Prep U: Chapter 30: Management of Patients with Hematologic Neoplasms

A nurse cares for a client with early Hodgkin lymphoma. While assessing the client, the nurse will most likely find painless enlargement of which lymph node? Cervical Popliteal Inguinal Axillary

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

A client is taking dasatinib as prescribed. Which findings indicate to the nurse the client is experiencing adverse effects from this medication? Select all that apply. Hypoactive bowel sounds Prolonged QT interval on electrocardiogram Chills Decreased urine output Fever

Chills Fever Decreased urine output Prolonged QT interval on electrocardiogram Most TKIs are oral agents whose effectiveness depends upon the client's ability and motivation to adhere to the prescribed treatment regimen. These drugs may cause side effects that the client may find difficult to manage. Adverse effects of these medications include signs of myelosuppression to include chills and fever. Decreased urine output and a prolonged QT interval are additional adverse effects of TKIs. Hypoactive bowel sounds are not identified as adverse effects of TKIs.

For a client with Hodgkin lymphoma, who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse places the client in a high Fowler's position to reduce deficits in the blood oxygen concentration. detect compromised ventilation. anticipate the need for airway management. increase lung expansion.

increase lung expansion. Explanation: For a client with Hodgkin disease who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse keeps the neck in the midline and places the client in a high Fowler's position if respiratory distress develops. Avoiding unnecessary pressure on the trachea and positioning for increased lung expansion improve air exchange. The nurse administers oxygen, per the physician's orders, to reduce deficits in the blood oxygen concentration. The nurse assesses the client's respiratory status during each shift to detect compromised ventilation. The nurse places an endotracheal tube, a laryngoscope, and a bag-valve mask at the bedside for intubation if the need for the airway management arises.

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 Remission Bone marrow depression Graft-versus-host disease

Graft-versus-host disease Explanation: 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.

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

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 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. Request a prescription of diphenoxylate and atropine for loose stools. Perform a neurologic assessment with vital signs. 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.

A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client is not appropriately dealing with spiritual distress? "I do not understand why this happened to me." "I am going to call my clergy to pray with me." "I have resources within myself that I can depend on." "I know I am going to die. I want to say good-bye to my family."

"I do not understand why this happened to me." Explanation: The statement "I do not understand why this happened to me" indicates that the client is not accepting of the consequences of his health problems and impending death. The other statements indicate the client has plans that would result in spiritual well-being or harmony.

Acute myeloid leukemia (AML) results from a defect in the hematopoietic stem cell that differentiates into which of the following myeloid cells? Select all that apply. Islet cells Monocytes Erythrocytes Platelets Granulocytes

Monocytes Granulocytes Erythrocytes Platelets AML results from a defect in the hematopoietic stem cell that differentiates into all myeloid cells: monocytes, granulocytes, erythrocytes, and platelets. Islet cells are associated with the pancreas.

A client with chronic lymphocytic leukemia (CLL) wants to have treatment for the condition. Which medication will the nurse question for this client? Dexamethasone Vincristine Ipilimumab Heparin

Heparin Explanation: Commonly prescribed pharmacological therapies for chronic lymphocytic leukemia (CLL) include immunotherapy agents (ipilimumab), corticosteroids (dexamethasone), and chemotherapeutic agents (vincristine). Clients with CLL are at risk of bleeding, and therefore the use of anticoagulants (heparin) is contraindicated.

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 1 and that the laboratory results will reveal 2

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 and that the laboratory results will reveal thrombocytopenia

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

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

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

"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.

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 24-year-old female taking oral contraceptives A 52-year-old patient with acute kidney injury A 40-year-old patient with a history of hypertension

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.

A client with a new onset of rib and spine pain is being evaluated for multiple myeloma. For which manifestations will the nurse assess this client? Select all that apply. Bone destructions Hypercalcemia Anemia Renal dysfunction Lymph enlargement

Anemia Hypercalcemia Renal dysfunction Bone destructions Explanation: Clinical manifestations of multiple myeloma result not only from the malignant cells themselves, but also from the abnormal protein they produce. The classic clinical manifestations of multiple myeloma are referred to as the CRAB features and include anemia, hypercalcemia, renal dysfunction, and bone destruction. Lymph enlargement is associated with lymphomas, but not with multiple myeloma.

