Chapter 30: Management of Patient's with Hematologic Neoplasms
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? a) Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. b) Put on a mask, gown, and gloves when entering the client's room. c) Provide a clear liquid, low-sodium diet. d) Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.
d
A client has multiple myeloma. Prior to starting treatment with thalidomide, what it is most important action for the nurse to take? a) Contract with the client regarding birth-control methods. b) Instruct the client about signs and symptoms of hypercalcemia. c) Encourage the client to drink at least 3000 mL of fluids per day. d) Assess the client's BUN and creatinine levels frequently.
a
A client with chronic lymphocytic leukemia (CLL) wants to have treatment for the condition. Which medication will the nurse question for this client? a) Heparin b) Ipilimumab c) Dexamethasone d) Vincristine
a
A client with polycythemia vera has a basophil count of greater than 2. Which assessment finding will the nurse expect to assess in this client? a) Pruritis b) Dizziness c) Early satiety d) Ruddy complexion
a
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? a) The dead red blood cells release excess uric acid. b) The dead red blood cells occlude the small vessels in the joints. c) Excess red blood cells produce extracellular toxins that build up. d) Excess red blood cells cause vascular injury in the joints.
a
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? a) Hypercalcemia b) Hyperkalemia c) Hypernatremia d) Hypermagnesemia
a
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? a) splenomegaly b) weight gain c) peripheral edema d) pale body color
a
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. a) Platelets b) Antibiotics c) Packed red blood cells d) Granulocytic growth factors e) Hematopoietic stem cell transplant
a, b, c, d
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. a) Hypercalcemia b) Renal insufficiency c) Anemia d) Bone lesions e) Acidosis
a, b, c, d
A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess? a) An enlarged liver b) A leukocyte count >100,000/mm3 c) Lymphadenopathy d) Increased number of blast cells
b
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? a) Clotting factors b) Bone marrow analysis c) Complete blood count d) Alkaline phosphatase level
b
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? a) Histology of tissue b) Staging of disease c) Involvement of lymph nodes d) Total blood cell count
b
Which term refers to a form of white blood cell involved in immune response? a) Granulocyte b) Lymphocyte c) Spherocyte d) Thrombocyte
b
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? a) Elevate the client's legs. b) Encourage ambulation. c) Assess for signs of injury. d) Keep the feet cool.
c
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? a) chronic liver failure. b) acute heart failure. c) pathologic bone fractures. d) hypoxemia.
c
The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? a) Too many erythrocytes b) A decrease in granulocytes c) A general reduction in all white blood cells d) A general reduction in neutrophils and basophils
c
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? a) Pancytopenia b) Thrombocytopenia c) Anemia d) Neutropenia
d
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? a) "Treatment is simple and consists of single-drug therapy." b) "Intrathecal chemotherapy is used primarily as preventive therapy." c) "The goal of therapy is palliation." d) "Side effects are rare with therapy."
b
A client is taking hydroxyurea as treatment for essential thrombocythemia. Which laboratory test will the nurse remind the client to have completed regularly? a) Uric acid level b) Clotting factors c) Complete blood count d) Serum potassium level
c
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? a) Pale skin and mucous membranes b) Bronze skin tone c) Ruddy complexion d) Jaundice skin and sclera
c
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? a) Increase mobility. b) Provide adequate hydration. c) Promote safety. d) Encourage adequate nutrition.
c
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? a) Address issues of negative body image. b) Place the client in reverse isolation. c) Administer pain medication. d) Maintain nutrition.
d
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? a) Hemolytic anemia b) Polycythemia vera c) Leukemia d) Multiple myeloma
d
A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? a) Ask the client whether they have recently fallen. b) Evaluate the client's INR. c) Keep the client on bed rest. d) Evaluate the client's platelet count.
d
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? a) Refer the client to a chiropractor. b) Place heating pads on the client's back. c) Administer pain medication, as ordered. d) Assess renal function.
d
A client with suspected multiple myeloma is reporting back pain. What is the priority nursing action? a) Have the client lie on a hard surface. b) Have the client rest. c) Encourage ambulation. d) Send the client for a spinal x-ray study.
d
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? a) Abdominal cramps b) Hypotension c) Seizure activity d) Infection
d
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? a) Blood transfusions b) Radiation c) Chelation therapy d) Phlebotomy
d
The nurse is reviewing the treatment options with a client diagnosed with myelodysplastic syndromes (MDS). Which therapy will the nurse emphasize as the option to cure the condition? a) Blood transfusions b) Hypomethylating agents c) Erythropoiesis-stimulating agents d) Allogeneic hematopoietic stem cell transplantation
d
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? a) polycythemia vera b) sickle cell disease c) aplastic anemia d) pernicious anemia
a
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan? a) "Consolidation therapy is administered to reduce the chance of leukemia recurrence." b) "Consolidation occurs as a side effect of chemotherapy." c) "Consolidation of the lungs is an expected effect of induction therapy." d) "Consolidation is the term used when a client does not tolerate chemotherapy."
a
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? a) A 24-year-old female taking oral contraceptives b) A 40-year-old patient with a history of hypertension c) A 52-year-old patient with acute kidney injury d) A 72-year-old patient with a history of cancer
d
A client with a new onset of rib and spine pain is being evaluated for multiple myeloma. For which manifestations will the nurse assess this client? Select all that apply. a) Anemia b) Lymph enlargement c) Hypercalcemia d) Renal dysfunction e) Bone destructions
a, c, d, e
Which laboratory test results indicate to the nurse that the client is experiencing symptoms of acute lymphocytic leukemia (ALL)? Select all that apply. a) Platelet count of 20,000 b) Blastocyte count 94 c) Hemoglobin 16 d) Erythocyte count 2.5 e) Granulocyte count 0.8
a, d, e
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? a) "Acute leukemia develops slowly." b) "Chronic leukemia develops slowly." c) "In chronic leukemia, the minority of leukocytes are mature." d) "In acute leukemia there are not many undifferentiated cells."
