Medical Surgical Nursing Chapter 31 Hematologic Problems

2 The patient with stage-favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of ABVD. Brentuximab vedotin is a newer agent that will be used to treat patients who have relapsed or refractory disease. 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. Text Reference - p. 671

A 22-year-old female 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? 1 Brentuximab vedotin 2 Two to four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) 3 Four to six cycles of ABVD 4 Bleomycin, etoposide, dosorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP)

1, 4, 5 Clinical manifestations of CLL include splenomegaly, lymphadenopathy, and hepatomegaly. Diagnostic findings include mild anemia, thrombocytopenia, and total white blood cell (WBC) count greater than 100,000/μL. Hemoglobin levels decrease. Sternal tenderness does not occur in CLL. Text Reference - p. 665

A 60-year-old patient came to the clinic complaining of recent weight loss, fever, and night sweats. The patient has been diagnosed with chronic lymphocytic leukemia (CLL). What manifestations of CLL will the nurse expect to find? Select all that apply. 1 Hepatomegaly 2 Sternal tenderness 3 Hemoglobin 19 g/dL 4 Platelet count 50,000/μL 5 White blood cell count 110,000/μL

1 A common integumentary change observed in anemia is pallor. Pruritus is seen in conditions associated with an increase in serum bile salts. Jaundice is seen in hemolytic anemia due to increased serum bilirubin. Hyperpigmentation is usually not associated with anemia. Text Reference - p. 633

A nurse is assessing a patient with nonhemolytic anemia. What integumentary finding is indicative of anemia? 1 Pallor 2 Pruritus 3 Jaundice 4 Hyperpigmentation

1, 3, 4 While undergoing therapy the nurse should evaluate the improvement in hemoglobin levels during every visit and should take necessary steps if hemoglobin levels do not improve. Long-term iron supplementation can cause liver dysfunction; therefore, the patient should be evaluated for liver function abnormalities. Iron therapy should be continued for two to three months after hemoglobin levels return to normal to replenish the iron stores in the body. Iron supplementation should not be stopped once hemoglobin levels are back to normal. Iron therapy is not associated with psychologic problems; hence, there is no need to monitor for psychologic changes. Text Reference - p. 639

A nurse is caring for a patient on iron therapy for the treatment of anemia. The patient requires lifelong iron supplementation. How can the nurse ensure maximum effectiveness of the therapy? Select all that apply. 1 By evaluating the patient's response to the therapy 2 By stopping the therapy once hemoglobin levels return to normal 3 By checking the patient for liver problems 4 By continuing iron therapy for two to three months after hemoglobin levels return to normal 5 By checking the patient for psychologic problems

4 Transfused blood does not contain calcium, so diluting the patient's own blood decreases the serum calcium level, resulting in hypocalcemia. This is a particular concern after multiple transfusions. Blood transfusions are not directly associated with any of the other answer options. However, patients who receive multiple transfusions should have their electrolytes monitored. Text Reference - p. 679

A nurse is caring for a patient who has received multiple blood transfusions. The patient is at risk for: 1 Hyponatremia 2 Hypernatremia 3 Hypercalcemia 4 Hypocalcemia

1, 2, 3 The compensatory respiratory changes that occur in severe anemia are tachypnea, orthopnea, and dyspnea at rest. Impaired thought process is a neurologic symptom associated with anemia. Dyspnea on exertion is seen in mild anemia. Text Reference - p. 634

A nurse is caring for a patient with severe anemia. Which compensatory respiratory changes is the nurse likely to find in the patient? Select all that apply. 1 Tachypnea 2 Orthopnea 3 Dyspnea at rest 4 Impaired thought process 5 Dyspnea on exertion

1, 2, 3, 4 The patient has thalessemia, is anemic, and has a history of blood transfusions. Oral deferasirox (Exjade) is a chelating agent that binds with iron to prevent iron overload. Such chelation therapy reduces zinc in the body, so zinc supplements should be administered. Blood transfusions are performed to keep the hemoglobin level at approximately 10 g/dL. Adequate hemoglobin promotes erythropoiesis and prevents spleen enlargement. Ascorbic acid supplements increase the excretion of iron, so they are administered during the chelation therapy. Blood transfusions and hemolysis lead to iron overload, so iron supplements should not be administered. Text Reference - p. 639

A nurse is caring for a patient with thalassemia major. The patient is anemic and has a history of numerous blood transfusions. The nurse expects what to be included in the patient's treatment plan? Select all that apply. 1 Oral deferasirox (Exjade) 2 Zinc supplementation 3 Continued blood transfusions 4 Ascorbic acid supplementation 5 Iron supplementation

1 Fever, night sweats, and weight loss are B symptoms that occur in patients diagnosed with high-grade lymphoma. Prednisone is an aggressive chemotherapeutic agent used to treat high-grade lymphoma. Vincristine, mitaxantrone, and cyclophosphamide are used in low-grade or indolent therapy to treat non-Hodgkin's lymphoma. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 673

A patient diagnosed with high-grade lymphoma complains of fever, night sweats, and weight loss. Which medication administered by the nurse may have a positive outcome for the patient? 1 Prednisone 2 Vincristine 3 Mitoxantrone 4 Cyclophosphamide

4 Non-Hodgkin's lymphoma can happen to a patient on immunosuppressive medication for the treatment of an autoimmune disorder. Multiple myeloma occurs due to environmental factors such as exposure to radiation, toxic metals, and herbicides. Hodgkin's lymphoma is caused by either an Epstein-Barr infection or a genetic predisposition. Myelodysplastic syndrome occurs in patients who have received radiation therapy or chemotherapy with alkylating agents. Text Reference - p. 671

