chapter 40

The nurse is teaching a client about induction therapy for acute leukemia. Which client statement indicates a need for additional education?

"After this therapy, I will not need to have any more."

A hematology unit is staffed by registered nurse's (RNs), licensed practical nurses (LPNs)/licensed vocational nurse (LVNs), and unlicensed assistive personnel (UAP). When the nurse manager is reviewing staff documentation, which entry indicates the need for staff education for his or her appropriate level of responsibility and client care?

"Client reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP"

The nurse is assessing the endurance level of a client in a long-term care facility. What question does the nurse ask to get this information?

"Do you feel more tired after you get up and go to the bathroom?"

Which client statement indicates in-home stem cell transplantation is not a viable option?

"I was a nurse, so I can take care of myself."

A client with thrombocytopenia is being discharged. Which instruction would the nurse include in a teaching plan for this client?

"Use a soft-bristled toothbrush."

The nurse is transfusing a unit of whole blood to a client when the primary health care provider prescribes "Furosemide (Lasix) 20 mg IV push." Which intervention would the nurse perform?

Administer the furosemide after completion of the transfusion.

The nurse assess the client with which hematologic condition first?

An 81-year-old with thrombocytopenia and an increase in abdominal girth

A 56-year-oldclient admitted with a diagnosis of acute myelogenous leukemia (AML) has been prescribed intravenous (IV) cytosine arabinoside and an IV infusion of daunorubicin. The client develops an infection. Which action would the nurse take to determine that the appropriate antibiotic has been prescribed to treat this condition?

Check the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection

A 32-year-oldclient is recovering from a sickle cell crisis. The client's discomfort is controlled with pain medications and discharge planning has been initiated. What medication will the nurse anticipate to be prescribed before discharge?

Hydroxyurea (Droxia)

The nurse is transfusing 2 units of packed red blood cells to a postoperative client. What electrolyte imbalance would the nurse monitor for after the blood transfusion?

Hyperkalemia

An 82-year-oldclient with anemia is prescribed 2 units of whole blood. Which assessment findings cause the nurse to discontinue the transfusion because it is unsafe for the client?

Hypertension Hypotension Rapid, bounding pulse

The nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant. What procedure does the nurse follow for administering this blood product?

Infuse the transfusion over a 15- to 30-minute period.

Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP) working on a medical-surgical unit?

Obtain vital signs on a client receiving a blood transfusion

What are serious side effects of antiviral agents prescribed for a client with acute myelogenous leukemia?

Ototoxicity Nephrotoxicity

The nurse is performing an assessment on a client with anemia. What are the typical clinical manifestations of anemia?

Pallor Fatigue Tachycardia Dyspnea on exertion

A client recovering from a sickle cell crisis is to be discharged. The nurse says to the client, "You and all clients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the primary health care provider (PHCP) will prescribe?

Penicillin V (Pen-V K)

The nurse is caring for a client with sickle cell disease. Which nursing action is most effective in reducing the potential for sepsis in this client?

Perform frequent and thorough handwashing

The nurse is caring for a client who is in sickle cell crisis. What action would the nurse perform first?

Provide pain medications as needed.

The nurse is teaching a client with newly diagnosed anemia about conserving energy. Which instructions would the nurse give to the client?

Provide yourself with four to six small, easy-to-eat meals daily." "Stop activity when shortness of breath or palpitations is present." "Allow others to perform your care during periods of extreme fatigue." "Drink small quantities of protein shakes and nutritional supplements daily."

The nurse is assessing several clients who are receiving transfusions of blood components. Which assessment finding requires immediate action by the nurse?

Respiratory rate of 36 breaths/min in a client receiving red blood cells

The nurse is to administer packed red blood cells to a client. How does the nurse ensure proper client identification?

Review all information with another registered nurse (RN)

What is the most important environmental risk for developing leukemia?

Smoking cigarettes

A client who has been newly diagnosed with leukemia is admitted to the hospital. Avoiding which potential problem takes priority in the client's nursing care plan?

infection

The nurse is teaching a client with vitamin B12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the client to eat?

Dairy products

What are the risk factors for the development of leukemia?

Down syndrome Chemical Exposure Ionizing Radiation Bone Marrow Hypoplaisa

The nurse is educating a group of young women who have sickle cell disease (SCD). Which statement from a class member indicates further teaching is necessary?

Getting an annual 'flu shot' would be dangerous for me."

A client who is receiving a blood transfusion suddenly tells the nurse, "I don't feel right!" What is the nurse's first action?

stop the transfusion

A client with leukemia is being discharged from the hospital. The nurse's discharge instructions say to keep regularly scheduled follow-up primary health care provider appointments. The client says, "I don't have transportation." Which is the most appropriate nursing response?

"The local American Cancer Society may be able to help."

The nurse is reinforcing information about genetic counseling to a client with sickle cell disease who has a healthy spouse. What information would the nurse explain to the parents about the risk of a child having sickle cell disease?

"The sickle cell trait will be inherited by your children."

A client with multiple myeloma reports bone pain that is unrelieved by analgesics. What is the most appropriate response by the nurse?

"Would you like to try some relaxation techniques?"

Which client does the nurse assign as a roommate for a client with aplastic anemia?

A 28-year-old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol)

Which client is at greatest risk for experiencing a hemolytic transfusion reaction?

A 34-year-old client with type O blood

A pediatric nurse is floated to a medical-surgical unit. Which client is assigned to the float nurse?

A 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells

A client admitted with a diagnosis of acute myelogenous leukemia is prescribed intravenous (IV) cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this drug therapy?

Bone marrow suppression

A recently admitted client who is in sickle cell crisis requests "something for pain." What medication would the nurse be prepared to administer?

Intravenous (IV) hydromorphone (Dilaudid)

The nurse is mentoring a recent graduate registered nurse (RN) about administering blood and blood products. What action does the nurse perform before starting the transfusion?

Verify with another RN all of the data on blood products.

The nurse is caring for a client with neutropenia. Which clinical manifestation indicates that the client has an infection or an infection needs to be ruled out?

Wheezes or crackles

A distant family member arrives to visit a female client recently diagnosed with leukemia. The family member asks the nurse, "What should I say to her?" Which responses does the nurse suggest?

ask her how she is feeling ask her if she needs anything "Talk to her as you normally would when you haven't seen her for a long time."

The nurse performs an assessment on a newly admitted client with thrombocytopenia. Which assessment finding requires immediate intervention by the nurse?

bleeding from the nose

Which nursing intervention most effectively protects a client with thrombocytopenia?

encourage the use of an electric shaver

The nurse is caring for a client with neutropenia who has a suspected infection. Which intervention would the nurse implement first?

obtain prescribed blood cultures