Leukemia, Lymphoma, MM MCQ

Which assessment findings are consistent with a complication related to leukemia? 1 Elevated white blood cell (WBC) count 2 Pyuria and urgency 3 Chest pain and shortness of breath 4 Decreased urinary output and elevated serum potassium

1 Clients with leukemia are often identified in relationship to frequent infections. With leukemia, the WBC count is elevated. However, an abundance of immature or ineffective WBCs is formed while all other blood components are not. Ineffective WBCs do not provide protection from infection. Chest pain and shortness of breath are consistent with myocardial infarction. Decreased urinary output and elevated serum potassium are findings associated with renal failure.

A client has a diagnosis of multiple myeloma. What would be the best nursing action? 1 Encourage a high fluid intake daily. 2 Provide a diet high in calcium. 3 Minimize weight bearing on affected extremities. 4 Maintain bed rest.

1 It is important to maintain good hydration to minimize the complications (e.g., renal calculi) associated with hypercalcemia and the renal failure that the client has as a result of the disease process, which deposits Bence-Jones proteins in the renal tubules. Weight bearing will assist the bones to resorb calcium, so it, not bed rest, should be encouraged. With the high calcium levels, calcium supplements are contraindicated.

The nurse is reviewing recent laboratory reports on an older adult client who has myelogenous leukemia (CML) and noticed a high percentage of blast cells. What does this indicate? 1 CML is in the blast phase, which is more acute and aggressive. 2 There is an increased resistance to infection. 3 CML medication regime is effective. 4 The leukemia is changing from myelogenous to lymphocytic.

1 The presence of blast cells and promyelocytes indicates that CML is progressing to a more acute, aggressive phase. Even with treatment the chronic phase of CML eventually progresses to the accelerated phase and ends in the blast phase, which becomes more like an acute leukemia and thus needing that type of treatment.

A client with leukemia is experiencing recurrent fevers. Which actions will the nurse take to improve this client's comfort? Select all that apply. Change bed clothes frequently. Apply ice packs to the groin. Provide a warm beverage before bedtime. Provide acetaminophen as prescribed. Sponge with cool water.

A,D,E Recurrent fevers are common in acute leukemia. Treatment for this symptom includes sponging with cool water and changing the bed clothes frequently. Acetaminophen should be provided as prescribed. Ice packs should be avoided because the heat cannot dissipate from the constricted blood vessels. A warm beverage before bedtime may encourage sweating and is not identified as an action to improve comfort.

A nurse is providing teaching to a client who will undergo chemotherapy and radiation prior to hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia (AML). What statement will the nurse use to describe the purpose of the chemotherapy and radiation? A. "These therapies shrink your tumor to ensure the stem cell transplant is more effective." B. "These therapies destroy the ability of your body to produce blood cells inside your bone marrow." C. "These therapies decrease your immune system to decrease the risk of allergic reaction." D. "These therapies destroy the bone marrow in an effort to shrink it and decrease your pain."

B The treatment goal of chemotherapy and radiation therapy is the destruction of hematopoietic function of the client's bone marrow. The client is then "rescued" with the infusion of the donor stem cells to reinitiate blood cell production

The nurse is caring for a patient with Hodgkin lymphoma in the hospital and preparing discharge planning education. Knowing that this patient is at risk for the development of a second malignancy, what education would be beneficial to reduce the risk factors? (Select all that apply.) Decrease fat intake Smoking cessation Decrease alcohol intake Reduce exposure to excessive sunlight Decrease intake of antipyretic medications such as acetaminophen

B,C,D The potential development of a second malignancy should be addressed with the patient when initial treatment decisions are made. The nurse should encourage patients 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.

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. Diarrheal stools B. Laryngeal edema C. Hair loss D. Adventitious lung sounds

A 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 nurse is teaching a client with multiple myeloma about the therapeutic benefits of radiation therapy. Which statements will the nurse include in the teaching? Select all that apply. A. "It helps to strengthen the bone." B. "It helps to decrease bone pain." C. "It decreases the bone malignancy." D. "It decreases excess calcium." E. "It helps to activate an immune response."

