Chapter 32: Caring for Clients with Disorders of the Lymphatic System

A client is recovering from infectious mononucleosis and asks the nurse when he or she will finally be rid of the disease. How should the nurse most accurately respond? "Your illness will clear up in 30 to 50 days." "You are at risk for recurrences related to stress for the rest of your life." "You are now immune to mono, but the virus will remain in your body for the rest of your life." "You may redevelop the illness if you are exposed to others who have it."

"You are now immune to mono, but the virus will remain in your body for the rest of your life."

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A 24-year-old female taking oral contraceptives A 40-year-old patient with a history of hypertension A 52-year-old patient with acute kidney injury A 72-year-old patient with a history of cancer

A 72-year-old patient with a history of cancer

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 Filgrastim Hydroxyurea Asparaginase

Allopurinol

A client with lymphedema is struggling with negative emotions related to her appearance. Which of the following suggestions from the nurse would be most effective in helping the client address the problem? "Try not to dwell on this too much--the problem will go away over time." "Let's discuss some clothing styles that can help conceal the problem while you are being treated." "I'd like to set up some time for you to talk with a chaplain about the importance of spirituality when things like this happen." "Let's make up a list of the people with whom you are most comfortable so you can spend time around them while you are recovering."

"Let's discuss some clothing styles that can help conceal the problem while you are being treated."

An emergency department nurse is triaging a 77-year-old man 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 what health problem? Hodgkin disease Non-Hodgkin lymphoma Multiple myeloma Acute thrombocythemia

Multiple myeloma

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? Chronic myeloid leukemia Multiple myeloma Hodgkin lymphoma Non-Hodgkin lymphoma

Multiple myeloma

A young adult is preparing to begin treatment for non-Hodgkin lymphoma (NHL), a disease that has disseminated widely. What is the most likely treatment regimen for this patient that the nurse will help prepare? Antiviral medications Surgery and whole blood transfusion Radiation and chemotherapy Bone marrow or stem cell transplantation

Radiation and chemotherapy

A nurse cares for an adult client with chronic lymphocytic leukemia (CLL). Which statements regarding the disease will the nurse include in the teaching? Select all that apply. "This type of leukemia primarily impacts older adults." ''This type of leukemia does not appear to have familial predisposition." "This type of leukemia is rarely seen in certain ethnicities." "This type of leukemia primarily impacts pediatric adults." "This type of leukemia is rarely aggressive."

"This type of leukemia primarily impacts older adults." "This type of leukemia is rarely seen in certain ethnicities."

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

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

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? Acute respiratory distress syndrome Graft-versus-host disease Remission Bone marrow depression

Graft-versus-host disease

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? Axillary Cervical Inguinal Popliteal

Cervical

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? Initiate measures to prevent venous thromboembolism (VTE). Check the client's most recent platelet level. Place the client on protective isolation. Ambulate the client to promote circulatory function.

Check the client's most recent platelet level.

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? There is a need for the client to be assessed for lymphoma. Infection is the most likely cause of the client's change in health status. The client is exhibiting signs and symptoms of leukemia. The client should undergo diagnostic testing for multiple myeloma

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

You are caring for a client with Hodgkin's disease who has developed associated respiratory problems. Which of the following interventions by the nurse are appropriate? Select all that apply. Keep the neck in midline. Place the client in a semi-Fowler's position. Assess respiratory status each shift and as needed. Administer oxygen per physician's orders if blood saturation is consistently less than 80%. Place an endotracheal tube, laryngoscope, and bag-valve mask at the bedside for intubation.

Keep the neck in midline. Assess respiratory status each shift and as needed. Place an endotracheal tube, laryngoscope, and bag-valve mask at the bedside for intubation.

A nurse is helping to prepare a client with lymphedema for a procedure in which an intravenous dye and radiography will be used to detect lymph node involvement and reveal the degree and extent of blockage in the lymph system. What procedure will the client be undergoing? Lymphangiography Lymphatic tomography Magnetic resonance imaging Lympharthoscopy

Lymphangiography

Which of the following interventions for infectious mononucleosis would the nurse include in a client's plan of care? Select all that apply. Maximize bed rest. Review instructions for antipyretic therapy. Increase fluid intake. Avoid blood donations for at least 6 months. Follow a high-protein diet.

Maximize bed rest. Review instructions for antipyretic therapy. Increase fluid intake. Avoid blood donations for at least 6 months.

