Chapter 34: Management of Patients With Hematologic Neoplasms
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? A.) Osteopathic tumors destroy bone causing fractures. B.) Osteoclasts break down bone cells so pathologic fractures occur. C.) Osteolytic activating factor weakens bones producing fractures. D.) Osteosarcomas form producing pathologic fractures.
Answer: B.) Osteoclasts break down bone cells so pathologic fractures occur.
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? A.) Use contact precautions with this client. B.) Perform a neurologic assessment with vital signs. C.) Request a prescription of diphenoxylate and atropine for loose stools. D.) Teach the client to vigorously floss the teeth to prevent infections.
Answer: B.) Perform a neurologic assessment with vital signs. Rationale: 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 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? A.) WBC count of 4,200 cells/uL B.) Hematocrit of 38% C.) Platelet count of 9,000/mm3 D.) Creatinine level of 1.0 mg/dL
Answer: C.) Platelet count of 9,000/mm3 Rationale: 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 is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? A.) Pale skin and mucous membranes B.) Bronze skin tone C.) Ruddy complexion D.) Jaundice skin and sclera
Answer: C.) Ruddy complexion Rationale: 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 AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? A.) Assess the client's skin. B.) Assess the client's hemoglobin and platelets. C.) Assess the client's pulse and blood pressure. D.) Check the client's history.
Answer: B.) Assess the client's hemoglobin and platelets.
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A.) A 24-year-old female taking oral contraceptives B.) A 40-year-old patient with a history of hypertension C.) A 52-year-old patient with acute kidney injury D.) A 72-year-old patient with a history of cancer
Answer:" D.) A 72-year-old patient with a history of cancer
What assessment finding best indicates that the client has recovered from induction therapy? A.) Neutrophil and platelet counts within normal limits B.) Vital signs within normal ranges C.) No evidence of edema D.) Absence of bone pain
Answer; A.) Neutrophil and platelet counts within normal limits
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? A.) Acute respiratory distress syndrome B.) Graft-versus-host disease C.) Remission D.) Bone marrow depression
Answer: B.) Graft-versus-host disease
A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? A.) Monitoring respiratory status B.) Balancing rest and activity C.) Restricting fluid intake D.) Preventing bone injury
Answer: D.) Preventing bone injury
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? A.) The dead red blood cells release excess uric acid. B.) The dead red blood cells occlude the small vessels in the joints. C.) Excess red blood cells produce extracellular toxins that build up. D.) Excess red blood cells cause vascular injury in the joints.
Answer: A.) The dead red blood cells release excess uric acid.
A nurse assesses a client who has been diagnosed with DIC. Which indicators are consistent with this diagnosis? Select all that apply. - Cyanosis in the extremities - Capillary fill time <3 seconds - Dyspnea and hypoxia - Increased breath sounds - Increased blood urea nitrogen (BUN) and creatinine - Polyuria
Answer: - Cyanosis in the extremities - Dyspnea and hypoxia - Increased blood urea nitrogen (BUN) and creatinine Rationale: Urine output would be decreased in DIC, and capillary fill time would be more than 3 seconds; breath sounds would be decreased.
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? A.) Pancytopenia B.) Anemia C.) Leukopenia D.) Thrombocytopenia
Answer: A.) Pancytopenia
The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? A.) Too many erythrocytes B.) A decrease in granulocytes C.) A general reduction in all white blood cells D..) A general reduction in neutrophils and basophils
Answer: C.) A general reduction in all white blood cells
A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? A.) Hemolytic anemia B.) Polycythemia vera C.) Leukemia D.) Multiple myeloma
Answer: D.) Multiple myeloma
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? A.) Monitor the client's temperature every shift. B.) Maintain contact precautions. C.) Encourage increased fluid consumption. D.) Practice vigilant handwashing.
Answer: D.) Practice vigilant handwashing.
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? A.) Refer the client to a chiropractor. B.) Place heating pads on the client's back. C.) Administer pain medication, as ordered. D.) Assess renal function.
Answer: D.) Assess renal function. Rationale: 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 has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? A.) Address issues of negative body image. B.) Place the client in reverse isolation. C.) Administer pain medication. D.) Maintain nutrition.
Answer: D.) Maintain nutrition.
The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the best interventions 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.
Answer; - Educate the family about medications and side effects. - Allow family members to express feelings. - Suggest support for household maintenance.
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? A.) Pathologic fractures B.) Osteoporosis C.) Calcified bones D.) Increased mobility
Answer: A.) Pathologic fractures
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? A.) Implement neutropenic precautions. B.) Eliminate direct contact with others who are infectious. C.) Apply prolonged pressure to needle sites or other sources of external bleeding. D.) Monitor temperature at least once per shift.
Answer: C.) Apply prolonged pressure to needle sites or other sources of external bleeding.
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? A.) Macrocytic anemia B.) Microcytic anemia C.) Proliferative anemia D.) Hemolytic anemia
Answer: A.) Macrocytic anemia
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? A.) chronic liver failure. B.) acute heart failure. C.) pathologic bone fractures. D.) hypoxemia.
Answer: C.) pathologic bone fractures.
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? A.) Chronic myeloid leukemia B.) Multiple myeloma C.) Hodgkin lymphoma D.) Non-Hodgkin lymphoma
Answer: B.) Multiple myeloma
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? A.) Induction therapy B.) Supportive therapy C.) Antimicrobial therapy D.) Standard therapy
Answer: A.) Induction therapy Rationale: 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.