Chapter 32: Caring for Clients with Disorders of the Lymphatic System Med Surg

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)?

A 72-year-old patient with a history of cancer

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

A client with non-Hodgkin's lymphoma has few symptoms. Her condition responds quickly to treatment. What terminology would the nurse use to document the client's condition?

Indolent

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

Which of the following interventions for infectious mononucleosis would the nurse include in a client's plan of care? Select all that apply.

Maximize bed rest. Review instructions for antipyretic therapy. Increase fluid intake. Avoid blood donations for at least 6 months.

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

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.

Which of the following medications would be least likely to be used in an older adult with Hodgkin's disease?

doxorubicin

A client presents with severe, weeping lower extremity edema and skin that is thickened and brawny. An important component of the nurse's care of this client is providing:

emotional support.

A nurse is planning the care of client who has been diagnosed with essential thrombocythemia (ET). Which nursing diagnosis should the nurse prioritize when choosing interventions?

Risk for ineffective tissue perfusion

A nurse is caring for a client with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this client, the nurse should assign the highest priority to which nursing diagnosis?

Risk for infection

The nurse is caring for a client receiving treatment for non-Hodgkin lymphoma (NHL). Which assessment findings indicate to the nurse that the client is developing multifocal leukoencephalopathy? Select all that apply.

Altered vision Change in speech Change in motor coordination

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

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?

Apply prolonged pressure to needle sites or other sources of external bleeding.

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 is being tested for acute myeloid leukemia (AML). The nurse knows that which diagnostic test will be used as the hallmark for the diagnosis?

Bone marrow analysis

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

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

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

A client with Hodgkin's disease is hospitalized and experiencing respiratory distress. In which position should the nurse place the client?

High Fowler's

The nurse is reviewing the health history of a client with essential thrombocythemia. Which findings increase the client's risk of developing a complication? Select all that apply.

Obesity Smoking Diabetes Hypertension

A 20-year-old client with no medical history arrives at a walk-in/urgent care clinic reporting swelling on the left side of the neck. On palpation, the lymph nodes on the neck are painless, firm but not hard. What is the next appropriate intervention for this client?

Perform diagnostic studies to rule out any infectious origin at a hospital.

A nurse is caring for a client whose diagnosis of multiple myeloma is being treated with bortezomib. The nurse should assess for what adverse effect of this treatment?

Peripheral neuropathy

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 is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept?

Staging of disease

A client has been diagnosed with Hodgkin's disease. The nurse should provide anticipatory guidance about what likely treatment?

localized radiation

A client presents with an elevated temperature and red, swollen, painful left axillary lymph nodes with visible red streaks. The physician would likely diagnose:

lymphadenitis.

A client with Hodgkin's disease is receiving chemotherapy with the regimen called "MOPP." For which of the following drugs does the "M" stand?

mechlorethamine (Mustargen)

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.

A client has a history of lymphedema. Impaired nutrition to the client's tissues could lead to:

ulcers and infection in the edematous area.

A client is taking dasatinib as prescribed. Which findings indicate to the nurse the client is experiencing adverse effects from this medication? Select all that apply.

Chills Fever Decreased urine output Prolonged QT interval on electrocardiogram

A client receiving treatment for leukemia is experiencing stomatitis. Which interventions will the nurse implement to improve the client's nutritional status? Select all that apply.

Encourage small frequent meals. Suggest foods that are soft in texture. Administer pain medication before meals. Provide mouth care before and after meals.

The nurse is caring for a client with erythematous fingers and renal calculi. Which assessment findings help determine if the client is experiencing polycythemia vera? Select all that apply.

Enlarged spleen Body mass index 33 Received erythropoietin injections History of receiving blood transfusions

A client with leukemia is experiencing recurrent fevers. Which actions will the nurse take to improve this client's comfort? Select all that apply.

Sponge with cool water. Change bed clothes frequently. Provide acetaminophen as prescribed.

Following an extensive diagnostic workup, a client has been diagnosed with myelodysplastic syndrome (MDS). Which assessment question most directly addresses the potential etiology of this client's health problem?

"Were you ever exposed to toxic chemicals in any of the jobs that you held?"

A client is recovering from infectious mononucleosis and asks the nurse when he or she will finally be rid of the disease. How should the nurse most accurately respond?

"You are now immune to mono, but the virus will remain in your body for the rest of your life."

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

The nurse is caring for a patient with Hodgkin lymphoma in the hospital and preparing discharge planning education. Knowing that this patient is at risk for the development of a second malignancy, what education would be beneficial to reduce the risk factors? (Select all that apply.)

Reduce exposure to excessive sunlight Smoking cessation Decrease alcohol intake

A nurse is monitoring the respiratory status of a client with Hodgkin's disease who has Impaired Gas Exchange and Ineffective Airway Clearance. What is the minimum percentage of blood oxygen saturation for this client to maintain? Fill in the blank with a number.

