PNE 105 Med-Surg. Chapter 32: Caring for Clients with Disorders of the Lymphatic System
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 70-year-old client has recently been diagnosed with lymphoma and asks what may have contributed to this illness. Which of the following statements from the nurse would be most accurate?
"Lymphoma incidence increases with age because of cumulative exposures to carcinogens and a decline in immune functioning." Explanation: The risk of lymphoma is increased in older adults, primarily because of the immunologic changes of aging and prolonged exposure to carcinogens. This age group has a higher risk than others for lymphomas. Development of lymphoma has no connection to previous history of infection with varicella. Lymphoma is a problem of the lymphatic system, not of circulatory or blood-vessel functioning.
What is the minimum daily fluid intake that the nurse recommends for the client undergoing chemotherapy, radiation, or both to treat lymphoma? Fill in the blank with a number.
2500
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)?
A 72-year-old 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 public health nurse is planning community teaching for a group of older adults regarding aging and hematological conditions. What condition will the nurse identify as most common among this population?
Anemia Explanation: Anemia is the most common hematological condition in older adults, particularly those admitted to hospitals and long-term care facilities.
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action?
Assess renal function.
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action?
Assess renal function. Explanation: Chemotherapy results in the destruction of cells and tumor lysis syndrome. Uric acid and phosphorus concentrations increase, and the client is susceptible to renal failure. The nurse should assess renal function if the client complains of low-back pain, as this could be indicative of kidney stone formation. Heating pads, pain medication, and referrals could be instituted once the cause of the pain is determined. The priority is further assessment to rule out important problems.
After receiving a diagnosis of acute lymphocytic leukemia, a client is visibly distraught, stating, "I have no idea where to go from here." How should the nurse prepare to meet this client's psychosocial needs?
Assess the client's specific needs for education and support. Explanation: In order to meets the client's needs, the nurse must first identify the specific nature of these needs. According to the nursing process, assessment must precede interventions. The plan of medical care is important, but not central to the provision of support. The client's previous health care is not a primary consideration, and the nurse cannot assure the client of successful treatment.
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?
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
A nurse is documenting skin findings in a client with lymphedema. Which of the following descriptions would be most consistent with the expected presentation?
Brawny Explanation: The skin of the client with lymphedema can appear thickened, rough, and discolored; it is described as brawny (orange). Rubor means a red appearance; cyanotic is a bluish skin tone when oxygenation to tissues is impaired; and jaundice is a yellow skin tone that develops in client with liver problems.
A young adult client has received the news that her treatment for Hodgkin lymphoma has been deemed successful and that no further treatment is necessary at this time. The care team should ensure that the client receives regular health assessments in the future due to the risk of what complication?
Cancer Explanation: Survivors of Hodgkin lymphoma have a high risk of second cancers. There is no consequent risk of anemia, lymphedema, or hemophilia.
A nurse is planning the care of a client who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the client's care plan, the nurse has identified a diagnosis of Risk for Injury, which should be attributed to what factor?
Decreased bone density. Explanation: Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Labyrinthitis is uncharacteristic, and patients do not normally experience hypercoagulation or cardiac hypertrophy.
A nurse is preparing health education for a client who has received a diagnosis of myelodysplastic syndrome (MDS). Which of the following topics should the nurse prioritize?
Emergency management of bleeding episodes. Explanation: Because of clients' risks of hemorrhage, clients with MDS should be taught techniques for managing emergent bleeding episodes. Bronchodilators are not indicated for the treatment of MDS and lymphedema is not normally associated with the disease. Energy conservation techniques are likely to be useful, but management of hemorrhage is a priority because of the potential consequences.
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. Explanation: The bone marrow biopsy of a client with acute myeloid leukemia will reveal an excess of immature leukocytes.
A client has lymphedema in the leg. The nurse measures the affected leg's circumference as 8 cm more than the unaffected leg and has cellulitis. When documenting findings, what stage would the nurse grade the lymphedema?
Grade III Explanation: Characteristics of Grade III (Severe) lymphedema is that the circumference of affected limb is 8 cm greater than the unaffected limb, involves the entire limb, or is accompanied by infection or cellulitis (inflammation of connective tissue in or close to the skin).
