Ch. 34 Patients with Hematologic Neoplasms Flashcards
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for?
a. acute heart failure.
b. pathologic bone fractures.
c. hypoxemia.
d. chronic liver failure.
b. pathologic bone fractures.
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.
A nurse is caring for an asymptomatic client with acute myelogenous leukemia. The client has a total white blood cell (WBC) count of 0, a platelet count of 3,000 mm2, and a hemoglobin level of 9 mg/dl. The client has a single lumen central venous catheter in place and the health care provider has ordered the nurse to administer imipenem cilastatin 500 mg every 8 hours, transfuse 1 unit packed red blood cells (RBCs), give amphotericin B 40 mg I.V. over 4 hours, and transfuse 2 pheresis units of platelets. In what order should the nurse infuse these medications and blood products?
a. Platelets, imipenem cilastatin, amphotericin B, packed RBCs
b. Amphotericin B, imipenem cilastatin, platelets, packed RBCs
c. Packed RBCs, platelets, imipenem cilastatin, amphotericin B
d. Packed RBCs, amphotericin B, imipenem cilastatin, platelets
a. Platelets, imipenem cilastatin, amphotericin B, packed RBCs
Although the client is currently asymptomatic, a platelet count of 3,000 mm2 puts the client at risk for spontaneous hemorrhage. A WBC count of 0 clearly indicates neutropenia; the client needs an antibiotic and antifungal therapy to prevent infection. Although the client is anemic, the client currently asymptomatic. The absence of clinical manifestations makes the need for a transfusion less urgent.
When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?
a. Lifestyle assessments, such as exercise routines
b. Age and gender
c. Health history, such as bleeding, fatigue, or fainting
d. Menstrual history
c. Health history, such as bleeding,
Which statement best describes the function of stem cells in the bone marrow?
a. They are active against hypersensitivity reactions.
b. They produce antibodies against foreign antigens.
c. They defend against bacterial infection.
d. They produce all blood cells.
d. They produce all blood cells.
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal?
a. Maintain nutrition.
b. Place the client in reverse isolation.
c. Address issues of negative body image.
d. Administer pain medication.
a. Maintain nutrition.
A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention?
a. Assess the client’s hemoglobin and platelets.
b. Check the client’s history.
c. Assess the client’s skin.
d. Assess the client’s pulse and blood pressure.
c. Assess the client’s hemoglobin and platelets.
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?
a. The patient can develop loosening of the teeth.
b. The patient is at risk for tooth decay.
c. The patient will develop gingival hyperplasia.
d. The patient can develop osteonecrosis of the jaw
c. The patient will develop osteonecrosis of the jaw
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.
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?
a. Bone pain in the back of the ribs
b. Gradual muscle paralysis
c. Debilitating fatigue
d. Severe thrombocytopenia
a. Bone pain in the back of the ribs
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.
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan?
a. “In acute leukemia there are not many undifferentiated cells.”
b. “Acute leukemia develops slowly.”
c. “In chronic leukemia, the minority of leukocytes are mature.”
d. “Chronic leukemia develops slowly.”
d. “Chronic leukemia develops slowly.”
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. Osteoporosis
b. Pathologic fractures
c. Calcified bones
d. Increased mobility
b. Pathologic fractures
Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.
The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has?
a. A decrease in granulocytes
b. A general reduction in all white blood cells
c. A general reduction in neutrophils and basophils
d. Too many erythrocytes
b. 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?
a. Eliminate direct contact with others who are infectious.
b. Monitor temperature at least once per shift.
c. Implement neutropenic precautions.
d. Apply prolonged pressure to needle sites or other sources of external bleeding.
d. Apply prolonged pressure to needle sites or other sources of external bleeding.
Which term refers to a form of white blood cell involved in immune response?
a. Lymphocyte
b. Thrombocyte
c. Spherocyte
d. Granulocyte
a. Lymphocyte
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. Absence of bone pain
d. No evidence of edema
a. Neutrophil and platelet counts within normal limits
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma?
a. The client with enlarged lymph nodes in the neck.
b. The client with painful lymph nodes under the arm.
c. The client with painful lymph nodes in the groin.
d. The client with a painful sore throat.
a. The client with enlarged lymph nodes in the neck.