A patient has been taking immunosuppressive medication for the treatment of psoriatic arthritis. About what complication of this treatment regimen should the nurse educate the patient? 1 Multiple myeloma 2 Hodgkin's lymphoma 3 Myelodysplastic syndrome 4 Non-Hodgkin's lymphoma

1, 4 Weight loss, fever, and drenching night sweats are clinical manifestations that occur in high-grade non-Hodgkin's lymphomas such as Burkitt's lymphoma and peripheral T cell lymphoma. Patients with non-Hodgkin's lymphomas are characterized by the presence of painless lymph node enlargement. Fatigue, fever, weakness, and tachycardia are manifestations of Hodgkin's lymphoma. Myelodysplastic syndrome has manifestations that result from the neoplastic transformation of pluripotent hematopoietic stem cells in the bone marrow. Human immunodeficiency viral infection is associated with Hodgkin's lymphoma. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. Text Reference - p. 671

A patient informs the nurse that he or she is experiencing weight loss, fever, drenching night sweats, and painless lymph node enlargement. Which diseases could likely be present in the patient? Select all that apply. 1 Burkitt's lymphoma 2 Hodgkin's lymphoma 3 Myelodysplastic syndrome 4 Peripheral T cell lymphoma 5 Human immunodeficiency viral infection

4, 3, 1, 2 Collaborative care is initially concerned with replacing blood volume to prevent shock. The source of the hemorrhage should then be identified in order to stop the blood loss. Once volume replacement is established, RBC loss is corrected by administering packed RBCs. The patient may also need supplemental iron because the availability of iron affects the marrow production of erythrocytes. Text Reference - p. 643

A patient is admitted to the emergency department following trauma from a motor vehicle accident (MVA) and is in a state of shock with acute blood loss. The following interventions are included in the collaborative care for this patient. In what order should these actions be performed? 1. Administer packed red blood cells (RBCs). 2. Provide supplemental iron. 3. Identify source of hemorrhage. 4. Replace blood volume.

2 Enlarged lymph nodes are a characteristic of Hodgkin's disease that occurs in the initial stage of development. Skeletal pain is a characteristic of multiple myeloma. B-cell blasts in the lymph nodes indicate Burkitt's lymphoma. Lymphoblasts in the cerebrospinal fluid are a diagnostic finding of acute lymphocytic lymphoma. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question Text Reference - p. 670

A patient is admitted with suspected Hodgkin's lymphoma. What assessment finding would the nurse correlate with the potential diagnosis? 1 Skeletal pain 2 Enlarged lymph nodes 3 B-cell blasts in the lymph node 4 Lymphoblasts in the cerebrospinal fluid

4 R-CHOP combination is used as both an indolent (low-grade) and aggressive (medium or high-grade) therapy in the treatment of non-Hodgkin's lymphoma. FND and FMC are used in indolent or low grade therapy to treat non-Hodgkin's lymphoma. RICE is used in aggressive therapy to treat non-Hodgkin's lymphoma. Text Reference - p. 673

A patient is being treated with chemotherapy for the treatment of non-Hodgkin's lymphoma. What combination therapy will the oncology nurse administer that is both an indolent and aggressive therapy? 1 FND (Fludarbine, novantronel, dexamethasone) 2 FMC (Fludaribine, metoxantrone, cyclophosphamide) 3 RICE (Rituximab, ifosfamide, cyclophosphamide, etoposide) 4 R-CHOP (Rituximab, cyclophosphamide, doxorubicin hydrochloride)

3 A lymph node excisional biopsy is instrumental in diagnosing the cell type and pattern in non-Hodgkin's lymphoma (NHL). An upper endoscopy and a CT scan are used to visualize any suspected gastrointestinal involvement in Hodgkin's lymphoma. An MRI scan is used to rule out central nervous system or bone marrow infiltration in Hodgkin's lymphoma. Text Reference - p. 672

A patient is diagnosed with non-Hodgkin's lymphoma (NHL). For what diagnostic test that will diagnose the cell type and pattern will the nurse prepare the patient? 1 Upper endoscopy 2 Computed tomography (CT) 3 Lymph node excisional biopsy 4 Magnetic resonance imaging (MRI)

1 The Schilling test measures B12 absorption. It is usually prescribed as the definitive test for pernicious anemia when other signs of the disease are present. A Schilling test does not measure the size of the spleen, gastric secretion levels, or thrombocytopenia severity. Text Reference - p. 640

A patient is scheduled for a Schilling test. The nurse explains that the purpose of the test is to measure: 1 B12 absorption 2 The size of the spleen 3 Gastric secretion levels 4 Severity of thrombocytopenia

2 The presence of Reed-Sternberg cells in a lymph node biopsy specimen is the main diagnostic feature in Hodgkin's lymphoma disease. Lymphoblasts in the cerebrospinal fluid indicate acute lymphocytic leukemia. Hypercellular bone marrow with myeloblasts is a diagnostic finding of acute myelogenous leukemia. The Philadelphia chromosome is a sign of chronic myelogenous leukemia. Text Reference - p. 669

A patient is suspected to have Hodgkin's lymphoma. When assessing the results of the diagnostic tests, which test results does the nurse recognize as indicative of this disease? 1 Lymphoblasts in the cerebrospinal fluid 2 Reed-Sternberg cells in the lymph node 3 Hypercellular bone marrow with myeloblasts 4 Philadelphia chromosome in the bone marrow cells