90 %

A teenage client presents with severe fatigue, sore throat, headache, oozing tonsils, and cervical lymph node enlargement. Considering the incubation period for Epstein-Barr virus, the nurse would estimate this client's exposure occurred:

30 to 50 days ago.

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."

A client receiving treatment for acute myeloid leukemia (AML) develops elevated potassium, uric acid, and phosphate levels. Which treatments will the nurse anticipate being prescribed to reduce this client's risk for kidney stone formation? Select all that apply.

Allopurinol Intravenous fluids

A client with Hodgkin lymphoma is receiving information from the oncology nurse. The client asks the nurse why it is necessary to stop drinking and smoking and stay out of the sun. Which response by the nurse would be best?

"It's important to reduce other factors that increase the risk of second cancers."

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."

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.

The nurse is reviewing the long-term treatment plan with a client diagnosed with Hodgkin lymphoma. Which recommendations will the nurse provide to reduce the client's risk of developing secondary malignancies? Select all that apply.

Avoid excessive sunlight. Restrict use of tobacco. Reduce intake of alcohol.

A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention?

Evaluate the client for potential infection.

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.

Fluid distribution problems Tender, painful enlargement of lymph nodes Weakened immunity

Which of the following reports from the client during the health history would lead the nurse to suspect that the client has a disorder of the hematopoietic or lymphatic system? Select all that apply.

Frequently becomes dizzy or faints. Bruises easily. Has frequent infections. Has difficulty swallowing.

The nurse is documenting findings in a client with lymphedema. Although the client reports no pain or limitations and there are no signs of infection, the affected limb is 3 cm larger in circumference than the unaffected limb. How should the nurse grade this client's lymphedema?

Grade I

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

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 adult. This client may be suffering from:

Hodgkin's lymphoma.

A client with primary myelofibrosis is diagnosed with splenomegaly. Which medications will the nurse prepare teaching for this client? Select all that apply

Hydroxyurea Thalidomide Pomalidomide

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 which imbalance?

Hypercalcemia

A nurse is caring for a client who has a diagnosis of acute myelocytic leukemia (AML). Assessment of which factor most directly addresses the most common cause of death among clients with leukemia?

Infection status

A client has been diagnosed with infectious mononucleosis. He asks the nurse how he contracted the illness. Which of the following would the nurse accurately identify as possible causes of the client's condition? Select all that apply.

Kissing Sharing cigarettes Being coughed or sneezed on

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

A nurse is teaching a client with lymphedema how to use a compression garment. Which instructions would be included? Select all that apply.

Limit the time that the garment is not worn to no more than 30 to 60 minutes. Wash the removed garment in soap and water each day.

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 Low socioeconomic status Not participating in a clinical trial Taking medication independent of meals

A nurse cares for a client with myelodysplastic syndrome (MDS). Which assessment finding does the nurse recognize is the most common finding with this condition?

Macrocytic anemia

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

A nurse is caring for a client who is being treated for leukemia in the hospital. The client was able to maintain nutritional status for the first few weeks following the 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.

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?

Reed-Sternberg cells

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

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

A client with polycythemia vera presents to the primary care clinic for an annual physical. Which health care provider prescriptions does the nurse recognize as preventive measures to prevent thrombosis in the client? Select all that apply.

Statin therapy Beta blocker therapy

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

The nurse is educating a client taking imatinib mesylate for treatment of leukemia. What should the nurse be sure to include when educating the client on the best way to take the medication to optimize absorption?

Take antacids if needed for gastrointestinal (GI) upset 2 hours after taking imatinib mesylate.

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.

A 60-year-old client with chronic myeloid leukemia (CML) will be treated in the home setting, and the nurse is preparing appropriate health education. Which topic should the nurse emphasize?

The importance of adhering to the prescribed drug regimen

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

They produce all blood cells.

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.

A client who has Hodgkin's disease should have their bed in high-Fowler's position whenever practical to:

increase lung expansion.

For a client with Hodgkin lymphoma, who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse places the client in a high Fowler's position to

increase lung expansion.

A client has been diagnosed with lymphoma and asks the oncologist for more information about the diagnosis. Which specifics would be included in a diagnosis of non-Hodgkin's lymphoma?

No Reed-Sternberg cells; B- and T-cell origin; common in abdomen and tonsils; can develop in areas other than lymph nodes

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.

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 has received the news that the client's 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 which complication?

Secondary malignancy

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

A client has lymphedema in the arm. The nurse measures the affected arm's circumference as 7 cm more than the unaffected arm. The client reports that the arm is heavy and sore; movement in the limb is limited. When documenting findings, what stage would the nurse grade the lymphedema?

Grade II

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