Management of Patients with Hematologic Neoplasms

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. A) Severe thrombocytopenia B) Bone pain in the back of the ribs C) Gradual muscle paralysis D) Debilitating fatigue

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

3. An oncology nurse is caring for a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood tests, the nurse should anticipate what imbalance? A) Hypercalcemia B) Hyperproteinemia C) Elevated serum viscosity D) Elevated RBC count

A) Hypercalcemia 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. Hyperproteinemia would not be present.

4. A nurse is planning the care of a patient who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the patient's care plan, the nurse has identified a diagnosis of Risk for Injury. What pathophysiologic effect of multiple myeloma most contributes to this risk? A) Labyrinthitis B) Left ventricular hypertrophy C) Decreased bone density D) Hypercoagulation

C) Decreased bone density Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Labyrinthitis is uncharacteristic, and patients do not normally experience hypercoagulation or cardiac hypertrophy.

7. A 77-year-old male is admitted to a unit with a suspected diagnosis of acute myeloid leukemia (AML). When planning this patient's care, the nurse should be aware of what epidemiologic fact? A) Early diagnosis is associated with good outcomes. B) Five-year survival for older adults is approximately 50%. C) Five-year survival for patients over 75 years old is less than 2%. D) Survival rates are wholly dependent on the patient's pre-illness level of health.

C) Five-year survival for patients over 75 years old is less than 2%. he 5-year survival rate for patients with AML who are 50 years of age or younger is 43%; it drops to 19% for those between 50 and 64 years, and drops to1.6% for those older than 75 years. Early diagnosis is beneficial, but is nonetheless not associated with good outcomes or high survival rates. Preillness health is significant, but not the most important variable.

33. A nurse is planning the care of a patient who has been diagnosed with essential thrombocythemia (ET). What nursing diagnosis should the nurse prioritize when choosing interventions? A) Risk for Ineffective Tissue Perfusion B) Risk for Imbalanced Fluid Volume C) Risk for Ineffective Breathing Pattern D) Risk for Ineffective Thermoregulation

A) Risk for Ineffective Tissue Perfusion Patients with ET are at risk for hypercoagulation and consequent ineffective tissue perfusion. Fluid volume, breathing, and thermoregulation are not normally affected

31. A clinic patient is being treated for polycythemia vera and the nurse is providing health education. What practice should the nurse recommend in order to prevent the complications of this health problem? A) Avoiding natural sources of vitamin K B) Avoiding altitudes of ³1500 feet (457 meters) C) Performing active range of motion exercises daily D) Avoiding tight and restrictive clothing on the legs

D) Avoiding tight and restrictive clothing on the legs Because of the risk of DVT, patients with polycythemia vera should avoid tight and restrictive clothing. There is no need to avoid foods with vitamin K or to avoid higher altitudes. Activity levels should be maintained, but there is no specific need for ROM exercises.

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? A) Assess the client's hemoglobin and platelets. B) Assess the client's pulse and blood pressure. C) Check the client's history. D) Assess the client's skin.

A (Assess the client's hemoglobin and platelets. Clients with AML 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 patient with a diagnosis of immune thrombocytopenic purpura (ITP) is currently receiving IVIG for the treatment of her health condition. The nurse who is providing this patient's care is aware that ITP is a consequence of: A) Platelet destruction and impaired platelet production resulting from an autoimmune process B) Impaired liver function and the sequestering of platelets by hepatocytes C) Hemolysis of platelets in individuals who lack immunity to the Epstein-Barr virus D) Inappropriate platelet aggregation on the walls of the great vessels

A (Platelet destruction and impaired platelet production resulting from an autoimmune process Although the precise cause of ITP remains unknown, the platelet count is decreased by a combination of autoantibody-mediated platelet destruction and impaired platelet production secondary to autoantibody effects on the megakaryocyte. Viruses, impaired liver function, and inappropriate platelet aggregation are not dimensions of the etiology of ITP.)

A nurse has established for a client the nursing diagnosis of risk for infection. Which of the following interventions would the nurse include in the plan of care for this client? Select all answers that apply. A) Assess skin and mucus membranes every shift. B) Provide oral hygiene once daily. C) Encourage the client to take deep breaths every 4 hours while awake. D) Place fresh flowers on a shelf on the opposite wall from the client. E) Auscultate lung sounds every shift and prn.

A, C, E (- Assess skin and mucus membranes every shift. - Encourage the client to take deep breaths every 4 hours while awake. - Auscultate lung sounds every shift and prn.)

The nursing instructor is talking with their clinical group about coagulopathies. How should the instructor define coagulopathies? A) Coagulopathies are bleeding disorders that are characterized by a deficiency of globulins in the plasma. B) Coagulopathies are bleeding disorders that involve platelets or clotting factors. C) Coagulopathies are bleeding disorders that are characterized by abnormalities in the numbers and types of red blood cells in the body. D) Coagulopathies are bleeding disorders that involve the destruction of stem cells in the bone marrow.