2, 5 Taking iron tablets an hour before food ensures maximum absorption, because iron will not get bound to food. When iron binds with food, absorption of iron falls. Orange juice and ascorbic acid enhance iron absorption. Taking iron tablets with food can reduce iron absorption. Taking iron tablets before or after exercise does not affect absorption. Text Reference - p. 638

A patient is taking iron tablets for the management of anemia. The nurse is aware that which measures will ensure maximum absorption of iron from the tablets? Select all that apply. 1 Take the tablet with food. 2 Take the tablet an hour before meals. 3 Take the tablet before exercise. 4 Take the tablet after exercise. 5 Take the tablet with orange juice

3, 5 Drenching night sweats, chills, fever, and tachycardia are possible signs of Hodgkin's lymphoma. Anemia may occur in patients with Hodgkin's lymphoma due to the increased destruction and decreased production of erythrocytes. Peripheral blood analysis and bone marrow examinations are used to diagnose Hodgkin's lymphoma. A lumbar puncture is used to detect the presence of leukemia cells. Prothrombin time is used to diagnose disseminated intravascular coagulation. A computed tomography scan is used to detect the presence of leukemia cells in other body parts. Text Reference - p. 670

A patient reports drenching night sweats, chills, fever, and rapid pulse rate. The nurse assesses a hemoglobin of 8.4 mg/dL. For what diagnostic tests will the nurse prepare the patient to determine a diagnosis? Select all that apply. 1 Lumbar puncture 2 Prothrombin time 3 Peripheral blood analysis 4 Computed tomography (CT) 5 Bone marrow examination

2 Maintaining oxygenation is a priority, because sickling episodes frequently are triggered by low oxygen tension in the blood, which commonly is caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity also will be used, but oxygenation is the priority. Text Reference - p. 646

A patient who has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient? 1 Start intravenous (IV) fluids 2 Maintain oxygenation 3 Maintain distal warmth 4 Check peripheral pulses

2 Weight loss, weakness, fever, and tachycardia are the clinical manifestations of Hodgkin's lymphoma. Anemia occurs in patients with Hodgkin's lymphoma because of the increased destruction and decreased production of erythrocytes. Signs of multiple myeloma are pain in the pelvis, spine, and ribs. Non-Hodgkin's lymphoma has clinical manifestations of painless lymph node enlargement, hepatomegaly with liver involvement, and renal failure. Acute lymphocytic leukemia shows symptoms of fever, anorexia, bleeding, and weakness. Text Reference - p. 670

A patient with cancer has weight loss, weakness, fever, tachycardia, and hemoglobin of 7.4 mg/dL. What complication does the nurse suspect may be occurring related to the clinical manifestations? 1 Multiple myeloma 2 Hodgkin's lymphoma 3 Non-Hodgkin's lymphoma 4 Acute lymphocytic leukemia

2, 3 Epoetin alfa is used to treat anemia related to cancer and its therapies. Methotrexate leads to folic acid deficiency resulting in megaloblastic anemia. Therefore, folic acid therapy is given to treat the patient. Oral iron is administered to patients with iron deficiency anemia, which is seen mostly in premenopausal and pregnant women. Blood transfusions are required to keep the approximate hemoglobin level to at least 10 g/dL in the case of thalassemia and severe anemia. Parenteral vitamin B12 is administered to treat cobalamin deficiency caused by pernicious anemia.

A patient with cancer who is receiving methotrexate therapy has developed anemia. Which therapies would be beneficial for this patient? Select all that apply. 1 Oral iron 2 Epoetin alfa 3 Oral folic acid 4 Blood transfusion 5 Parenteral vitamin B12

3 Hodgkin's lymphoma may occur in a patient with pancytopenia due to a deficiency of red blood cells, white blood cells, and platelets. Pancytopenia develops as a side effect that occurs after surgical therapy associated with Hodgkin's lymphoma. In polycythemia, leukemia myelofibrosis may develop as a side effect after chemotherapy. In multiple myeloma, renal dysfunction and peripheral neuropathy may occur as a side effect of drug therapy. In non-Hodgkin's lymphoma, tumor lysis syndrome may occur as a side effect of chemotherapy. Text Reference - p. 671

A patient with pancytopenia has a red blood cell count of 2.4 cells/mcL, white blood cell count of 2.8 cells/mcL, and platelet count of 50,000. For what complication should the nurse carefully monitor? 1 Polycythemia 2 Multiple myeloma 3 Hodgkin's lymphoma 4 Non-Hodgkin's lymphoma

1, 2, 4 The normal range of total serum iron level is 50 to 175 mcg/dL. The normal range of hemoglobin is 13.2 to 17.3 g/dL in males and 11.7 to 15.5 g/dL in females. Therefore, a hemoglobin value of 10 g/dL and total iron of 40 mcg/dL are indicative of iron deficiency anemia, which may be due to blood loss from peptic ulcer disease. The clinical manifestations of iron deficiency anemia are pallor, cheilitis (Inflammation of the lips), and paresthesias. Hepatomegaly may occur in patients with thalassemia due to iron deposition. Jaundice occurs due to prominent hemolysis of red blood cells in patients with thalassemia. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 637

A patient with peptic ulcer disease reports presence of blood in stools. The laboratory results reveal a hemoglobin level of 10 g/dL and a total iron level of 40 mcg/dL. Which clinical manifestations should the nurse expect to be present in the patient? Select all that apply. 1 Pallor 2 Cheilitis 3 Jaundice 4 Paresthesias 5 Hepatomegaly

