Chapter 30: Management of Patients with Hematologic Neoplasms
The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? Too many erythrocytes A decrease in granulocytes A general reduction in all white blood cells A general reduction in neutrophils and basophils
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 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? Abnormal blood cells deposit in small vessels. Bone marrow expands. Lymph nodes expand. Abnormal blood cells crystalize.
Bone marrow expands. Explanation: In acute myeloid leukemia, bone pain is caused when the bone marrow expands.
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? Axillary Cervical Inguinal Popliteal
Cervical Explanation: Non painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.
A client with primary myelofibrosis is diagnosed with splenomegaly. Which medications will the nurse prepare teaching for this client? Select all that apply. Anagrelide Hydroxyurea Thalidomide Pomalidomide Interferon-alfa
Hydroxyurea Thalidomide Pomalidomide Explanation: Primary myelofibrosis is characterized by extramedullary hematopoiesis [hematopoiesis occurring outside of the medulla of the bone (bone marrow)](body produces blood cells and blood plasma) that involves the spleen causing splenomegaly. Pharmacologic agents can be used to diminish splenomegaly and include hydroxyurea, thalidomide, and pomalidomide. Anagrelide and interferon-alfa are not used to treat splenomegaly caused by primary myelofibrosis.
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? Address issues of negative body image. Place the client in reverse isolation. Administer pain medication. Maintain nutrition.
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 with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Pancytopenia Thrombocytopenia Anemia Neutropenia
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.
What assessment finding best indicates that the client has recovered from induction therapy? Neutrophil and platelet counts within normal limits Vital signs within normal ranges No evidence of edema Absence of bone pain
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.
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? Chronic myeloid leukemia Multiple myeloma Hodgkin lymphoma Non-Hodgkin lymphoma
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 nurse reviews the laboratory results of a client with polycythemia vera. Which findings will the nurse find? Select all that apply. Decreased erythropoietin Increased hemoglobin Increased erythropoietin Decreased platelets Decreased leukocytes
Decreased erythropoietin Increased hemoglobin Explanation: Polycythemia vera causes increased hemoglobin and decreased erythropoietin. Additionally, polycythemia vera causes an increase in platelets and leukocytes as well.
A patient is taking hydroxyurea for the treatment of primary myelofibrosis. While the patient is taking this medication, what will the nurse monitor to determine effectiveness? Leukocyte and platelet count Blood urea nitrogen (BUN) and creatinine levels Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels Hemoglobin and hematocrit
Leukocyte and platelet count Explanation: Hydroxyurea is often used in patients with primary myelofibrosis to control high leukocyte and platelet counts and to reduce the size of the spleen.
A client has been diagnosed with polycythemia vera. What is the best instruction for the nurse to give to this client? Take a daily multivitamin with iron supplement Maintain adequate blood pressure control Drink alcohol to decrease blood viscosity Bath in tepid or cool water to control itching
Maintain adequate blood pressure control Explanation: The client with polycythemia vera needs to control blood pressure, because of the increased risk for thrombosis or hemorrhage. Iron supplements can stimulate red blood cell production. Ingestion of alcohol may cause bleeding. Bathing in cool or tepid water may control itching, but this is not as high a priority as preventing thrombosis or hemorrhage.
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? splenomegaly weight gain peripheral edema pale body color
splenomegaly Explanation: Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, weight loss, paresthesias, and blurred vision). Edema, pale body color, and weight gain are not classic symptoms of PV.
A client is taking hydroxyurea as treatment for essential thrombocythemia. Which laboratory test will the nurse remind the client to have completed regularly? Uric acid level Clotting factors Complete blood count Serum potassium level
Complete blood count Explanation: Clients taking hydroxyurea should have the CBC monitored regularly because the dosage is adjusted based on the platelet and WBC count. Uric acid, clotting factors, and serum potassium level do not need to be monitored when taking hydroxyurea.
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 Excess of immature erythrocytes Deficiency of neutrophils Deficiency of erythrocytes
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 is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for? Adventitious lung sounds Hair loss Diarrheal stools Laryngeal edema
Diarrheal stools Explanation: Side effects of radiation therapy are limited to the area being irradiated. Clients who have abdominal radiation therapy may experience diarrhea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal edema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? Hypercalcemia Hyperkalemia Hypernatremia Hypermagnesemia
Hypercalcemia Explanation: Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.
