Chapter 34: Hematology and Oncology
A client who had a splenectomy is being discharged. What should the nurse teach the client to do?
Report early signs of infection
The nurse examines the laboratory results for a client and notes a white blood cell (WBC) count of 112,000/mm3 (112 x109/L). What condition does the nurse review the client's medical record for to best explain this abnormal result?
Chronic myelogenous leukemia
A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching?
"I can eat whatever I want as long as its low in fat." - Should avoid raw fruits and vegetables
The nurse understands that the client who is undergoing induction therapy for leukemia needs additional instruction when the client makes which statement?
"I cannot wait to get home to my cat!" - Contact with animals should be avoided because they carry infection and induction therapy destroys the WBC's
A client in sickle cell crisis has been hospitalized during her pregnancy. After giving discharge instructions, the nurse determines the client needs further teaching when she makes which statement?
"I will need to take an iron supplement even if my laboratory values are normal." - Iron supplementation is needed only if there is laboratory evidence of iron deficiency anemia.
A nurse is teaching a young adult female client about self-management of systemic lupus erythematosus (SLE). The client is prescribed ibuprofen, hydroxychloroquine, and cyclophosphamide. The client asks the nurse about the possibility of becoming pregnant while being treated for SLE. What is the nurse's best response?
"You should speak with your healthcare provider about alternatives to taking cyclophosphamide."
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?
"I will receive parenteral vitamin B12 therapy for the rest of my life." - Patient lacks the intrinsic factor therefore parenteral B12 therapy is needed for life
A client with the beta-thalassemia trait plans to marry a person of Italian ancestry who also has the trait. Which client statement indicates understanding of the teaching provided by the nurse?
"We'll need more genetic counseling in the future." Two people with the trait have a 25% chance of having a child with thalassemia
A client is about to undergo bone marrow aspiration of the sternum. What should the nurse tell the client?
"You will feel a pulling type of discomfort for a few seconds."
A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute care facility. Concerned about hemorrhage, the nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below:
10,000
The nurse is making a room assignment for a client whose laboratory test result indicate pancytopenia. Which client should the nurse put into the same room with the client with pancytopenia?
A client with dig toxicity
The nurse is developing a plan of care for a client who has joint stiffness due to rheumatoid arthritis. Which measure will be the most effective in relieving stiffness?
A warm shower before performing ADLs
Which laboratory test should be monitored closely by the nurse while the client is receiving heparin therapy?
APTT
A 35-year-old female client is diagnosed with aplastic anemia. Which is the most important nursing measure to incorporate into the client's plan of care?
Alternate periods of activity with rest to decrease fatigue
A client who is sexually active asks the nurse about using pre-exposure prophylaxis (PrEP) for HIV. The nurse should tell the client the drug, a combination of 300 milligrams tenofovir disoproxil fumarate and 200 milligrams emtricitabine (TDF/FTC) can be used for which group of people who are at risk for becoming infected with HIV?
Anyone who is in an ongoing sexual relationship with an HIV-infected partner
A client with thrombocytopenia has just had a bone marrow aspirate performed to monitor for treatment effectiveness. Which nursing intervention takes priority?
Applying pressure to the puncture site for a full 10 minutes
A client with a pleural effusion has a diagnostic thoracentesis. The nurse notifies the healthcare provider immediately upon discovering what assessment finding?
Asymmetrical chest expansion
The daily white blood cell (WBC) count in a client with aplastic anemia drops overnight from 3,900 to 2,900/µl (3.9 to 2.9 X 109/L). Which is the appropriate nursing intervention?
Call the primary care provider, and request that the client be placed in reverse isolation.
A client with macrocytic anemia has a burn on her foot and reports watching television while lying on a heating pad. Which action should be the nurse's first response?
Check for diminished sensations
After one week in the hospital for chemotherapy treatment related to lymphocytic leukemia, a client develops abdominal pain, fever, and foul-smelling diarrhea. What priority recommendation does the nurse make to the healthcare provider?
Collect stool sample for c. diff
The nurse is teaching the parents of a child with sickle cell disease. What information should the nurse give the family on how to prevent sickle cell crisis?
Drink at least 2 quarts (1.9 liters) of fluids each day
The nurse is admitting a child who has been diagnosed with bacterial meningitis to the pediatric unit. The nurse should implement which type of isolation?
Droplet precautions
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?