B (Coagulopathies are bleeding disorders that involve platelets or clotting factors. Coagulopathies are bleeding disorders that involve platelets or clotting factors. Coagulopathies do not involve the numbers and types of red blood cells. They are not characterized by a deficiency of globulins in the plasma and they do not involve the destruction of stem cells in the bone marrow.)

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

B (The client with enlarged lymph nodes in the neck. 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.)

37. A young adult patient has received the news that her treatment for Hodgkin lymphoma has been deemed successful and that no further treatment is necessary at this time. The care team should ensure that the patient receives regular health assessments in the future due to the risk of what complication? A) Iron-deficiency anemia B) Hemophilia C) Hematologic cancers D) Genitourinary cancers

C) Hematologic cancers Survivors of Hodgkin lymphoma have a high risk of second cancers, with hematologic cancers being the most common. There is no consequent risk of anemia or hemophilia, and hematologic cancers are much more common than GU cancers.

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) Hyperkalemia D) Hypercalcemia

D (Hypercalcemia Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.)

What assessment findingbest indicates that the client has recovered from induction therapy? A) Absence of bone pain B) No evidence of edema C) Vital signs within normal ranges D) Neutrophil and platelet counts within normal limits

D (Neutrophil and platelet counts within normal limits Recovery from induction therapy is indicated when the neutrophil and platelet counts have returned to normal and any infection has resolved. Stable vital signs, lack of edema, and absence of pain are not indicative of recovery from induction therapy.)

18. A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patient's care plan? A) Protective isolation and vigilant use of standard precautions B) Provision of a high-calorie, low-texture diet and appropriate oral hygiene C) Including the family in planning the patient's activities of daily living D) Monitoring and treating the patient's pain

A) Protective isolation and vigilant use of standard precautions Induction therapy causes neutropenia and a severe risk of infection. This risk must be addressed directly in order to ensure the patient's survival. For this reason, infection control would be prioritized over nutritional interventions, family care, and pain, even though each of these are important aspects of nursing care.

Following bone marrow aspiration of a 19-year-old client, analysis reveals more than 20% immature blast cells. Platelet counts are 9000/mm³. What nursing interventions should the nurse employ for the care of this client? Select all answers that apply. A) Administer prescribed docusate (Colace) daily. B) Recommend taking ibuprofen for mild aches and pains. C) Apply pressure to venipuncture sites for 1 to 2 minutes. D) Assess for mental state changes. E) Discuss the withholding of oral contraceptives.

A, D (Administer prescribed docusate (Colace) daily. Assess for mental state changes. The client has leukemia with immature blast cells and an extremely low platelet count. The client is at increased risk for bleeding. Interventions that would address bleeding include assessing for mental status changes (because bleeding could occur in the brain) and administering stool softeners to prevent constipation (which would increase the risk of bleeding from the rectum). Oral contraceptives would be administered to induce amenorrhea. Ibuprofen would be avoided because this medication inhibits platelet function. The nurse is to apply pressure to venipuncture sites for 5 minutes.)

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) Acute respiratory distress syndrome B) Graft-versus-host disease C) Remission D) Bone marrow depression

B (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 assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: A) Hypoxemia. B) Pathologic bone fractures. C) Chronic liver failure. D) Acute heart failure.

B (Pathologic bone fractures. 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. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.)

Which term refers to a form of white blood cell involved in immune response? A) Spherocyte B) Thrombocyte C) Lymphocyte D) Granulocyte

C (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.)

5. A patient with advanced leukemia is responding poorly to treatment. The nurse finds the patient tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurse's most appropriate action? A) Tell him that you will give him privacy and leave the room. B) Offer to call pastoral care. C) Ask if he would like you to sit with him while he collects his thoughts. D) Tell him that you can understand how he's feeling.

C) Ask if he would like you to sit with him while he collects his thoughts. Providing emotional support and discussing the uncertain future are crucial. Leaving is incorrect because leaving the patient doesn't show acceptance of his feelings. Offering to call pastoral care may be helpful for some patients but should be done after the nurse has spent time with the patient. Telling the patient that you understand how he's feeling is inappropriate because it doesn't help him express his feelings.

A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? A) Ask the client whether they have recently fallen. B) Keep the client on bed rest. C) Evaluate the client's INR. D) Evaluate the client's platelet count.

D (Evaluate the client's platelet count. Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3. The bleeding is usually unrelated to falling. Keeping the client on bed rest will not prevent bleeding when the client has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.)

12. A home health nurse is caring for a patient with multiple myeloma. Which of the following interventions should the nurse prioritize when addressing the patient's severe bone pain? A) Implementing distraction techniques B) Educating the patient about the effective use of hot and cold packs C) Teaching the patient to use NSAIDs effectively D) Helping the patient manage the opioid analgesic regime

D) Helping the patient manage the opioid analgesic regime For severe pain resulting from multiple myeloma, opioids are likely necessary. NSAIDs would likely be ineffective and are associated with significant adverse effects. Hot and cold packs as well as distraction would be insufficient for severe pain.

