Chapter 30 Prepu: Management of Patients with Hematologic Neoplasms
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? a. "Acute leukemia develops slowly." b. "In acute leukemia there are not many undifferentiated cells." c. "In chronic leukemia, the minority of leukocytes are mature." d. "Chronic leukemia develops slowly."
"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? a. "Consolidation is the term used when a client does not tolerate chemotherapy." b. "Consolidation therapy is administered to reduce the chance of leukemia recurrence." c. "Consolidation of the lungs is an expected effect of induction therapy." d. "Consolidation occurs as a side effect of 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 of recurrence. It is also termed post-remission therapy. It is not a side effect of chemotherapy, but the administration of chemotherapy.)
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? a. "Side effects are rare with therapy." b. "Intrathecal chemotherapy is used primarily as preventive therapy." c. "The goal of therapy is palliation." d. Treatment is simple and consists of single-drug 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.)
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? a. Assess for signs of injury. b. Keep the feet cool. c. Elevate the client's legs. d. Encourage ambulation.
Assess for signs of injury. (Hypoesthesia = numbness) (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.)
A client who is undergoing chemotherapy for AML reports pain in the lower back. What is the nurse's first action? a. Refer the client to a chiropractor. b. Place heating pads on the client's back. c. Assess renal function. d. Administer pain medication, as ordered.
Assess renal function.
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. (Clients with AML= acute multiple myeloma, 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 which diagnostic test will be used as the hallmark for the diagnosis? a. Complete blood count b. Clotting factors c. Bone marrow analysis d. 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.)
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? a. Lymph nodes expand. b. Bone marrow expands. c. Abnormal blood cells crystalize. d. Abnormal blood cells deposit in small vessels.
Bone marrow expands.
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? a. Inguinal b. Axillary c. Popliteal d. Cervical
Cervical Non painful swelling of the cervical lymph nodes is the earliest symptom of 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? a. Chronic b. Accelerated c. Transformation d. Blast crisis
Chronic
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? a. Excess of immature leukocytes b. Deficiency of erythrocytes c. Excess of immature erythrocytes d. Deficiency of neutrophils
Excess of immature leukocytes
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. a. Hypercalcemia b. Bone lesions c. Renal insufficiency d. Acidosis e. Anemia
Hypercalcemia Renal insufficiency Anemia Bone lesions (The acronym CRAB is used to describe the combined pathologic effects of multiple myeloma and include elevated calcium levels (hypercalcemia), renal insufficiency, anemia, and bone lesions. Acidosis is not part of the acronym used to describe the pathologic effects of the disease.)
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? a. Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels b. Hemoglobin and hematocrit c. Leukocyte and platelet count d. Blood urea nitrogen (BUN) and creatinine levels
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.)
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? a. Address issues of negative body image. b. Maintain nutrition. c. Administer pain medication. d. Place the client in reverse isolation.
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? a. Multiple myeloma b. Non-Hodgkin lymphoma c. Hodgkin lymphoma d. Chronic myeloid leukemia
Multiple myeloma Any older adult with unprovoked or unexplained back pain and increased protein in the serum should be assessed for multiple myeloma.
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? a. Thrombocytopenia b. Neutropenia c. Anemia d. Pancytopenia
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.)
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? a. Pancytopenia b. Thrombocytopenia c. Leukopenia d. Anemia
Pancytopenia describes having low levels of all three blood cell types: red blood cells, white blood cells and platelets.
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? a. hypoxemia. b. pathologic bone fractures. c. chronic liver failure. d. acute heart failure.
Pathologic bone fractures.
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? a. Osteoporosis b. Pathologic fractures c. Increased mobility d. Calcified bones
Pathologic fractures (Pathologic fracturesOsteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.)
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? a. Radiation b. Phlebotomy c. Blood transfusions d. Chelation therapy
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 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? a. WBC count of 4,200 cells/uL b. Platelet count of 9,000/mm3 c. Creatinine level of 1.0 mg/dL d. Hematocrit of 38%
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.)
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? a. Increase mobility. b. Provide adequate hydration. c. Promote safety. d. 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 is awaiting test results to diagnose Hodgkin lymphoma. The nurse knows that which result is the hallmark for the diagnosis of this condition? a. Elevated platelet count b. Misshaped red blood cells c. Increased basophils d. Reed-Sternberg 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.)
