Hinkle Chapter 30: Management of Patients with Hematologic Neoplasms

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 deposit in small vessels. Bone marrow expands. Lymph nodes expand. Abnormal blood cells crystalize.

Bone marrow expands In acute myeloid leukemia, bone pain is caused when the bone marrow expands.

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% Platelet count of 9,000/mm3 Creatinine level of 1.0 mg/dL

Platelet count of 9,000/mm3 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.

A nurse plans care for a client with multiple myeloma. Using the CRAB acronym for symptoms associated with this disease, which clinical features does the nurse expect to find upon assessment of the client? Select all that apply. Hypercalcemia Renal insufficiency Anemia Bone lesions Acidosis

Hypercalcemia Renal insufficiency Anemia Bone lesions 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.

A client has been diagnosed with polycythemia vera. What is the best instruction for the nurse to give to this client? Take a daily multivitamin with iron supplement Maintain adequate blood pressure control Drink alcohol to decrease blood viscosity Bath in tepid or cool water to control itching

Maintain adequate blood pressure control The client with polycythemia vera needs to control blood pressure, because of the increased risk for thrombosis or hemorrhage. Iron supplements can stimulate red blood cell production. Ingestion of alcohol may cause bleeding. Bathing in cool or tepid water may control itching, but this is not as high a priority as preventing thrombosis or hemorrhage.

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? Address issues of negative body image. Place the client in reverse isolation. Administer pain medication. Maintain nutrition.

Maintain nutrition. 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 Multiple myeloma Hodgkin lymphoma Non-Hodgkin lymphoma

Multiple myeloma 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.

What assessment finding best indicates that the client has recovered from induction therapy? Neutrophil and platelet counts within normal limits Vital signs within normal ranges No evidence of edema Absence of bone pain

Neutrophil and platelet counts within normal limits Recovery from induction therapy is indicated when the neutrophil and platelet counts have returned to normal and any infection has resolved. Stable vital signs, lack of edema, and absence of pain are not indicative of recovery from induction therapy.

The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? "Treatment is simple and consists of single-drug therapy." "Intrathecal chemotherapy is used primarily as preventive therapy." "The goal of therapy is palliation." "Side effects are rare with therapy."

"Intrathecal chemotherapy is used primarily as preventive therapy." 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.

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A 24-year-old female taking oral contraceptives A 40-year-old patient with a history of hypertension A 52-year-old patient with acute kidney injury A 72-year-old patient with a history of cancer

A 72-year-old patient with a history of cancer Primary MDS tends to be a disease of people older than 70 years. Because the initial findings are so subtle, the disease may not be diagnosed until later in the illness trajectory, if at all. Thus, the actual incidence of MDS is not known.

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? Too many erythrocytes A decrease in granulocytes A general reduction in all white blood cells A general reduction in neutrophils and basophilsf

A general reduction in all white blood cells Leukopenia is a general reduction in all WBCs. Leukopenia does not have anything to do with erythrocytes.

Which assessment findings support the client's diagnosis of acute myeloid leukemia? Select all that apply. Petechiae Enlarged lymph nodes Weakness and fatigue Enlarged heart Bone pain

Petechiae Enlarged lymph nodes Weakness and fatigue Bone pain Clients with AML may present with petechiae, enlarged lymph nodes, weakness, fatigue, and bone pain. An enlarged heart is not a typical finding with this disorder.

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? Blood transfusions Radiation Chelation therapy Phlebotomy

Phlebotomy The objective of management is to reduce the high RBC count and reduce the risk of thrombosis. Phlebotomy is an important part of therapy (Fig. 34-5). It involves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete the patient's iron stores, thereby rendering the patient iron deficient and consequently unable to continue to manufacture hemoglobin excessively.

The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? Pale skin and mucous membranes Bronze skin tone Ruddy complexion Jaundice skin and sclera

Ruddy complexion Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.

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 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.

A client with leukemia is experiencing recurrent fevers. Which actions will the nurse take to improve this client's comfort? Select all that apply. Sponge with cool water. Apply ice packs to the groin. Change bed clothes frequently. Provide acetaminophen as prescribed. Provide a warm beverage before bedtime.

Sponge with cool water. Change bed clothes frequently. Provide acetaminophen as prescribed. Recurrent fevers are common in acute leukemia. Treatment for this symptom includes sponging with cool water and changing the bed clothes frequently. Acetaminophen should be provided as prescribed. Ice packs should be avoided because the heat cannot dissipate from the constricted blood vessels. A warm beverage before bedtime may encourage sweating and is not identified as an action to improve comfort.

A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? Histology of tissue Staging of disease Involvement of lymph nodes Total blood cell count

Staging of disease 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 painful lymph nodes in the groin. The client with enlarged lymph nodes in the neck. The client with a painful sore throat.

The client with enlarged lymph nodes in the neck. 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.