The client was admitted to the Emergency Department after an accident with a chain saw. The client is exhibiting signs and symptoms of acute hypovolemic anemia from severe blood loss. What signs and symptoms would the nurse assess for? A) Reduced urine output B) Malabsorption disorders C) Fatigue D) Postural hypotension

A (Reduced urine output Acute hypovolemic anemia from severe blood loss is evidenced by the signs and symptoms of hypovolemic shock, which include reduced urine output. The symptoms of chronic hypovolemic anemia include fatigue and postural hypotension. Clients with malabsorption disorders are at great risk of iron deficiency anemia.)

39. A patient has a diagnosis of multiple myeloma and the nurse is preparing health education in preparation for discharge from the hospital. What action should the nurse promote? A) Daily performance of weight-bearing exercise to prevent muscle atrophy B) Close monitoring of urine output and kidney function C) Daily administration of warfarin (Coumadin) as ordered D) Safe use of supplementary oxygen in the home setting

B) Close monitoring of urine output and kidney function Renal function must be monitored closely in the patient with multiple myeloma. Excessive weight-bearing can cause pathologic fractures. There is no direct indication for anticoagulation or supplementary oxygen.

34. A nurse at a long-term care facility is amending the care plan of a resident who has just been diagnosed with essential thrombocythemia (ET). The nurse should anticipate the administration of what medication? A) Dalteparin B) Allopurinol C) Hydroxyurea D) Hydrochlorothiazide

C) Hydroxyurea Hydroxyurea is effective in lowering the platelet count for patients with ET. Dalteparin, allopurinol, and HCTZ do not have this therapeutic effect.

21. An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL? A) Increased numbers of blast cells B) Increased lymphocyte levels C) Intractable bone pain D) Thrombocytopenia with no evidence of bleeding

B) Increased lymphocyte levels An increased lymphocyte count (lymphocytosis) is always present in patients with CLL. Each of the other listed symptoms may or may not be present, and none is definitive for CLL.

The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing diagnosis to help prevent fractures in this client? A) Safety B) Adequate nutrition C) Adequate hydration D) Increased mobility

A (Safety)

The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply. A) Suggest the family go to church more often. B) Suggest support for household maintenance. C) Suggest the prescription of antianxiety medications. D) Educate the family about medications and side effects. E) Allow family members to express feelings.

B, D, E (- Suggest support for household maintenance. - Educate the family about medications and side effects. - Allow family members to express feelings.)

17. Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult patient who is otherwise healthy. The patient and the care team have collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient for which of the following? A) Daily treatment with targeted therapy medications B) Radiation therapy on a daily basis C) Hematopoietic stem cell transplantation D) An aggressive course of chemotherapy

D) An aggressive course of chemotherapy Attempts are made to achieve remission of AML by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks. Induction therapy is not synonymous with radiation, stem cell transplantation, or targeted therapies.

40. A nurse is caring for patient whose diagnosis of multiple myeloma is being treated with bortezomib. The nurse should assess for what adverse effect of this treatment? A) Stomatitis B) Nephropathy C) Cognitive changes D) Peripheral neuropathy

D) Peripheral neuropathy A significant toxicity associated with the use of bortezomib for multiple myeloma is peripheral neuropathy. Stomatitis, cognitive changes, and nephropathy are not noted to be adverse effects of this medication.

9. A patient with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the patient? A) Chew with care to avoid inadvertently biting the tongue. B) Use the oral anesthetic 1 hour prior to meal time. C) Brush teeth before and after eating. D) Swallow slowly and deliberately.

A) Chew with care to avoid inadvertently biting the tongue. If oral anesthetics are used, the patient must be warned to chew with extreme care to avoid inadvertently biting the tongue or buccal mucosa. An oral anesthetic would be metabolized by the time the patient eats if it is used 1 hour prior to meals. There is no specific need to warn the patient about brushing teeth or swallowing slowly because an oral anesthetic has been used.

13. A nurse is caring for a patient with Hodgkin lymphoma at the oncology clinic. The nurse should be aware of what main goal of care? A) Cure of the disease B) Enhancing quality of life C) Controlling symptoms D) Palliation

A) Cure of the disease The goal in the treatment of Hodgkin lymphoma is cure. Palliation is thus not normally necessary. Quality of life and symptom control are vital, but the overarching goal is the cure the disease.

A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client has not achieved the goal for the nursing diagnosis Spiritual Distress? A) "I do not understand why this happened to me." B) "I know I am going to die. I want to say good-bye to my family." C) "I am going to call my clergy to pray with me." D) "I have resources within myself that I can depend on."

A ("I do not understand why this happened to me." The statement "I do not understand why this happened to me" indicates that the client is not accepting of the consequences of his health problems and impending death. The other statements indicate the client has plans that would result in spiritual well-being or harmony.)