Which statement indicates the client understands teaching about induction therapy for leukemia? a. "I will be in the hospital for several weeks." b. "I will start slowly with medication treatment." c. "I will need to come every week for treatment." d. "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.)
The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? a. Too many erythrocytes b. A general reduction in neutrophils and basophils c. A decrease in granulocytes d. A general reduction in all white blood cells
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.)
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. a. Avoid excessive sunlight. b. Avoid foods high in carbohydrates. c. Limit the intake of citrus fruits. d. Reduce intake of alcohol. e. Restrict the use of tobacco.
Avoid excessive sunlight. Reduce intake of alcohol. Restrict the use of tobacco.
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? a. Bone marrow depression b. Remission c. Acute respiratory distress syndrome d. Graft-versus-host disease
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.
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? a. Hypermagnesemia b. Hypernatremia c. Hypercalcemia d. Hyperkalemia
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? a. Antimicrobial therapy b. Standard therapy c. Supportive therapy d. Induction therapy
Induction therapy
Which term refers to a form of white blood cell involved in immune response? a. Thrombocyte b. Spherocyte c. Granulocyte d. Lymphocyte
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.)
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? a. Osteopathic tumors destroy bone causing fractures. b. Osteosarcomas form producing pathologic fractures. c. Osteoclasts break down bone cells so pathologic fractures occur. d. Osteolytic activating factor weakens bones producing fractures.
Osteoclasts break down bone cells so pathologic fractures occur.
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? a. Hematocrit of 38% b. Creatinine level of 1.0 mg/dL c. WBC count of 4,200 cells/uL d. Platelet count of 9,000/mm3
Platelet count of 9,000/mm3
The nurse was discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis? a. polycythemia vera b. sickle cell disease c. aplastic anemia d. pernicious anemia
Polycythemia vera (Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow. It makes blood thicker and less able to travel through blood vessels and organs. Many of the symptoms of erythrocytosis are caused by this sluggish blood flow. In sickle cell disease, HbS causes RBCs to assume a sickled shape under hypoxic conditions. Aplastic anemia has a deficiency of erythrocytes.)
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? a. Sensory-perception disturbance b. Acute pain c. Impaired tissue integrity d. Risk for falls
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 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? a. pale body color b. weight gain c. splenomegaly d. peripheral edema
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.
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? a. Involvement of lymph nodes b. Total blood cell count c. Histology of tissue d. Staging of disease
Staging of disease
Which statement best describes the function of stem cells in the bone marrow? a. They are active against hypersensitivity reactions. b. They produce antibodies against foreign antigens. c. They defend against bacterial infection. d. They produce all blood cells.
They produce all blood cells. (All blood cells are produced from undifferentiated precursors called pluripotential stem cells in the bone marrow. Other cells produced from the pluripotential stem cells help defend against bacterial infection, produce antibodies against foreign antigens, and are active against hypersensitivity reactions.)
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 list of options. The nurse anticipates that the client has developed ________________________and that the laboratory results will reveal ______________
hemorrhage and thrombocytopenia
The nurse instructs a client with polycythemia vera on actions to reduce the symptoms. Which statement indicates that client teaching was effective? a. "I will use an alcohol-based lotion after bathing." b. "I will avoid caffeinated beverages." c. "I will take a multivitamin with iron every day." d. "I will shower in tepid water."
"I will shower in tepid water." (A common symptom in clients with polycythemia vera is pruritus, described as strong itching, stinging, or burning. The exact etiology is not known but is thought to be related to pro-inflammatory cytokines. Pruritus can be triggered by contact with water at any temperature. Bathing in tepid water is recommended as a strategy to manage pruritus. Caffeinated beverages are recommended to help manage the feelings of fatigue. A multivitamin with iron should be avoided as the iron stimulates further red blood cell production. An alcohol-based lotion can dry the skin and aggravate pruritus.)
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? a. "These screenings are health promotion activities that apply to everyone." b. "These are seen among survivors like yourself." c. "You need to do this just to be on the safe side." d. "You don't want to develop a second cancer, do you?"
"These are seen among survivors like yourself." (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.)
The nurse is reviewing the treatment options with a client diagnosed with myelodysplastic syndrome (MDS). Which therapy will the nurse emphasize as the option to cure the condition? a. Hypomethylating agents b. Blood transfusions c. Erythropoiesis-stimulating agents d. 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.) (Myelodysplastic syndrome (MDS): a group of disorders caused when something disrupts the production of blood cells. Some types have no known cause. Others occur in response to cancer treatments or chemical exposure. Symptoms may include shortness of breath, fatigue, easy bruising, and paleness. Myelodysplastic syndrome may progress to leukemia. Transfusions and medications help manage symptoms. Medications or bone marrow transplants may lessen transfusion needs and slow or prevent progression to leukemia.)