b
A client diagnosed with multiple myeloma (MM) is prescribed long-term corticosteroid therapy. Which assessment(s) will the nurse prioritize to monitor for possible complications? Select all that apply. a) Glucose levels b) Sleeping patterns c) Vision problems d) Hair growth disorders e) Skin disorders
a, b, c
Which assessment findings support the client's diagnosis of acute myeloid leukemia? Select all that apply. a) Petechiae b) Enlarged lymph nodes c) Weakness and fatigue d) Enlarged heart e) Bone pain
a, b, c, e
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? a) Osteopathic tumors destroy bone causing fractures. b) Osteoclasts break down bone cells so pathologic fractures occur. c) Osteolytic activating factor weakens bones producing fractures. d) Osteosarcomas form producing pathologic fractures.
b
A client has been diagnosed with polycythemia vera. What is the best instruction for the nurse to give to this client? a) Take a daily multivitamin with iron supplement b) Maintain adequate blood pressure control c) Drink alcohol to decrease blood viscosity d) Bath in tepid or cool water to control itching
b
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) Increased basophils b) Reed-Sternberg cells c) Elevated platelet count d) Misshaped red blood cells
b
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? a) Acute pain b) Risk for falls c) Impaired tissue integrity d) Sensory-perception disturbance
b
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? a) Axillary b) Cervical c) Inguinal d) Popliteal
b
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? a) Excess of immature leukocytes b) Excess of immature erythrocytes c) Deficiency of neutrophils d) Deficiency of erythrocytes
b
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? a) Acute respiratory distress syndrome b) Graft-versus-host disease c) Remission d) Bone marrow depression
b
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? a) Have the client maintain complete bedrest. b) Assist the client to sit in a chair for meals. c) Talk to the family about not visiting so the client can obtain rest. d) Provide sedentary activities only, such as watching television.
b
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? a) Use contact precautions with this client. b) Perform a neurologic assessment with vital signs. c) Request a prescription of diphenoxylate and atropine for loose stools. d) Teach the client to vigorously floss the teeth to prevent infections.
b
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? a) Abnormal blood cells deposit in small vessels. b) Bone marrow expands. c) Lymph nodes expand. d) Abnormal blood cells crystalize.
b
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? a) Pancytopenia b) Anemia c) Leukopenia d) Thrombocytopenia
a
A home care nurse is caring for a client with multiple myeloma. Which nursing interventions are appropriate for this client? Select all that apply. a) Delay position changes and bathing if the client is experiencing pain. b) Instruct the client to avoid activities that may cause injury. c) Assist with ambulation because exercise can worsen loss of calcium from the bone. d) Limit fluid intake. e) Monitor renal function
a, b, e
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? a) Chronic myeloid leukemia b) Multiple myeloma c) Hodgkin lymphoma d) Non-Hodgkin lymphoma
b
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? a) Debilitating fatigue b) Bone pain in the back of the ribs c) Gradual muscle paralysis d) Severe thrombocytopenia
b
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 a) reduce deficits in the blood oxygen concentration. b) detect compromised ventilation. c) increase lung expansion. d) anticipate the need for airway management.
c
The nurse is reviewing the health history of a client with essential thrombocythemia. Which findings increase the client's risk of developing a complication? Select all that apply. a) Obesity b) Smoking c) Diabetes d) Hypertension e) Osteoarthritis
a, b, c, d
A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? a) Evaluate the client for potential infection. b) Administer an antitussive. c) Place a cooling blanket on the client. d) Medicate the client to relieve pain.
a
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? a) Induction therapy b) Supportive therapy c) Antimicrobial therapy d) Standard therapy
a
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? a) Pathologic fractures b) Osteoporosis c) Calcified bones d) Increased mobility
a
The nurse instructs a client with polycythemia vera on actions to reduce the symptoms. Which statement indicates that client teaching was effective? a) "I will shower in tepid water." b) "I will avoid caffeinated beverages." c) "I will take a multivitamin with iron every day." d) "I will use an alcohol-based lotion after bathing."
a
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? a) Polycythemia vera b) Sickle cell disease c) Aplastic anemia d) Pernicious anemia
a
What assessment finding best indicates that the client has recovered from induction therapy? a) Neutrophil and platelet counts within normal limits b) Vital signs within normal ranges c) No evidence of edema d) Absence of bone pain
a
When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? a) Health history, such as bleeding, fatigue, or fainting b) Menstrual history c) Age and gender d) Lifestyle assessments, such as exercise routines
a
The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the bestinterventions to assist in relieving caregiver stress in this family? Select all that apply. a) Educate the family about medications and side effects. b) Allow family members to express feelings. c) Suggest support for household maintenance. d) Suggest the prescription of antianxiety medications. e) Suggest the family go to church more often.
a, b, c
The nurse is caring for a patient who will begin taking long-term biphosphate therapy. Why is it important for the nurse to encourage the patient to receive a thorough evaluation of dentition, including panoramic dental x-rays? a) The patient is at risk for tooth decay. b) The patient will develop gingival hyperplasia. c) The patient can develop osteonecrosis of the jaw. d) The patient can develop loosening of the teeth.
c
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? a) WBC count of 4,200 cells/uL b) Hematocrit of 38% c) Platelet count of 9,000/mm3 d) Creatinine level of 1.0 mg/dL
c
Which statement indicates the client understands teaching about induction therapy for leukemia? a) "I will start slowly with medication treatment." b) "I will need to come every week for treatment." c) "I will be in the hospital for several weeks." d) "I know I can never be cured."
c