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "Acute leukemia develops slowly." "Chronic leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature." "In acute leukemia there are not many undifferentiated cells."

"Chronic leukemia develops slowly." 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 therapy is administered to reduce the chance of leukemia recurrence." "Consolidation occurs as a side effect of chemotherapy." "Consolidation of the lungs is an expected effect of induction therapy." "Consolidation is the term used when a client does not tolerate chemotherapy."

"Consolidation therapy is administered to reduce the chance of leukemia recurrence." 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.

The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? Allopurinol Filgrastim Hydroxyurea Asparaginase

Allopurinol 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

A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? Elevate the client's legs. Encourage ambulation. Assess for signs of injury. Keep the feet cool.

Assess for signs of injury. 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. Restrict use of tobacco. Reduce intake of alcohol. Limit the intake of citrus fruits. Avoid foods high in carbohydrates.

Avoid excessive sunlight. Restrict use of tobacco. Reduce intake of alcohol. 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 caring for a client with chronic myeloid leukemia (CML) who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission? Chronic Transformation Accelerated Blast crisis

Chronic 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 who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? Ask the client whether they have recently fallen. Evaluate the client's INR. Keep the client on bed rest. Evaluate the client's platelet count.

Evaluate the client's platelet count. 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 The bone marrow biopsy of a client with acute myeloid leukemia will reveal an excess of immature leukocytes.

A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host? Acute respiratory distress syndrome Graft-versus-host disease Remission Bone marrow depression

Graft-versus-host disease Patients who undergo HSCT have a significant risk of infection, graft-versus host disease (in which the donor's lymphocytes [graft] recognize the patient's body as "foreign" and set up reactions to attack the foreign host), and other complications.

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? Health history, such as bleeding, fatigue, or fainting Menstrual history Age and gender Lifestyle assessments, such as exercise routines

Health history, such as bleeding, fatigue, or fainting 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 Hyperkalemia Hypernatremia Hypermagnesemia

Hypercalcemia Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.

A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive? Induction therapy Supportive therapy Antimicrobial therapy Standard therapy

Induction therapy 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.

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 Iron levels Magnesium levels Potassium levels

Iron levels For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).

A patient is taking hydroxyurea for the treatment of primary myelofibrosis. While the patient is taking this medication, what will the nurse monitor to determine effectiveness? Leukocyte and platelet count Blood urea nitrogen (BUN) and creatinine levels Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels Hemoglobin and hematocrit

Leukocyte and platelet count Hydroxyurea is often used in patients with primary myelofibrosis to control high leukocyte and platelet counts and to reduce the size of the spleen.

Which term refers to a form of white blood cell involved in immune response? Granulocyte Lymphocyte Spherocyte Thrombocyte

Lymphocyte Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.

A 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? Hemolytic anemia Polycythemia vera Leukemia Multiple myeloma

Multiple myeloma The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

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

Neutropenia 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.

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? Increase mobility. Provide adequate hydration. Promote safety. Encourage adequate nutrition.

Promote safety. 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 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 Risk for falls Impaired tissue integrity Sensory-perception disturbance

Risk for falls 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 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 osteonecrosis of the jaw. The patient can develop loosening of the teeth.

The patient can develop osteonecrosis of the jaw. Osteonecrosis of the jaw is an infrequent but serious complication that can arise in patients treated long-term with bisphosphonates; the mandible or maxilla are affected. Careful assessment for this complication should be conducted and a thorough evaluation of the patient's dentition should be performed prior to initiating bisphosphonate therapy, including panoramic dental x-rays.

Which statement best describes the function of stem cells in the bone marrow? They are active against hypersensitivity reactions. They defend against bacterial infection. They produce all blood cells. They produce antibodies against foreign antigens.

They produce all blood cells. 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.

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? Assess the client's skin. Assess the client's hemoglobin and platelets. Assess the client's pulse and blood pressure. Check the client's history.

Assess the client's hemoglobin and platelets. 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.

Which statement indicates the client understands teaching about induction therapy for leukemia? "I will start slowly with medication treatment." "I will need to come every week for treatment." "I will be in the hospital for several weeks." "I know I can never be cured."

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

A nurse is teaching a client with multiple myeloma about the therapeutic benefits of radiation therapy. Which statements will the nurse include in the teaching? Select all that apply. "It helps to strengthen the bone." "It helps to decrease bone pain." "It decreases the bone malignancy." "It decreases excess calcium." "It helps to activate an immune response."

"It helps to strengthen the bone." "It helps to decrease bone pain." Radiation therapy is useful in strengthening the bone at a specific lesion, particularly a bone at risk for fracture or spinal cord compression. It is also extremely useful in relieving bone pain. Radiation therapy is not effective in decreasing bone malignancy, decreasing excess calcium, or activating an immune response.

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? Have the client maintain complete bedrest. Assist the client to sit in a chair for meals. Talk to the family about not visiting so the client can obtain rest. Provide sedentary activities only, such as watching television.