A client hospitalized with Hodgkin's disease is currently under visitor restrictions and asks the nurse why this is necessary. Which of the following explanations from the nurse is most accurate? The client needs as much rest as possible to facilitate recovery. The client will be too weakened to interact effectively. Restricting visitors and personnel reduces the risk of transmission of pathogens to the client. The nurse needs to minimize the possibility of the client transmitting his or her illness to others.

Restricting visitors and personnel reduces the risk of transmission of pathogens to the client.

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? Implementing distraction techniques Educating the client about the effective use of hot and cold packs Teaching the client to use NSAIDs effectively Helping the client manage the opioid analgesic regimen

Helping the client manage the opioid analgesic regimen

A nurse is having a discussion with a group of 14-year-old camp counselors about how infectious mononucleosis is transmitted. This disease is transmitted by: contact with the saliva of an infected person. consuming contaminated food or water. the bite of an insect such as a mosquito. microorganisms in infected blood.

contact with the saliva of an infected person.

A client is in the early stages of Hodgkin's disease. When palpating the client's lymph nodes, the nurse is most likely to find that the lymph nodes are: enlarged and painless. fixed and hard. small and firm. swollen and tender.

enlarged and painless

A client who has Hodgkin's disease should have their bed in high-Fowler's position whenever practical to: increase lung expansion. reduce cervical edema. detect compromised ventilation. anticipate the need for the airway management.

increase lung expansion.

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? Assess the client's previous experience with the health care system. Reassure the client that treatment will be challenging but successful. Assess the client's specific needs for education and support. Identify the client's plan of medical care.

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

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? Teach the client about the risks of immobility and the benefits of exercise. Assist the client to a chair during awake times, as tolerated. Collaborate with the physical therapist to arrange for stair exercises. Teach the client to perform deep breathing and coughing exercises.

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

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

Avoiding tight and restrictive clothing on the legs

A client has a history of lymphedema. Impaired nutrition to the client's tissues could lead to: ulcers and infection in the edematous area. tenting skin. evident scaring. cyanosis.

ulcers and infection in the edematous area.

A public health nurse is planning community teaching for a group of older adults regarding aging and hematological conditions. What condition will the nurse identify as most common among this population? Leukemia Thalassemia Anemia Lymphopenia

Anemia

A client with Hodgkin's disease is hospitalized and experiencing respiratory distress. In which position should the nurse place the client? High Fowler's Semi-Fowler's Trendelenburg Sims'

High Fowler's

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? Monitor the client's temperature every shift. Maintain contact precautions. Encourage increased fluid consumption. Practice vigilant handwashing.

Practice vigilant handwashing.

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? Protective isolation and vigilant use of standard precautions Provision of a high-calorie, low-texture diet and appropriate oral hygiene Including the family in planning the client's activities of daily living Monitoring and treating the client's pain

Protective isolation and vigilant use of standard precautions

A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? Refer the client to a chiropractor. Place heating pads on the client's back. Administer pain medication, as ordered. Assess renal function.

Assess renal function.

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? Osteopathic tumors destroy bone causing fractures. Osteoclasts break down bone cells so pathologic fractures occur. Osteolytic activating factor weakens bones producing fractures. Osteosarcomas form producing pathologic fractures.

Osteoclasts break down bone cells so pathologic fractures occur.

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 what factor? Labyrinthitis Left ventricular hypertrophy Decreased bone density Hypercoagulation

Decreased bone density

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? Techniques for energy conservation and activity management Emergency management of bleeding episodes Technique for the administration of bronchodilators by metered-dose inhaler Techniques for self-palpation of the lymph nodes

Emergency management of bleeding episodes

A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? Ask the client whether they have recently fallen. Evaluate the client's INR. Keep the client on bed rest. Evaluate the client's platelet count.

Evaluate the client's platelet count.

A client is recovering from infectious mononucleosis. For which of the following conditions is the nurse aware that the client may also be at increased future risk? Hodgkin's lymphoma Tuberculosis Lymphedema Hashimoto's thyroiditis

Hodgkin's lymphoma

A client presents with painless enlargement of the cervical and axillary lymph nodes, has lost 20 pounds in the last 2 months, and reports an alarming lack of energy. The client's history is positive for infectious mononucleosis as a young teen. This client may be suffering from: Hodgkin's lymphoma. non-Hodgkin's lymphoma. lymphadenitis. lymphangitis.

