Exam 3: Oncologic Emergencies and Hematologic Disorders

Which of the following complications are three main consequences of leukemia? A) Anemia, infection, and bleeding tendencies B) Bone deformities, spherocytosis, and infection C) Polycythemia, decreased clotting time, and infection D) Lymphocytopoiesis, growth delays, and hirsutism

A) Anemia, infection, and bleeding tendencies The three main consequences of leukemia are anemia, caused by decreased erythrocyte production; infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production.

The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? A) Elevated D-dimers B) Elevated fibrinogen C) Reduced prothrombin time (PT) D) Reduced fibrin degradation products (FDPs)

A) Elevated D-dimers The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.

The nurse is caring for a client in the early stages of disseminated intravascular coagulation (DIC). At this stage, what medication would the nurse expect to be prescribed? A) Heparin B) Platelets C) Antibiotic D) Clotting factors

A) Heparin During the early phase of DIC, anticoagulants (especially heparin) are given to limit clotting and prevent the rapid consumption of circulating clotting factors and platelets. Antibiotics are given when sepsis is suspected in an attempt to prevent DIC from occurring.

What are the three most important prognostic factors in determining long-term survival for children with acute leukemia? A) Histologic type of disease, initial WBC count, and client's age at diagnosis B) Progression of illness, WBC at the time of diagnosis, and client's age at the time of diagnosis C) Histologic type of disease, initial platelet count, and type of treatment D) Type of treatment and client's sex

A) Histologic type of disease, initial WBC count, and client's age at diagnosis The factor whose prognostic value is considered to be of greatest significance in determining the long-range outcome is the histologic type of leukemia. Children with a normal or low WBC count appear to have a much better prognosis than those with a high WBC count. Children diagnosed between ages 2 and 10 have consistently demonstrated a better prognosis because of age 2 or after 10.

The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem would most likely cause these manifestations? A) Multiple myeloma B) Thrombocytopenia C) Megaloblastic anemia D) Myelodysplastic syndrome

A) Multiple myeloma Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.

Which of the following immunizations should not be given to a 4-month-old sibling of a client with leukemia? A) Oral poliovirus vaccine (OPV) B) Hepatitis B vaccine C) Diphtheria and tetanus and pertussis (DPT) vaccine D) Haemophilus influenzae type b vaccines (Hib)

A) Oral poliovirus vaccine (OPV) OPV is a live attenuated virus excreted in the stool. The excreted virus can be communicated to the immunosuppressed child, resulting in an overwhelming infection. Inactivated polio vaccine would be indicated because it isn't a live virus and wouldn't pose the threat of infection.

A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? A) Prevent patient infection. B) Avoid abnormal bleeding. C) Give pneumococcal vaccine. D) Provide companionship while isolated.

A) Prevent patient infection After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus, the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done; it should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.

A patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about? (Select all that apply.) A) Strict hand washing. B) Daily nasal swabs for culture. C) Monitor temperature every hour. D) Daily skin care and oral hygiene. E) Encourage the patient to eat all foods to increase nutrients. F) Private room with a high-efficiency particulate air (HEPA) filter

A) Strict handwashing D) Daily skin care and oral hygiene F) Private room with a high-efficiency particulate air (HEPA) filter Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora; other people; and uncooked meats, seafood, and eggs; unwashed fruits and vegetables; and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4° F or more, but temperature is not monitored every hour.

Which of the following is the reason to perform a spinal tap on a client newly diagnosed with leukemia? A) To assess for central nervous system infiltration B) To aid in classification of the leukemia C) To rule out meningitis D) To decrease intracranial pressure

A) To assess for central nervous system infiltration A spinal tap is performed to check if leukemia has infiltrated into the central nervous system specifically to the cerebrospinal fluid (CSF).

The nurse is developing a plan of care for the client with multiple myeloma. The nurse includes which priority intervention in the plan of care? A. Encouraging fluids B. Providing frequent oral care C. Coughing and deep breathing D. Monitoring red blood cell count

A. Encouraging fluids Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain an output of 1.5 to 2 L a day. Clients require about 3 L of fluid per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in renal tubules.

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder? A. Increased WBC's B. Increased calcium levels C. Decreased blood urea nitrogen D. Decreased number of plasma cells in the bone marrow.

B. Increased calcium levels Hypercalcemia (increased calcium level) is caused by the release of calcium from the deteriorating bone tissue in multiple myeloma. This may cause symptoms of excessive thirst, constipation, dehydration, nausea, frequent urination, dizziness, confusion, and eventually to coma.

