Med-Surg (Blood Cancers EAQ)

Tumor Lysis Syndrome

Hyperkalemia occurs when large quantities of tumor cells are destroyed, rapidly releasing potassium and purines quicker than the body can manage them (tumor lysis syndrome). A serum potassium of 5.8 mEq/L is more than the expected range of 3.5 to 5.3 mEq/L, resulting in the abnormal ECG results. Hyperkalemia can cause a pulse in the lower range of that expected for an adult, numbness in the extremities, flaccid paresis, hyperactive bowel sounds, and diarrhea.

Parents are considering a bone marrow transplant for their child who has recurrent leukemia. The parents ask the nurse for clarification about the procedure. What is the best response by the nurse?

"Your child's immune system must be destroyed before the transplantation can take place." An intensive preparatory regimen is needed to destroy the child's immune system. Once the process is started, no rescue therapy except for the transplant is provided. The procedure is performed in children for recurrent malignancies. The child's bone marrow must be clear of all cells before transfusion of the stem cells is performed.

On admission, the laboratory results of a client with leukemia indicate elevated blood urea nitrogen (BUN) and uric acid levels. The nurse determines that these laboratory results may be related to:

Hypermetabolic status The hypermetabolic state associated with leukemia causes more urea and uric acid (end products of metabolism) to be produced and to accumulate in the blood.

A client who has been diagnosed with acute lymphocytic leukemia will be receiving doxorubicin (Adriamycin) infusions as part of a chemotherapy regimen. The nurse monitors the client for signs and symptoms of doxorubicin toxicity. What clinical finding indicates that toxicity has occurred?

Abnormalities in cardiac rhythm Doxorubicin is cardiotoxic, which is manifested by transient ECG abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect.

A client who is suspected of having leukemia has a bone marrow aspiration. Immediately after the procedure, the nurse should:

Apply brief pressure to site.

A health care provider prescribes epoetin (Epogen) subcutaneously three times a week for an older adult with chronic lymphocytic leukemia (CLL) who lives alone. The nurse plans to teach the client about the medication. What should the nurse do first?

Assess the client's readiness to learn. Readiness to learn, including attitude and physical ability to see and use equipment, must be assessed before the skill can be taught. Demonstrating the injection technique as an initial intervention may be overwhelming for the client. Explanations are not as effective as a demonstration and a return demonstration when a skill is being taught.

An adolescent who has been prescribed prednisone (Meticorten) and vincristine (Oncovin) for leukemia tells the nurse that he is very constipated. What should the nurse cite as the probable cause of the constipation?

Constipation is a side effect of vincristine (Oncovin) because it slows gastrointestinal motility.

The nurse expects that the most definitive test to confirm a diagnosis of multiple myeloma is:

Bone marrow biopsy A definite confirmation of multiple myeloma can be made only through a bone marrow biopsy; this is a plasma cell malignancy with widespread bone destruction. Although calcium is lost from bone tissue and hypercalcemia results, this is not a confirmation of the disease. Although Bence Jones protein is found in the urine, it does not confirm the disease.

A blood transfusion of packed cells has been prescribed for a client with leukemia. The nurse will complete the following steps in what order?

Check the health care provider's prescription to notify blood bank what product will be needed. Obtain the client's baseline vital signs and ask if the client has had previous transfusions and if there were any untoward effects. Ascertaining the intravenous catheter size is at least an 18 will prevent hemolysis of red blood cells. The main line solution must be normal saline 0.9 to flush the line and use as a main line if the blood administration must occur because of a reaction. Other solutions can affect blood, causing it to clot. Checking the client identification and verification of blood product is necessary before proceeding.

A nurse is caring for a 15-year-old client who is undergoing chemotherapy for leukemia. The nurse expects that adolescents with health problems are most concerned about:

Feeling different regarding changes in body image The 15-year-old is preoccupied with appearance. The side effects of the antineoplastics and prednisone may result in the adolescent feeling different, which affects body image.

A client who is receiving methotrexate for acute lymphocytic leukemia (ALL) develops a temperature of 101° F. The nurse notifies the health care provider. Aspirin 650 mg every four hours as needed for temperature equal to or greater than 101° F is prescribed. What should the nurse do regarding this prescription?

Express concern about the type of antipyretic prescribed. Express concern about the type of antipyretic prescribed.

