blood cells. Explanation: All blood cells are produced from undifferentiated precursors called pluripotent stem cells in the bone marrow. Other cells produced from the pluripotent stem cells help defend against bacterial infection, produce antibodies against foreign antigens, and are active against hypersensitivity reactions.
The nurse assesses a patient for late-stage chronic lymphocytic leukemia (CLL) by looking for what? Hepatomegaly. Thrombocytopenia. Lymphadenopathy. Splenomegaly.
Thrombocytopenia. Explanation: Anemia and thrombocytopenia are late-stage indicators of CLL. The others are early-stage signs.
A client receiving treatment for acute myeloid leukemia (AML) develops elevated potassium, uric acid, and phosphate levels. Which treatments will the nurse anticipate being prescribed to reduce this client's risk for kidney stone formation? Select all that apply. -Acetaminophen -Anticoagulants -Antibiotics -Intravenous fluids -Allopurinol
-Allopurinol -Intravenous fluids Explanation: Massive leukemic cell destruction from chemotherapy in the treatment of AML results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate indicate the development of tumor lysis syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute kidney injury. Clients require a high fluid intake, and prophylaxis with allopurinol to prevent crystallization of uric acid and subsequent stone formation. Antibiotics, anticoagulants, and acetaminophen are not used to reduce the risk for the formation of kidney stones in the client being treated for AML.
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? -Keep the feet cool. -Encourage ambulation. -Assess for signs of injury. -Elevate the client's legs.
Assess for signs of injury. Explanation: A client with hypoesthesia of the feet will have decreased sensation and numbness. The nurse should assess for signs of injury. If the client is injured, he or she will not be able to feel it; this could lead to the development of infection. Ambulation will not help the client, and elevating the legs may make the problem worse, as blood flow to the feet would be decreased. Keeping the feet cold will also decrease blood flow.
The nurse is reviewing the long-term treatment plan with a client diagnosed with Hodgkin lymphoma. Which recommendations will the nurse provide to reduce the client's risk of developing secondary malignancies? Select all that apply. -Avoid excessive sunlight. -Limit the intake of citrus fruits. -Restrict use of tobacco. -Reduce intake of alcohol. -Avoid foods high in carbohydrates.
-Avoid excessive sunlight. -Restrict use of tobacco. -Reduce intake of alcohol. Explanation: The potential development of a second malignancy should be addressed with the client when initial treatment decisions are made. The nurse should encourage clients to reduce factors that increase the risk of developing second cancers, such as avoiding excess sunlight, restricting the use of tobacco, and reducing the intake of alcohol. Citrus foods and carbohydrates will not increase the client's risk of developing a secondary malignancy after treatment for Hodgkin lymphoma.
The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? Creatinine and blood urea nitrogen (BUN) levels Potassium levels Iron levels Magnesium levels
Iron levels Explanation: For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? -Pancytopenia -Leukopenia -Anemia -Thrombocytopenia
Pancytopenia Explanation: Pancytopenia may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.
The hospitalized client is experiencing gastrointestinal bleeding with a platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take? Use contact precautions with this client. Perform a neurologic assessment with vital signs. Request a prescription of diphenoxylate and atropine for loose stools. Teach the client to vigorously floss the teeth to prevent infections.
Perform a neurologic assessment with vital signs. Explanation: With platelets less than 10,000/mm³ there is a risk for spontaneous bleeding, including within the cranial vault. The nurse performs a neurologic examination to assess for this possibility. Though the client is receiving immunosuppressants, it is not necessary to use contact precautions with this client. Contact precautions are used with clients who have known or suspected transmittable illnesses. Diphenoxylate and atropine can cause constipation and inhibit accurate assessment of the client's gastrointestinal bleeding. If the client strains when having a bowel movement, the client could bleed even more. The client is not to floss vigorously; doing so can cause bleeding.
The nurse notes that a client with essential thrombocythemia has a headache and a platelet count of 1 million/mm3 (1 million/ ×109/L). Which additional neurologic findings will the nurse expect to assess in this client? Select all that apply. Dizziness Transient ischemic attacks Paresthesias Diplopia Facial paralysis
-Diplopia -Dizziness -Paresthesias -Transient ischemic attacks Explanation: Essential thrombocythemia, also called primary thrombocythemia, is a rare, chronic, Philadelphia chromosome-negative myeloproliferative disorder characterized by an increased production of megakaryocytes. A marked increase in platelet production occurs. One of the most common neurologic symptoms of essential thrombocythemia is headaches. Other neurological manifestations that may be related to compromised blood flow include diplopia, dizziness, paresthesias, and transient ischemic attacks. Facial paralysis is not a symptom of essential thrombocytopenia.
