Management of Patients with Hematologic Neoplasms

A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client has not achieved the goal for the nursing diagnosis Spiritual Distress?

"I do not understand why this happened to me."

Which statement indicates the client understands teaching about induction therapy for leukemia?

"I will be in the hospital for several weeks."

The nurse is providing teaching to a client diagnosed with chronic myeloid leukemia (CML). Which statement will the nurse include in the teaching on the pathophysiology of the disease?

"Uncontrolled growth of blood cells causes the marrow to expand to organs."

A home care nurse is caring for a client with MM. what nursing interventions are appropriate for this client? Select all that apply.

1. Delay position changes and bathing if the client is experiencing pain. 2. Instruct the client to avoid activities that may cause injury 3. monitor renal function

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

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

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has?

A general reduction in all white blood cells

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 is receiving chemotherapy for acute myeloid leukemia and has poor nutritional intake. The first action of the nurse is to

Ask, "Are you experiencing nausea?"

Following bone marrow aspiration of a 19 year old client, analysis reveals more than 20% immature blast cells. Platelet counts are 90000/mm3. What nursing interventions should the nurse employ for the care of this client? Select all answers that apply

Assess for mental state changes Administer prescribed docusate (colace) daily

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention?

Assess the client;s hemoglobin and platelets

A client is undergoing tests for MM. Diagnostic study findings in multiple myeloma include

Bence Jones protein in the urine

The nurse cares for a client with acute myeloid leukemia with sever bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain?

Bone marrow expans

The Oncology Advanced Practice Nurse (APN) is assessing a client with leukemia. How would the Oncology APN assess for enlargement and tenderness over the liver and spleen?

By palpating the abdomen

Which of the following are complications related to polycythemia vera (PV)? Select all that apply.

CVA MI Ulcers Hematuria

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

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan?

Chronic Leukemia develops slowly

A client diagnosed with polycythemia Vera has come into the clinic because he has developed a nighttime cough, fatigue and SOB. What complication would you suspect in this client?

Congestive Heart Failure

A nurse assesses a patient who has been diagnosed with DIC. Which of the following indicators are consistent with this diagnosis? Select all that apply.

Cyanosis in the extremities Dyspnea and hypoxia Increased blood urea nitrogen (BUN) and creatinine

A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity?

Do not lift more than 10 pounds.

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

Which precaution should a nurse include in the care plan for a client with leukemia and neutropenia?

Eliminate fresh fruits and vegetables, avoid using enemas and practice frequent hand washing

A client with MM 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

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

Evaluate the client for potential infection.

A patient is schedule for a test to help confirm the diagnosis of acute myeloid leukemia. Which of the following is the result that the nurse knows is consistent with the diagnosis

Excess of immature blast cells

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

A nurse is caring for a client with MM. Which lab values is the nurse most likely to see

Hypercalcemia

After chemotherapy for AML, what interventions will best help to prevent renal complications? Select all that apply.

Increase hydration. Administer allopurinol. Administer rasburicase.

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

A home care nurse is caring for a client with multiple myeloma. Which nursing interventions are appropriate for this client. Select all that apply

Instruct the client to avoid activities that may cause injury Delay position changes and bathing if the client is experiencing pain Monitor renal function

What type of cancer is the most common type of secondary malignancy in patient's with hodgkin's disease

Lung

Which term refers to a form of white blood cell involved in immune response

Lymphocyte

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 couple weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms

MM

A client has completed induction therapy and has diarrhea and severe mucusitis. What is the appropriate nursing goal?

Maintain nutrition

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of a client's fever?

Neutropenia

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever?

Neutropenia

You are caring for a client with multiple myeloma. Why should it be important to assess this client for fractures?

Osteoclasts break down bone cells so pathological fractures occur

Which term refers to an abnormal decrease in white blood cells, red blood cells and platelets?

Pancytopenia

Clients with MM have abnormal plasma cells that proliferate in the bone marrow where they release osteoclasts-activating factor, resulting in the formation of osteoclasts. Which of the following is the most common complication of the pathology resulting from this process

Pathological fractures

A patient with polycythemia Vera has a high red blood cell (RBC) count and is at risk for the development of thrombosis. What treatment is important to reduce blood viscosity and to deplete the patient's iron stores?

