Ch. 34: Management of Patients With Hematologic Neoplasms

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)?

A 72-year-old patient with a history of cancer

Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

Myeloid stem cell

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has?

A general reduction in all white blood cells

Which of the following is the only curative treatment for chronic myeloid leukemia (CML)?

Allogeneic stem cell transplant

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?

Iron levels

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

A patient has completed induction therapy and has diarrhoea and severe mucositis. What is the appropriate nursing goal?

Maintain nutrition.

A client has been diagnosed with polycythemia vera. It is most important for the nurse to teach the client about:

Maintaining adequate blood pressure control

A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for:

pathologic bone fractures.

The nurse practitioner suspects that a patient has multiple myeloma based on his major presenting symptom and the analysis of his laboratory results. Select the classic symptom for this disease.

Bone pain in the back of the ribs

A 40-year-old client has multiple myeloma. Prior to starting treatment with thalidomide (Thalomid), it is most important for the nurse to:

Contract with the client regarding birth-control methods.

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia?

Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.

A patient is scheduled for a test to help confirm the diagnosis of acute myeloid leukemia (AML). Which of the following is the result that the nurse knows is consistent with the diagnosis?

Excess of immature blast cells

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?

Graft-versus-host disease

When assessing a female patient with a disorder of the hematopoietic or the lymphatic system, which of the following assessments is most essential?

Health history, such as bleeding, fatigue, or fainting

Which of the following terms refers to a form of white blood cell involved in immune response?

Lymphocyte

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

The nurse is teaching a patient about the development of leukemia. What statement should be included in the teaching plan?

"Chronic leukemia develops slowly."

The nurse is caring for a patient 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 (Zyloprim)

A patient with multiple myeloma is complaining about pain. What instructions will the nurse give the patient to help to reduce pain during activity?

Do not lift more than 10 pounds.

A patient with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention?

Evaluate the patient for potential infection.

What assessment findings best indicate that the patient has recovered from induction therapy?

Neutrophil and platelet counts within normal limits

The term that is used to refer to a primitive cell, capable of self-replication and differentiation, is which of the following?

Stem cell

You are assisting your client with multiple myeloma to ambulate. What is the most important nursing diagnosis to help prevent fractures in this client?

Safety

A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client has not achieved the goal for the nursing diagnosis Spiritual Distress?

"I do not understand why this happened to me."

The nurse is teaching a patient with acute lymphocytic leukemia (ALL) about therapy. What statements should be included in the plan of care?

"Intrathecal chemotherapy is used primarily as preventive therapy."

A nurse has established for a client the nursing diagnosis of risk for infection. Which of the following interventions would the nurse include in the plan of care for this client? Select all answers that apply.

-Assess skin and mucus membranes every shift. -Auscultate lung sounds every shift and prn. -Encourage the client to take deep breaths every 4 hours while awake.

A patient presents with peripheral neuropathy and hypothesia of the feet. What is the best nursing intervention?

Assess for signs of injury.

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?

Assist the client to sit in a chair for meals.

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

Hypercalcemia

For a patient with Hodgkin disease, who is at a risk for an ineffective airway clearance and an impaired gas exchange, the nurse places the patient in a high Fowler's position to do which of the following?

Increase the lung expansion.

A client has been diagnosed with multiple myeloma. Which of the following laboratory values should the nurse expect to find in a client with multiple myeloma?

Increased urinary protein

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

A patient with acute myeloid leukemia (AML) has a neutrophil count that persists at less than 100/mm3. What should the nurse cautiously monitor this patient for?

Infection

The hospitalized client is experiencing gastrointestinal bleeding. Laboratory test results show that the client's platelets are 9000/mm³. The client is receiving prednisone and azathioprine (Imuran). The nurse:

Performs a neurologic assessment with vital signs

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?

Phlebotomy

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

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

Which nursing intervention is most appropriate for a client with multiple myeloma?

Preventing bone injury

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 can develop osteonecrosis of the jaw.

The nurse is assessing several patients. Which patient does the nurse determine is most likely to have Hodgkin lymphoma?

The patient with enlarged lymph nodes in the neck.

Which of the following statements best describes the function of stem cells in the bone marrow?

They produce all blood cells.

What is the rationale for the classification of leukemia?

Which bone marrow stem cell line is dysfunctional

A patient is being evaluated for a diagnosis of chronic myeloid leukemia (CML). The nurse understands that a diagnostic indicator is:

A leukocyte count >100,000/mm3.

A patient who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action?

Evaluate the patient's platelet count.

The nurse is interacting with a family that has been caring for a patient 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.

The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient?

Ruddy complexion