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? A) Apply prolonged pressure to needle sites or other sources of external bleeding. B) Monitor temperature at least once per shift. C) Eliminate direct contact with others who are infectious. D) Implement neutropenic precautions.

A (Apply prolonged pressure to needle sites or other sources of external bleeding. For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.)

A 50-year-old woman was recently diagnosed with non-Hodgkin's lymphoma (NHL) and has begun a treatment regimen that includes simultaneous radiation therapy and chemotherapy. The combination of severe symptoms and aggressive therapy has necessitated admission to the hospital. When providing care for this patient, which of the following actions should the nurse implement? A) Applying standard precautions conscientiously to reduce the patient's risk of infection B) Monitoring the patient's bowel pattern and facilitating a high-fiber diet C) Encouraging frequent mobilization and independence in activities of daily living D) Providing meticulous skin care and turning the patient at least once every 2 hours

A (Applying standard precautions conscientiously to reduce the patient's risk of infection Treatment for NHL creates a significant risk of infection, a threat that must be minimized when planning and implementing nursing care. This is a priority over ADLs in the short term. The patient does not have a significantly increased risk of skin breakdown or constipation, although the nurse would assess for each problem.)

The nurse is currently planning the care of a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood work, what value would the nurse pay particular attention to? A) Hypercalcemia B) Elevated red blood cell (RBC) count C) Hyperproteinemia D) Elevated serum viscosity

A (Hypercalcemia Hypercalcemia may occur when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin. RBC count will be decreased. Hyperproteinemia would not be present.)

28. Following an extensive diagnostic workup, an older adult patient has been diagnosed with a secondary myelodysplastic syndrome (MDS). What assessment question most directly addresses the potential etiology of this patient's health problem? A) Were you ever exposed to toxic chemicals in any of the jobs that you held? B) When you were younger, did you tend to have recurrent infections of any kind? C) Have your parents or siblings had any disease like this? D) Would you say that you've had a lot of sun exposure in your lifetime?"

A) Were you ever exposed to toxic chemicals in any of the jobs that you held? Secondary MDS can occur at any age and results from prior toxic exposure to chemicals, including chemotherapeutic medications. Family history, sun exposure, and previous infections are unrelated to the pathophysiology of secondary MDS.

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) Platelet count of 9,000/mm3 B) WBC count of 4,200 cells/mcL C) Hematocrit of 38% D) Creatinine level of 1.0 mg/dL

A (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.)

25. An oncology nurse recognizes a patient's risk for fluid imbalance while the patient is undergoing treatment for leukemia. What relevant assessments should the nurse include in the patient's plan of care? Select all that apply. A) Monitoring the patient's electrolyte levels B) Monitoring the patient's hepatic function C) Measuring the patient's weight on a daily basis D) Measuring and recording the patient's intake and output E) Auscultating the patient's lungs frequently

A) Monitoring the patient's electrolyte levels C) Measuring the patient's weight on a daily basis D) Measuring and recording the patient's intake and output E) Auscultating the patient's lungs frequently Assessments that relate to fluid balance include monitoring the patient's electrolytes, auscultating the patient's chest for adventitious sounds, weighing the patient daily, and closely monitoring intake and output. Liver function is not directly relevant to the patient's fluid status in most cases.

35. A nurse is writing the care plan of a patient who has been diagnosed with myelofibrosis. What nursing diagnoses should the nurse address? Select all that apply. A) Disturbed Body Image B) Impaired Mobility C) Imbalanced Nutrition: Less than Body Requirements D) Acute Confusion E) Risk for Infection

A) Disturbed Body Image B) Impaired Mobility C) Imbalanced Nutrition: Less than Body Requirements E) Risk for Infection The profound splenomegaly that accompanies myelofibrosis can impact the patient's body image and mobility. As well, nutritional deficits are common and the patient is at risk for infection. Cognitive effects are less common.

10. A patient diagnosed with acute myelogenous leukemia has just been admitted to the oncology unit. When writing this patient's care plan, what potential complication should the nurse address? A) Pancreatitis B) Hemorrhage C) Arteritis D) Liver dysfunction

B) Hemorrhage Pancreatitis, arteritis, and liver dysfunction are generally not complications of leukemia. However, the patient faces a high risk of hemorrhage.

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? A) Multiple myeloma B) Leukemia C) Hemolytic anemia D) Polycythemia vera

A (Multiple myeloma The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.)

20. A 60-year-old patient with chronic myeloid leukemia will be treated in the home setting and the nurse is preparing appropriate health education. What topic should the nurse emphasize? A) The importance of adhering to the prescribed drug regimen B) The need to ensure that vaccinations are up to date C) The importance of daily physical activity D) The need to avoid shellfish and raw foods

A) The importance of adhering to the prescribed drug regimen Nurses need to understand that the effectiveness of the drugs used to treat CML is based on the ability of the patient to adhere to the medication regimen as prescribed. Adherence is often incomplete, thus this must be a focus of health education. Vaccinations normally would not be administered during treatment and daily physical activity may be impossible for the patient. Dietary restrictions are not normally necessary.

