ch 30- Hematologic Neoplasm
The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has? Multiple myeloma Non-Hodgkin lymphoma Chronic myeloid leukemia Hodgkin lymphoma
Multiple myeloma Explanation: Any older adult with unprovoked or unexplained back pain and increased protein in the serum should be assessed for multiple myeloma. Bone pain occurs because of bone breakdown and the malignant cells of multiple myeloma increase the serum protein levels
What assessment finding best indicates that the client has recovered from induction therapy? Vital signs within normal ranges Absence of bone pain Neutrophil and platelet counts within normal limits No evidence of edema
Neutrophil and platelet counts within normal limits Explanation: 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.
A client is awaiting test results to diagnose Hodgkin lymphoma. The nurse knows that which result is the hallmark for the diagnosis of this condition?
A general reduction in all white blood cells Explanation: Leukopenia is a general reduction in all WBCs. Leukopenia does not have anything to do with erythrocytes.
Which term refers to a form of white blood cell involved in immune response? Thrombocyte Spherocyte Granulocyte Lymphocyte
Lymphocyte Explanation: 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.
A nurse cares for a client with myelodysplastic syndrome (MDS). Which assessment finding does the nurse recognize is the most common finding with this condition? Macrocytic anemia Proliferative anemia Hemolytic anemia Microcytic anemia
Macrocytic anemia Explanation: Macrocytic anemia is the most common symptom of MDS.
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "In acute leukemia there are not many undifferentiated cells." "Acute leukemia develops slowly." "Chronic leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature."
"Chronic leukemia develops slowly." Explanation: Chronic leukemia develops slowly, and the majority of leukocytes produced are mature. Acute leukemia develops quickly and the majority of leukocytes are undifferentiated cells.
A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client is not appropriately dealing with spiritual distress? "I am going to call my clergy to pray with me." "I have resources within myself that I can depend on." "I know I am going to die. I want to say good-bye to my family." "I do not understand why this happened to me."
"I do not understand why this happened to me." Explanation: 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
A nurse assesses a client who has been diagnosed with DIC. Which indicators are consistent with this diagnosis? Select all that apply. Increased blood urea nitrogen (BUN) and creatinine Increased breath sounds Cyanosis in the extremities Dyspnea and hypoxia Polyuria Capillary fill time <3 seconds
Increased blood urea nitrogen (BUN) and creatinine Dyspnea and hypoxia Cyanosis in the extremities
The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis?
Polycythemia vera Explanation: Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow. In sickle cell disease, HbS causes RBCs to assume a sickled shape under hypoxic conditions. Aplastic anemia has a deficiency of erythrocytes. The other options do not have the characteristics of erythrocytosi
A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? Preventing bone injury Monitoring respiratory status Balancing rest and activity Restricting fluid intake
Preventing bone injury Explanation: 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 fluid intake.
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? The client with painful lymph nodes in the groin. The client with a painful sore throat. The client with painful lymph nodes under the arm. The client with enlarged lymph nodes in the neck.
The client with enlarged lymph nodes in the neck. Explanation: Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.
A client with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom? The dead red blood cells occlude the small vessels in the joints. Excess red blood cells produce extracellular toxins that build up. The dead red blood cells release excess uric acid. Excess red blood cells cause vascular injury in the joints.
The dead red blood cells release excess uric acid. Explanation: There is a rapid proliferation of red blood cells from the marrow in polycythemia vera. However, these red blood cells die sooner than normal and the dead red blood cells release potassium and uric acid. This build up of uric acid in the blood leads to gouty arthritis symptoms.
The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing intervention to help prevent fractures in the client? Provide adequate hydration. Encourage adequate nutrition. Increase mobility. Promote safety.
Promote safety. Explanation: Safety is paramount because any injury, no matter how slight, can result in a fracture. Mobility, hydration, and nutrition are important, but will not prevent fractures.