A client is at risk for developing disseminated intravascular coagulopathy (DIC). The nurse determines that which fibrinogen level is normal? A) 170 mg/dL (1.7 g/L) B) 400 mg/dL (4.0 g/L) C) 480 mg/dL (4.8 g/L) D) 500 mg/dL (5.0 g/L)

B) 400 mg/dL (4.0 g/L) The normal fibrinogen level is 200 to 400 mg/dL (2 to 4 g/L). With DIC, the fibrinogen level drops because fibrinogen is used up in the clotting process. The correct option is the only one that identifies a normal level.

Which of the following types of leukemia carries the best prognosis? A) Basophilic leukemia B) Acute lymphoblastic leukemia C)Acute myelogenous leukemia D) Eosinophilic leukemia

B) Acute lymphoblastic leukemia Acute lymphoblastic leukemia, which accounts for more than 85% of all childhood cases, carries the best prognosis compared to adults. Survival rate depends on the person's age or white blood cell count at time of diagnosis and individuals with cell subtypes such as pre-B also considered to have a higher survival rate than those with mature B-cell leukemia.

A patient has been diagnosed with acute myelogenous leukemia (AML). What should the nurse educate the patient that care will focus on? A) Leukapheresis B) Attaining remission C) One chemotherapy agent D) Waiting with active supportive care

B) Attaining remission Attaining remission is the initial goal of care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the white blood cell count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia, waiting may be done to attain remission, but not with AML.

Which of the following substances has abnormal values early in the course of multiple myeloma (MM)? A) Red blood cells B) Immunoglobulins C) White blood cells D) Platelets

B) Immunoglobulins MM is characterized by malignant plasma cells that produce an increased amount of immunoglobulin that isn't functional.

The nurse is reviewing the blood work drawn for a client on the oncology unit. The nurse should recognize which laboratory result correlates with a diagnosis of tumor lysis syndrome (TLS)? A) Phosphorus level of 4.4 mg/dL B) Potassium level of 6.1 mEq/L C) Calcium level of 8.4 mg/dL D) Uric acid level of 6.9 mg/dL

B) Potassium level of 6.1 mEq/L TLS is a metabolic complication resulting from a rapid release of intracellular components, such as potassium, in response to chemotherapy. Potassium greater than 6 mEq/L correlates with a diagnosis of TLS. Normal potassium levels are 3.5-5.1 mEq/L

A 62-yr-old patient with disseminated intravascular coagulation (DIC) after urosepsis has a platelet count of 48,000/μL. The nurse should assess the patient for which abnormality? A) Pallor B) Purpura C) Pruritus D) Palpitation

B) Purpura The normal range for a platelet count is 150,000 to 400,000/μL. Purpura is caused by decreased platelets or clotting factors, resulting in small hemorrhages into the skin or mucous membranes. Pallor is decreased or absent coloration in the conjunctiva or skin. Pruritus is an intense itching sensation. Palpitation is a sensation of feeling the heart beat, flutter, or pound in the chest.

A patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? A) Brentuximab vedotin (Adcetris) B) Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine C) Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine D) BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone

B) Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine The patient with a favorable prognosis early-stage Hodgkin's lymphoma (stage 1A) will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.Note: Some of acronyms for drug protocols use the brand/trade name of drugs (Adriamycin, Oncovin). These brand/trade names have been discontinued but the drugs are still available as generic drugs.

A client is diagnosed with multiple myeloma. The client asks the nurse about the diagnosis. The nurse bases the response on which of the following descriptions of this disorder? A. Altered red blood cell production B. Malignant proliferation of plasma cells and tumors within the bone C. Altered production of lymph D. Malignant exacerbation in the number of leukocytes

B. Malignant proliferation of plasma cells and tumors within the bone Multiple myeloma is a B cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow.

The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further education is needed if a nursing staff member states which of the following is characteristic of the disease? A. Prognosis depends on the stage of the disease B. Occurs most often in the older client C. Presence of Reed-Sternberg cells D. Involvement of lymph nodes, spleen, and liver

B. Occurs most often in the older client Hodgkin's disease is a disorder of young people up to age 40 and among adults. It is more common in adolescents between the ages of 15 and 19

The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse assess first? A) A 60-yr-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL B) A 50-yr-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer C) A 40-yr-old patient with a temperature of 100.8°F (38.2°C) and a neutrophil count of 256/µL D) A 30-yr-old patient with a pulse of 112 beats/min and a white blood cell count of 14,000/µL

C) A 40-yr-old patient with a temperature of 100.8°F (38.2°C) and a neutrophil count of 256/µL A low-grade fever greater than 100.4° F (38° C) in a patient with a neutrophil count below 500/µL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.

