NUR 202 Hematology

A patient with suspected multiple myeloma is complaining of pain in the back. What is the priority nursing action?

Send the patient for x-ray study of the spine

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has?

A general reduction in all white blood cells

Which of the following is the only curative treatment for chronic myeloid leukaemia (CML)?

Allogeneic stem cell transplant

Hemophilia A is the most common of the three types of hemophilia. What is diminished in the less serious form of hemophilia A, known as von Willebrand's disease?

Amount and quality of factor VIII

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, you find evidence of petechiae and ecchymoses. You note that the spleen appears enlarged. What would you suspect is wrong with this client?

Aplastic anemia

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure?

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

A client is receiving chemotherapy for acute myeloid leukemia and has poor nutritional intake. The first action of the nurse is to

Ask, "Are you experiencing nausea?"

A patient with AML has pale mucous membranes and bruises on his legs. What is the primary nursing intervention?

Assess the patient's hemoglobin and platelets.

The Oncology Advanced Practice Nurse (APN) is assessing a client with leukemia. How would the Oncology APN assess for enlargement and tenderness over the liver and spleen?

By palpating the abdomen

A client reports feeling tired, cold, and short of breath at times. Your assessment reveals tachycardia and reduced energy. What would you expect the physician to order?

CBC

A client diagnosed with polycythemia vera has come into the clinic because he has developed a nighttime cough, fatigue, and shortness of breath. What complication would you suspect in this client?

Congestive heart failure

A 40-year-old client has multiple myeloma. Prior to starting treatment with thalidomide (Thalomid), it is most important for the nurse to

Contract with the client regarding birth-control methods. Thalidomide may cause birth defects. Prior to taking this drug, the client must agree to use approved methods of birth control.

client is suspected of having leukemia and is having a series of laboratory and diagnostic studies performed. What does the nurse recognize as the hallmark signs of leukemia?

Fatigue from anemia• Easy bruising

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

Hypercalcemia

An 82-year-old client has pernicious anemia and has been receiving treatment for several years. What is she lacking that results in pernicious anemia?

Intrinsic factor

Which of the following terms refers to a form of white blood cell involved in immune response?

Lymphocyte

The nurse is collecting data for a patient who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?

Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased.

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 client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in their arms and legs. What do these symptoms indicate?

Neurologic involvement

What assessment findings best indicate that the patient has recovered from induction therapy?

Neutrophil and platelet counts within normal limits

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide?

Observe stools for blood.

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?

Obtain the pain medication and delay the bath and position change until the medication reaches its peak.

You are 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 at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron?

Rich sources of vitamin C

The nurse is assessing several patients. Which patient does the nurse determine is most likely to have Hodgkin lymphoma?

The patient with enlarged lymph nodes in the neck.

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

They produce all blood cells.

You are caring for a client with thalassemia who is being transfused. What your role during a transfusion?

To closely monitor the rate of administration

The Pediatric Nurse Practitioner is doing a physical examination of a client with sickle cell anemia. Why would the nurse practitioner auscultate the lungs and heart?

To detect the abnormal sounds suggestive of acute chest syndrome and heart failure

The nurse caring for an older adult with a diagnosis of leukemia would encourage the client to use an electric razor. Why?

Trauma and microabrasions may contribute to anemia.

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which of the following would not be included in the client's discharge instructions?

Use a disposable razor when shaving.

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for:

pathologic bone fractures.

Acute myeloid leukaemia (AML) results from a defect in the haematopoietic stem cell that differentiates into which of the following myeloid cells?

• Monocytes• Granulocytes • Erythrocytes • Platelets AML results from a defect in the hematopoietic stem cell that differentiates into all myeloid cells: monocytes, granulocytes, erythrocytes, and platelets.

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise?

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

A patient with multiple myeloma is complaining about pain. What instructions will the nurse give the patient to help to reduce pain during activity?

Do not lift more than 10 pounds.

A client has been diagnosed with multiple myeloma. Which of the following laboratory values should the nurse expect to find in a client with multiple myeloma?

Increased urinary protein

Parents arrive to the clinic with their 5-year-old child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse?

The child must inherit two defective genes, one from each parent."

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents?

Hypochromic. A normocytic RBC is normal or average in size. A microcytic RBC is smaller than normal. Hyperchromic is used to describe an RBC that has darker cellular contents.

Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and platelets?

Pancytopenia may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

Which nursing intervention is most appropriate for a client with multiple myeloma?

Preventing bone injury, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration.

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

Erythrocytes that are microcytic and hypochromic