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? a. Asparaginase b. Allopurinol c. Filgrastim d. Hydroxyurea
Allopurinol - Zyloprim (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 (see Chapter 15). The increased uric acid and phosphorus levels make the patient 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 (Zyloprim) to prevent crystallization of uric acid and subsequent stone formation.)
A client is receiving chemotherapy for acute myeloid leukemia and has poor nutritional intake. What is the first action the nurse should take? a. Provide mouth care before each meal. b. Caution the client to chew carefully after administration of the prescribed lidocaine. c. Ask, "Are you experiencing nausea?" d. Provide nutritional supplements in addition to a diet that has a soft texture and moderate temperature.
Ask, "Are you experiencing nausea?" All these options are things the nurse can do to assist the client in obtaining better nutrition. The nurse first needs to assess the reason for poor nutritional intake. It could be because of nausea, in which case the nurse would implement interventions to address the client's nausea.
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. a. Renal dysfunction b. Bone destructions c. Hypercalcemia d. Lymph enlargement e. Anemia
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 suspects that a client has multiple myeloma based on the client's major presenting symptoms and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for? a. Bone pain in the back of the ribs b. Debilitating fatigue c. Gradual muscle paralysis d. 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.)
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? a. Adventitious lung sounds b. Diarrheal stools c. Hair loss d. Laryngeal edema
Diarrheal stools (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 client with primary myelofibrosis is diagnosed with splenomegaly. Which medications will the nurse prepare teaching for this client? Select all that apply. a. Hydroxyurea b. Thalidomide c. Interferon-alfa d. Anagrelide e. Pomalidomide
Hydroxyurea Thalidomide Pomalidomide (Primary myelofibrosis is characterized by extramedullary hematopoiesis [hematopoiesis occurring outside of the medulla of the bone (bone marrow)](body produces blood cells and blood plasma) that involves the spleen causing splenomegaly. Pharmacologic agents can be used to diminish splenomegaly and include hydroxyurea, thalidomide, and pomalidomide. Anagrelide and interferon-alfa are not used to treat splenomegaly caused by primary myelofibrosis.)
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? a. Magnesium levels b. Creatinine and blood urea nitrogen (BUN) levels c. Iron levels d. Potassium levels
Iron level (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).)
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? a. Practice vigilant handwashing. b. Monitor the client's temperature every shift. c. Maintain contact precautions. d. Encourage increased fluid consumption.
Practice vigilant handwashing. (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.)
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? a. Pale skin and mucous membranes b. Bronze skin tone c. Ruddy complexion d. 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.)
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? a. The patient can develop osteonecrosis of the jaw. b. The patient will develop gingival hyperplasia. c. The patient can develop loosening of the teeth. d. The patient is at risk for tooth decay.
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 patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? a. A 24-year-old female taking oral contraceptives b. A 40-year-old patient with a history of hypertension c. A 72-year-old patient with a history of cancer d. A 52-year-old patient with acute kidney injury
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.)
A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess? a. Increased number of blast cells b. An enlarged liver c. Lymphadenopathy d. A leukocyte count >100,000/mm3
A leukocyte count >100,000/mm3 (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.)
A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? a, Restricting fluid intake b. Preventing bone injury c. Balancing rest and activity d. Monitoring respiratory status
Preventing bone injury (Multiple myeloma is a cancer of plasma cells. 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.)
When assessing a female client with a disorder of the hematopoietic or lymphatic system, which assessment is most essential? a. Health history, such as bleeding, fatigue, or fainting b. Age and gender c. Lifestyle assessments, such as exercise routines d. Menstrual history
Health history, such as bleeding, fatigue, or fainting (When assessing a patient with a disorder of the hematopoietic or lymphatic system, it is essential to assess the patient'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.)
The hospitalized client is experiencing gastrointestinal bleeding with platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take? a. Use contact precautions with this client. b. Teach the client to vigorously floss the teeth to prevent infections. c. Perform a neurologic assessment with vital signs. d. Request a prescription of diphenoxylate and atropine for loose stools.
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.)