Chapter 30: Management of Patients with Hematologic Neo- plasms

B. Assess how much information is desired from the client in terms of illness, treatment, and complications.

1A client with a new diagnosis of leukemia is about to start treatment and expresses fear and anxiety with the prognosis. Which action is the nurse's most appropriate? A. Communicate to the health care provider the need to provide more information to the client and family. B. Assess how much information is desired from the client in terms of illness, treatment, and complications. C. Offer to call pastoral services and review hospice and/or palliative care so the client can have a quiet, dignified death. D. Encourage the client to call their family and discuss immediate role restructuring in both their family and professional life.

B. Perform diagnostic studies to rule out any infectious origin at a hospital.

A 20-year-old client with no medical history arrives at a walk-in/urgent care clinic reporting swelling on the left side of the neck. On palpation, the lymph nodes on the neck are painless, firm but not hard. What is the next appropriate intervention for this client? A. Recommend immediate and urgent transfer to the nearest trauma center. B. Perform diagnostic studies to rule out any infectious origin at a hospital. C. Refer the client to a primary health care provider for a nonurgent appointment. D. Complete a computed tomography scan because the client has Hodgkin lymphoma.

D. Acute lymphocytic leukemia (ALL)

A 35-year-old client is admitted to the hospital reporting severe headaches, vomiting, and testicular pain. The client's blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this client suspects which diagnosis? A. Acute myeloid leukemia (AML) B. Chronic myeloid leukemia (CML) C. Myelodysplastic syndromes (MDS) D. Acute lymphocytic leukemia (ALL)

A. The importance of adhering to the prescribed drug regimen

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

B. Hemorrhage

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

B. Close monitoring of urine output and kidney function

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

C. Secondary malignancy

A client has received the news that the client's treatment for Hodgkin lymphoma has been deemed successful and that no further treatment is necessary at this time. The care team should ensure that the client receives regular health assessments in the future due to the risk of which complication? A. Iron-deficiency anemia B. Hemophilia C. Secondary malignancy D. Lymphedema

D. Avoiding tight and restrictive clothing on the legs

A client is being treated for polycythemia vera, and the nurse is providing health education. Which practice should the nurse recommend to prevent the complications of this health problem? A. Avoiding natural sources of vitamin K B. Avoiding altitudes of 1500 feet (457 meters) C. Performing active range of motion exercises daily D. Avoiding tight and restrictive clothing on the legs

A. 82-year-old Vietnam War veteran with widely disseminated shingles

A client is receiving treatment for a new diagnosis of chronic lymphocytic leukemia (CLL). Based on known risk factors, age, ethnicity, and accompanying clinical conditions, which client is most likely to have this disease? A. 82-year-old Vietnam War veteran with widely disseminated shingles B. 62-year-old client of Asian descent with a left fractured hip C. 69-year-old Gulf War veteran with deep vein thrombosis (DVT) D. 85-year-old client of Native American/First Nation descent with chest pain

B. Increased lymphocyte levels

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

B. Assist the client to a chair during awake times, as tolerated.

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

D. "It's important to reduce other factors that increase the risk of second cancers."

A client with Hodgkin lymphoma is receiving information from the oncology nurse. The client asks the nurse why it is necessary to stop drinking and smoking and stay out of the sun. Which response by the nurse would be best? A."Avoiding these factors can reduce the risk of Reed-Sternberg cells developing." B. "These behaviors can reduce the effectiveness of your chemotherapy." C. "Engaging in these activities increases your risk of hemorrhage." D. "It's important to reduce other factors that increase the risk of second cancers."

A. Protective isolation and vigilant use of standard precautions

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

A. Chew with care to avoid inadvertently biting the tongue.

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

C. An oral temperature of 37.5°C (99.5°F)

A client with myelodysplastic syndrome (MDS) is being treated on a medical unit. Which priority finding should prompt the nurse to contact the client's primary care provider? A. Reports of a frontal lobe headache B. An episode of urinary incontinence C. An oral temperature of 37.5°C (99.5°F) D. An oxygen saturation (SpO2) of 91% on room air

D. Follow the trends of the client's hematocrit.

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

D. Helping the client manage the opioid analgesic regimen

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

C. Hydroxyurea

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

A. Infection status

A nurse is caring for a client who has a diagnosis of acute myelocytic leukemia (AML). Assessment of which factor most directly addresses the most common cause of death among clients with leukemia? A. Infection status B. Nutritional status C. Electrolyte levels D. Liver function

B. Check the client's most recent platelet level.

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

C. Provide the client with several small, soft-textured meals each day.

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

D. Peripheral neuropathy

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

A. Cure of the disease

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

B. Risk for infection

A nurse is caring for a client with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this client, the nurse should assign the highest priority to which nursing diagnosis? A. Activity intolerance B. Risk for infection C. Acute confusion D. Risk for spiritual distress

C. Decreased bone density

A nurse is planning the care of a client who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the client's care plan, the nurse has identified a diagnosis of Risk for Injury, which should be attributed to which factor? A. Labyrinthitis B. Left ventricular hypertrophy C. Decreased bone density D. Hypercoagulation

A. Risk for ineffective tissue perfusion

A nurse is planning the care of client who has been diagnosed with essential thrombocythemia (ET). Which nursing diagnosis should the nurse prioritize when choosing interventions? A. Risk for ineffective tissue perfusion B. Risk for imbalanced fluid volume C. Risk for ineffective breathing pattern D. Risk for ineffective thermoregulation

B. Emergency management of bleeding episodes

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

C. Doxorubicin

A nurse is providing care to a client with multiple myeloma with reports of nausea, diarrhea, alopecia, and red urine. The client's recent interventions include electrocardiogram (ECG), multigated acquisition scan (MUGA), and a central line venous access placed on the right chest wall. Which medication is the client most likely receiving? A. Dexamethasone B. Lenalidomide C. Doxorubicin D. Etoposide

A. Disturbed body image B. Impaired mobility C. Imbalanced nutrition: Less than body requirements E. Risk for infection

A nurse is writing the care plan of a client who has been diagnosed with myelofibrosis. What nursing diagnoses should the nurse address? Select all that apply. A. Disturbed body image B. Impaired mobility C. Imbalanced nutrition: Less than body requirements D. Acute confusion E. Risk for infection

B. Infection is the most likely cause of the client's change in health status.

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

C. Assess the client's specific needs for education and support.

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

B. Reed-Sternberg cells

An adult client's abnormal complete blood count (FBC) and physical assessment have prompted the primary care provider to order a diagnostic workup for Hodgkin lymphoma. The presence of what assessment finding is considered diagnostic of the disease? A. Schwann cells B. Reed-Sternberg cells C. Lewy bodies D. Loops of Henle

C. Multiple myeloma

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

A. Hypercalcemia

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

A. The different leukemias all involve unregulated proliferation of white blood cells.

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

A. Monitoring the client's electrolyte levels C. Measuring the client's weight on a daily basis D. Measuring and recording the client's intake and output E. Auscultating the client's lungs frequently

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

D. an aggressive course of chemotherapy.

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

A. "Were you ever exposed to toxic chemicals in any of the jobs that you held?"

Following an extensive diagnostic workup, a client has been diagnosed with myelodysplastic syndrome (MDS). Which assessment question most directly addresses the potential etiology of this client's health problem? A. "Were you ever exposed to toxic chemicals in any of the jobs that you held?" B. "When you were younger, did you tend to have recurrent infections of any kind?" C. "Have you ever smoked cigarettes or used other tobacco products?" D. "Would you say that you've had a lot of sun exposure in your lifetime?"

C. Avoiding highly crowded public places

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