Chapter 30 PrepU: Management of Patients with Hematologic Neoplasms

A client is taking hydroxyurea as treatment for essential thrombocythemia. Which laboratory test will the nurse remind the client to have completed regularly?

Complete blood count

The nurse is caring for a client with acute lymphocytic leukemia (ALL) who is Philadephia chromosome negative. Which medications will the nurse anticipate providing to the client during initiation of pharmacological therapies? Select all that apply.

-Vincristine -Dexamethasone

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

A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action?

Assess renal function.

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?

Bone marrow expands.

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

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?

Cervical

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?

Hypercalcemia

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

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

What assessment finding best indicates that the client has recovered from induction therapy?

Neutrophil and platelet counts within normal limits

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures?

Osteoclasts break down bone cells so pathologic fractures occur.

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?

Perform a neurologic assessment with vital signs.

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?

Promote safety.

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?

Reed-Sternberg cells

A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for?

pathologic bone fractures.

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

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?

splenomegaly

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?

Allopurinol

A client is being tested for acute myeloid leukemia (AML). The nurse knows that which diagnostic test will be used as the hallmark for the diagnosis?

Bone marrow analysis

A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity?

Do not lift more than 10 pounds.

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

The nurse assesses a patient for late-stage chronic lymphocytic leukemia (CLL) by looking for what?

Thrombocytopenia.

For a client with Hodgkin lymphoma, who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse places the client in a high Fowler's position to

increase lung expansion.

Which statement best describes the function of stem cells in the bone marrow?

They produce all blood cells.

Which assessment findings support the client's diagnosis of acute myeloid leukemia? Select all that apply.

-Petechiae -Enlarged lymph nodes -Weakness and fatigue -Bone pain

A client with leukemia is experiencing recurrent fevers. Which actions will the nurse take to improve this client's comfort? Select all that apply.

-Sponge with cool water. -Change bed clothes frequently. -Provide acetaminophen as prescribed.

The nurse is reviewing the long-term treatment plan with a client diagnosed with Hodgkin lymphoma. Which recommendations will the nurse provide to reduce the client's risk of developing secondary malignancies? Select all that apply.

-Avoid excessive sunlight. -Restrict use of tobacco. -Reduce intake of alcohol.

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma?

The client with enlarged lymph nodes in the neck.

The nurse is teaching the client about consolidation. What statement should be included in the teaching plan?

"Consolidation therapy is administered to reduce the chance of leukemia recurrence."

The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care?

"Intrathecal chemotherapy is used primarily as preventive therapy."

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.

Educate the family about medications and side effects. -Allow family members to express feelings. -Suggest support for household maintenance.

A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept?

Staging of disease

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan?

"Chronic leukemia develops slowly."

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.

-Assess skin and mucus membranes every shift. -Auscultate lung sounds every shift and as needed. -Encourage the client to take deep breaths every 4 hours while awake.

Acute myeloid leukemia (AML) results from a defect in the hematopoietic stem cell that differentiates into which of the following myeloid cells? Select all that apply.

-Monocytes -Granulocytes -Erythrocytes -Platelets

A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention?

Assess for signs of injury.

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention?

Assess the client's hemoglobin and platelets.

A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect?

Excess of immature leukocytes

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

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets?

Pancytopenia

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

A patient with polycythemia vera has a high red blood cell (RBC) count and is at risk for the development of thrombosis. What treatment is important to reduce blood viscosity and to deplete the patient's iron stores?

Phlebotomy

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

The nurse recognizes the clinical assessment of a patient with acute myeloid leukemia (AML) includes observing for signs of infection early. What nursing action will most likely help prevent infection?

Practice vigilant handwashing.

A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose?

Risk for falls

A client with polycythemia vera presents to the primary care clinic for an annual physical. Which health care provider prescriptions does the nurse recognize as preventive measures to prevent thrombosis in the client? Select all that apply.

Statin therapy Beta blocker therapy

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

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever?

Neutropenia

A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client?

Preventing bone injury

A nurse is providing teaching to a client who will undergo chemotherapy and radiation prior to hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia (AML). What statement will the nurse use to describe the purpose of the chemotherapy and radiation?

"These therapies destroy the ability of your body to produce blood cells inside your bone marrow."