1 In thalassemia, a low mean corpuscular volume and a high reticulocyte count are observed. In sickle cell anemia, a normal MCV and low reticulocyte count are seen. In hemolytic anemia, a normal MCV and increased reticulocytes are found. An increased MCV and normal or low reticulocyte count occur due to a folic acid deficiency. Text Reference - p. 638

A patient's laboratory reports show a low mean corpuscular volume (MCV) and a high reticulocyte count. Which condition should the nurse anticipate finding in the patient's medical record? 1 Thalassemia 2 Sickle cell anemia 3 Hemolytic anemia 4 Folic acid deficiency

4 In complete remission there is no evidence of overt disease on physical examination, and the bone marrow and peripheral blood appear normal. A lesser state of control is known as partial remission. Minimal residual disease is defined as tumor cells that cannot be detected by morphologic examination, but can be identified by molecular testing. Partial remission is characterized by a lack of symptoms and a normal peripheral blood smear, but still evidence of disease in the bone marrow. Molecular remission indicates that all molecular studies are negative for residual leukemia. Text Reference - p. 666

After receiving chemotherapy treatments for leukemia, a patient is declared to be in partial remission. Which statement does the nurse identify as being true about partial remission? 1 All molecular studies for residual leukemia are negative. 2 No evidence of overt disease on examination, and normal bone marrow and peripheral blood. 3 Tumor cells cannot be detected by morphologic examination, but are present in molecular testing. 4 A lack of symptoms and a normal peripheral blood smear, but evidence of the disease is still present in bone marrow.

2 Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. If there is not another nurse available, a health care provider could check the blood with the nurse. The unit secretary and UAP are not licensed to perform this duty. Text Reference - p. 676

An 82-year-old patient has a prescription to receive a transfusion of two units of packed red blood cells. The nurse would ask which health team member to assist in checking the unit before administration? 1 The unlicensed assistive personnel (UAP) 2 Another registered nurse (RN) 3 The physician's assistant 4 The unit secretary

3 With microcytic, hypochromic anemia, there may be an iron, B6, or copper deficiency, thalassemia, or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals as it is absorbed best in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider. Text Reference - p. 637

An older patient relates that he or she has increased fatigue and a headache. The nurse identifies pale skin and glossitis on assessment. In response to these findings, which teaching will be helpful to the patient if he or she has microcytic, hypochromic anemia? 1 Take enteric-coated iron with each meal. 2 Take cobalamin with green leafy vegetables. 3 Take the iron with orange juice one hour before meals. 4 Decrease the intake of the antiseizure medications to improve.

3 Iron is mostly absorbed in the form of ferrous sulfate. Ferrous sulfate chelates with food, impairing iron absorption. Iron supplements should be taken one hour before meals to ensure effective absorption. Iron supplements may stain the teeth, so they may be taken with a straw. The patient can take iron supplements at bedtime if he or she experiences abdominal discomfort. Orange juice is rich in vitamin C, which enhances iron absorption. Text Reference - p. 638

During follow-up visits, a nurse who has been teaching a patient about the use of liquid iron supplements determines that the patient still has iron-deficiency anemia even after receiving complete treatment. Which action could be responsible for this condition? 1 Taking iron supplements with a straw 2 Taking iron supplements during bedtime 3 Taking iron supplements along with meals 4 Taking iron supplements along with orange juice

2 An Hgb range of 10 to 12 g/dL indicates mild anemia. Therefore, the patient with an Hgb of 11 g/dL may experience palpitations. Glossitis is one of the manifestations of severe anemia in which the patient would have an Hgb level below 6 g/dL. Exertional dyspnea is seen in patients with mild anemia. However, dyspnea at rest is a manifestation of severe anemia. Roaring in the ears is seen in patients with moderate anemia whose Hgb values range between 6 and 10 g/dL. Text Reference - p. 634

The laboratory reports for a patient reveal a hemoglobin (Hgb) level of 11 g/dL. Which clinical manifestation would the nurse observe in the patient? 1 Glossitis 2 Palpitations 3 Dyspnea at rest 4 Roaring in the ears

1, 2, 4 Peripheral T-cell lymphoma cannot be treated with rituximab, because the CD 20 antigen is not present on the cell surface of B cells lymphomas. The treatment is not effective for patients with HIV and will not lower the CD4 count. Text Reference - p. 673

The nurse is administering rituximab to a patient. What disorders may the nurse be administering the medication for? Select all that apply. 1 Follicular lymphoma 2 Mantle cell lymphoma 3 Peripheral T-cell lymphoma 4 Cutaneous T- cell lymphoma 5 Human Immunodeficiency Virus (HIV)

2 Hyperuricemia (the presence of excess uric acid in the blood) is one of the nonspecific ways that non-Hodgkin's lymphoma manifests. Anemia is a manifestation of acute myelogenous leukemia. Lymphadenopathy is a manifestation of non-Hodgkin's lymphoma. Hepatosplenomegaly is a clinical manifestation of acute myeloid leukemia. Text Reference - p. 672

The nurse is assessing a newly admitted patient with non-Hodgkin's lymphoma. What data obtained indicate a nonspecific clinical manifestation associated with this disease? 1 Anemia 2 Hyperuricemia 3 Lymphadenopathy 4 Hepatospleenomegaly

1, 2, 4, 5 In severe anemia (Hgb less than 6 g/dL [60 g/L]), the patient has many clinical manifestations involving multiple body systems, including jaundice, pruritis, glossitis,smooth tongue, vertigo, dyspnea at rest, and sensitivity to cold. The patient will not have sensitivity to heat. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. Text Reference - p. 633