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. The dead red blood cells occlude the small vessels in the joints. Excess red blood cells produce extracellular toxins that build up. Excess red blood cells cause vascular injury in the joints.
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.
Which statement indicates the client understands teaching about induction therapy for leukemia? "I will start slowly with medication treatment." "I will need to come every week for treatment." "I will be in the hospital for several weeks." "I know I can never be cured."
"I will be in the hospital for several weeks." Explanation: Induction therapy involves high doses of several medications and the client is usually admitted to the hospital for several weeks. The treatment is started quickly and the goal is to cure or put the disease into remission.
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? "Treatment is simple and consists of single-drug therapy." "Intrathecal chemotherapy is used primarily as preventive therapy." "The goal of therapy is palliation." "Side effects are rare with therapy."
"Intrathecal chemotherapy is used primarily as preventive therapy." Explanation: Intrathecal chemotherapy is a key part of the treatment plan to prevent invasion of the central nervous system. The therapy uses multiple drugs, with many side effects. The goal of therapy is remission.
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "Acute leukemia develops slowly." "Chronic leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature." "In acute leukemia there are not many undifferentiated cells."
"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 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? Blood transfusions Hypomethylating agents Erythropoiesis-stimulating agents Allogeneic hematopoietic stem cell transplantation
Allogeneic hematopoietic stem cell transplantation Explanation: Medical management strategies for MDS are based on risk stratification to determine stage of disease and prognosis. Allogeneic HSCT continues to be the only potential option of cure for MDS. Blood transfusions are used for those with low-risk disease. Hypomethylating agents are used to treat clients with low to intermediate-risk disease. Erythropoiesis-stimulating agents are used to treat clients with low risk disease.
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 Filgrastim Hydroxyurea Asparaginase
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 who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? Refer the client to a chiropractor. Place heating pads on the client's back. Administer pain medication, as ordered. Assess renal function.
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.
A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? Assess the client's skin. Assess the client's hemoglobin and platelets. Assess the client's pulse and blood pressure. Check the client's history.
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 acute myeloid leukemia (AML) receiving chemotherapy is treated for an acute renal injury. What is the nurse's best understanding of the pathophysiological reason behind the client's injury? The majority of the disease process occurs in the tissue of the kidneys. Chemotherapy causes an increase in kidney stone formation. Chemotherapy causes destruction of the nephrons in the kidney. The majority of the disease process occurs in the vessels of the kidneys.
Chemotherapy causes an increase in kidney stone formation. Explanation: Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. This causes an increase in uric acid levels, potassium, and phosphate (also known as tumor lysis). The increase in uric acid predisposes the client to the development of kidney stones and increases the risk for renal injury.
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? Stroke Tissue infarction Congestive heart failure Pulmonary embolus
Congestive heart failure Explanation: The symptoms exhibited by this client are indicative of congestive heart failure. Complications include: hypertension, congestive heart failure, stroke, tissue and organ infarction, and hemorrhage. Stroke would present with headache, aphasia, and/or numbness in extremities. Tissue infarction would involve extremity discoloration or an organ failure. Pulmonary embolism would be associated with chest pain. Google: polycythemia vera= rare blood disorder in which there is an increase in all blood cells, particularly red blood cells
A client with multiple myeloma reports uncomfortable muscle cramping. Which nursing interventions will the nurse implement in response to the client's report of symptoms? Select all that apply. Encourage hydration Encourage ambulation Warn client to avoid abrupt position change Warn client to avoid extremes in temperatures Encourage range of motion exercises
Encourage hydration Encourage ambulation Explanation: Muscle cramping can be alleviated or reduced by encouraging hydration and ambulation. Warning the client to avoid abrupt position change best supports the client with postural hypotension. Paresthesias (tingling) can best be mediated with range of motion exercises. Clients experiencing hypoesthesia should be warned to avoid extremes in temperatures.
A client with chronic lymphocytic leukemia (CLL) wants to have treatment for the condition. Which medication will the nurse question for this client? Heparin Ipilimumab Dexamethasone Vincristine
Heparin Explanation: Commonly prescribed pharmacological therapies for chronic lymphocytic leukemia (CLL) include - - - immunotherapy agents (ipilimumab), - corticosteroids (dexamethasone), - and chemotherapeutic agents (vincristine). Clients with CLL are at risk of bleeding, and therefore the use of anticoagulants (heparin) is contraindicated.