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
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 is recovering from infectious mononucleosis. For which of the following conditions is the nurse aware that the client may also be at increased future risk?
Hodgkin's lymphoma Explanation: The Epstein-Barr virus is believed to trigger Hodgkin's lymphoma in approximately 40% of people with this disease.
A client has completed the full course of treatment for acute lymphocytic leukemia and has failed to respond appreciably. When preparing for the client's subsequent care, the nurse should perform what action?
Identify the client's specific wishes around end-of-life care.
An older adult client is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the client has CLL?
Increased lymphocyte levels. Explanation: An increased lymphocyte count (lymphocytosis) is always present in clients with CLL. Each of the other listed symptoms may or may not be present, and none is definitive for CLL.
A nurse practitioner is assessing a client who has a fever, malaise, and a white blood cell count that is elevated. What principle should guide the nurse's management of the client's care?
Infection is the most likely cause of the client's change in health status. Explanation: Leukocytosis is most often the result of infection. It is only considered pathologic (and suggestive of leukemia) if it is persistent and extreme. Multiple myeloma and lymphoma are not likely causes of this constellation of symptoms.
A nurse prepares teaching for a group of clients with chronic myeloid leukemia (CML). When planning the teaching on medication adherence, which factors associated with lower oral therapy adherence will the nurse keep in mind? Select all that apply.
Living alone Not participating in a clinical trial Taking medication independent of meals Low socioeconomic status
A nurse is helping to prepare a client with lymphedema for a procedure in which an intravenous dye and radiography will be used to detect lymph node involvement and reveal the degree and extent of blockage in the lymph system. What procedure will the client be undergoing?
Lymphangiography Explanation: Lymphangiography is a special examination in which an intravenous (IV) dye and radiography are used to detect lymph node involvement, which reveals the degree and extent of blockage in the lymph system.
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 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 16-year-old girl has been brought to her primary care provider by her mother due to the daughter's recent malaise and lethargy. Which of the following assessments should the clinician perform in an effort to confirm or rule out infectious mononucleosis?
Palpating the patient's lymph nodes Explanation: In cases of infectious mononucleosis, the lymph nodes are typically enlarged throughout the body, particularly in the cervical, axillary, and groin areas. Palpation of these nodes is a priority assessment in cases of suspected mononucleosis. Bone pain, adventitious lungs sounds, and abnormal cranial nerve reflexes do not accompany mononucleosis.
A nurse is caring for client whose diagnosis of multiple myeloma is being treated with bortezomib. The nurse should assess for what adverse effect of this treatment?
Peripheral neuropathy
The nurse is caring for a client who is developing hypovolemic shock from a duodenal ulcer bleed. What is the first intervention the nurse can provide to facilitate blood flow to the brain?
Place the client in a modified Trendelenburg position. Explanation: The first action by the nurse would be to place the client in a modified Trendelenburg position to facilitate blood flow to the brain. Administering a crystalloid solution and testing the client for blood in the stool may be later action but is not relevant in facilitating blood flow to the brain. Preparing the client for an endoscopy would be important after the physician obtains the informed consent but would not facilitate blood flow to the brain.
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 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 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. 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 client with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the client's care plan?
Protective isolation and vigilant use of standard precautions
A client with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the client's care plan?
Protective isolation and vigilant use of standard precautions. Explanation: Induction therapy causes neutropenia and a severe risk of infection. This risk must be addressed directly in order to ensure the client's survival. For this reason, infection control would be prioritized over nutritional interventions, family care, and pain, even though each of these are important aspects of nursing care.
A young adult is preparing to begin treatment for non-Hodgkin lymphoma (NHL), a disease that has disseminated widely. What is the most likely treatment regimen for this patient that the nurse will help prepare?
Radiation and chemotherapy Explanation: NHL is normally treated with either radiation (early stage) or radiation and chemotherapy (later stages). Antivirals, blood transfusion, surgery, bone marrow transplantation, and stem cell transplantations are not common treatment modalities for NHLs.
The nurse is reviewing the chart of a client with lymphoma. Which of the following findings would best indicate to the nurse that the client has Hodgkin's disease as opposed to non-Hodgkin's lymphoma?