The nurse is assessing a patient who has severe anemia and would expect to find which manifestations? Select all that apply. 1 Vertigo 2 Sensitivity to heat 3 Jaundice and pruritus 4 Dyspnea at rest 5 Glossitis and smooth tongue

1, 2 A decrease in the number of white blood cells and thrombocytes indicates leukopenia and thrombocytopenia respectively, which may occur after Hodgkin's lymphoma therapy. Other conditions such as hypoferremia (excessive uptake of iron by the liver and spleen) and hypercalcemia from bone involvement may also occur in a patient after Hodgkin's lymphoma therapy. Hypogammaglobulinemia, autoimmune hemolytic anemia, and idiopathic thrombocytopenic purpura are diagnostic findings of chronic lymphocytic leukemia. Test-Taking Tip: Recall the conditions that occur due to abnormal count of white blood cells and thrombocytes and correlate it with the diagnostic finding of a disease. Text Reference - p. 670

The nurse is assessing a patient who underwent treatment for Hodgkin's lymphoma. The laboratory reports show a decrease in the number of white blood cells and thrombocytes. For which other conditions should the nurse monitor? Select all that apply. 1 Hypoferremia 2 Hypercalcemia 3 Hypogammaglobulinemia 4 Autoimmune hemolytic anemia 5 Idiopathic thrombocytopenic purpura

1 Sickle cell anemia is most common in African Americans. African Americans and people of Mediterranean origin are at the highest risk for thalassemia. Tay-Sachs disease is a rare, autosomal-recessive genetic metabolic disorder found in Ashkenazi Jews. Deficiency in red blood cell production due to a lack of vitamin B12 results in pernicious anemia and most commonly occurs in Scandinavians and African Americans. Text Reference - p. 633

The nurse is assessing four patients. Which patient is at the highest risk for sickle cell anemia? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

4, 6, 1, 8, 3, 7, 2, 5, 9 In the case of an acute transfusion reaction, the nurse should stop the transfusion immediately and maintain a patent IV line with saline solution. The blood bank and health care provider should be notified immediately. The nurse should recheck identifying tags and numbers. The patient's vital signs and urine output should be monitored. Symptoms should be treated as prescribed by the health care provider. The blood bag and urine tubing should be sent to the blood bank for examination. The patient should be evaluated periodically for hemolysis, and transfusion reaction should be documented in the patient's chart. Text Reference - p. 678

The nurse is caring for a patient receiving a blood transfusion. In the case of an acute transfusion reaction, the nurse is required to perform all of these interventions. In which order should these interventions be carried out? 1. Notify blood bank and health care provider immediately. 2. Send blood bag and tubing for examination. 3. Monitor vital signs and urine output. 4. Stop transfusion. 5. Evaluate periodically for hemolysis. 6. Maintain a patent IV line with saline solution. 7. Treat symptoms as prescribed. 8. Recheck identifying tags and numbers. 9. Document transfusion reaction.

4 Positron emission tomography (PET) is used to diagnose and evaluate mediastinal lymphadenopathy. Barium enemas and upper endoscopies are used to diagnose any suspected gastrointestinal involvement in non-Hodgkin's lymphoma. Radiologic evaluation is helpful to determine the clinical stage of Hodgkin's lymphoma. Text Reference - p. 670

The nurse is caring for a patient with suspected mediastinal lymphadenopathy. Which diagnostic test will the nurse prepare the patient for to confirm the diagnosis? 1 Barium enema 2 Upper endoscopy 3 Radiologic evaluation 4 Positron emission tomography (PET)

4 An MRI scan is used to diagnose non-Hodgkin's disease and to rule out central nervous system or bone marrow infiltration. A lumbar puncture is used to detect leukemia cells outside of the blood and bone marrow. Peripheral blood analysis is used to diagnose Hodgkin's lymphoma. Bone marrow examinations are used to diagnose multiple myeloma and leukemia. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer Text Reference - p. 672

The nurse is caring for a patient with suspected non-Hodgkin's disease. For what diagnostic testing will the nurse prepare the patient? 1 Lumbar puncture 2 Peripheral blood analysis 3 Bone marrow examination 4 Magnetic resonance imaging (MRI)

4 Arsenic trioxide causes DNA fragmentation and cell death. It is used to treat acute promyelocytic leukemia. Imatinib acts by targeting the BCR-ABL protein, which is commonly found in patients with chronic myelogenous leukemia. Rituximab acts by binding to B-cell antigens (CD20) and is used to treat chronic lymphocytic leukemia. Alemtuzumab acts by binding to CD52 and is used to treat chronic lymphocytic leukemia. Text Reference - p. 667

Which drug used to treat acute promyelocytic leukemia acts by causing DNA fragmentation and cell death? 1 Imatinib 2 Rituximab 3 Alemtuzumab 4 Arsenic trioxide

1 Aplastic anemia is characterized by decreased hemoglobin, slightly increased mean corpuscular volume, and decreased reticulocyte. Aplastic anemia is also characterized by the presence of normal levels of serum iron, vitamin B12, and serum bilirubin. Sickle cell anemia is characterized by increased bilirubin serum levels. Hemolytic anemia is characterized by increased reticulocyte levels and bilirubin levels. Cobalamin deficiency can result in pernicious anemia and is associated with decreased serum vitamin B12 levels. Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the patient in formats such as the medical record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, health history), physical assessment data, and assistant/patient interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking. In a clinical exam, you may be expected to select instruments, arrange instruments, and/or perform some other task. Acquaint yourself with the physical facility. If the required procedures are not clear to you, ask for clarification. Text Reference - p. 642