A client with primary myelofibrosis is diagnosed with splenomegaly. Which medications will the nurse prepare teaching for this client? Select all that apply. Anagrelide Hydroxyurea Thalidomide Pomalidomide Interferon-alfa
Hydroxyurea Thalidomide Pomalidomide Explanation: Primary myelofibrosis is characterized by extramedullary hematopoiesis that involves the spleen causing splenomegaly. Pharmacologic agents can be used to diminish splenomegaly and include hydroxyurea, thalidomide, and pomalidomide. Anagrelide and interferon-alfa are not used to treat splenomegaly caused by primary myelofibrosis.
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? Pancytopenia Anemia Leukopenia Thrombocytopenia
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.
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? Use contact precautions with this client. Perform a neurologic assessment with vital signs. Request a prescription of diphenoxylate and atropine for loose stools. Teach the client to vigorously floss the teeth to prevent infections.
Perform a neurologic assessment with vital signs. Explanation: With platelets less than 10,000/mm³ there is a risk for spontaneous bleeding, including within the cranial vault. The nurse performs a neurologic examination to assess for this possibility. Though the client is receiving immunosuppressants, it is not necessary to use contact precautions with this client. Contact precautions are used with clients who have known or suspected transmittable illnesses. Diphenoxylate and atropine can cause constipation and inhibit accurate assessment of the client's gastrointestinal bleeding. If the client strains when having a bowel movement, the client could bleed even more. The client is not to floss vigorously; doing so can cause bleeding.
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? Polycythemia vera Sickle cell disease Aplastic anemia Pernicious anemia
Polycythemia vera Explanation: Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow. In sickle cell disease, HbS causes RBCs to assume a sickled shape under hypoxic conditions. Aplastic anemia has a deficiency of erythrocytes. The other options do not have the characteristics of erythrocytosis.
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? Monitor the client's temperature every shift. Maintain contact precautions. Encourage increased fluid consumption. Practice vigilant handwashing.
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 multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? Acute pain Risk for falls Impaired tissue integrity Sensory-perception disturbance
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
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? Pale skin and mucous membranes Bronze skin tone Ruddy complexion Jaundice skin and sclera
Ruddy complexion Explanation: Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.
A client with suspected multiple myeloma is reporting back pain. What is the priority nursing action? Have the client lie on a hard surface. Have the client rest. Encourage ambulation. Send the client for a spinal x-ray study.
Send the client for a spinal x-ray study. Explanation: The client with myeloma can have bone pain, especially in the back and ribs. The pain will decrease with rest and increase with activity. Lying on a hard surface will not relieve the pain. The priority action is to make certain the client does not have a fractured spine, as the bone destruction in this disease is sufficiently severe to cause vertebral collapse
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? Histology of tissue Staging of disease Involvement of lymph nodes Total blood cell count
Staging of disease Explanation: Treatment of Hodgkin lymphoma is based on the stage of the disease, not the histology of tissue, involvement of lymph nodes, or total blood cell count.
Which statement best describes the function of stem cells in the bone marrow? They are active against hypersensitivity reactions. They defend against bacterial infection. They produce all blood cells. They produce antibodies against foreign antigens.
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.
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? polycythemia vera sickle cell disease aplastic anemia pernicious anemia
polycythemia vera Explanation: Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow. In sickle cell disease, HbS causes RBCs to assume a sickled shape under hypoxic conditions. Aplastic anemia has a deficiency of erythrocytes. Sickle cell disease and the anemias do not have the characteristics of erythrocytosis.
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. Anemia Lymph enlargement Hypercalcemia Renal dysfunction Bone destructions
Anemia Hypercalcemia Renal dysfunction Bone destructions Explanation: Clinical manifestations of multiple myeloma result not only from the malignant cells themselves, but also from the abnormal protein they produce. The classic clinical manifestations of multiple myeloma are referred to as the CRAB features and include anemia, hypercalcemia, renal dysfunction, and bone destruction. Lymph enlargement is associated with lymphomas, but not with multiple myeloma.
