UNIT 2: Management of Patients with Hematologic Disorders

Question 1

1. An oncology nurse is providing health education for a client who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia?
   A. The different leukemias all involve unregulated proliferation of white blood cells.
   B. The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function.
   C. The different leukemias all result in a decrease in the production of white blood cells.
   D. The different leukemias all involve the development of cancer in the lymphatic system.

Answer 1

ANS: A

Rationale: Leukemia commonly involves unregulated proliferation of white blood cells. Decreased production of red blood cells is associated with anemias. Decreased production of white blood cells is associated with leukopenia. The leukemias are not characterized by their involvement with the lymphatic system.

Question 2

2. 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?
   A. Infection status
   B. Nutritional status
   C. Electrolyte levels
   D. Liver function

Answer 2

ANS: A
Rationale: Because of the lack of mature and normal granulocytes that help fight infection, clients with leukemia are prone to infection. In clients with AML, death typically occurs from infection or bleeding. Symptoms of AML include weight loss, fever, night sweats, and fatigue, which would guide the nurse to monitor the client’s nutrition and electrolytes. Gastrointestinal problems (nausea and vomiting) and electrolyte imbalances (hyperkalemia and hypocalcemia) may result from chemotherapy use. The liver is responsible for metabolism and metabolic detoxification, so monitoring liver function is important for the client who is receiving chemotherapy. These problems may contribute to and/or result in death but are not the most common cause.

Question 3

3. 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?
   A. Hypercalcemia
   B. Hyperproteinemia
   C. Elevated serum viscosity
   D. Elevated red blood count (RBC)

Answer 3

ANS: A

Rationale: Hypercalcemia may result when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin but would not result from bone destruction. The RBC count will decrease, not increase, resulting in anemia due to the abnormal protein produced from the malignant cells. Hyperproteinemia is defined as high protein in the blood and is commonly seen in clients with dehydration but would not result from bone destruction.

Question 4

4. A nurse is planning the care of a client who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the client’s care plan, the nurse has identified a diagnosis of Risk for Injury, which should be attributed to which factor?
   A. Labyrinthitis
   B. Left ventricular hypertrophy
   C. Decreased bone density
   D. Hypercoagulation

Answer 4

ANS: C
Rationale: Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis (decreased bone density) and osteolytic lesions. Labyrinthitis is uncharacteristic, and clients do not normally experience hypercoagulation or cardiac hypertrophy as a result of multiple myeloma.

Question 5

5. A client with a new diagnosis of leukemia is about to start treatment and expresses fear and anxiety with the prognosis. Which action is the nurse’s most appropriate?
   A. Communicate to the health care provider the need to provide more information to the client and family.
   B. Assess how much information is desired from the client in terms of illness, treatment, and complications.
   C. Offer to call pastoral services and review hospice and/or palliative care so the client can have a quiet, dignified death.
   D. Encourage the client to call their family and discuss immediate role restructuring in both their family and professional life.

Answer 5

ANS: B

Rationale: As with any client exhibiting anxiety and fear about a prognosis, listening should come first in order to assess how much information the client wants to have regarding the illness, treatment and potential complications. This is an ongoing assessment, since needs and interest in information changes throughout the course of treatment. Managing a client’s care is a team effort, so involving the primary care provider and family is important, but not the nurse’s priority action. Offering pastoral services and role restructuring has its place in treatment but should be discussed after an assessment of the client’s needs. A discussion about palliative care and hospice is not appropriate at this time. Offering realistic hope is important and only after all treatment options are exhausted, or the client is diagnosed as terminal, should palliative and/or hospice care be considered.

Question 6

6. 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?
   A. Activity intolerance
   B. Risk for infection
   C. Acute confusion
   D. Risk for spiritual distress

Answer 6

ANS: B

Rationale: Induction therapy places the client at risk for infection, thus this is the priority nursing diagnosis. During the time of induction therapy, the client is very ill, with bacterial, fungal, and occasional viral infections; bleeding and severe mucositis, which causes diarrhea; and marked decline in the ability to maintain adequate nutrition.
Supportive care consists of administering blood products and promptly treating infections. Immobility, confusion, and spiritual distress are possible, but infection is the client’s most acute physiologic threat.

Question 7

8. A 35-year-old client is admitted to the hospital reporting severe headaches, vomiting, and testicular pain. The client’s blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this client suspects which diagnosis?
   A. Acute myeloid leukemia (AML)
   B. Chronic myeloid leukemia (CML)
   C. Myelodysplastic syndromes (MDS)
   D. Acute lymphocytic leukemia (ALL)

Answer 7

ANS: D
Rationale: In acute lymphocytic leukemia (ALL), manifestations of leukemic cell infiltration into other organs are more common than with other forms of leukemia, and include pain from an enlarged liver or spleen, as well as bone pain. The central nervous system is frequently a site for leukemic cells; thus, clients may exhibit headache and vomiting because of meningeal involvement. Other extranodal sites include the testes and breasts. All the listed types of leukemia, depending on severity and stage, can have the same blood work results. The difference is the client’s signs and symptoms, which are closely associated with ALL. A large number of clients when first diagnosed with any type of leukemia are asymptomatic or have nonspecific symptoms It is discovered on routine
lab work.