The nurse is reviewing the blood test reports of a patient. Which condition does the nurse expect in the patient from these findings? 1 Aplastic anemia 2 Sickle cell anemia 3 Hemolytic anemia 4 Pernicious anemia

2 Hemoglobin content of less than 60 g/dL indicates severe anemia, which can result in tachycardia, or increased heart rate. Patient B is showing symptoms of tachycardia and increased pulse pressure. Patient A has a hemoglobin content between 60 and 100 g/dL, which indicates moderate anemia but is not associated with an increased heart rate. Patients C and D have a hemoglobin content between 100 and 120 g/dL, which indicates mild anemia. Text Reference - p. 634

The nurse is reviewing the blood test reports of four patients. Which patient will have a heart rate of 110 beats/minute? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

2, 4 After a splenectomy, there can be a dramatic increase in peripheral RBC, WBC, and platelet counts. IgM levels are reduced, whereas IgG and IgA values remain within normal limits. Text Reference - p. 676

The nurse is reviewing the patient's laboratory values after a splenectomy. What results would the nurse expect to see? Select all that apply. 1 Leukopenia 2 Reduced IgM levels 3 Increased IgG levels 4 Increased white blood cell (WBC) count 5 Decreased red blood cell (RBC) count 6 Decreased platelet count

2, 3, 5 The nurse should teach the patient to take iron capsules with orange juice or vitamin C to enhance iron absorption. The patient should be informed that use of iron preparations will make the stool appear black because the gastrointestinal (GI) tract excretes excess iron. Constipation is a common side effect, and the patient should be started on stool softeners or laxatives. Iron should be taken at least one hour before meals, when the duodenal mucosa is most acidic to enhance absorption; however, gastric side effects may necessitate ingesting iron with meals. In order to replenish the body's stores, the patient needs to take iron therapy for two to three months after the hemoglobin level returns to normal. Text Reference - p. 638

The nurse is teaching a patient the proper intake of prescribed iron capsules. Which actions should the nurse teach the patient? Select all that apply. 1 Take the medication about an hour after meals. 2 Take the medication with orange juice. 3 Do not worry if stools appear black. 4 Stop therapy when hemoglobin level returns to normal. 5 Take laxatives if needed.

3 Macroangiopathic or microangiopathic extrinsic factors lead to acquired hemolytic anemias. Trauma or splenic sequestration crisis can lead to anemia from acute blood loss. Abnormal hemoglobin or enzyme deficiency are intrinsic factors that lead to hereditary hemolytic anemias. Chronic diseases or medications and chemicals can decrease the number of red blood cell (RBC) precursors; this reduces RBC production. Text Reference - p. 647

The nurse knows that hemolytic anemia can be caused by which extrinsic factors? 1 Trauma or splenic sequestration crisis 2 Abnormal hemoglobin or enzyme deficiency 3 Macroangiopathic or microangiopathic factors 4 Chronic diseases or medications and chemicals

3 The cause of chronic anemia is often inadequate dietary intake of foods high in iron. In most cases of iron-deficiency anemia, the condition may be prevented by consuming a nutritionally balanced diet. Attending a nutrition education session will increase compliance with the recommended diet. Taking supplements of vitamin C, which will increase iron absorption from the GI tract, avoiding large crowds, and discussing the possibility of long-term supplemental iron injections will not have a direct effect on postdischarge management of anemia. Text Reference - p. 641

The nurse provides teaching to a patient with chronic anemia. What should the nurse's instructions to help manage the condition after the patient's discharge include? 1 Take vitamin C 2 Avoid large crowds 3 Participate in a nutrition education session 4 Anticipate the need for supplemental iron injectio

4 Brentuximab vedotin is the recommended drug used to treat relapsed or refractory Hodgkin's lymphoma disease by releasing an agent that disrupts the microtubule network. Fludarabine, mitoxantrone, and cyclophosphamide are used as combination chemotherapy to treat non-Hodgkin's lymphoma. Text Reference - p. 670

The oncology nurse is administering a chemotherapeutic agent to a patient with relapsed Hodgkin's lymphoma. Which medication administered will have the best outcome for this patient? 1 Fludarabine 2 Mitoxantrone 3 Cyclophosphamide 4 Brentuximab vedotin

4 Marginal zone B-cell lymphoma is a type of non-Hodgkin's lymphoma that can be treated with low-grade chemotherapy. Mantel cell, peripheral T-cell and natural killer cell lymphomas are treated by aggressive or high-grade chemotherapy. Text Reference - p. 673

The oncology nurse is administering low-grade chemotherapy to a patient. What type of condition does the patient have? 1 Mantel cell lymphoma 2 Peripheral T-cell lymphoma 3 Natural killer cell lymphoma 4 Marginal zone B-cell lymphoma

2 Fludarabine, mitoxantrone, and cyclophosphamide (FMC) are used to treat marginal zone B-cell lymphoma. Ifosfamide, cyclophosphamide, and etoposide (ICE) are used to treat mantle cell lymphoma. Steroids, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) are used to treat peripheral T-cell lymphoma. Dexamethasone, high-dose cytarabine (Ara-C), and cisplatin (Platinol), with rituximab (DHAP±R) are used to treat of diffuse large B-cell lymphoma. Text Reference - p. 673

