MedSurg Ch. 34
A patient with AML has pale mucous membranes and bruises on his legs. What is the primary nursing intervention?
Assess the patient's hemoglobin and platelets.
A client with multiple myeloma presents to the emergency department complaining of excessive thirst and constipation. His family members report that he has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms?
Serum calcium level 13.8 mg/dl Excessive thirst, constipation, dehydration, confusion, and altered mental state are possible signs of hypercalcemia. Hypercalcemia is common in multiple myeloma because of the increased bone destruction. A platelet count of 300,000/mm3 is normal and wouldn't cause the client's symptoms. A sodium level of 133 mEq/L is slightly decreased but wouldn't cause confusion and excessive thirst. A hemoglobin of 9.8 g/dl level is slightly low but isn't likely responsible for the client's symptoms
Which of the following is the only curative treatment for chronic myeloid leukaemia (CML)?
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)
Which of the following nursing interventions should be incorporated into the plan of care to manage the delayed clotting process in a patient with leukemia?
Apply prolonged pressure to needle sites or other sources of external bleeding.
A patient presents with peripheral neuropathy and hypothesia of the feet. What is the best nursing intervention?
Assess for signs of injury.
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.
Bone pain in the back of the ribs
The nurse is teaching a patient about the development of leukemia. What statement should be included in the teaching plan?
"Chronic leukemia develops slowly." Chronic leukemia develops slowly, and the majority of leukocytes are still maturing. Acute leukemia develops quickly and the majority of leukocytes are undifferentiated cells.
Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?
Myeloid stem cell
A patient has completed induction therapy and has diarrhoea and severe mucositis. What is the appropriate nursing goal?
Maintain nutrition. Maintaining nutrition is the most important goal after induction therapy because the patient experiences severe diarrhoea and can easily become nutritionally deficient as well as develop fluid and electrolyte imbalance. The patient is most likely not in pain at this point, and this is an intervention not a goal.
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?
Multiple myeloma
What assessment findings best indicate that the patient has recovered from induction therapy?
Neutrophil and platelet counts within normal limits
You are assisting your client with multiple myeloma to ambulate. What is the most important nursing diagnosis to help prevent fractures in this client?
Safety
The term that is used to refer to a primitive cell, capable of self-replication and differentiation, is which of the following?
Stem cell
The nurse is assessing several patients. Which patient does the nurse determine is most likely to have Hodgkin lymphoma?
The patient with enlarged lymph nodes in the neck.
Which of the following statements best describes the function of stem cells in the bone marrow?
They produce all blood cells.
A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for:
pathologic bone fractures.
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.
• Assess skin and mucus membranes every shift. • Auscultate lung sounds every shift and prn. • Encourage the client to take deep breaths every 4 hours while awake.
The nurse is interacting with a family that has been caring for a patient with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply.
• Suggest support for household maintenance. • Educate the family about medications and side effects. • Allow family members to express feelings.
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.)
• Temperature change • Alcohol consumption • Exposure to water of any temperature
Which of the following are complications related to polycythaemia vera (PV)? Select all that apply.
• Ulcers • CVA • MI • Haematuria
The nurse is teaching a patient with acute lymphocytic leukaemia (ALL) about therapy. What statements should be included in the plan of care?
"Intrathecal chemotherapy is used primarily as preventive therapy."
A patient with multiple myeloma is complaining about pain. What instructions will the nurse give the patient to help to reduce pain during activity?
Do not lift more than 10 pounds.
A patient with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention?
Evaluate the patient for potential infection.
A patient is scheduled for a test to help confirm the diagnosis of acute myeloid leukemia (AML). Which of the following is the result that the nurse knows is consistent with the diagnosis?
Excess of immature blast cells
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?
Graft-versus-host disease
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?
Hypercalcemia
For a patient with Hodgkin disease, who is at a risk for an ineffective airway clearance and an impaired gas exchange, the nurse places the patient in a high Fowler's position to do which of the following?
Increase the lung expansion.
A patient with acute myeloid leukemia (AML) has a neutrophil count that persists at less than 100/mm3. What should the nurse cautiously monitor this patient for?
Infection
The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions?
Iron levels
A patient is taking hydroxyurea for the treatment of primary myelofibrosis. While the patient is taking this medication, what will the nurse monitor to determine effectiveness?
Leukocyte and platelet count
Which of the following terms refers to a form of white blood cell involved in immune response?
Lymphocyte
A client has been diagnosed with polycythaemia vera. It is most important for the nurse to teach the client about
Maintaining adequate blood pressure control
Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and platelets?
Pancytopenia
The hospitalized client is experiencing gastrointestinal bleeding. Laboratory test results show that the client's platelets are 9000/mm³. The client is receiving prednisone and azathioprine (Imuran). The nurse
Performs a neurologic assessment with vital signs With platelets less than 10,000/mm³ there is a risk for spontaneous bleeding, including within the cranial vault. The nurse performs a neurologic examination to assess for this possibility. Though the client is receiving immunosuppressants, it is not necessary to use contact precautions with this client. Contact precautions are used with clients who have known or suspected transmittable illnesses. Diphenoxylate/atropine can cause constipation and inhibit accurate assessment of the client's gastrointestinal bleeding. If the client strains when having a bowel movement, the client could bleed even more. The client is not to floss vigorously; doing so can cause bleeding.
Which nursing intervention is most appropriate for a client with multiple myeloma?
Preventing bone injury
The nurse meets with the family of a patient who had been diagnosed with stage I Hodgkin's lymphoma. She tells the family that the course of treatment will include:
Radiotherapy to the specific node over a space of 2 to 4 months. Stage I, without "B symptoms," is managed with radiotherapy to the specific node over a space of 2 to 4 months.
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)?
A 72-year-old patient with a history of cancer
The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has?
A general reduction in all white blood cells
When assessing a female patient with a disorder of the hematopoietic or the lymphatic system, which of the following assessments is most essential?
Health history, such as bleeding, fatigue, or fainting
A nurse is caring for an asymptomatic client with acute myelogenous leukemia. The client has a total white blood cell (WBC) count of 0 ?l, a platelet count of 3,000 mm2, and a hemoglobin level of 9 mg/dl. He has a single lumen central venous catheter in place and the physician has ordered the nurse to administer imipenem cilastatin (Primaxin) 500 mg every 8 hours, transfuse 1 unit packed red blood cells (RBCs), give amphotericin B (Fungizone) 40 mg I.V. over 4 hours, and transfuse 2 pheresis units of platelets. In what order should the nurse infuse these medications and blood products?
Platelets, imipenem cilastatin, amphotericin B, packed RBCs Although the client is currently asymptomatic, a platelet count of 3,000 mm2 puts him at risk for spontaneous hemorrhage, the most immediate and serious risk he faces. A WBC count of 0 clearly indicates neutropenia; the client needs an antibiotic and antifungal therapy to prevent infection. Although the client is anemic, he's currently asymptomatic. The absence of clinical manifestations makes his need for a transfusion less urgent.