Dyspnea, tachycardia, and pallor
A nurse preparing to discharge a child with leukemia observes a family member who has a cold sharing a meal with the child. How should the nurse approach the situation?
Offer a face mask to the person with the cold and use this as an opportunity for further teaching
The nurse should assess a client for which complications associated with disseminated intravascular coagulation (DIC)?
PE
A client being treated for leukemia has an absolute neutrophil count of 400 cells/mm3. What precautions would the nurse include in the plan of care?
Place sign on client's door for all persons to wash their hands before entering
The nurse examines laboratory findings for a client. What result should the nurse investigate further?
Platelet count 115,000/mm3
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?
Platelets, PT, and PTT
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?
Risk for injury
A client is to have a Schilling's test. How should the nurse prepare the client for this test?
Start a 24- to 48-hour specimen collection - used to dx Vitamin B12 anemia
A client has fatigue, temperature of 99.5°F (37.5°C), dark bronze skin, and dark urine. Hemoglobin is 9 g/dL (90 g/L); hematocrit is 49 (0.49). What should the nurse do first?
Start an I/O record - Client is experiencing s/sx of anemia and jaundice
A client is having a blood transfusion reaction. What must the nurse do in order of priority from first to last? All options must be used.
Stop the transfusion. Keep the IV open with normal saline infusion. Notify the health care provider (HCP) and blood bank. Complete the appropriate transfusion reaction form(s).
A client is diagnosed with human immunodeficiency virus (HIV). What information does the nurse provide to best protect the client from advancing to the acquired immunodeficiency syndrome (AIDS) phase of this infection?
Strictly adhere to antiviral medication therapy
A client has moved into the acquired immunodeficiency syndrome (AIDS) phase of the human immunodeficiency virus (HIV) positive infection. The nurse advises the client to avoid what outdoor recreational activity?
Swimming in rivers or lakes
A pregnant client who developed deep vein thrombosis (DVT) in her right leg is receiving heparin I.V. on the medical floor. Physical therapy is ordered to maintain her mobility and prevent additional DVT. A nursing assistant working on the medical unit helps the client with bathing, range-of-motion exercises, and personal care. Which collaborative multidisciplinary considerations should the care plan address?
The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include reporting evidence of bleeding or easy bruising.
A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used
To provide long-term access to central veins
A nurse applies standard precautions when caring for a client with human immunodeficiency virus (HIV). The nurse takes what action when applying standard precautions?
Wearing gloves while providing mouth care
A parent asks the nurse if a child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which principle?
Children with iron deficiency anemia are more susceptible to infection than are other children.
On the fourth day after surgery, a client's incision is red and inflamed. There is moderate drainage from the incision. The client has a temperature of 102°F (38.9°C). The total white blood cell (WBC) count is 10,000/mm3 (10 × 109/L). What should the nurse do first?
Notify the HCP
A nurse is caring for a client receiving radiation for Hodgkin's lymphoma who begins to exhibit confusion. Upon further assessment, the nurse notes that the client has warm, flushed, dry skin; a heart rate of 110 beats per minute; and a temperature of 101.8° F (38.8° C). Which is the nurse's next best action?
Notify the HCP - client is exhibiting s/sx of sepsis and must be treated immediately
On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for which symptoms?
Early morning stiffness
A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). What is the expected outcome of AZT for this client?
Enable slow replication of the virus
A client with disseminated intravascular coagulation develops clinical manifestations of microvascular thrombosis. The nurse should assess the client for:
Focal ischemia
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?
Hypercalcemia
A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that the client has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority?
Ineffective tissue perfusion: cerebral, cardiopulmonary, GI
Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat?
Lamb and peaches
A 25-year-old client taking hydroxychloroquine for rheumatoid arthritis reports difficulty seeing out of the left eye. What does this finding indicate?
Possible retinal degeneration
The nurse is caring for a client being discharged following kidney transplantation. The client is ordered mofetil to prevent organ rejection. Which nursing instruction is essential regarding medication use?
Notify HCP at first signs of infection
A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?
Intrinsic factor
A client with a suspected diagnosis of Hodgkin's disease is to have a lymph node biopsy. What should the nurse make sure that personnel involved with the procedure do?
Maintain sterile technique
Which is an appropriate outcome for a client with rheumatoid arthritis who is receiving anti-inflammatory drugs and physical therapy? The client will:
Manage joint pain and fatigue to perform activities of daily living.