A client being treated for non-Hodgkin lymphoma asks the nurse why they need to be monitored for additional forms of leukemia. Which is the nurse's best response? "These screening are health promotion activities that apply to everyone." "You need to do this just to be on the safe side." "You don't want to develop a second cancer, do you?" "These are seen among survivors like yourself."
"These are seen among survivors like yourself." Explanation: Many lymphomas can be cured with current treatments. However, as survival rates increase, the incidence of secondary malignancies, particularly acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS), also increases. Therefore, survivors should be screened regularly for the development of second malignancies. The nurse should encourage clients to reduce other factors that increase the risk of developing second cancers. The other options do not answer the client's question, and also seem insensitive to the client's question.
Which of the following are complications related to polycythemia vera (PV)? Select all that apply. -Hematuria -Ulcers -MI -CVA -Splenomegaly
-CVA -MI -Ulcers -Hematuria Explanation: Patients with PV are at increased risk for thromboses resulting in a CVA or myocardial infarction. Bleeding can be significant and can occur in the form of nosebleeds, ulcers, frank gastrointestinal bleeding, and intracranial hemorrhage. Splenomegaly is a clinical manifestation of PV, not a complication.
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. -Allow family members to express feelings. -Suggest the family go to church more often. -Suggest support for household maintenance. -Educate the family about medications and side effects. -Suggest the prescription of antianxiety medications.
-Educate the family about medications and side effects. -Allow family members to express feelings. -Suggest support for household maintenance. Explanation: Family members benefit from increased education on what to expect. Allowing family members to express their feelings has also been shown to relieve stress. Supporting the caregiver and family with help in household duties will also help the overburdened family. Antianxiety medications and church attendance have not been shown to reduce caregiver stress.
A client diagnosed with multiple myeloma (MM) is prescribed long-term corticosteroid therapy. Which assessment(s) will the nurse prioritize to monitor for possible complications? Select all that apply. -Skin disorders -Sleeping patterns -Glucose levels -Vision problems -Hair growth disorders
-Glucose levels -Sleeping patterns -Vision problems Explanation: Many clients with MM are treated with high doses of corticosteroids for protracted periods of time. Clients must be monitored for potential short- and long-term effects of steroids, including hyperglycemia and insomnia (short term), and osteopenia, osteoporosis, cataracts, and diabetes (long term). Neither skin disorders nor hair-growth--pattern disorders are generally associated with corticosteroid therapy.
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. -Acidosis -Renal insufficiency -Bone lesions -Hypercalcemia -Anemia
-Hypercalcemia -Renal insufficiency -Anemia -Bone lesions Explanation: The acronym CRAB is used to describe the combined pathologic effects of multiple myeloma and include: calcium levels elevated (hypercalcemia), renal insufficiency, anemia, bone lesions. Acidosis is not part of the acronym used to describe the pathologic effects of the disease.
Place the pathophysiology of multiple myeloma in the correct order. -Break down and removal of bone cells -Increased blood calcium levels -Proliferation of abnormal plasma cells -Release of osteoclast-activating factor
1) Proliferation of abnormal plasma cells 2) Release of osteoclast-activating factor 3) Break down and removal of bone cells 4) Increased blood calcium levels Explanation: The pathophysiology of multiple myeloma is as follows: Proliferation of abnormal plasma cells, release of osteoclast-activating factor, break down and removal of bone cells, increased blood calcium levels.
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A 72-year-old patient with a history of cancer A 52-year-old patient with acute kidney injury A 40-year-old patient with a history of hypertension A 24-year-old female taking oral contraceptives
A 72-year-old patient with a history of cancer Explanation: Primary MDS tends to be a disease of people older than 70 years. Because the initial findings are so subtle, the disease may not be diagnosed until later in the illness trajectory, if at all. Thus, the actual incidence of MDS is not known.
The 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? Hydroxyurea Filgrastim Asparaginase Allopurinol
Allopurinol Explanation: Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate are seen; this process is referred to as tumor lysis (cell destruction) syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Patients require a high fluid intake, and prophylaxis with allopurinol or rasburicase to prevent crystallization of uric acid and subsequent stone formation
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? Severe thrombocytopenia Gradual muscle paralysis Debilitating fatigue Bone pain in the back of the ribs
Bone pain in the back of the ribs Explanation: Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; clients may report that they have less pain on awakening but the pain intensity increases during the day.