22. A patient has been found to have an indolent neoplasm. The nurse should recognize what implication of this condition? A) The patient faces a significant risk of malignancy. B) The patient has a myeloid form of leukemia. C) The patient has a lymphocytic form of leukemia. D) The patient has a major risk factor for hemophilia.

A) The patient faces a significant risk of malignancy. Indolent neoplasms have the potential to develop into a neoplasm, but this is not always the case. The patient does not necessary have, or go on to develop, leukemia. Indolent neoplasms are unrelated to the pathophysiology of hemophilia.

A client presents with peripheral neuropathy and hypothesia of the feet. What is the best nursing intervention? - Assess for signs of injury. - Keep the feet cool. - Elevate the client's legs. - Encourage ambulation.

Assess for signs of injury. A client with hypothesia 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.

Which statement indicates the client understands teaching about induction therapy for leukemia? A) "I will start slowly with medication treatment." B) "I will need to come every week for treatment." C) "I know I can never be cured." D) "I will be in the hospital for several weeks."

D ("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.)

27. A patient has completed the full course of treatment for acute lymphocytic leukemia and has failed to respond appreciably. When preparing for the patient's subsequent care, the nurse should perform what action? A) Arrange a meeting between the patient's family and the hospital chaplain. B) Assess the factors underlying the patient's failure to adhere to the treatment regimen. C) Encourage the patient to vigorously pursue complementary and alternative medicine (CAM). D) Identify the patient's specific wishes around end-of-life care.

D) Identify the patient's specific wishes around end-of-life care Should the patient not respond to therapy, it is important to identify and respect the patient's choices about treatment, including measures to prolong life and other end-of-life measures. The patient may or may not be open to pursuing CAM. Unsuccessful treatment is not necessarily the result of failure to adhere to the treatment plan. Assessment should precede meetings with a chaplain, which may or may not be beneficial to the patient and congruent with the family's belief system.

2. A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia? A) Monitoring for infection B) Monitoring nutritional status C) Monitor electrolyte levels D) Monitoring liver function

A) Monitoring for infection In patients with acute leukemia, death typically occurs from infection or bleeding. Compromised nutrition, electrolyte imbalances, and impaired liver function are all plausible, but none is among the most common causes of death in this patient population.

Which term is used to refer to a primitive cell that is capable of self-replication and differentiation? A) Reticulocyte B) Spherocyte C) Band cell D) Stem cell

D (Stem cell Stem cells may differentiate into myeloid or lymphoid stem cells. A band cell is a slightly immature neutrophil. A spherocyte is a red blood cell without central pallor. A reticulocyte is a slightly immature red blood cell.)

1.An oncology nurse is providing health education for a patient who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia? A) The different leukemias all involve unregulated proliferation of white blood cells. B) The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function. C) The different leukemias all result in a decrease in the production of white blood cells. D) The different leukemias all involve the development of cancer in the lymphatic system.

A) The different leukemias all involve unregulated proliferation of white blood cells. Leukemia commonly involves unregulated proliferation of white blood cells. Decreased production of red blood cells is associated with anemias. Decreased production of white blood cells is associated with leukopenia. The leukemias are not characterized by their involvement with the lymphatic system.

Which nursing intervention is most appropriate for a client with multiple myeloma? A) Restricting fluid intake B) Preventing bone injury C) Monitoring respiratory status D) Balancing rest and activity

B (Preventing bone injury 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 his fluid intake.)

19. A nurse is caring for a patient who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoseson the patient's sacral area and petechiae in her forearms. In addition to informing the patient's primary care provider, the nurse should perform what action? A) Initiate measures to prevent venous thromboembolism (VTE). B) Check the patient's most recent platelet level. C) Place the patient on protective isolation. D) Ambulate the patient to promote circulatory function.

B) Check the patient's most recent platelet level. The patient's signs are suggestive of thrombocytopenia, thus the nurse should check the patient's most recent platelet level. VTE is not a risk and this does not constitute a need for isolation. Ambulation and activity may be contraindicated due to the risk of bleeding.

A 63-year-old woman has been diagnosed with polycythemia vera (PV) after undergoing a series of diagnostic tests. When the woman's nurse is providing health education, what subject should the nurse prioritize? A) Maintenance of long-term vascular access device B) Lifestyle modifications and techniques for preventing thromboembolism C) Strategies for managing activity D) Nutritional modifications necessary for maintaining a low-iron diet

B (Lifestyle modifications and techniques for preventing thromboembolism The increased blood volume and viscosity that are the hallmarks of PV create a significant risk of thromboembolism. A vascular access device is not necessary for the treatment of PV, and a low-iron diet does not resolve the disease. Patients may experience fatigue, but this risk is superseded by that of thromboembolism.)