Reed-Sternberg cells are found diagnostically. Explanation: Although the exact cause of Hodgkin's disease is unknown, it appears that a virus, particularly the Epstein-Barr virus, causes mutations in some but not all lymphocytes, creating malignant cells known as Reed-Sternberg cells. Reed-Sternberg cells are present with Hodgkin's disease. The other findings, although also possible with Hodgkin's disease, could also be found in clients with non-Hodgkin's lymphoma.
A client hospitalized with Hodgkin's disease is currently under visitor restrictions and asks the nurse why this is necessary. Which of the following explanations from the nurse is most accurate?
Restricting visitors and personnel reduces the risk of transmission of pathogens to the client.
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 Explanation: A client with paresthesia in the feet is at risk for falls due to impaired sensation. Acute pain, impaired tissue integrity, and sensory-perception disturbance are all nursing diagnoses that are appropriate for the client; however, risk for falls is priority.
A client at the health care facility is diagnosed with Hodgkin's disease that has extended to the liver. What stage should the nurse use to describe the progress of the disease?
Stage IV
Laboratory and diagnostic test results have returned for a client with suspected lymphangitis. Which of the following would be most likely for the nurse to review in the results?
Streptococcus Explanation: An infectious agent, commonly a streptococcal microorganism, usually causes both lymphangitis and lymphadenitis.
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma?
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.
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. Explanation: There is a rapid proliferation of red blood cells from the marrow in polycythemia vera. However, these red blood cells die sooner than normal and the dead red blood cells release potassium and uric acid. This build up of uric acid in the blood leads to gouty arthritis symptoms.
A 60-year-old client with chronic myeloid leukemia will be treated in the home setting and the nurse is preparing appropriate health education. What topic should the nurse emphasize?
The importance of adhering to the prescribed drug regimen. Explanation: Nurses need to understand that the effectiveness of the drugs used to treat CML is based on the ability of the client to adhere to the medication regimen as prescribed. Adherence is often incomplete, thus this must be a focus of health education. Vaccinations normally would not be given during treatment and daily physical activity may be impossible for the client. Dietary restrictions are not normally necessary.
A home care nurse is caring for a client with multiple myeloma. Which nursing interventions are appropriate for this client? Select all that apply.
The nurse delays position changes and bathing if the client is experiencing pain. The nurse instructs the client to avoid activities that may cause injury.
A client has a history of lymphedema. Impaired nutrition to the client's tissues could lead to:
Ulcers and infection in the edematous area. Explanation: In a client with lymphedema, tissue nutrition is impaired from the stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area.
A client recently diagnosed with a lymphatic disorder asks the nurse why the lymphatic system is so important. Which of the following would the nurse be correct in identifying as potential complications of a compromised lymphatic system? Select all that apply. a.) Digestive disorders b.) Cardiovascular disease c.) Tender, painful enlargement of lymph nodes d.) Fluid distribution problems e.) Weakened immunity
c.) Tender, painful enlargement of lymph nodes d.) Fluid distribution problems e.) Weakened immunity Explanation: Disorders of the lymphatic system result in fluid distribution problems, tender and painful lymph node enlargement, compromised immune function, or a combination of these.
A nurse is having a discussion with a group of 14-year-old camp counselors about how infectious mononucleosis is transmitted. This disease is transmitted by:
contact with the saliva of an infected person. Explanation: Infectious mononucleosis spreads by direct contact with saliva and pharyngeal secretions from an infected person. It is transmitted by kissing; oral spraying during coughing, talking, or sneezing; or sharing food, cigarettes, or other items containing oral secretions.
A client is in the early stages of Hodgkin's disease. When palpating the client's lymph nodes, the nurse is most likely to find that the lymph nodes are:
enlarged and painless. Explanation: Early symptoms of Hodgkin's disease include painless enlargement of one or more lymph nodes.
A client who has Hodgkin's disease should have their bed in high-Fowler's position whenever practical to:
increase lung expansion.
A client who has Hodgkin's disease should have their bed in high-Fowler's position whenever practical to:
increase lung expansion. Explanation: Those who have Hodgkin's disease are at risk for ineffective airway clearance and impaired gas exchange. High-Fowler's position promotes lung expansion.
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 Explanation: For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).