The oncology nurse is preparing to administer chemotherapy to a patient with marginal zone B-cell lymphoma. What combination of chemotherapy does the nurse monitor for effectiveness? 1 Ifosfamide, cyclophosphamide, etoposide (ICE) 2 Fludarabine, mitoxantrone, cyclophosphamide (FMC) 3 Steroids, methotrexate, ifosfamide, L-asparaginase, etoposide (SMILE) 4 Dexamethasone, high-dose cytarabine (Ara-C), cisplatin (Platinol), with rituximab (DHAP±R)

2 Using ratio and proportion, multiply 250 by x and multiply 1000 × 1 to yield 250x = 1000. Divide 1000 by 250 to yield four tablets. Text Reference - p. 641

The patient has a prescription for cobalamin (vitamin B12) 1,000 mg by mouth (PO). On hand, the nurse has 250-mg tablets available. How many tablets should the nurse give? 1 Two tablets 2 Four tablets 3 Six tablets 4 Eight tablets

4 The patient first should 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. Text Reference - p. 673

The patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? 1 Skin care that will be needed 2 Method of obtaining the treatment 3 Gastrointestinal tract effects of treatment 4 Treatment type and expected side effects

4 The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Lactated Ringer's, 5% dextrose in water, and 3% normal saline are not compatible with blood products. Text Reference - p. 676

To prepare for a transfusion of packed red blood cells, the nurse selects which intravenous solution to use for the procedure? 1 3% normal saline 2 Lactated Ringer's 3 5% dextrose in water 4 0.9% normal saline

2 Folic acid promotes maturation of red blood cells (RBC). Ascorbic acid aids in the absorption of iron. Iron and pyridoxine promote hemoglobin synthesis. Copper helps in the mobilization of iron from tissue to plasma. Text Reference - p. 637

What is the role of folic acid in erythropoiesis? 1 Aids in absorption of iron 2 Promotes RBC maturation 3 Promotes hemoglobin synthesis 4 Aids in mobilization of iron from tissue to plasma

2 Iron deficiency may cause anemia due to decreased hemoglobin synthesis. Leukemia may cause anemia due to a decreased number of red blood cell (RBC) precursors. Cobalamin deficiency may result in anemia due to defective DNA synthesis. G6PD enzyme deficiency is hereditary and causes increased RBC destruction (hemolytic anemias). Text Reference - p. 634

Which condition may cause anemia due to decreased hemoglobin synthesis? 1 Leukemia 2 Iron deficiency 3 Cobalamin deficiency 4 G6PD enzyme deficiency

3 Folic acid deficiency can cause the synthesis of defective deoxyribonucleic acid (DNA) and result in anemia. A decreased number of red blood cell precursors results in anemia in patients with myelodysplasia and Fanconi syndrome. Increased red blood cell destruction can result in anemia in patients with G6PD enzyme deficiency. Text Reference - p. 634

Which condition results in anemia due to synthesis of defective DNA in the body? 1 Myelodysplasia 2 Fanconi syndrome 3 Folic acid deficiency 4 G6PD enzyme deficiency

1 Burkitt's lymphoma is a highly aggressive disease that originates from B-cell blasts in lymph nodes. Hodgkin's lymphoma originates from proliferation of Reed-Sternberg cells. Diffuse large B-cell lymphoma originates at lymph nodes of the neck and abdomen. Non-Hodgkin's lymphoma (NHL) originates outside the lymph nodes. Text Reference - p. 671

Which disease originates from B-cell blasts present in the lymph nodes? 1 Burkitt's lymphoma 2 Hodgkin's lymphoma 3 Diffuse large B-cell lymphoma 4 Non-Hodgkin's lymphoma (NHL)

4 Chromosomal translocations (a condition in which the chromosomes break and the broken fragments join other chromosomes) are a cause of Non-Hodgkin's lymphoma. Multiple myeloma occurs because of environmental factors such as exposure to radiation, toxic metals, and herbicides. Hodgkin's lymphoma is caused by a proliferation of Reed-Sternberg cells in the lymph nodes. Leukemia develops due to exposure to chemical agents, chemotherapeutic agents, and radiation. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. Text Reference - p. 671

Which disease process has chromosomal translocations as its contributing factor? 1 Leukemia 2 Multiple myeloma 3 Hodgkin's lymphoma 4 Non-Hodgkin's lymphoma

4 Undiluted liquid iron may stain the patient's teeth; therefore, liquid iron should be diluted and ingested through a straw. Iron is best absorbed as ferrous sulfate (Fe2+) in an acidic environment. Therefore, iron supplements should be taken about an hour before meals when the duodenal mucosa is acidic. Orange juice contains vitamin C (ascorbic acid), which enhances iron absorption. Therefore, it is advisable to take vitamin C supplements along with iron. Constipation may occur commonly in patients who are prescribed iron therapy. Therefore, it is advisable to take laxatives and stool softeners when receiving iron therapy. Text Reference - p. 638

Which factor should be considered before the administration of iron? 1 Taking iron supplements along with food 2 Refraining from drinking orange juice when administering iron 3 Refraining from the use of laxatives when on iron therapy 4 Diluting the liquid iron and ingesting it through a straw

2 Pernicious anemia is characterized by the presence of a smooth, beefy-red tongue, and abdominal pain. Platelet function is reduced in the patient with leukemia; therefore, bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron deficiency anemia. Text Reference - p. 640

Which finding supports the nurse's conclusion that a patient has pernicious anemia? 1 Bleeding of the gums 2 Smooth, beefy-red tongue 3 Spoon-shaped concave nails 4 Fissures in corners of the mouth