Clinical assessment of a patient with AML includes observing for signs of infection, the major cause of death for AML. The nurse should assess for indicators of: A) Thrombocytopenia. B) Splenomegaly. C) Bone marrow expansion. D) Neutropenia.

B (Splenomegaly. Acute myeloid leukemia starts inside the bone marrow and prevents the formation of white blood cells. A bone marrow analysis that shows greater than 30% of immature blast cells is indicative of an AML diagnosis.)

30. A nurse is preparing health education for a patient who has received a diagnosis of myelodysplastic syndrome (MDS). Which of the following topics should the nurse prioritize? A) Techniques for energy conservation and activity management B) Emergency management of bleeding episodes C) Technique for the administration of bronchodilators by metered-dose inhaler D) Techniques for self-palpation of the lymph nodes

B) Emergency management of bleeding episodes Because of patients' risks of hemorrhage, patients with MDS should be taught techniques for managing emergent bleeding episodes. Bronchodilators are not indicated for the treatment of MDS and lymphedema is not normally associated with the disease. Energy conservation techniques are likely to be useful, but management of hemorrhage is a priority because of the potential consequences.

16. A nurse practitioner is assessing a patient who has a fever, malaise, and a white blood cell count that is elevated. Which of the following principles should guide the nurse's management of the patient's care? A) There is a need for the patient to be assessed for lymphoma. B) Infection is the most likely cause of the patient's change in health status. C) The patient is exhibiting signs and symptoms of leukemia. D) The patient should undergo diagnostic testing for multiple myeloma

B) Infection is the most likely cause of the patient's change in health status. Leukocytosis is most often the result of infection. It is only considered pathologic (and suggestive of leukemia) if it is persistent and extreme. Multiple myeloma and lymphoma are not likely causes of this constellation of symptoms.

The nurse caring for an older adult with a diagnosis of leukemia would encourage the client to use an electric razor. Why? A) The client is at risk for spontaneous and uncontrolled bleeding. B) Trauma and microabrasions may contribute to anemia. C) Fragile tissues and altered clotting mechanisms may result in hemorrhage. D) The client is at risk for infection from microorganisms.

B (Trauma and microabrasions may contribute to anemia. 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. Fragile tissues and altered clotting mechanisms may result in hemorrhage even after minor trauma. Therefore, the nurse inspects the skin for signs of bruising and petechiae and reports melena, hematuria, or epistaxis (nosebleeds). The risks for spontaneous and uncontrolled bleeding or infection from microorganisms are not addressed by the use of electric razors.)

24. A patient who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this patient's needs for physical activity? A) Teach the patient about the risks of immobility and the benefits of exercise. B) Assist the patient to a chair during awake times, as tolerated. C) Collaborate with the physical therapist to arrange for stair exercises. D) Teach the patient to perform deep breathing and coughing exercises.

B) Assist the patient to a chair during awake times, as tolerated. Sitting is a chair is preferable to bed rest, even if a patient is experiencing severe fatigue. A patient who has debilitating fatigue would not likely be able to perform stair exercises. Teaching about mobility may be necessary, but education must be followed by interventions that actually involve mobility. Deep breathing and coughing reduce the risk of respiratory complications but are not substitutes for physical mobility in preventing deconditioning.

15. An adult patient has presented to the health clinic with a complaint of a firm, painless cervical lymph node. The patient denies any recent infectious diseases. What is the nurse's most appropriate response to the patient's complaint? A) Call 911. B) Promptly refer the patient for medical assessment. C) Facilitate a radiograph of the patient's neck and have the results forwarded to the patient's primary care provider. D) Encourage the patient to track the size of the lymph node and seek care in 1 week.

B) Promptly refer the patient for medical assessment Hodgkin lymphoma usually begins as an enlargement of one or more lymph nodes on one side of the neck. The individual nodes are painless and firm but not hard. Prompt medical assessment is necessary if a patient has this presentation. However, there is no acute need to call 911. Delaying care for 1 week could have serious consequences and x-rays are not among the common diagnostic tests.

36. An adult patient'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? A) Schwann cells B) Reed-Sternberg cells C) Lewy bodies D) Loops of Henle

B) 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. 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.

6. A nursing student is caring for a patient with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnoses? A) Activity Intolerance B) Risk for Infection C) Acute Confusion D) Risk for Spiritual Distress

B) Risk for Infection Induction therapy places the patient at risk for infection, thus this is the priority nursing diagnosis. During the time of induction therapy, the patient is very ill, with bacterial, fungal, and occasional viral infections; bleeding and severe mucositis, which causes diarrhea; and marked decline in the ability to maintain adequate nutrition. Supportive care consists of administering blood products and promptly treating infections. Immobility, confusion, and spiritual distress are possible, but infection is the patient's most acute physiologic threat.