A teenage client presents with severe fatigue, sore throat, headache, oozing tonsils, and cervical lymph node enlargement. Which accessory lymphatic structure could enlarge?
lymph nodes
A client who is a breast cancer survivor is battling secondary lymphedema. How many women are affected by secondary lymphedema after cancer treatment?
more than one-fourth Explanation: Lymphedema affects more than one fourth of women who have received treatment for breast cancer; this accounts for an appreciable number of the 2 to 3 million Americans affected by this condition (Holcomb, 2006).
What is the primary mechanism of lymphatic fluid circulation?
skeletal muscle contraction
A client presents with weeping lower extremity edema and skin that is thickened and brawny. This condition has been present for 4 weeks. The physician would likely order:
symptomatic treatment. Explanation: In lymphedema, treatment is usually symptomatic.
A client has primary lymphedema. The nurse explains that primary lymphedema is:
usually congenitally acquired. Explanation: Primary lymphedema usually is congenitally acquired, although manifestations usually do not appear until adolescence or early adulthood. Secondary lymphedema is a complication of other disorders. Secondary lymphedema is a consequence of treatment.
A home health nurse is caring for a client with multiple myeloma. What intervention should the nurse prioritize when addressing the client's severe bone pain?
Helping the client manage the opioid analgesic regimen Explanation: For severe pain resulting from multiple myeloma, opioids are likely necessary. NSAIDs would likely be ineffective and are associated with significant adverse effects. Hot and cold packs as well as distraction would be insufficient for severe pain, though they may be useful as adjuncts.
A home health nurse is caring for a client with multiple myeloma. What intervention should the nurse prioritize when addressing the client's severe bone pain?
Helping the client manage the opioid analgesic regimen. Explanation: For severe pain resulting from multiple myeloma, opioids are likely necessary. NSAIDs would likely be ineffective and are associated with significant adverse effects. Hot and cold packs as well as distraction would be insufficient for severe pain, though they may be useful as adjuncts.
A client with Hodgkin's disease is hospitalized and experiencing respiratory distress. In which position should the nurse place the client?
High Fowler's Explanation: The nurse should keep the neck in midline and place the client in high Fowler's position if respiratory distress develops. This position avoids unnecessary pressure on the trachea and provides for increased lung expansion and improved air exchange.
A client presents with painless enlargement of the cervical and axillary lymph nodes, has lost 20 pounds in the last 2 months, and reports an alarming lack of energy. The client's history is positive for infectious mononucleosis as a young teen. This client may be suffering from:
Hodgkin's lymphoma. Explanation: Early symptoms of Hodgkin's disease include painless enlargement of one or more lymph nodes. The cervical lymph nodes are the first to be affected. Marked weight loss, anorexia, fatigue, and weakness occur. Low-grade fever, pruritus, and night sweats are common. The Epstein-Barr virus is believed to trigger Hodgkin's lymphoma in approximately 40% of people with a history of infectious mononucleosis.
A client who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this client's needs for physical activity?
Assist the client to a chair during awake times, as tolerated. Explanation: Sitting up in a chair is preferable to bed rest, even if a client is experiencing severe fatigue. A client who has debilitating fatigue would not likely be able to perform stair exercises. Teaching about mobility may be necessary, but education must be followed by interventions that actually involve mobility. Deep breathing and coughing reduce the risk of respiratory complications but are not substitutes for physical mobility in preventing deconditioning.
A clinic client is being treated for polycythemia vera and the nurse is providing health education. What practice should the nurse recommend in order to prevent the complications of this health problem?
Avoiding tight and restrictive clothing on the legs. Explanation: Because of the risk of DVT, clients with polycythemia vera should avoid tight and restrictive clothing. There is no need to avoid foods with vitamin K or to avoid higher altitudes. Activity levels should be maintained, but there is no specific need for ROM exercises.
An oncology nurse is caring for a client with multiple myeloma who is experiencing bone destruction. When reviewing the client's most recent blood tests, the nurse should anticipate what imbalance?
Hypercalcemia Explanation: Hypercalcemia may result when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin. RBC count will be decreased. Hyperproteinemia would not be present.
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 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.
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.
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 Explanation: Non painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.
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 Explanation: Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate are seen; this process is referred to as tumor lysis (cell destruction) syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Clients require a high fluid intake, and prophylaxis with allopurinol (Zyloprim) to prevent crystallization of uric acid and subsequent stone formation.