1, 2, 3

Which laboratory report findings support the nurse's conclusion that a patient has thalassemia major? Select all that apply. 1 Increased bilirubin levels 2 Increased serum iron levels 3 Increased reticulocyte level 4 Increased mean corpuscular volume 5 Increased total iron-binding capacity

2 A patient with thalassemia major requires frequent blood transfusions and is at risk of iron toxicity. Deferoxamine chelates with the iron and reduces iron overload or hemochromatosis. Methotrexate is an anticancer drug, and it does not reduce iron overload. Iron supplements such as ferrous gluconate and iron dextran complex should not be administered to the patient because they further increase the risk of iron overload. Test-Taking Tip: You should recollect the signs and symptoms to be monitored in a patient who is undergoing blood transfusion to answer this question accurately. Text Reference - p. 639

Which medication is beneficial in a patient with thalassemia major receiving a blood transfusion who is showing signs of hemochromatosis? 1 Methotrexate 2 Deferoxamine 3 Ferrous gluconate 4 Iron dextran complex

4 Non-Hodgkin's lymphoma originates from immune cells such as natural killer lymphocytes. Non-Hodgkin's lymphoma is disseminated. Non-Hodgkin's lymphoma is characterized by 40 percent B symptoms and common extra-nodal involvement. Text Reference - p. 669

Which statement is true regarding non-Hodgkin's lymphoma? 1 Non-Hodgkin's lymphoma is localized to regional nodes. 2 Non-Hodgkin's lymphoma involves common B symptoms. 3 Non-Hodgkin's lymphoma has rare extranodal involvement. 4 Non-Hodgkin's lymphoma originates from natural killer lymphocytes

2 Folic acid is given if there is any evidence of hemolysis in patients with thalassemia. Zinc supplementation is required in patients with thalassemia after chelation therapy, because zinc levels may decline. Vitamin B12 supplementation is required for patients with megaloblastic anemias. Ascorbic acid supplementation may be needed during chelation therapy in patients receiving treatment for thalassemia, because it increases urinary excretion of iron. Text Reference - p. 640

Which supplementation is given if there is evidence of hemolysis in patients who are receiving treatment for thalassemia? 1 Zinc 2 Folic acid 3 Vitamin B12 4 Ascorbic acid

2 Diffuse large B-cell lymphoma is an aggressive lymphoma that arises in the lymph nodes of the neck or abdomen. Burkitt's lymphoma originates from B-cell blasts in the lymph nodes. Small lymphocytic lymphoma (SLL), and chronic lymphocytic leukemia (CLL) result from malignant proliferation of small B-lymphocytes. Text Reference - p. 671

Which type of lymphoma originates from lymph nodes in the abdomen? 1 Burkitt's lymphoma 2 Diffuse large B-cell lymphoma 3 Small lymphocytic lymphoma (SLL) 4 Chronic lymphocytic leukemia (CLL)

3 Enlarged retroperitoneal nodes may cause palpable abdominal masses, which can interfere with renal function. Spinal cord compression causes paraplegia. If Hodgkin's lymphoma begins to affect the liver, bilirubin levels will increase and the patient will suffer from jaundice. Superior vena cava syndrome can occur due to intrathoracic involvement. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 670

While assessing a patient diagnosed with Hodgkin's lymphoma, the nurse identifies enlarged retroperitoneal nodes. For which complication should the nurse monitor? 1 Paraplegia 2 Liver dysfunction 3 Renal dysfunction 4 Superior vena cava syndrome

1, 4, 2, 3 Leukemia is a condition characterized by the proliferation of immature white blood cells that are malignant, or blast, cells. In this condition, blast cells replace bone marrow, causing bone marrow failure and leading to a low platelet count. Low platelet counts are associated with bleeding, which causes red spots on the skin, known as petechiae. Text Reference - p. 666

While examining a leukemia patient, a registered nurse says to a student nurse, "These tiny red spots on the skin are due to leukemia." The student nurse asks, "How do these red spots relate to leukemia?" Arrange the steps in the chronologic order that the registered nurse would teach to the student nurse? 1. Petechiae due to bleeding 2. Decrease in the platelet count 3. Blast cells replace bone marrow 4. Leukemia leads to high count of immature white blood cells

3 An undiluted iron preparation causes staining of the teeth if consumed without using a straw. Such preparations should therefore be taken using a straw. Compared to drinking undiluted liquid iron without a straw, consuming it with a straw does not boost iron absorption, reduce iron absorption, or reduce allergic reactions. Text Reference - p. 638

While taking undiluted liquid iron that was prescribed, a patient asks the nurse why it must be drunk through a straw. How should the nurse respond? 1 It increases iron absorption. 2 It reduces iron absorption. 3 It prevents staining of the teeth. 4 It reduces allergic reactions

3 Almetuzumab is used to treat chronic lymphocytic leukemia by binding to CD52, a panlymphocyte antigen present on both T and B cells. Lomustine acts by breaking DNA helix and interfering with DNA replication. Carboplatin acts by binding to DNA and RNA and inhibiting DNA replication. Cyclophosphamide damages DNA by causing breaks in the double-stranded helix. Text Reference - p. 667

While treating a patient with chronic lymphocytic leukemia, the primary health care provider prescribes a drug that acts by binding to CD52, a panlymphocyte antigen present on both T and B cells. What drug may be prescribed by the primary health care provider? 1 Lomustine 2 Carboplatin 3 Almetuzumab 4 Cyclophosphamide