Which of the following is the only curative treatment for chronic myeloid leukemia (CML)? A) Idarubicin B) Cytarabine C) Allogeneic stem cell transplant D) Imatinib

C (Allogeneic stem cell transplant Allogeneic stem cell transplantation remains the only curative treatment for CML. The efficacy of Imatinib as first-line treatment and the treatment-related mortality of stem cell transplant limits use of transplant to patients with high risk or relapsed disease, or in those patients who did not respond to therapy with TKI. Cytarabine and idarubicin are part of induction therapy for acute myeloid leukemia (AML).)

A client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include: A) Serum calcium level of 7.5 mg/dl B) Serum creatinine level 0.5 mg/dl C) Bence Jones protein in the urine D) Serum protein level 5.8 g/dl

C (Bence Jones protein in the urine Presence of Bence Jones protein in the urine almost always confirms multiple myeloma; however, the absence of the protein doesn't rule out the disease. Serum creatinine level may be increased (above 1.2 mg/dl in men and 0.9 mg/dl in women). Serum calcium levels are above 10.2 mg/dl in multiple myeloma because calcium is lost from the bone and reabsorbed in the serum. The serum protein level is increased in multiple myeloma, not decreased.)

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? A) Provide a clear liquid, low-sodium diet. B) Put on a mask, gown, and gloves when entering the client's room. C) Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. D) Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding.

C (Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. Neutropenia occurs when the absolute neutrophil count falls below 1,000/mm3, reflecting a severe risk of infection. The nurse should provide a low-bacterial diet, which means eliminating fresh fruits and vegetables, avoiding invasive procedures such as enemas, and practicing frequent hand washing. Using a soft toothbrush, avoiding straight-edged razors and enemas, and monitoring for bleeding are precautions for clients with thrombocytopenia. Putting on a mask, gown, and gloves when entering the client's room are reverse isolation measures. A neutropenic client doesn't need a clear liquid diet or sodium restrictions.)

A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? A) Medicate the client to relieve pain. B) Place a cooling blanket on the client. C) Evaluate the client for potential infection. D) Administer an antitussive.

C (Evaluate the client for potential infection. The client with leukemia has a lack of mature and normal granulocytes to fight infection. For this reason, the client is susceptible to infection. The primary nursing intervention is to evaluate for potential infection if the client has a cough and increased fatigue. Administering an antitussive would not be appropriate before determining the cause of the cough. A cooling blanket would not be needed if the client does not have a fever. Medicating the client to relieve pain would come after the assessment phase.)

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? A) Anemia B) Thrombocytopenia C) Pancytopenia D) Leukopenia

C (Pancytopenia Pancytopenia may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.)

26. After receiving a diagnosis of acute lymphocytic leukemia, a patient is visibly distraught, stating, I have no idea where to go from here. How should the nurse prepare to meet this patient's psychosocial needs? A) Assess the patient's previous experience with the health care system. B) Reassure the patient that treatment will be challenging but successful. C) Assess the patient's specific needs for education and support. D) Identify the patient's plan of medical care.

C) Assess the patient's specific needs for education and support. In order to meets the patient's needs, the nurse must first identify the specific nature of these needs. According to the nursing process, assessment must precede interventions. The plan of medical care is important, but not central to the provision of support. The patient's previous health care is not a primary consideration, and the nurse cannot assure the patient of successful treatment

38. The clinical nurse educator is presenting health promotion education to a patient who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions? A) Avoiding direct sun exposure in excess of 15 minutes daily B) Avoiding grapefruit juice and fresh grapefruit C) Avoiding highly crowded public places D) Using an electric shaver rather than a razor

C) Avoiding highly crowded public places The risk of infection is significant for these patients, not only from treatment-related myelosuppression but also from the defective immune response that results from the disease itself. Limiting infection exposure is thus necessary. The need to avoid grapefruit is dependent on the patient's medication regimen. Sun exposure and the use of razors are not necessarily contraindicated.

11. An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem? A) Hodgkin disease B) Non-Hodgkin lymphoma C) Multiple myeloma D) Acute thrombocythemia

C) Multiple myeloma Back pain, which is often a presenting symptom in multiple myeloma, should be closely investigated in older patients. The lymphomas and bleeding disorders do not typically present with the primary symptom of back pain or rib pain.

23. A nurse is caring for a patient who is being treated for leukemia in the hospital. The patient was able to maintain her nutritional status for the first few weeks following her diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement what intervention? A) Arrange for total parenteral nutrition (TPN). B) Facilitate placement of a percutaneous endoscopic gastrostomy (PEG) tube. C) Provide the patient with several small, soft-textured meals each day. D) Assign responsibility for the patient's nutrition to the patient's friends and family.

C) Provide the patient with several small, soft-textured meals each day. For patients experiencing difficulties with oral intake, the provision of small, easily chewed meals may be beneficial. This option would be trialed before resorting to tube feeding or TPN. The family should be encouraged to participate in care, but should not be assigned full responsibility.

29. A patient with a myelodysplastic syndrome is being treated on the medical unit. What assessment finding should prompt the nurse to contact the patient's primary care provider? A) The patient is experiencing a frontal lobe headache. B) The patient has an episode of urinary incontinence. C) The patient has an oral temperature of 37.5ºC (99.5ºF). D) The patient's SpO2 is 91% on room air.