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? -Put on a mask, gown, and gloves when entering the client's room. -Provide a clear liquid, low-sodium diet. -Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. -Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.
Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. Explanation: Neutropenia occurs when the absolute neutrophil count falls below 1,000/mm3, reflecting a severe risk of infection. The nurse should provide a low-bacterial diet, which means eliminating fresh fruits and vegetables, avoiding invasive procedures such as enemas, and practicing frequent hand washing. Using a soft toothbrush, avoiding straight-edged razors and enemas, and monitoring for bleeding are precautions for clients with thrombocytopenia. Putting on a mask, gown, and gloves when entering the client's room are reverse isolation measures. A neutropenic client doesn't need a clear liquid diet or sodium restrictions.
A client with polycythemia vera has a basophil count of greater than 2. Which assessment finding will the nurse expect to assess in this client? Early satiety Pruritis Dizziness Ruddy complexion
Pruritis Explanation: In polycythemia vera the bone marrow is hypercellular, and the erythrocyte, leukocyte, and platelet counts in the peripheral blood are often elevated. An increase in blood cell mass increases blood viscosity leading to a variety of symptoms. The condition increases the number of basophils which are responsible for histamine release. This causes the symptom of pruritus. Dizziness is a neurologic symptom from the condition. Early satiety is am abdominal symptom from the condition. Ruddy complexion is a cardiovascular symptom of the disorder.
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? Platelet count 300,000/mm3 Serum calcium level 13.8 mg/dl Serum sodium level of 133 mEq/L Hemoglobin of 9.8 g/dl
Serum calcium level 13.8 mg/dl Explanation: 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 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? weight gain peripheral edema splenomegaly pale body color
splenomegaly Explanation: Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, weight loss, paresthesias, and blurred vision). Edema, pale body color, and weight gain are not classic symptoms of PV.
The nurse in the oncology clinic is caring for a 42-year-old female client receiving chemotherapy with fludarabine for acute myeloid leukemia who has developed petechiae, epistaxis, and ecchymosis. Complete the following sentence by choosing from the lists of options: The nurse anticipates that the client has developed... [hemorrhage / infection / hyperkalemia /deep vein thrombosis] ...and that the laboratory results will reveal... [thrombocytopenia / leukocytosis / electrolyte imbalances / abnormal renal function tests]
The nurse anticipates that the client has developed hemorrhage and that the laboratory results will reveal thrombocytopenia. Explanation: This client has manifestations of hemorrhage, including petechiae (pinpoint bleeding in the skin), epistaxis (nosebleeds), and ecchymosis (bruises) due to a low platelet count (thrombocytopenia) secondary to chemotherapy. Chemotherapy with fludarabine may cause bone marrow suppression with neutropenia (low neutrophil count) and thrombocytopenia (low platelet count). When the platelet count is low, the client is at risk for hemorrhage as evidenced by petechiae, epistaxis, and ecchymosis. Chemotherapy with fludarabine may cause bone marrow suppression, leading to thrombocytopenia (low platelet count) and hemorrhage. Although the client is at risk for infection, the assessment findings of petechiae, epistaxis, and ecchymoses are indicators of a low platelet count. The assessment findings do not support a diagnosis of deep vein thrombosis (DVT). Manifestations of DVT include calf pain, leg swelling, and warmth, and pain over the thrombosis. Hyperkalemia does not cause signs and symptoms of hemorrhage. Leukocytosis (a low white count) may occur following treatment with fludarabine, but it does not cause petechiae, epistaxis, and ecchymosis. Electrolyte imbalances and abnormal renal function also do not cause petechiae, epistaxis, and ecchymosis.
The nurse is caring for a patient who will begin taking long-term biphosphate therapy. Why is it important for the nurse to encourage the patient to receive a thorough evaluation of dentition, including panoramic dental x-rays? The patient is at risk for tooth decay. The patient will develop gingival hyperplasia. The patient can develop loosening of the teeth. The patient can develop osteonecrosis of the jaw.
The patient can develop osteonecrosis of the jaw. Explanation: Osteonecrosis of the jaw is an infrequent but serious complication that can arise in patients treated long-term with bisphosphonates; the mandible or maxilla are affected. Careful assessment for this complication should be conducted and a thorough evaluation of the patient's dentition should be performed prior to initiating bisphosphonate therapy, including panoramic dental x-rays.