A client is awaiting test results to diagnose Hodgkin lymphoma. The nurse knows that which result is the hallmark for the diagnosis of this condition? Increased basophils Misshaped red blood cells Reed-Sternberg cells Elevated platelet count
Reed-Sternberg cells Explanation: 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. These cells arise from the B lymphocyte. They may have more than one nucleus and often have an owl-like appearance. The presence of Reed-Sternberg cells is the pathologic hallmark and essential diagnostic criterion. Basophils, platelets, or red blood cells are not used to diagnose Hodgkin lymphoma.
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? Bronze skin tone Pale skin and mucous membranes Jaundice skin and sclera Ruddy complexion
Ruddy complexion Explanation: Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.
A client with multiple myeloma presents to the emergency department and reports excessive thirst and constipation. Family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? Serum calcium level 13.8 mg/dl Platelet count 300,000/mm3 Serum sodium level of 133 mEq/L Hemoglobin of 9.8 g/dl
Serum calcium level 13.8 mg/dl Explanation: 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.
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Pancytopenia Thrombocytopenia Anemia Neutropenia
Neutropenia Explanation: Fever and infection result from a decrease in neutrophils (neutropenia). Decreased red blood cells (anemia) cause weakness, fatigue, dyspnea on exertion, and pallor in AML. Pancytopenia, an overall decrease in all blood components, is not cause of fever in clients with AML. Decreased platelet count (thrombocytopenia) causes petechiae and bruising in AML.
What interventions are most appropriate for the nurse to include in the plan of care for a client at risk for infection? Select all that apply. Encourage the client to take deep breaths every 4 hours while awake. Provide oral hygiene once daily. Assess skin and mucus membranes every shift. Place fresh flowers on a shelf on the opposite wall from the client. Auscultate lung sounds every shift and as needed.
Encourage the client to take deep breaths every 4 hours while awake. Auscultate lung sounds every shift and as needed. Assess skin and mucus membranes every shift.
A client with Hodgkin lymphoma is planning to receive the Stanford V treatment protocol. Which medication teaching will the nurse prepare for this client? Select all that apply. Doxorubicin Vinblastine Adriamycin Mechlorethamine Etoposide
Etoposide Vinblastine Doxorubicin Mechlorethamine
The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis? polycythemia vera sickle cell disease aplastic anemia pernicious anemia
polycythemia vera Explanation: Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow. In sickle cell disease, HbS causes RBCs to assume a sickled shape under hypoxic conditions. Aplastic anemia has a deficiency of erythrocytes. Sickle cell disease and the anemias do not have the characteristics of erythrocytosis.
The nurse is assessing a client admitted with a deep vein thrombosis with an elevated red blood cell count. The admitting diagnosis is polycythemia vera. What is the hallmark clinical sign of PV? weight gain splenomegaly peripheral edema pale body color
splenomegaly Explanation: Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, weight loss, paresthesias, and blurred vision). Edema, pale body color, and weight gain are not classic symptoms of PV.
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A 24-year-old female taking oral contraceptives A 52-year-old patient with acute kidney injury A 40-year-old patient with a history of hypertension A 72-year-old patient with a history of cancer
A 72-year-old patient with a history of cancer Explanation: Primary MDS tends to be a disease of people older than 70 years. Because the initial findings are so subtle, the disease may not be diagnosed until later in the illness trajectory, if at all. Thus, the actual incidence of MDS is not known
The nurse is providing teaching to a client diagnosed with chronic myeloid leukemia (CML). Which statement will the nurse include in the teaching on the pathophysiology of the disease? "Uncontrolled growth of blood cells causes the marrow to expand to organs." "Uncontrolled growth of blood cells causes occlusion in the vessels and tissues." "Abnormally-shaped blood cells cause thickening of the vessels and leads to necrosis of tissue." "Abnormally-shaped blood cells cause malfunction of the marrow."
"Uncontrolled growth of blood cells causes the marrow to expand to organs." Explanation: Because there is an uncontrolled proliferation of cells, the marrow expands into the cavities of long bones, such as the femur, and cells are also formed in the liver and spleen (extramedullary hematopoiesis), resulting in enlargement of these organs that is sometimes painful.