Hodgkin's lymphoma.

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 Antimicrobial therapy Standard therapy

Induction therapy

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

The nurse is caring for a client who is developing hypovolemic shock from a duodenal ulcer bleed. What is the first intervention the nurse can provide to facilitate blood flow to the brain? Prepare the client for an endoscopy. Administer a crystalloid solution. Place the client in a modified Trendelenburg position. Test the client for blood in the stool.

Place the client in a modified Trendelenburg position

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? WBC count of 4,200 cells/uL Hematocrit of 38% Platelet count of 9,000/mm3 Creatinine level of 1.0 mg/dL

Platelet count of 9,000/mm3

The nurse is reviewing the chart of a client with lymphoma. Which of the following findings would best indicate to the nurse that the client has Hodgkin's disease as opposed to non-Hodgkin's lymphoma? Reed-Sternberg cells are found diagnostically. Client is of male gender. Client is 58 years old. The spleen is enlarged.

Reed-Sternberg cells are found diagnostically.

A nurse working on a hem/onc floor is caring for a client with lymphoma. What would not be a common nursing diagnosis for this client? Risk for Altered Cardiac Output Risk for Ineffective Airway Clearance Risk for Infection Risk for Impaired Skin Integrity

Risk for Altered Cardiac Output

A nurse is planning the care of client who has been diagnosed with essential thrombocythemia (ET). What nursing diagnosis should the nurse prioritize when choosing interventions? Risk for Ineffective Tissue Perfusion Risk for Imbalanced Fluid Volume Risk for Ineffective Breathing Pattern Risk for Ineffective Thermoregulation

Risk for Ineffective Tissue Perfusion

A client at the health care facility is diagnosed with Hodgkin's disease that has extended to the liver. What stage should the nurse use to describe the progress of the disease? Stage I Stage II Stage III Stage IV

Stage IV

Laboratory and diagnostic test results have returned for a client with suspected lymphangitis. Which of the following would be most likely for the nurse to review in the results? Streptococcus Escherichia coli Staphylococcus Pseudomonas

Streptococcus

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 under the arm. The client with painful lymph nodes in the groin. The client with enlarged lymph nodes in the neck. The client with a painful sore throat.

The client with enlarged lymph nodes in the neck

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 release excess uric acid. The dead red blood cells occlude the small vessels in the joints. Excess red blood cells produce extracellular toxins that build up. Excess red blood cells cause vascular injury in the joints.

The dead red blood cells release excess uric acid.

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? The different leukemias all involve unregulated proliferation of white blood cells. The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function. The different leukemias all result in a decrease in the production of white blood cells. The different leukemias all involve the development of cancer in the lymphatic system

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

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

The importance of adhering to the prescribed drug regimen

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: daily treatment with targeted therapy medications. radiation therapy on a daily basis. hematopoietic stem cell transplantation. an aggressive course of chemotherapy.

an aggressive course of chemotherapy.

What is included in the management of lymphadenitis? Select all that apply. broad-spectrum antibiotic elevate the extremity apply cold compresses; 20 minute on, 20 minute off schedule All options are correct.

broad-spectrum antibiotic elevate the extremity

A 70-year-old client has recently been diagnosed with lymphoma and asks what may have contributed to this illness. Which of the following statements from the nurse would be most accurate? "Lymphoma incidence increases with age because of cumulative exposures to carcinogens and a decline in immune functioning." "People of all age groups are at the same risk for lymphoma." "Previous infection with varicella, before there were immunizations against it, may have contributed to this development." "Lymphoma commonly develops in older adults because their circulation and blood-vessel functioning are weaker than in younger people."

"Lymphoma incidence increases with age because of cumulative exposures to carcinogens and a decline in immune functioning."

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? Debilitating fatigue Bone pain in the back of the ribs Gradual muscle paralysis Severe thrombocytopenia

Bone pain in the back of the ribs

A nurse is documenting skin findings in a client with lymphedema. Which of the following descriptions would be most consistent with the expected presentation? Brawny Rubor Cyanotic Jaundice

Brawny

A client has been diagnosed with infectious mononucleosis. He asks the nurse how he contracted the illness. Which of the following would the nurse accurately identify as possible causes of the client's condition? Select all that apply. Kissing Sharing cigarettes Being coughed or sneezed on Allergic reaction to an immunization Ingesting contaminated food

Kissing Sharing cigarettes Being coughed or sneezed on