A client with lymphedema is struggling with negative emotions related to her appearance. Which of the following suggestions from the nurse would be most effective in helping the client address the problem?
"Let's discuss some clothing styles that can help conceal the problem while you are being treated." Explanation: Extensive emotional support is necessary when the edema is severe. The client's self-esteem often is decreased, which can lead to social withdrawal. The nurse supports the client's self-image by suggesting certain styles of clothing that conceal abnormal enlargement of an arm or leg. Telling the client not to dwell on the problem is dismissive and inappropriate; also, sometimes lymphedema does not go away. The nurse should not automatically suggest spiritual counseling to assist with a client's practical problem, unless a client specifically initiates interest in such a referral. While it might be helpful for the client to spend the most time with the people with whom she feels most comfortable, this may increase her isolation. It also may not be practical if a client must return to work or other activities.
A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. In addition to informing the client's primary care provider, the nurse should perform what action?
Check the client's most recent platelet level. Explanation: The client's signs are suggestive of thrombocytopenia, thus the nurse should check the client's most recent platelet level. VTE is not a risk and this does not constitute a need for isolation. Ambulation and activity may be contraindicated due to the risk of bleeding.
The nurse is managing care for a client with respiratory distress secondary to Hodgkin's disease. What equipment should the nurse have available? Select all that apply.
Endotracheal tube Laryngoscope Bag-valve mask Explanation: The nurse should place an endotracheal tube, laryngoscope, and bag-valve mask at the bedside for intubation. Anticipation of the need for airway management ensures that medical intervention and emergency assistance are not delayed.
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. Explanation: Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3. The bleeding is usually unrelated to falling. Keeping the client on bed rest will not prevent bleeding when the client has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.
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. 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
Which term refers to a form of white blood cell involved in immune response?
Lymphocyte Explanation: Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.
Which of the following measures would the nurse recommend to the client with lymphedema to help manage the condition? Select all that apply.
Movement and exercise of the limb Elevation of the limb Compression garments Explanation:The nurse encourages the client to move and exercise the affected arm or leg to enhance the flow of lymph from the congested area. The nurse instructs the client to elevate the edematous extremities when sitting and teaches how to apply and use elastic garments and mechanical devices.
An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The client denies any recent injuries. The nurse should recognize the need for this client to be assessed for what health problem?
Multiple myeloma. Explanation: Back pain, which is often a presenting symptom in multiple myeloma, should be closely investigated in older clients. The lymphomas and bleeding disorders do not typically present with the primary symptom of back pain or rib pain.
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. 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.
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets?
Pancytopenia Explanation: 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.
A nurse is caring for a client who is being treated for leukemia in the hospital. The client was able to maintain her nutritional status for the first few weeks following her diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement what intervention?
Provide the client with several small, soft-textured meals each day. Explanation: For clients experiencing difficulties with oral intake, the provision of small, easily chewed meals may be beneficial. This option would be trialed before resorting to tube feeding or TPN. The family should be encouraged to participate in care, but should not be assigned full responsibility.
An adult client's abnormal complete blood count (FBC) and physical assessment have prompted the primary care provider to order a diagnostic workup for Hodgkin lymphoma. The presence of what assessment finding is considered diagnostic of the disease?
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. It is the pathologic hallmark and essential diagnostic criterion. Schwann cells exist in the peripheral nervous system and Lewy bodies are markers of Parkinson disease. Loops of Henle exist in nephrons.
Which of the following in a client's history would the nurse be likely to identify as risk factors for secondary lymphedema? Select all that apply.
Repeated phlebitis Burns Mastectomy Explanation: Secondary lymphedema develops (1) as a complication of other disorders, such as repeated bouts of phlebitis and streptococcal infection, burns, or insect bites; or (2) as a consequence of treatment, such as the removal of multiple lymph nodes at the time of a mastectomy or radiation for cancer. Lymphedema affects more than one fourth of women who have received treatment for breast cancer. Worldwide, the most common cause of lymphedema is a parasitic worm; mosquitoes transmit the parasite, resulting in a condition known as elephantiasis.
A nurse is planning the care of client who has been diagnosed with essential thrombocythemia (ET). What nursing diagnosis should the nurse prioritize when choosing interventions?
