Hematology and Oncologic Complications

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? 1) Pancytopenia 2) Thrombocytopenia 3) Anemia 4) Neutropenia

4) Neutropenia Explanation: Fever and infection result from a decrease in neutrophils (neutropenia). Decreased red blood cells (anemia) cause weakness, fatigue, dyspnea on exertion, and pallor in AML. Pancytopenia, an overall decrease in all blood components, is not cause of fever in clients with AML. Decreased platelet count (thrombocytopenia) causes petechiae and bruising in AML.

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? 1) Monitor the client's temperature every shift. 2) Maintain contact precautions. 3) Encourage increased fluid consumption. 4) Practice vigilant handwashing.

4) Practice vigilant handwashing. Explanation: Infection prevention is best handled by vigilant handwashing. Monitoring the client's temperature once a shift is not often enough. The client will take precautions, but precautions are enough to prevent infections. Encouraging increased fluid consumption will not prevent infection.

A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? 1) Monitoring respiratory status 2) Balancing rest and activity 3) Restricting fluid intake 4) Preventing bone injury

4) Preventing bone injury Explanation: When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict fluid intake.

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? 1) Chronic myeloid leukemia 2) Multiple myeloma 3) Hodgkin lymphoma 4) Non-Hodgkin lymphoma

2) Multiple myeloma Explanation: Any older adult with unprovoked or unexplained back pain and increased protein in the serum should be assessed for multiple myeloma. Bone pain occurs because of bone breakdown and the malignant cells of multiple myeloma increase the serum protein levels.

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? 1) Increased basophils 2) Reed-Sternberg cells 3) Elevated platelet count 4) Misshaped red blood cells

2) Reed-Sternberg cells Explanation: The malignant cell of Hodgkin lymphoma is the Reed-Sternberg cell, a gigantic tumor cell that is morphologically unique and thought to be of immature lymphoid origin. These cells arise from the B lymphocyte. They may have more than one nucleus and often have an owl-like appearance. The presence of Reed-Sternberg cells is the pathologic hallmark and essential diagnostic criterion. Basophils, platelets, or red blood cells are not used to diagnose Hodgkin lymphoma.

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? 1) Too many erythrocytes 2) A decrease in granulocytes 3) A general reduction in all white blood cells 4) A general reduction in neutrophils and basophils

4) A general reduction in all white blood cells Explanation: Leukopenia is a general reduction in all WBCs. Leukopenia does not have anything to do with erythrocytes.

What assessment finding best indicates that the client has recovered from induction therapy? 1) Neutrophil and platelet counts within normal limits 2) Vital signs within normal ranges 3) No evidence of edema 4) Absence of bone pain

1) Neutrophil and platelet counts within normal limits Explanation: Recovery from induction therapy is indicated when the neutrophil and platelet counts have returned to normal and any infection has resolved. Stable vital signs, lack of edema, and absence of pain are not indicative of recovery from induction therapy.

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? 1) Pruritis 2) Dizziness 3) Early satiety 4) Ruddy complexion

1) Pruitis Explanation: In polycythemia vera the bone marrow is hypercellular, and the erythrocyte, leukocyte, and platelet counts in the peripheral blood are often elevated. An increase in blood cell mass increases blood viscosity leading to a variety of symptoms. The condition increases the number of basophils which are responsible for histamine release. This causes the symptom of pruritus. Dizziness is a neurologic symptom from the condition. Early satiety is am abdominal symptom from the condition. Ruddy complexion is a cardiovascular symptom of the disorder.

Which laboratory test results indicate to the nurse that the client is experiencing symptoms of acute lymphocytic leukemia (ALL)? Select all that apply. 1) Platelet count of 20,000 2) Blastocyte count 94 3) Hemoglobin 16 4) Erythocyte count 2.5 5) Granulocyte count 0.8

1) Platelet count of 20,000 4) Erythocyte count 2.5 5) Granulocyte count 0.8 Explanation: Acute lymphocytic leukemia (ALL) results from an uncontrolled proliferation of immature cells (lymphoblasts) derived from the lymphoid stem cell. Immature lymphocytes proliferate in the marrow and impede the development of normal myeloid cells. As a result, normal hematopoiesis is inhibited, resulting in reduced numbers of platelets, granulocytes, and erythrocytes. ALL does not cause an increase in blastocytes or elevate the hemoglobin level.