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? Elevate the client's legs. Encourage ambulation. Assess for signs of injury. Keep the feet cool.
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 is being tested for acute myeloid leukemia (AML). The nurse knows that which diagnostic test will be used as the hallmark for the diagnosis? Clotting factors Bone marrow analysis Complete blood count Alkaline phosphatase level
Bone marrow analysis Explanation: To confirm the diagnosis of AML, laboratory studies need to be performed. A bone marrow analysis shows an excess or more than 20% of blast cells which is the hallmark of the diagnosis. Clotting factors are not used to diagnose AML. The complete blood count (CBC) commonly shows a decrease in both erythrocytes and platelets but is not as specific as the bone marrow analysis. The alkaline phosphatase level measures a liver enzyme.
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? Debilitating fatigue Bone pain in the back of the ribs Gradual muscle paralysis Severe thrombocytopenia
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 caring for a client with myeloma prepares to administer dexamethasone to the client. What is the nurse's best understanding of how this medication is an effective treatment option for this client? It kills affected cells. It decreases immune response. It decreases tumor necrosis factor. It kills affected bone marrow.
It kills affected cells. Explanation: Dexamethasone is used to induce myeloma apoptosis and cell death and to reduce bone pain.
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? Pathologic fractures Osteoporosis Calcified bones Increased mobility
Pathologic fractures Explanation: Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.
A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? Monitoring respiratory status Balancing rest and activity Restricting fluid intake Preventing bone injury
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.
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? chronic liver failure. acute heart failure. pathologic bone fractures. hypoxemia.
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.
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan? "Consolidation therapy is administered to reduce the chance of leukemia recurrence." "Consolidation occurs as a side effect of chemotherapy." "Consolidation of the lungs is an expected effect of induction therapy." "Consolidation is the term used when a client does not tolerate chemotherapy."
Consolidation therapy is administered to reduce the chance of leukemia recurrence." Explanation: Consolidation therapy is administered to eliminate residual leukemia cells that are not clinically detectable and reduce the chance for recurrence. It is also termed post-remission therapy. It is not a side effect of chemotherapy, but the administration of chemotherapy.
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? Polycythemia vera Decreased serum protein Decreased calcium level Increased urinary protein
Increased urinary protein Explanation: A characteristic finding in multiple myeloma is protein in the urine. Other laboratory findings include increased serum protein, hypercalcemia, anemia, and hyperuricemia. Polycythemia vera is not found in multiple myeloma.
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? Creatinine and blood urea nitrogen (BUN) levels Iron levels Magnesium levels Potassium levels
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).
Place the pathophysiology of multiple myeloma in the correct order. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Proliferation of abnormal plasma cells 2Release of osteoclast-activating factor 3Break down and removal of bone cells 4Increased blood calcium levels
Proliferation of abnormal plasma cells Release of osteoclast-activating factor Break down and removal of bone cells Increased blood calcium levels Explanation: The pathophysiology of multiple myeloma is as follows: Proliferation of abnormal plasma cells, release of osteoclast-activating factor, break down and removal of bone cells, increased blood calcium levels.
A client with polycythemia vera reports severe itching. What triggers does the nurse know can cause this distressing symptom? Select all that apply. Temperature change Allergic reaction to the red blood cell increase Alcohol consumption Exposure to water of any temperature Aspirin
Temperature change Alcohol consumption Exposure to water of any temperature Explanation: Pruritus is very common, occurring in up to 70% of clients with polycythemia vera (Saini, Patnaik & Tefferi, 2010) and is one of the most distressing symptoms of this disease. It is triggered by contact with temperature change, alcohol consumption, or, more typically, exposure to water of any temperature but seems to be worse with exposure to hot water.
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? The client with painful lymph nodes under the arm. The client with painful lymph nodes in the groin. The client with enlarged lymph nodes in the neck. The client with a painful sore throat.
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 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. Hypercalcemia Renal insufficiency Anemia Bone lesions Acidosis
Hypercalcemia Renal insufficiency Anemia Bone lesions Explanation: The acronym CRAB is used to describe the combined pathologic effects of multiple myeloma and include: calcium levels elevated (hypercalcemia), renal insufficiency, anemia, bone lesions. Acidosis is not part of the acronym used to describe the pathologic effects of the disease.