Question 8

9. A client with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the client?
   A. Chew with care to avoid inadvertently biting the tongue.
   B. Use the oral anesthetic 1 hour prior to mealtime.
   C. Brush teeth before and after eating.
   D. Swallow slowly and deliberately.

Answer 8

ANS: A

Rationale: If oral anesthetics are used, the client must be warned to chew with extreme care to avoid inadvertently biting the tongue or buccal mucosa. An oral anesthetic would be metabolized by the time the client eats if it is used 1 hour prior to meals. There is no specific need to warn the client about brushing teeth or swallowing slowly because an oral anesthetic has been used

Question 9

10. A client diagnosed with acute myeloid leukemia has just been admitted to the oncology unit. When writing this client’s care plan, which potential complication should the nurse address?
    A. Pancreatitis
    B. Hemorrhage
    C. Arteritis
    D. Liver dysfunction

Answer 9

ANS: B
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. The low platelet count can cause ecchymoses and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3. The most common bleeding sources include gastrointestinal (GI), pulmonary, vaginal, and intracranial. Pancreatitis, arteritis, and liver dysfunction are generally not complications of leukemia.

Question 10

11. An emergency department nurse is triaging a 77-year-old client who presents with uncharacteristic fatigue as well as back and rib pain. The client denies any recent injuries. The nurse should recognize the need for this client to be assessed for which health problem?
    A. Hodgkin disease
    B. Non-Hodgkin lymphoma
    C. Multiple myeloma
    D. Acute thrombocythemia

Answer 10

ANS: C
Rationale: Back pain, which is often a presenting symptom in multiple myeloma, should be closely investigated in older clients. The lymphomas and bleeding disorders do not typically present with the primary symptom of back pain or rib pain.

Question 11

12. A home health nurse is caring for a client with multiple myeloma. What intervention should the nurse prioritize when addressing the client’s severe bone pain?
    A. Implementing distraction techniques
    B. Educating the client about the effective use of hot and cold packs
    C. Teaching the client to use NSAIDs effectively
    D. Helping the client manage the opioid analgesic regimen

Answer 11

ANS: D
Rationale: For severe pain resulting from multiple myeloma, opioids are likely necessary. NSAIDs would likely be ineffective and are associated with significant adverse effects. Hot and cold packs as well as distraction would be insufficient for severe pain, though they may be useful as adjuncts.

Question 12

13. A nurse is caring for a client with Hodgkin lymphoma at the oncology clinic. The nurse should identify what main goal of care?
    A. Cure of the disease
    B. Enhancing quality of life
    C. Controlling symptoms
    D. Palliation

Answer 12

ANS: A

Rationale: The goal in the treatment of Hodgkin lymphoma is cure. Palliation is thus not normally necessary. Quality of life and symptom control are vital, but the overarching goal is the cure of the disease.

Question 13

14. 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?
    A. “Avoiding these factors can reduce the risk of Reed-Sternberg cells developing.”
    B. “These behaviors can reduce the effectiveness of your chemotherapy.”
    C. “Engaging in these activities increases your risk of hemorrhage.”
    D. “It’s important to reduce other factors that increase the risk of second cancers.”

Answer 13

ANS: D
Rationale: The nurse should encourage clients to reduce other factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and exposure to environmental carcinogens and excessive sunlight. The presence of Reed-Sternberg cells is the pathologic hallmark and essential diagnostic criterion for Hodgkin lymphoma, so avoiding these behaviors will not reduce the risk of Reed-Sternberg cells developing.
There is no evidence that these behaviors will reduce the effectiveness of chemotherapy or increase the risk of hemorrhage, which is not a typical complication of Hodgkin lymphoma.

Question 14

15. 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?
    A. Recommend immediate and urgent transfer to the nearest trauma center.
    B. Perform diagnostic studies to rule out any infectious origin at a hospital.
    C. Refer the client to a primary health care provider for a nonurgent appointment.
    D. Complete a computed tomography scan because the client has Hodgkin lymphoma.

Answer 14

ANS: B

Rationale: Although a high suspicion of Hodgkin lymphoma is present, diagnosis is premature prior to ruling out any infectious origin with diagnostic testing. This testing is by excisional node biopsy and usually done at a surgical center or hospital. Transfer is not an urgent manner unless the swelling is impacting the airway. Hodgkin lymphoma usually begins as an enlargement of one or more lymph nodes on one side of the neck. The individual nodes are painless and firm but not hard. It is also more common in males with 2 peaks in age groups. The first peak is between 15-34 and the second is after 60 years of age. Because these findings are consistent with Hodgkin lymphoma, a hospital admission, not a nonurgent appointment, is appropriate. Chest x-ray, computed tomography scan, and positron emission tomography scan are all involved in staging of Hodgkin lymphoma.