Assist the client to sit in a chair for meals. 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.

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 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 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. Place heating pads on the client's back. Administer pain medication, as ordered. Assess renal function.

Assess renal function. 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.

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. Osteolytic activating factor weakens bones producing fractures. Osteosarcomas form producing pathologic fractures.

Osteoclasts break down bone cells so pathologic fractures occur. The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This in turn causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a 'punched-out' or 'honeycombed' appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. Options A, C, and D are distractors for this question.

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

Pancytopenia 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.

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 Osteoporosis Calcified bones Increased mobility

Pathologic fractures Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.

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. 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.

A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? chronic liver failure. acute heart failure. pathologic bone fractures. hypoxemia.

pathologic bone fractures Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.

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 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.

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? Debilitating fatigue Bone pain in the back of the ribs Gradual muscle paralysis Severe thrombocytopenia

Bone pain in the back of the ribs Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; clients may report that they have less pain on awakening but the pain intensity increases during the day.

The nurse is providing teaching to a client diagnosed with chronic myeloid leukemia (CML). Which statement will the nurse include in the teaching on the pathophysiology of the disease? "Uncontrolled growth of blood cells causes the marrow to expand to organs." "Uncontrolled growth of blood cells causes occlusion in the vessels and tissues." "Abnormally-shaped blood cells cause malfunction of the marrow." "Abnormally-shaped blood cells cause thickening of the vessels and leads to necrosis of tissue."

"Uncontrolled growth of blood cells causes the marrow to expand to organs." Because there is an uncontrolled proliferation of cells, the marrow expands into the cavities of long bones, such as the femur, and cells are also formed in the liver and spleen (extramedullary hematopoiesis), resulting in enlargement of these organs that is sometimes painful.

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? Blood transfusions Hypomethylating agents Erythropoiesis-stimulating agents Allogeneic hematopoietic stem cell transplantation

Allogeneic hematopoietic stem cell transplantation Medical management strategies for MDS are based on risk stratification to determine stage of disease and prognosis. Allogeneic HSCT continues to be the only potential option of cure for MDS. Blood transfusions are used for those with low-risk disease. Hypomethylating agents are used to treat clients with low to intermediate-risk disease. Erythropoiesis-stimulating agents are used to treat clients with low risk disease.

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 Inguinal Popliteal

Cervical Non painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.

A client with acute myeloid leukemia (AML) receiving chemotherapy is treated for an acute renal injury. What is the nurse's best understanding of the pathophysiological reason behind the client's injury? The majority of the disease process occurs in the tissue of the kidneys. Chemotherapy causes an increase in kidney stone formation. Chemotherapy causes destruction of the nephrons in the kidney. The majority of the disease process occurs in the vessels of the kidneys.

Chemotherapy causes an increase in kidney stone formation. Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. This causes an increase in uric acid levels, potassium, and phosphate (also known as tumor lysis). The increase in uric acid predisposes the client to the development of kidney stones and increases the risk for renal injury.

The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply. Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance. Suggest the prescription of antianxiety medications. Suggest the family go to church more often.

Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance. 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.

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. Put on a mask, gown, and gloves when entering the client's room. Provide a clear liquid, low-sodium diet. 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. 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? Pruritis Dizziness Early satiety Ruddy complexion

Pruritis 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.

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.) Reduce exposure to excessive sunlight Smoking cessation Decrease alcohol intake Decrease intake of antipyretic medications such as acetaminophen Decrease fat intake

Reduce exposure to excessive sunlight Smoking cessation Decrease alcohol intake The potential development of a second malignancy should be addressed with the patient when initial treatment decisions are made. However, patients should also be told that Hodgkin lymphoma is often curable. The nurse should encourage patients to reduce other factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and exposure to environmental carcinogens and excessive sunlight.

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? Increased basophils Reed-Sternberg cells Elevated platelet count Misshaped red blood cells

Reed-Sternberg cells 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 polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom? The dead red blood cells release excess uric acid. The dead red blood cells occlude the small vessels in the joints. Excess red blood cells produce extracellular toxins that build up. Excess red blood cells cause vascular injury in the joints.

The dead red blood cells release excess uric acid. 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 client with myelofibrosis is experiencing extreme fatigue. Which suggestions will the nurse recommend to this client? Select all that apply. Use adaptive equipment as needed Take a walk Set activity priorities Increase bedrest Postpone nonessential activities

Use adaptive equipment as needed Take a walk Set activity priorities Postpone nonessential activities Fatigue is a major symptom in clients with myelofibrosis. Actions to reduce the fatigue focus on energy conservation activities to include exercise, taking a walk, setting activity priorities, and postponing non-essential activities. Increased bedrest is not a strategy to reduce the fatigue caused by this condition.

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 weight gain peripheral edema pale body color

splenomegaly Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, weight loss, paresthesias, and blurred vision). Edema, pale body color, and weight gain are not classic symptoms of PV.