Phlebotomy

Place the pathophysiology of MM in the correct order

Proliferation of abnormal plasma cells Release of osteoclast-activating factor Break down and removal of bone cells Increased blood calcium levels

The nurse meets the family of a patient who has been diagnosed with Stage I hodgkin's lymphona. She tells the family that the course of treatment will include

Radiotherapy to the specific node over a space of 2-4 months

A nurse plans care for a client with MM. Using the CRAB acronym for symptoms associated with this disease which clinical features does the nurse expect to find upon assessment of the client

Renal insufficiency Hypercalcemia Anemia Bone lesion

A client with MM reports severe parenthesis in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose?

Risk for falls

Which of the following is the hallmark of polycythemia Vera.

Splenomegaly

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

Which term is used to refer to a primitive cell that is capable of self-replication and differentiation

Stem Cell

The nurse is educating a patient taking imatinib (gleevec)for treatment of leukemia. What should the nurse be sure to include when educating the patient on the best way to take the medication to optimize absorption

Take antacids if needed for GI upset 2 hours after taking gleevec

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 client with polycythemia Vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of paths physiological reason for this symptom?

The dead red blood cells release excess Uric acid

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 can develop osteonecrosis of the jaw.

A nurse cares for an adult client with chronic lymphocytic leukemia (CLL). Which statements regarding the disease will the nurses include in the teaching. Select all that apply.

This type of leukemia does not appear to have familial predisposition This type of leukemia is rarely seen in certain ethnicities

The nurse is aware that chronic lymphocytic leukemia (CLL), a common malignancy in those older than 60, has an early stage and a late stage. The nurse assesses a patient for late stage CLL by looking for:

Thrombocytopenia.

which of the following is the only curative treatment for chronic myeloid leukemia (CML)

allogeneic stem cell transplant

a client presents with peripheral neuropathy and hypothesia of the feet. What is the best nursing intervention?

assess for signs of injury

the clinic nurse is caring for a client diagnosed with leukopenia. what does the nurse know this client has

general reduction in all white blood cells

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 vs. host disease

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.

Which term refers to a form of white blood cell involved in immune response

lymphocyte

a client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal?

maintain nutrition

What assessment finding best indicates that the client has recovered from induction therapy?

neutrophil and platelet counts within normal limits

a nurse is assessing a client with multiple myeloma. the nurse should keep in mind that clients with multiple myeloma are at risk for

pathologic bone fractures

the nurse is performing an assessment on a patient with acute myelod leukemia and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about?

platelet count of 9,000/mm3

Which nursing intervention is most appropriate for a client with multiple myeloma

preventing bone injury

A client with MM reports severe paresthesia in the feet. when planning care for the client, which priority nursing diagnosis will the nurse choose

risk for falls

the nurse is assisting the client with multiple myeloma to ambulate. what is the most important nursing diagnosis to help prevent fractures in this client

safety

The nurse has established for a client the nursing diagnosis of risk for infection. Which of the following interventions would the nurse include in the plan of care for this client? Select all that apply

Assess the skin and mucus membranes every shift Auscultate lung sounds every shift and prn Encourage the client to take deep breaths every 4 hours while awake

the nurse practitioner suspects that a patient has multiple myeloma based on his major presenting symptom and the analysis of his laboratory results. select the classic symptom for this disease

bone pain in the back of the ribs

a 40 year olf client has multiple myeloma. prior to starting treatment with thalidomide, it is most important for the nurse to

contract with the client regarding birth control methods

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

What assessment finding best indicates that the client has recovered from induction therapy?

Neutrophil and platelet counts within normal limits

A client with a multiple myeloma presents to the emergency department complaining of excessive thirst and constipation. His family members report that he has been confused for the last day. which lab value is most likely responsible for this client's symptoms?

serum calcium level 13.8 mg/dl

Which term is used to refer to a primitive cell that is capable of self-replication and differentiation?

stem cell

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

the produce all blood cells

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 effective treatment option for this client?

It kills affected cells

The nurse is assessing a patient with polycythemia Vera. What skin assessment data would the nurse determine is a normal finding for this patient?

Ruddy Complexion

The nurse is assisting the client with MM to ambulated. What is the most important nurse diagnosis to help prevent fractures in this client?

Safety

A client with suspected MM is reporting back pain. What is the priority nursing action

Send the client for a spinal x-ray study

A nurse is teaching a client with multiple myeloma about the therapeutic benefits of radiation therapy. Which statements will the nurse include in the teaching? Select all that apply.

"It helps to strengthen the bone." "It helps to decrease bone pain."