In which of the following diseases would bone marrow transplantation not be indicated in a newly diagnosed client? A) Severe aplastic anemia B) Severe combined immunodeficiency C) Acute lymphocytic leukemia D) Chronic myeloid leukemia

C) Acute lymphocytic leukemia For the first episode of acute lymphocytic leukemia, conventional therapy is superior to bone marrow transplantation. Treatment is usually long-term chemotherapy and is composed of 3 phases (induction, consolidation, and maintenance).

The nurse overhears a primary health care provider (PHCP) stating that a client diagnosed with disseminated intravascular coagulation (DIC) requires a transfusion. Which blood product should the nurse anticipate that the PHCP will write a prescription for? A) Albumin B) Platelets C) Cryoprecipitate D) Packed red blood cells

C) Cryoprecipitate Cryoprecipitate is useful in treating bleeding from hemophilia or DIC because it is rich in clotting factors. Albumin may be used as a plasma expander in hypovolemia with or without shock. Platelets are used when the client's platelet count is low. Packed red blood cells replace erythrocytes, not fibrinogen.

A child is seen in the pediatrician's office for complaints of bone and joint pain. Which of the following other assessment findings may suggest leukemia? A) Increased activity level B) Increased appetite C) Petechiae D) Abdominal pain

C) Petechiae The most frequent signs and symptoms of leukemia are a result of infiltration of the bone marrow. These include fever, pallor, fatigue, anorexia, and petechiae, along with bone and joint pain. Petechiae is brought about by damaged or broken blood vessels underneath the skin

The nurse is caring for a patient with a diagnosis of disseminated intravascular coagulation (DIC). What is the first priority of care? A) Administer heparin. B) Administer whole blood. C) Treat the causative problem. D) Administer fresh frozen plasma.

C) Treat the causative problem. Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.

A patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? A) Skin care that will be needed B) Method of obtaining the treatment C) Treatment type and expected side effects D) Gastrointestinal tract effects of treatment

C) Treatment type and expected side effects The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.

A patient with leukemia is admitted for severe hypovolemia after prolonged diarrhea. The platelet count is 43, 000/µL. It is most important for the nurse to take which action? A) Insert two 18-gauge IV catheters B) Administer prescribed enoxaparin C) Monitor the patient's temperature every 2 hours D) Check stools for presence of frank or occult blood

D) Check stools for presence of frank or occult blood A platelet count below 150,000/µL indicates thrombocytopenia. Prolonged bleeding from trauma or injury does not usually occur until the platelet counts are below 50,000/µL. Bleeding precautions (e.g., check all secretions for frank and occult blood) are indicated for patients with thrombocytopenia. Injections (including IVs) should be avoided; however, when needed for critical fluids and medications, IV access should be provided through the smallest bore devices that are feasible. Enoxaparin, an anticoagulant administered subcutaneously, is contraindicated in patients with thrombocytopenia. Monitoring temperature would be indicated in a patient with leukopenia.A

Nurse Andrei is caring for a client with multiple myeloma. During the review of the laboratory results. The nurse will monitor the client for which of the following conditions? A) Hypermagnesemia B) Hyperkalemia C) Hypernatremia D) Hypercalcemia

D) Hypercalcemia Patients with multiple myeloma develop a bone disease that causes bone destruction. Calcium is released during this, causing an increase in serum calcium levels.

The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention is the highest priority in the nursing plan of care? A) Monitoring temperature B) Monitoring for pathological factors C) Ambulation three times a day D) Monitoring the platelet count

D) Monitoring the platelet count Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding.

Which of the following medications usually is given to a client with leukemia as prophylaxis against P. carinii pneumonia? A) Vincristine (Oncovin) B) Prednisone (Deltasone) C) Oral nystatin suspension D) Sulfamethoxazole and trimethoprim (Bactrim)

D) Sulfamethoxazole and trimethoprim (Bactrim) The most frequent cause of death from leukemia is an overwhelming infection. P. carinii infection is lethal to a child with leukemia. As prophylaxis against P. carinii pneumonia, continuous low doses of co-trimoxazole (Bactrim) are frequently prescribed.

A with tumor lysis syndrome (TLS) is taking allopurinol (Zyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication? A) Blood urea nitrogen (BUN) B) Serum phosphate C) Serum potassium D) Uric acid level

D) Uric acid level Allopurinol is used to decrease uric acid levels. BUN. potassium. and phosphate levels are also increased in TLS but are not affected by allopurinol therapy.

The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following? A. Assess skin turgor B. Assess bowel sounds C. Assess temperature D. Assess level of consciousness

D. Assess level of consciousness A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000. The client should be assessed for changes in levels of consciousness, which may be an early indication of an intracranial hemorrhage.