C) The patient has an oral temperature of 37.5ºC (99.5ºF). Because the patient with MDS is at a high risk for infection, any early signs of infection must be reported promptly. The nurse should address each of the listed assessment findings, but none is as direct a threat to the patient's immediate health as an infection.

A patient with polycythemia vera is complaining of severe itching. What triggers does the nurse know can cause this distressing symptom? (Select all that apply.) A) Aspirin B) Allergic reaction to the red blood cell increase C) Alcohol consumption D) Exposure to water of any temperature E) Temperature change

C, D, E (- Alcohol consumption - Exposure to water of any temperature - Temperature change Pruritus is very common, occurring in up to 70% of patients with polycythemia vera (Saini, Patnaik & Tefferi, 2010) and is one of the most distressing symptoms of this disease. It is triggered by contact with temperature change, alcohol consumption, or, more typically, exposure to water of any temperature but seems to be worse with exposure to hot water.)

A nurse assesses a patient who has been diagnosed with DIC. Which of the following indicators are consistent with this diagnosis? Select all that apply. A) Capillary fill time <3 seconds B) Increased breath sounds C) Cyanosis in the extremities D) Polyuria E) Increased blood urea nitrogen (BUN) and creatinine F) Dyspnea and hypoxia

C, E, F (- Increased blood urea nitrogen (BUN) and creatinine - Dyspnea and hypoxia - Cyanosis in the extremities Urine output would be decreased in DIC, and capillary fill time would be more than 3 seconds; breath sounds would be decreased. Refer to Table 20-4 in the text.)

A 71-year-old woman with a history of rheumatoid arthritis and chronic heart failure has been admitted to the hospital for the treatment of a suspected upper gastrointestinal bleed. When performing an assessment of this patient, which of the following questions most directly addresses a likely cause of the woman's bleeding disorder? A) "Did either of your parents or siblings have problems with bleeding?" B) "How closely do you tend to monitor your blood pressure when you're at home?" C) "Has your doctor prescribed a water pill for your heart failure?" D) "Do you ever take aspirin to treat the pain of your arthritis?"

D ("Do you ever take aspirin to treat the pain of your arthritis?" An important functional platelet disorder is that induced by aspirin. Even small amounts of aspirin reduce normal platelet aggregation, and the prolonged bleeding time lasts for several days after aspirin ingestion. Diuretics, hypertension, and family history are not central parameters in the assessment of a bleeding disorder.)

Your client has just been prescribed oral iron. Why would you advise this client to avoid taking their medication with coffee, tea, eggs, or milk? A) Untoward reactions may occur. B) Coffee, tea, eggs, and milk interact with oral iron. C) Grand mal seizures may result. D) Absorption of iron will decrease.

D (Absorption of iron will decrease. When a client takes the drug with coffee, tea, eggs, or milk, absorption of oral iron decreases. The use of meperidine or Demerol when treating pain in clients with sickle cell crisis may result in grand mal seizures. Antacids, tetracyclines, and vitamin C interact with oral iron.)

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) Standard therapy B) Supportive therapy C) Antimicrobial therapy D) Induction therapy

D (Induction therapy 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.)

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) Administer pain medication. C) Place the client in reverse isolation. D) Maintain nutrition.

D (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.)

8. A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what? A) AML B) CML C) MDS D) ALL

D) ALL In acute lymphocytic leukemia (ALL), manifestations of leukemic cell infiltration into other organs are more common than with other forms of leukemia, and include pain from an enlarged liver or spleen, as well as bone pain. The central nervous system is frequently a site for leukemic cells; thus, patients may exhibit headache and vomiting because of meningeal involvement. Other extranodal sites include the testes and breasts. This particular presentation is not closely associated with acute myeloid leukemia (AML), chronic myeloid leukemia (CML), or myelodysplastic syndromes (MDS)

32. A clinic nurse is working with a patient who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the patient's disease? A) Document the color of the patient's palms and face during each visit. B) Follow the patient's erythrocyte sedimentation rate over time. C) Document the patient's response to erythropoietin injections. D) Follow the trends of the patient's hematocrit.

D) Follow the trends of the patient's hematocrit . The course of polycythemia vera can be best ascertained by monitoring the patient's hematocrit, which should remain below 45%. Erythropoietin injections would exacerbate the condition. Skin tone should be observed, but is a subjective assessment finding. The patient's ESR is not relevant to the course of the disease.

14. A patient with non-Hodgkin's lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurse's best response? A) Everyone should do these things because they're health promotion activities that apply to everyone. B) You don't want to develop a second cancer, do you? C) You need to do this just to be on the safe side. D) It's important to reduce other factors that increase the risk of second cancers.

D) It's important to reduce other factors that increase the risk of second cancers. 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. The other options do not answer the patient's question, and also make light of the patient's question.