Risk for Ineffective Tissue Perfusion Explanation: Clients with ET are at risk for hypercoagulation and consequent ineffective tissue perfusion. Fluid volume, breathing, and thermoregulation are not normally affected.
A client with a myelodysplastic syndrome is being treated on the medical unit. What assessment finding should prompt the nurse to contact the client's primary care provider?
The client has an oral temperature of 37.5ºC (99.5ºF).
Which statement best describes the function of stem cells in the bone marrow?
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.
An oncology nurse recognizes a client's risk for fluid imbalance while the client is undergoing treatment for leukemia. What related assessments should the nurse include in the client's plan of care? Select all that apply. a.) Measuring the client's weight on a daily basis b.) Monitoring the client's hepatic function c.) Measuring and recording the client's intake and output d.) Auscultating the client's lungs frequently e.) Monitoring the client's electrolyte levels
a.) Measuring the client's weight on a daily basis c.) Measuring and recording the client's intake and output d.) Auscultating the client's lungs frequently e.) Monitoring the client's electrolyte levels Explanation: Assessments that relate to fluid balance include monitoring the client's electrolytes, auscultating the client's chest for adventitious sounds, weighing the client daily, and closely monitoring intake and output. Liver function is not directly relevant to the client's fluid status in most cases.
A nurse cares for an adult client with chronic lymphocytic leukemia (CLL). Which statements regarding the disease will the nurse include in the teaching? Select all that apply. a.) "This type of leukemia primarily impacts pediatric adults." b.) "This type of leukemia is rarely seen in certain ethnicities." c.) "This type of leukemia is rarely aggressive." d.) ''This type of leukemia does not appear to have familial predisposition." e.) "This type of leukemia primarily impacts older adults."
b.) "This type of leukemia is rarely seen in certain ethnicities." e.) "This type of leukemia primarily impacts older adults." Explanation: Chronic lymphocytic leukemia (CLL) is a common malignancy of older adults and primarily impacts older adults and has a strong familial predisposition. This type of leukemia rarely impacts Native Americans and infrequently individuals of Asian descent. While many clients will have a normal life expectancy, others will have a very short life expectancy due to the aggressive nature of the disease.
A client with Hodgkin's disease is experiencing severe pruritus. What measures can the nurse employ and recommend to assist the client best? Select all that apply. a.) Ask the physician to order drugs to be delivered parenterally. b.) Use mild soap to clean the area. c.) Use a stick to scratch the area. d.) Change the client's bedding regularly and often. e.) Apply heat to the affected area.
b.) Use mild soap to clean the area. d.) Change the client's bedding regularly and often. Explanation: Mild soap should be used for bathing, because it prevents excessive drying of the skin. Applying ice, not heat, to the skin for brief periods can be helpful. Cooling the skin reduces the sensation of itching. The nurse should discourage the client from scratching, which can abrade the skin and provide an entrance for pathogens. The bedding should be changed as soon as possible if night sweats occur, because wet bedding contributes to skin maceration. The nurse also should collaborate with the physician to avoid drugs administered by the parenteral route. Any breaks in skin integrity can provide an open route for the entrance of pathogens.
A nurse is reviewing components of complex decongestive physiotherapy with a client about to undergo the treatment. Which of the following would the nurse accurately identify as aspects of this procedure? Select all that apply. a.) Elevation of the affected limb b.) Proximal-to-distal massage of edematous areas to facilitate lymphatic drainage into collateral vessels c.) Application of compression dressings to relieve edema by reducing the excess volume of fluid in the interstitial space d.) Care and maintenance of skin and nails that are vulnerable to secondary complications e.) Passive exercises to promote lymphatic circulation and maintain functional use of the limb
c.) Application of compression dressings to relieve edema by reducing the excess volume of fluid in the interstitial space. d.) Care and maintenance of skin and nails that are vulnerable to secondary complications. Explanation: Complex decongestive physiotherapy includes: (1) distal-to-proximal massage of edematous areas to facilitate lymphatic drainage into collateral vessels, (2) application of compression dressings to relieve edema by reducing the excess volume of fluid in the interstitial space, (3) active exercise to promote lymphatic circulation and maintain functional use of the limb, and (4) care and maintenance of skin and nails that are vulnerable to secondary complications.