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

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.

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

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 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 Induction therapy Standard therapy Supportive 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.

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 Neutropenia Anemia

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.

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? Platelet count of 9,000/mm3 Hematocrit of 38% WBC count of 4,200 cells/uL Creatinine level of 1.0 mg/dL

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 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. Practice vigilant handwashing. Encourage increased fluid consumption. 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 multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? Risk for falls Acute pain Sensory-perception disturbance Impaired tissue integrity

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 assisting the client with multiple myeloma to ambulate. What is the most important nursing intervention to help prevent fractures in the client? Provide adequate hydration. Increase mobility. Promote safety. Encourage adequate nutrition.

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.

The nurse is caring for a client with erythematous fingers and renal calculi. Which assessment findings help determine if the client is experiencing polycythemia vera? Select all that apply. Enlarged spleen Received erythropoietin injections History of receiving blood transfusions Body mass index 33 Difficulty swallowing

Received erythropoietin injections History of receiving blood transfusions Enlarged spleen Body mass index 33 The diagnosis of polycythemia vera is based upon the evaluation of clinical symptoms and laboratory values. An abdominal symptom of polycythemia vera is an enlarged spleen. Obesity is a cardiovascular risk factor for the condition. A history of receiving erythropoietin injections and receiving blood transfusion are both risk factors for the condition. Difficulty swallowing is not a symptom of polycythemia vera.

Select 1: hyperkalemia , infection , hemorrhage , deep vein thrombosis Select 2: thrombocytopenia, leukocytosis, abnormal renal function tests, electrolyte imbalances

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).

A home care nurse is caring for a client with multiple myeloma. Which nursing interventions are appropriate for this client? Select all that apply. Limit fluid intake. Assist with ambulation because exercise can worsen loss of calcium from the bone. Delay position changes and bathing if the client is experiencing pain. Monitor renal function Instruct the client to avoid activities that may cause injury.

Delay position changes and bathing if the client is experiencing pain. Instruct the client to avoid activities that may cause injury. Monitor renal function Pain can become quite severe. Delay position changes and bathing until analgesic has reached peak concentration level and the client is experiencing maximum pain relief. Safety is paramount because any injury, no matter how slight, can result in a fracture. The nurse assists the client with ambulation because immobility can worsen loss of calcium from the bone. The nurse provides up to 4000 mL of fluid to prevent renal damage from hypercalcemia and precipitation of protein in the renal tubules.

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

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.

Select 1: hyperkalemia , infection , hemorrhage , deep vein thrombosis Select 2: thrombocytopenia, leukocytosis, abnormal renal function tests, electrolyte imbalances

Manifestations of DVT include calf pain, leg swelling, + 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, + ecchymosis. Electrolyte imbalances and abnormal renal function also do not cause petechiae, epistaxis, and ecchymosis.

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 Osteoporosis Calcified bones

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

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

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.

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? Complete blood count Alkaline phosphatase level Bone marrow analysis Clotting factors

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.

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

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.

A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity? Limit fluids to prevent going to the bathroom. Limit activity to once a day. Stay in bed as much as possible. Do not lift more than 10 pounds.

Do not lift more than 10 pounds. Explanation: The client with multiple myeloma needs education about activity instructions, such as lifting no more than 10 pounds and using proper body mechanics. Braces may be needed. The client should be active and would not be instructed to stay in bed or limit activity, as he or she would become very stiff. Limiting fluids would be contraindicated; the client needs to remain well hydrated.

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

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? Hemoglobin and hematocrit Leukocyte and platelet count Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels Blood urea nitrogen (BUN) and creatinine levels

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

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? peripheral edema pale body color weight gain splenomegaly

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.