A client with multiple myeloma presents to the emergency department and reports excessive thirst and constipation. Family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? Platelet count 300,000/mm3 Serum calcium level 13.8 mg/dl Serum sodium level of 133 mEq/L Hemoglobin of 9.8 g/dl
Serum calcium level 13.8 mg/dl Explanation: Excessive thirst, constipation, dehydration, confusion, and altered mental state are possible signs of hypercalcemia. Hypercalcemia is common in multiple myeloma because of the increased bone destruction. A platelet count of 300,000/mm3 is normal and wouldn't cause the client's symptoms. A sodium level of 133 mEq/L is slightly decreased but wouldn't cause confusion and excessive thirst. A hemoglobin of 9.8 g/dl level is slightly low but isn't likely responsible for the client's symptoms.
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? Acute respiratory distress syndrome Graft-versus-host disease Remission Bone marrow depression
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.
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? Implement neutropenic precautions. Eliminate direct contact with others who are infectious. Apply prolonged pressure to needle sites or other sources of external bleeding. Monitor temperature at least once per shift.
Apply prolonged pressure to needle sites or other sources of external bleeding. Explanation: For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.
The nurse is caring for a client with chronic myeloid leukemia (CML) who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission? Chronic Transformation Accelerated Blast crisis
Chronic Explanation: Advances in understanding the pathology of CML at a molecular level have led to dramatic changes in treatment. An oral formulation of a tyrosine kinase inhibitor, imatinib mesylate (Gleevec), works by blocking signals within the leukemia cells that express the BCR-ABL protein, thus preventing a series of chemical reactions that cause the cell to grow and divide. Imatinib therapy appears to be most useful in the chronic phase of the illness. It can induce complete remission at the cellular and even molecular level.
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? WBC count of 4,200 cells/uL Hematocrit of 38% Platelet count of 9,000/mm3 Creatinine level of 1.0 mg/dL
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.
A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? Ask the client whether they have recently fallen. Evaluate the client's INR. Keep the client on bed rest. Evaluate the client's platelet count.
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 client being treated for non-Hodgkin lymphoma asks the nurse why they need to be monitored for additional forms of leukemia. Which is the nurse's best response? "These screening are health promotion activities that apply to everyone." "You don't want to develop a second cancer, do you?" "You need to do this just to be on the safe side." "These are seen among survivors like yourself."
"These are seen among survivors like yourself." Explanation: Many lymphomas can be cured with current treatments. However, as survival rates increase, the incidence of secondary malignancies, particularly acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS), also increases. Therefore, survivors should be screened regularly for the development of second malignancies. The nurse should encourage clients to reduce other factors that increase the risk of developing second cancers. The other options do not answer the client's question, and also seem insensitive to the client's question.
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A 24-year-old female taking oral contraceptives A 40-year-old patient with a history of hypertension A 52-year-old patient with acute kidney injury A 72-year-old patient with a history of cancer
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.
The nurse is caring for a client with myelodysplastic syndrome (MDS). Which interventions will the nurse implement for this client? Select all that apply. Energy conservation techniques Stretching exercises for muscle cramps Tylenol as ordered for fever Reorientation techniques Monitoring for spontanous bleeding
Energy conservation techniques Tylenol as ordered for fever Monitoring for spontanous bleeding Explanation: The MDS are a group of clonal disorders of the myeloid stem cell that cause dysplasia in one or more types of cell lines. These disorders commonly result in low blood cell counts, with the tendency to develop into acute leukemia The manifestations of MDS can vary widely. Symptoms include fatigue, recurrent pneumonia, and other infections that cause fever. Bleeding can also occur. MDS is not associated with muscle cramps or transient confusion.
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 Menstrual history Age and gender Lifestyle assessments, such as exercise routines
Health history, such as bleeding, fatigue, or fainting Explanation: When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.
