PrepU Ch 30: Management of Patients with Hematologic Neoplasms

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

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal?

Maintain nutrition.

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

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 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.

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

The nurse is assessing a client with leukemia. How would the nurse assess for enlargement and tenderness over the liver and spleen?

By palpating the abdomen

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

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

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

pathologic bone fractures.

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

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 nurse is teaching a client with multiple myeloma about the therapeutic benefits of radiation therapy. Which statements will the nurse include in the teaching? Select all that apply.

- "It helps to strengthen the bone." - "It helps to decrease bone pain."

A client with polycythemia vera reports severe itching. What triggers does the nurse know can cause this distressing symptom? Select all that apply.

- Alcohol consumption - Temperature change - Exposure to water of any temperature

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.

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

The nurse is caring for a client with myelodysplastic syndrome (MDS). Which interventions will the nurse implement for this client? Select all that apply.

- Energy conservation techniques - Monitoring for spontaneous bleeding - Tylenol as ordered for fever

A nurse plans care for a client with multiple myeloma. Using the CRAB acronym for symptoms associated with this disease, which clinical features does the nurse expect to find upon assessment of the client? Select all that apply.

- Renal insufficiency - Hypercalcemia - Anemia - Bone lesions

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 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 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

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

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.

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

Assess for signs of injury.

A client has been diagnosed with polycythemia vera. What is the best instruction for the nurse to give to this client?

Maintain adequate blood pressure control

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

"Chronic leukemia develops slowly."

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

Assess renal function.

An elderly client is hospitalized for induction of chemotherapy to treat leukemia. The client reports fatigue to the nurse. What nursing intervention would best address the client's fatigue?

Assist the client to sit in a chair for meals.

A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action?

Evaluate the client's platelet count.

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

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 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?

Platelet count of 9,000/mm3

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

Preventing bone injury

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 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

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.

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

They produce all blood cells.

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

Hypercalcemia