A,B Radiation therapy is useful in strengthening the bone at a specific lesion, particularly a bone at risk for fracture or spinal cord compression. It is also extremely useful in relieving bone pain. Radiation therapy is not effective in decreasing bone malignancy, decreasing excess calcium, or activating an immune response.

A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia? Chronic lymphocytic leukemia Acute lymphocytic leukemia Acute myelogenous leukemia Chronic myelogenous leukemia

A Clients with CLL are typically older than 40 years of age, have increased immature lymphocytes, normal or decreased granulocytes, but erythrocyte and platelet counts may be normal or low. Clients with ALL are younger than 5 years of age; uncommon after 15 years of age. Clients with AML have a decrease in all myeloid formed cells: monocytes, granulocytes, erythrocytes, and platelets. Clients with CML are similar to those with AML but greater number of normal cells than in acute form.

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

A 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 nurse cares for a client with myelodysplastic syndrome (MDS). Which assessment finding does the nurse recognize is the most common finding with this condition? Macrocytic anemia Proliferative anemia Microcytic anemia Hemolytic anemia

A Macrocytic anemia is the most common symptom of MDS.

The nurse is providing palliative care for a 69-year-old patient who has a diagnosis of multiple myeloma. The patient states that she enjoyed good health for most of her life and rarely had to visit her family health care provider until she experienced the first signs and symptoms of her current illness. Which of the following complaints most likely prompted the patient to initially seek care? A. Fatigue and activity intolerance B. Bone pain C. Lymphadenopathy D. Recurrent infections

B As many as 90% of patients with multiple myeloma develop bone lesions. Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. For elderly patient presenting with bone pain, multiple myeloma should always be included in differential Dx.

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? A. Talk to the family about not visiting so the client can obtain rest. B. Assist the client to sit in a chair for meals. C. Provide sedentary activities only, such as watching television. D. Have the client maintain complete bedrest.

B Fatigue is a common symptom with clients who have leukemia. Despite the fatigue, clients still need to maintain some physical activity. An example of physical activity is having the client sit in a chair for meals. The nurse does not want to encourage complete bedrest or sedentary activities, such as watching television, due to possible deconditioning. The nurse has not discussed with the client about limiting family visits. The client may want some family to visit.

A client with multiple myeloma presents to the emergency department and reports excessive thirst and constipation. Family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? A. Serum sodium level of 133 mEq/L B. Platelet count 300,000/mm3 C. Serum calcium level 13.8 mg/dl D. Hemoglobin of 9.8 g/dl

C Excessive thirst, constipation, dehydration, confusion, and altered mental state are possible signs of hypercalcemia. Hypercalcemia is common in multiple myeloma because of the increased bone destruction. A platelet count of 300,000/mm3 is normal and wouldn't cause the client's symptoms. A sodium level of 133 mEq/L is slightly decreased but wouldn't cause confusion and excessive thirst. A hemoglobin of 9.8 g/dl level is slightly low but isn't likely responsible for the client's symptoms.

The nurse caring for an older adult with a diagnosis of leukemia would encourage the client to use an electric razor. What is the rationale for this statement by the nurse? A. Strong tissues and intact clotting mechanisms may prevent hemorrhage. B. The client is not at risk for infection from microorganisms. C. Trauma and microabrasions from a non-electric razor may contribute to anemia. D. The client is at risk for spontaneous and uncontrolled bleeding.

C In a client with leukemia who is at risk for hemorrhage, the nurse handles the client gently when assisting and encourages the client to use electric razors. Trauma and microabrasions from razors may contribute to anemia from bleeding.

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. Osteolytic activating factor weakens bones producing fractures. C. Osteoclasts break down bone cells so pathologic fractures occur. D. Osteosarcomas form producing pathologic fractures.

C In multiple myeloma, the abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This in turn causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a 'punched-out' or 'honeycombed' appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain

The nurse assesses a patient for late-stage chronic lymphocytic leukemia (CLL) by looking for what? Splenomegaly. Lymphadenopathy. Hepatomegaly. Thrombocytopenia.