The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? Hydroxyurea Allopurinol Asparaginase Filgrastim
Allopurinol Explanation: Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate are seen; this process is referred to as tumor lysis (cell destruction) syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Clients require a high fluid intake, and prophylaxis with allopurinol (Zyloprim) to prevent crystallization of uric acid and subsequent stone formation.
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? Keep the feet cool. Encourage ambulation. Elevate the client's legs. Assess for signs of injury.
Assess for signs of injury. Explanation: A client with hypoesthesia 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.
The nurse cares for a client with acute myeloid leukemia with severe bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain? Abnormal blood cells deposit in small vessels. Abnormal blood cells crystalize. Bone marrow expands. Lymph nodes expand.
Bone marrow expands. Explanation: In acute myeloid leukemia, bone pain is caused when the bone marrow expands.
A nurse cares for a client with early Hodgkin lymphoma. While assessing the client, the nurse will most likely find painless enlargement of which lymph node? Popliteal Cervical Inguinal Axillary
Cervical Explanation: Non painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.
A client with acute myeloid leukemia (AML) is scheduled to begin induction therapy. Which treatments will the nurse expect to be prescribed to prevent life-threatening effects of this therapy? Select all that apply. Granulocytic growth factors Packed red blood cells Platelets Antibiotics Hematopoietic stem cell transplant
During induction therapy, chemotherapy not only destroys leukemic cells, but also healthy cells, requiring clients to be hospitalized for several weeks (typically 4 to 6 weeks) due to severe and potentially life-threatening side effects, such as neutropenia. Management consists of blood products such as platelets. Antibiotics are used to treat bacterial infections that occur because of the neutropenia. Packed red blood cell infusions may also be used especially for clients that need a large volume of blood. The use of granulocytic growth factors may be used during the induction phase only for clients who have a life-threatening infection in order to shorten the neutropenic period. Hematopoietic stem cell transplant (HSCT) is routinely done following induction and consolidation therapy. In certain instances it may be performed following induction but not during induction.
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. Suggest support for household maintenance. Suggest the family go to church more often. Educate the family about medications and side effects. Suggest the prescription of antianxiety medications. Allow family members to express feelings.
Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance.
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? Induction therapy Supportive therapy Standard therapy Antimicrobial therapy
Induction therapy Explanation: 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 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? Abdominal cramps Hypotension Seizure activity Infection
Infection Explanation: Because of the lack of mature and normal granulocytes that help fight infection, patients with leukemia are prone to infection. The likelihood of infection increases with the degree and duration of neutropenia; neutrophil counts that persist at less than 100/mm3 dramatically increase the risk of systemic infections.
The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for? Bone pain in the back of the ribs Severe thrombocytopenia Gradual muscle paralysis Debilitating fatigue
one pain in the back of the ribs Explanation: 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; clients may report that they have less pain on awakening but the pain intensity increases during the day.
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 Magnesium levels Creatinine and blood urea nitrogen (BUN) levels Potassium levels
Iron levels Explanation: For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management
Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. What is the most common complication of the pathology resulting from this process? Calcified bones Increased mobility Osteoporosis Pathologic fractures
Pathologic fractures Explanation: Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.
Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. What is the most common complication of the pathology resulting from this process? Pathologic fractures Calcified bones Osteoporosis Increased mobility
Pathologic fractures Explanation: Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.
The hospitalized client is experiencing gastrointestinal bleeding with a platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take? Request a prescription of diphenoxylate and atropine for loose stools. Use contact precautions with this client. Perform a neurologic assessment with vital signs. Teach the client to vigorously floss the teeth to prevent infections.
Perform a neurologic assessment with vital signs. Explanation: 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 and 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.
A client with polycythemia vera reports severe itching. What triggers does the nurse know can cause this distressing symptom? Select all that apply. Temperature change Allergic reaction to the red blood cell increase Exposure to water of any temperature Aspirin Alcohol consumption
Temperature change Alcohol consumption Exposure to water of any temperature