msp rep u 30: Management of Patients with Hematologic Neoplasms

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? You Selected: Reed-Sternberg cells Correct response: 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.

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? You Selected: Reed-Sternberg cells Correct response: 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.

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? You Selected: Hypercalcemia Correct response: Hypercalcemia Explanation: Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? You Selected: Hypercalcemia Correct response: Hypercalcemia Explanation: Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? You Selected: Maintain nutrition. Correct response: 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 client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? You Selected: Maintain nutrition. Correct response: 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.

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? You Selected: A general reduction in all white blood cells Correct response: 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.

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? You Selected: A general reduction in all white blood cells Correct response: 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.

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? You Selected: Platelet count of 9,000/mm3 Correct response: Platelet count of 9,000/mm3 Explanation: Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.

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? You Selected: Platelet count of 9,000/mm3 Correct response: Platelet count of 9,000/mm3 Explanation: Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.

What assessment finding best indicates that the client has recovered from induction therapy? You Selected: Neutrophil and platelet counts within normal limits Correct response: 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.

What assessment finding best indicates that the client has recovered from induction therapy? You Selected: Neutrophil and platelet counts within normal limits Correct response: 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 is taking dasatinib as prescribed. Which findings indicate to the nurse the client is experiencing adverse effects from this medication? Select all that apply. Chills Fever Decreased urine output Hypoactive bowel sounds Prolonged QT interval on electrocardiogram Correct response: Incorrect response: Your selection: Explanation: Most TKIs are oral agents whose effectiveness depends upon the client's ability and motivation to adhere to the prescribed treatment regimen. These drugs may cause side effects that the client may find difficult to manage. Adverse effects of these medications include signs of myelosuppression to include chills and fever. Decreased urine output and a prolonged QT interval are additional adverse effects of TKIs. Hypoactive bowel sounds are not identified as adverse effects of TKIs.

A client is taking dasatinib as prescribed. Which findings indicate to the nurse the client is experiencing adverse effects from this medication? Select all that apply. Chills Fever Decreased urine output Hypoactive bowel sounds Prolonged QT interval on electrocardiogram Correct response: Incorrect response: Your selection: Explanation: Most TKIs are oral agents whose effectiveness depends upon the client's ability and motivation to adhere to the prescribed treatment regimen. These drugs may cause side effects that the client may find difficult to manage. Adverse effects of these medications include signs of myelosuppression to include chills and fever. Decreased urine output and a prolonged QT interval are additional adverse effects of TKIs. Hypoactive bowel sounds are not identified as adverse effects of TKIs.

A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? You Selected: Assess for signs of injury. Correct response: 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.

A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? You Selected: Assess for signs of injury. Correct response: 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.

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? You Selected: Multiple myeloma Correct response: Multiple myeloma Explanation: The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

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? You Selected: Multiple myeloma Correct response: Multiple myeloma Explanation: The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? You Selected: Assess the client's hemoglobin and platelets. Correct response: Assess the client's hemoglobin and platelets. Explanation: Clients with AML may develop pallor from anemia and a tendency to bleed because of a low platelet count. Assessing the client's hemoglobin and platelets will help to determine whether this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? You Selected: Assess the client's hemoglobin and platelets. Correct response: Assess the client's hemoglobin and platelets. Explanation: Clients with AML may develop pallor from anemia and a tendency to bleed because of a low platelet count. Assessing the client's hemoglobin and platelets will help to determine whether this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.

A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? You Selected: Evaluate the client for potential infection. Correct response: Evaluate the client for potential infection. Explanation: The client with leukemia has a lack of mature and normal granulocytes to fight infection. For this reason, the client is susceptible to infection. The primary nursing intervention is to evaluate for potential infection if the client has a cough and increased fatigue. Administering an antitussive would not be appropriate before determining the cause of the cough. A cooling blanket would not be needed if the client does not have a fever. Medicating the client to relieve pain would come after the assessment phase.

A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? You Selected: Evaluate the client for potential infection. Correct response: Evaluate the client for potential infection. Explanation: The client with leukemia has a lack of mature and normal granulocytes to fight infection. For this reason, the client is susceptible to infection. The primary nursing intervention is to evaluate for potential infection if the client has a cough and increased fatigue. Administering an antitussive would not be appropriate before determining the cause of the cough. A cooling blanket would not be needed if the client does not have a fever. Medicating the client to relieve pain would come after the assessment phase.