A client with multiple myeloma is scheduled to have a chest x-ray examination and a bone scan. For this client, the primary responsibility of the nurses and other members of the health care team is to:

Handle the client with supportive movements Because of bone erosion, pathological fractures are a common complication of multiple myeloma. Although explaining the procedure and its purpose is done, the priority is to prevent injury.

What is important nursing care for clients with leukemia on chemotherapeutic protocols?

Having them avoid contact with infected persons Chemotherapy and acute lymphoblastic leukemia (ALL) cause immunosuppression (low white blood cells), thus increasing the risk for infection. The client should maintain physical activity that can be tolerated. Although vital signs must be checked to assess for changes in pulse or blood pressure, unless there is clinical evidence of bleeding, it is not necessary to obtain vital signs every two hours.

What group of clients should the nurse anticipate to have the highest incidence of non-Hodgkin lymphomas?

Older adults The incidence increases with age; the median age when diagnosed is 67 years old.

While providing nursing care for an adolescent undergoing chemotherapy for leukemia, a nurse notes blood on the child's pillowcase, as well as several bloody tissues. Which of the child's laboratory test results should the nurse review?

Platelet count The platelet count is reduced as a result of bone marrow depression associated with leukemia and the side effects of chemotherapeutic agents. A low hematocrit level might indicate anemia, but it does not establish its cause

A client diagnosed with multiple myeloma has been given a poor prognosis. After discharge, the client plans to travel on an airplane and attend sporting events with friends and family. The nurse prepares a discharge teaching plan for this client and includes:

Preventing infection; the client is at risk for leukopenia The bone marrow is impaired with multiple myeloma; the effectiveness of white blood cells and immunoglobulins is reduced, which increases susceptibility to bacterial infections. Travel can be accomplished with careful planning and adequate rest periods.

A client's discouragement with the diagnosis of nodular, poorly differentiated lymphocytic lymphoma continues during radiation therapy because of the long time required for treatment and its side effects. What should the nurse emphasize when assisting the client to plan for the future?

Prognosis for this disease is more favorable than for other cancers

An adolescent with leukemia is to be sent home on a protocol that includes several antineoplastics. Before discharge, what instructions should the nurse give the parents?

Schedule laboratory blood tests to evaluate response to the medication. Blood tests indicate response to therapy; if the white blood cell count drops precipitously, therapy may be halted temporarily. These children undergo therapy for extended periods, and prolonged separation from their peers may lead to social isolation. Contact with children who have active infections should be avoided. Although nausea commonly occurs with this therapy, antiemetic measures are instituted; the drug is not withdrawn for this reason. A bone marrow aspiration is a painful procedure and is performed selectively (e.g., to confirm the diagnosis), not routinely.

A client who is immunosuppressed is receiving filgrastim (Neupogen). When the nurse evaluates the client's response to this medication, the finding that is most significant is an increase in:

White blood cells Filgastrin, a granulocyte colony-stimulating factor, increases the production of neutrophils with little effect on the production of hematopoietic cells.

A nurse is caring for a client with a diagnosis of polycythemia vera. The client asks, "Why do I have an increased tendency to develop blood clots?" Which effect of the polycythemia vera should the nurse explain increases the risk of these thromboses?

Increased blood viscosity Polycythemia vera results in pathologically high concentrations of erythrocytes in the blood; increased viscosity promotes thrombus formation.

The nurse expects that the plan of care for a client diagnosed with multiple myeloma will include:

Chemotherapy employing a combination of drugs is the treatment of choice; a variety of chemotherapeutic drugs affect rapidly dividing cells at different stages of cell division.

A client is diagnosed with acute lymphoid leukemia and is receiving chemotherapy. The nurse should monitor what thrombocytopenic side effects of chemotherapy? Select all that apply.

Melena, Purpura, Hematuria Black, tarry feces (Melena) caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with reduced number of thrombocytes, which are part of the coagulation process.

A client is prescribed epoetin (Epogen) injections. To ensure the client's safety, which lab value should the nurse assess before administration?

Hematocrit Epoetin is used to treat anemia. Epoetin is also used before and after certain types of surgery to decrease the chance that blood transfusions will be needed because of blood loss during surgery. The lab value the nurse should assess before administration is the hematocrit (HCT). HCT measures the percentage of whole blood.