The nurse in the oncology clinic is caring for a 42-year-old female client receiving chemotherapy with fludarabine for acute myeloid leukemia who has developed petechiae, epistaxis, and ecchymosis. Complete the following sentence by choosing from the lists of options. The nurse anticipates that the client has developed hemorrhage infection deep vein thrombosis hyperkalemia and that the laboratory results will reveal thrombocytopenia leukocytosis electrolyte imbalances abnormal renal function tests
hemorrhage thrombocytopenia Explanation: This client has manifestations of hemorrhage, including petechiae (pinpoint bleeding in the skin), epistaxis (nosebleeds), and ecchymosis (bruises) due to a low platelet count (thrombocytopenia) secondary to chemotherapy. Chemotherapy with fludarabine may cause bone marrow suppression with neutropenia (low neutrophil count) and thrombocytopenia (low platelet count). When the platelet count is low, the client is at risk for hemorrhage as evidenced by petechiae, epistaxis, and ecchymosis. Chemotherapy with fludarabine may cause bone marrow suppression, leading to thrombocytopenia (low platelet count) and hemorrhage. Although the client is at risk for infection, the assessment findings of petechiae, epistaxis, and ecchymoses are indicators of a low platelet count. The assessment findings do not support a diagnosis of deep vein thrombosis (DVT). Manifestations of DVT include calf pain, leg swelling, and warmth, and pain over the thrombosis. Hyperkalemia does not cause signs and symptoms of hemorrhage. Leukocytosis (a low white count) may occur following treatment with fludarabine, but it does not cause petechiae, epistaxis, and ecchymosis. Electrolyte imbalances and abnormal renal function also do not cause petechiae, epistaxis, and ecchymosis.
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? Have the client maintain complete bedrest. Assist the client to sit in a chair for meals. Talk to the family about not visiting so the client can obtain rest. Provide sedentary activities only, such as watching television.
Assist the client to sit in a chair for meals. Explanation: Fatigue is a common symptom with clients who have leukemia. Despite the fatigue, clients still need to maintain some physical activity. An example of physical activity is having the client sit in a chair for meals. The nurse does not want to encourage complete bedrest or sedentary activities, such as watching television, due to possible deconditioning. The nurse has not discussed with the client about limiting family visits. The client may want some family to visit.
The nurse is teaching a client who is undergoing diagnostic tests for multiple myeloma. What clinical findings support the client's diagnosis of multiple myeloma? serum creatinine level 0.5 mg/dL serum calcium level of 7.5 mg/dL serum albumin level of 2.0 g/dL serum protein level 5.8 g/dL
serum albumin level of 2.0 g/dL Explanation: Albumin is a protein found in the blood and low levels can be seen in myeloma. Normal albumin level is 3.4 to 5.4 g/dL. Serum creatinine level may be increased (above 1.2 mg/dL in men and 0.9 mg/dL in women). Serum calcium levels exceed 10.2 mg/dL in multiple myeloma because calcium is lost from the bone and reabsorbed in the serum. The serum protein level is increased in multiple myeloma, not decreased.
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. Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance. Suggest the prescription of antianxiety medications. Suggest the family go to church more often.
Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance. Explanation: Family members benefit from increased education on what to expect. Allowing family members to express their feelings has also been shown to relieve stress. Supporting the caregiver and family with help in household duties will also help the overburdened family. Antianxiety medications and church attendance have not been shown to reduce caregiver stress.
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? Osteopathic tumors destroy bone causing fractures. Osteoclasts break down bone cells so pathologic fractures occur. Osteolytic activating factor weakens bones producing fractures. Osteosarcomas form producing pathologic 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 assessment findings support the client's diagnosis of acute myeloid leukemia? Select all that apply. Petechiae Enlarged lymph nodes Weakness and fatigue Enlarged heart Bone pain
Petechiae Enlarged lymph nodes Weakness and fatigue Bone pain Explanation: Clients with AML may present with petechiae, enlarged lymph nodes, weakness, fatigue, and bone pain. An enlarged heart is not a typical finding with this disorder.
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 Supportive therapy Antimicrobial therapy Standard therapy
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.
A nurse is providing teaching to a client who will undergo chemotherapy and radiation prior to hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia (AML). What statement will the nurse use to describe the purpose of the chemotherapy and radiation? "These therapies shrink your tumor to ensure the stem cell transplant is more effective." "These therapies destroy the ability of your body to produce blood cells inside your bone marrow." "These therapies destroy the bone marrow in an effort to shrink it and decrease your pain." "These therapies decrease your immune system to decrease the risk of allergic reaction."