A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client is not appropriately dealing with spiritual distress? You Selected: "I have resources within myself that I can depend on." Correct response: "I do not understand why this happened to me." Explanation: The statement "I do not understand why this happened to me" indicates that the client is not accepting of the consequences of his health problems and impending death. The other statements indicate the client has plans that would result in spiritual well-being or harmony.

A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client is not appropriately dealing with spiritual distress? You Selected: "I have resources within myself that I can depend on." Correct response: "I do not understand why this happened to me." Explanation: The statement "I do not understand why this happened to me" indicates that the client is not accepting of the consequences of his health problems and impending death. The other statements indicate the client has plans that would result in spiritual well-being or harmony.

A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity? You Selected: Do not lift more than 10 pounds. Correct response: Do not lift more than 10 pounds. Explanation: The client with multiple myeloma needs education about activity instructions, such as lifting no more than 10 pounds and using proper body mechanics. Braces may be needed. The client should be active and would not be instructed to stay in bed or limit activity, as he or she would become very stiff. Limiting fluids would be contraindicated; the client needs to remain well hydrated.

A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity? You Selected: Do not lift more than 10 pounds. Correct response: Do not lift more than 10 pounds. Explanation: The client with multiple myeloma needs education about activity instructions, such as lifting no more than 10 pounds and using proper body mechanics. Braces may be needed. The client should be active and would not be instructed to stay in bed or limit activity, as he or she would become very stiff. Limiting fluids would be contraindicated; the client needs to remain well hydrated.

A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? You Selected: pathologic bone fractures. Correct response: pathologic bone fractures. Explanation: Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.

A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? You Selected: pathologic bone fractures. Correct response: pathologic bone fractures. Explanation: Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.

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? You Selected: Induction therapy Correct response: 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.

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? You Selected: Induction therapy Correct response: 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.

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? You Selected: Graft-versus-host disease Correct response: Graft-versus-host disease Explanation: Patients who undergo HSCT have a significant risk of infection, graft-versus host disease (in which the donor's lymphocytes [graft] recognize the patient's body as "foreign" and set up reactions to attack the foreign host), and other complications.

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? You Selected: Graft-versus-host disease Correct response: Graft-versus-host disease Explanation: Patients who undergo HSCT have a significant risk of infection, graft-versus host disease (in which the donor's lymphocytes [graft] recognize the patient's body as "foreign" and set up reactions to attack the foreign host), and other complications.

The nurse is caring for a client receiving treatment for non-Hodgkin lymphoma (NHL). Which assessment findings indicate to the nurse that the client is developing multifocal leukoencephalopathy? Select all that apply. Altered vision Change in speech Facial nerve paralysis Change in motor coordination Peripheral neuropathy Correct response: Incorrect response: Your selection: Explanation: The goal of treatment for NHL is to obtain remission of disease by killing as many of the malignant cells as possible. A rare but potentially life-threatening complication is progressive multifocal leukoencephalopathy which may occur in clients with NHL who are severely immunocompromised and treated with chemotherapeutic agents. Symptoms of this complication include confusion, altered vision, change in speech, and a change in motor coordination. Facial nerve paralysis and peripheral neuropathy are not symptoms of this complication.

The nurse is caring for a client receiving treatment for non-Hodgkin lymphoma (NHL). Which assessment findings indicate to the nurse that the client is developing multifocal leukoencephalopathy? Select all that apply. Altered vision Change in speech Change in motor coordination The goal of treatment for NHL is to obtain remission of disease by killing as many of the malignant cells as possible. A rare but potentially life-threatening complication is progressive multifocal leukoencephalopathy which may occur in clients with NHL who are severely immunocompromised and treated with chemotherapeutic agents. Symptoms of this complication include confusion, altered vision, change in speech, and a change in motor coordination. Facial nerve paralysis and peripheral neuropathy are not symptoms of this complication.

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? You Selected: "Chronic leukemia develops slowly." Correct response: "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 is teaching a client about the development of leukemia. What statement should be included in the teaching plan? You Selected: "Chronic leukemia develops slowly." Correct response: "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? You Selected: Gradual muscle paralysis Correct response: 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 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? You Selected: Gradual muscle paralysis Correct response: 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.