D Anemia and thrombocytopenia are late-stage indicators of CLL. The others are early-stage signs.

A client has been diagnosed with multiple myeloma. What laboratory and diagnostic findings would the nurse expect with this client? Select all that apply. 1 Increased serum creatinine 2 Decreased BUN 3 Bence-Jones protein in urine 4 Hypercalcemia 5 Hyperkalemia 6 Decreased hemoglobin

1,3,4,6 The nurse understands that diagnostic tests involve laboratory, radiologic, and bone marrow examination. Bence-Jones protein is found in the urine. Other findings include pancytopenia (anemia—hemoglobin less than 10 g/dL), and hypercalcemia, and a high serum creatinine. The BUN would be elevated along with the creatinine and the potassium would be normal, not elevated.

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. 1 Severe thrombocytopenia 2 Bone pain in the back of the ribs 3 Gradual muscle paralysis 4 Debilitating fatigue

2 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; patients may report that they have less pain on awakening but the pain intensity increases during the day.

A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: 1 hypoxemia. 2 pathologic bone fractures. 3 chronic liver failure. 4 acute heart failure.

2 Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction.

The nurse is explaining to the family of a client about the characteristics of Hodgkin disease. Which characteristics are common findings? Select all that apply. 1 Is a benign lymphoma that is outside of the lymph nodes 2 Insidious onset of symptoms 3 Pain at affected lymph node sites caused by ingestion of small amounts of alcohol 4 Absence of hepatomegaly and splenomegaly 5 May be caused by Epstein-Barr virus or exposure to occupational toxins 6 Painless enlargement of cervical, axillary, inguinal, or mediastinal lymph nodes

2,3,5,6 Hodgkin disease has an insidious onset; it is characterized by painless enlargement of lymph nodes that progresses to involve the liver (hepatomegaly) and spleen (splenomegaly); malignant neoplasms originate in the bone marrow and lymphocytes, with common metastatic sites of the spleen, liver, bone marrow, and lungs. Disease is spread by extension along the lymphatic system. This is the most curable of the lymphomas. It may be caused by Epstein-Barr virus or exposure to occupational toxins.

A home care nurse is caring for a client with multiple myeloma. Which nursing interventions are appropriate for this client? Select all that apply. A. Assist with ambulation because exercise can worsen loss of calcium from the bone. B. Monitor renal function C. Delay position changes and bathing if the client is experiencing pain. D. Limit fluid intake. E. Instruct the client to avoid activities that may cause injury.

B,C,E Pain can become quite severe. Delay position changes and bathing until analgesic has reached peak concentration level and the client is experiencing maximum pain relief. Safety is paramount because any injury, no matter how slight, can result in a fracture. The nurse assists the client with ambulation because immobility can worsen loss of calcium from the bone. The nurse provides up to 4000 mL of fluid to prevent renal damage from hypercalcemia and precipitation of protein in the renal tubules.

A client receiving treatment for acute myeloid leukemia (AML) develops elevated potassium, uric acid, and phosphate levels. Which treatments will the nurse anticipate being prescribed to reduce this client's risk for kidney stone formation? Select all that apply. A. Anticoagulants B. Allopurinol C. Antibiotics D. Acetaminophen E. Intravenous fluids

B,E Massive leukemic cell destruction from chemotherapy in the treatment of AML results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate indicate the development of tumor lysis syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute kidney injury. Clients require a high fluid intake, and prophylaxis with allopurinol to prevent crystallization of uric acid and subsequent stone formation. Antibiotics, anticoagulants, and acetaminophen are not used to reduce the risk for the formation of kidney stones in the client being treated for AML.

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? Calcified bones Osteoporosis Pathologic fractures Increased mobility

C Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia? Perform a cardiovascular assessment every 4 hours. Monitor daily platelet counts. Closely observe the client's skin for petechiae and bruising. Check the client's history for a congenital link to thrombocytopenia.

C The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin.

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. Popliteal B. Axillary C. Inguinal D. Cervical

D Non painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.