"These therapies destroy the ability of your body to produce blood cells inside your bone marrow." Explanation: The treatment goal of chemotherapy and radiation therapy is the destruction of hematopoietic function of the client's bone marrow. The client is then "rescued" with the infusion of the donor stem cells to reinitiate blood cell production. AML is a cancer of the blood and does not have a mass effect/tumor that other cancers may cause. Also, these therapies are not used to decrease a client's pain or to decrease the risk of allergic reaction.
Which of the following are complications related to polycythemia vera (PV)? Select all that apply. CVA MI Ulcers Hematuria Splenomegaly
CVA MI Ulcers Hematuria Explanation: Patients with PV are at increased risk for thromboses resulting in a CVA or myocardial infarction. Bleeding can be significant and can occur in the form of nosebleeds, ulcers, frank gastrointestinal bleeding, and intracranial hemorrhage. Splenomegaly is a clinical manifestation of PV, not a complication.
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. Put on a mask, gown, and gloves when entering the client's room. Provide a clear liquid, low-sodium diet. Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.
Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. Explanation: Neutropenia occurs when the absolute neutrophil count falls below 1,000/mm3, reflecting a severe risk of infection. The nurse should provide a low-bacterial diet, which means eliminating fresh fruits and vegetables, avoiding invasive procedures such as enemas, and practicing frequent hand washing. Using a soft toothbrush, avoiding straight-edged razors and enemas, and monitoring for bleeding are precautions for clients with thrombocytopenia. Putting on a mask, gown, and gloves when entering the client's room are reverse isolation measures. A neutropenic client doesn't need a clear liquid diet or sodium restrictions.
A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? Evaluate the client for potential infection. Administer an antitussive. Place a cooling blanket on the client. Medicate the client to relieve pain.
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 is diagnosed with low risk asymptomatic polycythemia vera. For which treatment will the nurse prepare teaching for this client? Ruxolitinib Phlebotomy Hydroxyurea Interferon-alfa
Phlebotomy Explanation: The objectives of management in polycythemia vera are to reduce the risk of thrombosis without increasing the risk of bleeding, reduce the risk of evolution to myelofibrosis or AML, and ameliorate symptoms associated with the disease. Phlebotomy is considered the mainstay of therapy and is used to maintain the hematocrit level at less than 45%. It involves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete iron stores, thereby rendering the patient iron deficient and consequently unable to continue to manufacture excessive RBCs. Ruxolitinib is a JAK2 inhibitor and is used in clients who are unable to tolerate other treatment approaches. Cytoreductive therapy should be considered in clients at low-risk who are symptomatic due to progressive splenomegaly, leukocytosis, thrombocytosis, or have poor tolerance to phlebotomy. This type of therapy is accomplished through the use of hydroxyurea or interferon-alpha.
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. Platelets Antibiotics Packed red blood cells Granulocytic growth factors Hematopoietic stem cell transplant
Platelets Antibiotics Packed red blood cells Granulocytic growth factors Explanation: During induction therapy, chemotherapy not only destroys leukemic cells, but also healthy cells, requiring clients to be hospitalized for several weeks (typically 4 to 6 weeks) due to severe and potentially life-threatening side effects, such as neutropenia. Management consists of blood products such as platelets. Antibiotics are used to treat bacterial infections that occur because of the neutropenia. Packed red blood cell infusions may also be used especially for clients that need a large volume of blood. The use of granulocytic growth factors may be used during the induction phase only for clients who have a life-threatening infection in order to shorten the neutropenic period. Hematopoietic stem cell transplant (HSCT) is routinely done following induction and consolidation therapy. In certain instances it may be performed following induction but not during induction.
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? Increase mobility. Provide adequate hydration. Promote safety. Encourage adequate nutrition.
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.
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? Increased basophils Reed-Sternberg cells Elevated platelet count Misshaped red blood cells
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 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? The patient is at risk for tooth decay. The patient will develop gingival hyperplasia. The patient can develop osteonecrosis of the jaw. The patient can develop loosening of the teeth.
The patient can develop osteonecrosis of the jaw. Explanation: Osteonecrosis of the jaw is an infrequent but serious complication that can arise in patients treated long-term with bisphosphonates; the mandible or maxilla are affected. Careful assessment for this complication should be conducted and a thorough evaluation of the patient's dentition should be performed prior to initiating bisphosphonate therapy, including panoramic dental x-rays.