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? 1) Axillary 2) Cervical 3) Inguinal 4) Popliteal

2) Cervical Explanation: Non- painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? 1) A 24-year-old female taking oral contraceptives 2) A 40-year-old patient with a history of hypertension 3) A 52-year-old patient with acute kidney injury 4) A 72-year-old patient with a history of cancer

4) A 72- y/o patient with a history of cancer Explanation: Primary MDS tends to be a disease of people older than 70 years. Because the initial findings are so subtle, the disease may not be diagnosed until later in the illness trajectory, if at all. Thus, the actual incidence of MDS is not known.

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? 1) Address issues of negative body image. 2) Place the client in reverse isolation. 3) Administer pain medication. 4) Maintain nutrition.

4) Maintain nutrition. Explanation: Maintaining nutrition is the most important goal after induction therapy because the client experiences severe diarrhea and can easily become nutritionally deficient and develop fluid and electrolyte imbalance. The client is most likely not in pain at this point, and this is an intervention, not a goal.

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? 1) Induction therapy 2) Supportive therapy 3) Antimicrobial therapy 4) Standard therapy

1) Induction therapy Explanation: Despite advances in understanding of the biology of AML, substantive advances in treatment response rates and survival rates have not occurred for decades, with the exception of advances made in treating APL (see later discussion). Even for patients with subtypes that have not benefited from advances in treatment, cure is still possible. The overall objective of treatment is to achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow. Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks.

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? 1) "Acute leukemia develops slowly." 2) "Chronic leukemia develops slowly." 3) "In chronic leukemia, the minority of leukocytes are mature." 4) "In acute leukemia there are not many undifferentiated cells."

2) "Chronic leukemia develops slowly" Explanation: Chronic leukemia develops slowly, and the majority of leukocytes produced are mature. Acute leukemia develops quickly and the majority of leukocytes are undifferentiated cells.

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? 1) Debilitating fatigue 2) Bone pain in the back of the ribs 3) Gradual muscle paralysis 4) Severe thrombocytopenia

2) Bone pain in the back of the ribs Explanation: Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; clients may report that they have less pain on awakening but the pain intensity increases during the day.

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? 1) Osteopathic tumors destroy bone causing fractures. 2) Osteoclasts break down bone cells so pathologic fractures occur. 3) Osteolytic activating factor weakens bones producing fractures. 4) Osteosarcomas form producing pathologic fractures.

2) Osteoclasts break down bone cells so pathologic fractures occur. Explanation: The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This, in turn, causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a "punched-out" or "honeycombed" appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. The other options are distractors for this question.

A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? 1) Elevate the client's legs. 2) Encourage ambulation. 3) Assess for signs of injury. 4) Keep the feet cool.

3) Assess for signs of injury. Explanation: A client with hypoesthesia of the feet will have decreased sensation and numbness. The nurse should assess for signs of injury. If the client is injured, he or she will not be able to feel it; this could lead to the development of infection. Ambulation will not help the client, and elevating the legs may make the problem worse, as blood flow to the feet would be decreased. Keeping the feet cold will also decrease blood flow.

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? 1) Increase mobility. 2) Provide adequate hydration. 3) Promote safety. 4) Encourage adequate nutrition.

3) Promote safety. Explanation: Safety is paramount because any injury, no matter how slight, can result in a fracture. Mobility, hydration, and nutrition are important, but will not prevent fractures.

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? 1) The client with painful lymph nodes under the arm. 2) The client with painful lymph nodes in the groin. 3) The client with enlarged lymph nodes in the neck. 4) The client with a painful sore throat.

3) The client with enlarged lymph nodes in the neck Explanation: Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.

Which statement best describes the function of stem cells in the bone marrow? 1) They are active against hypersensitivity reactions. 2) They defend against bacterial infection. 3) They produce all blood cells. 4) They produce antibodies against foreign antigens.

3) They produce all blood cells. Explanation: All blood cells are produced from undifferentiated precursors called pluripotent stem cells in the bone marrow. Other cells produced from the pluripotent stem cells help defend against bacterial infection, produce antibodies against foreign antigens, and are active against hypersensitivity reactions.