Chapter 32: Caring for Clients with Disorders of the Lymphatic System

A client with Hodgkin lymphoma is receiving information from the oncology nurse. The client asks the nurse why it is necessary to stop drinking and smoking and stay out of the sun. Which response by the nurse would be best? "It's important to reduce other factors that increase the risk of second cancers." "Engaging in these activities increases your risk of hemorrhage." "These behaviors can reduce the effectiveness of your chemotherapy." "Avoiding these factors can reduce the risk of Reed-Sternberg cells developing."

"It's important to reduce other factors that increase the risk of second cancers." Explanation: The nurse should encourage clients 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. The presence of Reed-Sternberg cells is the pathologic hallmark and essential diagnostic criterion for Hodgkin lymphoma, so avoiding these behaviors will not reduce the risk of Reed-Sternberg cells developing. There is no evidence that these behaviors will reduce the effectiveness of chemotherapy or increase the risk of hemorrhage, which is not a typical complication of Hodgkin lymphoma.

A public health nurse is planning community teaching for a group of older adults regarding aging and hematological conditions. What condition will the nurse identify as most common among this population? -Thalassemia -Anemia -Leukemia -Lymphopenia

Anemia Explanation: Anemia is the most common hematological condition in older adults, particularly those admitted to hospitals and long-term care facilities.

A nurse is caring for a client with multiple myeloma who is experiencing bone destruction. When reviewing the client's most recent blood tests, the nurse will identify which clinical finding(s)? Select all that apply. Hyperproteinemia Elevated serum viscosity Decreased red blood cell (RBC) count Hyperlipidemia Hypercalcemia

Hypercalcemia Elevated serum viscosity Decreased red blood cell (RBC) count Explanation: Hypercalcemia may result when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin. RBC count will be decreased. Neither hyperlipidemia nor hyperproteinemia would be relevant.

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

Induction therapy Explanation: Despite advances in understanding of the biology of AML, substantive advances in treatment response rates and survival rates have not occurred for decades, with the exception of advances made in treating APL (see later discussion). Even for patients with subtypes that have not benefited from advances in treatment, cure is still possible. The overall objective of treatment is to achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow. Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks.

An adult client's abnormal complete blood count (CBC) and physical assessment have prompted the primary care provider to order a diagnostic workup for Hodgkin lymphoma. The presence of what assessment finding is considered diagnostic of the disease? -Loops of Henle -Lewy bodies -Reed-Sternberg cells -Schwann cells

Reed-Sternberg cells Explanation: The malignant cell of Hodgkin lymphoma is the Reed-Sternberg cell, a gigantic tumor cell that is morphologically unique and thought to be of immature lymphoid origin. It is the pathologic hallmark and essential diagnostic criterion. Schwann cells exist in the peripheral nervous system and Lewy bodies are markers of Parkinson disease. Loops of Henle exist in nephrons.

A client hospitalized with Hodgkin's disease is currently under visitor restrictions and asks the nurse why this is necessary. Which of the following explanations from the nurse is most accurate? The nurse needs to minimize the possibility of the client transmitting his or her illness to others. The client needs as much rest as possible to facilitate recovery. The client will be too weakened to interact effectively. Restricting visitors and personnel reduces the risk of transmission of pathogens to the client.

Restricting visitors and personnel reduces the risk of transmission of pathogens to the client. Explanation: Reducing the number of organisms in the environment and restricting visitors and personnel with an infection reduce the transmission of pathogens to the client, whose immune system may be compromised as a result of the illness and treatment for it. While the client may be weak and does need rest, these are not the primary reasons for activity restrictions. The client's illness is not contagious.

A client at the health care facility is diagnosed with Hodgkin's disease that has extended to the liver. What stage should the nurse use to describe the progress of the disease? -Stage II -Stage IV -Stage III -Stage I

Stage IV Explanation: In stage IV, the disease extends to one or more extralymphatic organs or tissue. Here, it has extended to the liver. In stage I, the disease is limited to a single node or single extralymphatic site. In stage II, the disease spreads to more than a single node, but is confined to one side of the diaphragm, and in stage III, the disease is present both above and below the diaphragm.

Laboratory and diagnostic test results have returned for a client with suspected lymphangitis. Which of the following would be most likely for the nurse to review in the results? -Escherichia coli -Staphylococcus -Streptococcus -Pseudomonas

Streptococcus Explanation: An infectious agent, commonly a streptococcal microorganism, usually causes both lymphangitis and lymphadenitis.

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? -The client with enlarged lymph nodes in the neck. -The client with painful lymph nodes in the groin. -The client with painful lymph nodes under the arm. -The client with a painful sore throat.

The client with enlarged lymph nodes in the neck. Explanation: Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.

A client has a history of lymphedema. Impaired nutrition to the client's tissues could lead to: -tenting skin. -ulcers and infection in the edematous area. -cyanosis. -evident scaring.

ulcers and infection in the edematous area. Explanation: In a client with lymphedema, tissue nutrition is impaired from the stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area.