Question 15

16. A nurse practitioner is assessing a client who has a fever, malaise, and a white blood cell count that is elevated. What principle should guide the nurse’s management of the client’s care?
    A. There is a need for the client to be assessed for lymphoma.
    B. Infection is the most likely cause of the client’s change in health status.
    C. The client is exhibiting signs and symptoms of leukemia.
    D. The client should undergo diagnostic testing for multiple myeloma.

Answer 15

ANS: B

Rationale: Leukocytosis is most often the result of infection. It is only considered pathologic (and suggestive of leukemia) if it is persistent and extreme. Multiple myeloma and lymphoma are not likely causes of this constellation of symptoms

Question 16

17. Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult client who is otherwise healthy. The client and the care team have collaborated and the client will soon begin induction therapy. The nurse should prepare the client for:
    A. daily treatment with targeted therapy medications.
    B. radiation therapy on a daily basis.
    C. hematopoietic stem cell transplantation.
    D. an aggressive course of chemotherapy.

Answer 16

ANS: D

Rationale: Attempts are made to achieve remission of AML by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks. Induction therapy is not synonymous with radiation, stem cell transplantation, or targeted therapies

Question 17

18. 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?
    A. Protective isolation and vigilant use of standard precautions
    B. Provision of a high-calorie, low-texture diet and appropriate oral hygiene
    C. Including the family in planning the client’s activities of daily living
    D. Monitoring and treating the client’s pain

Answer 17

ANS: A
Rationale: Induction therapy causes neutropenia and a severe risk of infection. This risk must be addressed directly in order to ensure the client’s survival. For this reason, infection control would be prioritized over nutritional interventions, family care, and pain, even though each of these are important aspects of nursing care.

Question 18

19. A nurse is caring for a client who has been diagnosed with leukemia. The nurse’s most recent assessment reveals the presence of ecchymoses on the client’s sacral area and petechiae on the forearms. In addition to informing the client’s primary care provider, the nurse should perform what action?
    A. Initiate measures to prevent venous thromboembolism (VTE).
    B. Check the client’s most recent platelet level.
    C. Place the client on protective isolation.
    D. Ambulate the client to promote circulatory function.

Answer 18

ANS: B

Rationale: The client’s signs are suggestive of thrombocytopenia, thus the nurse should check the client’s most recent platelet level. VTE is not a risk and this does not constitute a need for isolation. Ambulation and activity may be contraindicated due to the risk of bleeding.

Question 19

20. 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?
    A. The importance of adhering to the prescribed drug regimen
    B. The need to ensure that vaccinations are up to date
    C. The importance of daily physical activity
    D. The need to avoid shellfish and raw foods

Answer 19

ANS: A
Rationale: Nurses need to understand that the effectiveness of the drugs used to treat CML is based on the ability of the client to adhere to the medication regimen as prescribed. Adherence is often incomplete, thus this must be a focus of health education. Vaccinations normally would not be given during treatment, and daily physical activity may be impossible for the client. Dietary restrictions are not normally necessary.

Question 20

21. A client is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). Which assessment finding is certain to be present if the client has CLL?
    A. Increased numbers of blast cells
    B. Increased lymphocyte levels
    C. Intractable bone pain
    D. Thrombocytopenia with no evidence of bleeding

Answer 20

ANS: B
Rationale: An increased lymphocyte count (lymphocytosis) is always present in clients with CLL. Each of the other listed symptoms may or may not be present, and none is definitive for CLL.

Question 21

22. A client is receiving treatment for a new diagnosis of chronic lymphocytic leukemia (CLL). Based on known risk factors, age, ethnicity, and accompanying clinical conditions, which client is most likely to have this disease?
    A. 82-year-old Vietnam War veteran with widely disseminated shingles
    B. 62-year-old client of Asian descent with a left fractured hip
    C. 69-year-old Gulf War veteran with deep vein thrombosis (DVT)
    D. 85-year-old client of Native American/First Nation descent with chest pain

Answer 21

ANS: A

Rationale: CLL is a common malignancy of older adults with an average age of 71 at diagnosis and the most prevalent leukemia in the Western world. It is rarely seen in clients of Native American/First Nation descent and has an infrequent incidence in clients of Asian descent. Veterans of the Vietnam War who were exposed to the herbicide Agent
Orange are at risk for CLL. The time period of exposure was from 1962 to 1975 so veterans from the Gulf War in 1991 were not exposed. Infections are common with advanced CLL. None of the other conditions are related to infection, so they are not the best choice. Viral infections such as herpes zoster (shingles) can be widely disseminated with CLL.

Question 22

23. 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?
    A. Arrange for total parenteral nutrition (TPN).
    B. Facilitate placement of a percutaneous endoscopic gastrostomy (PEG) tube.
    C. Provide the client with several small, soft-textured meals each day.
    D. Assign responsibility for the client’s nutrition to the client’s friends and family.

Answer 22

ANS: C

Rationale: For clients experiencing difficulties with oral intake, the provision of small, easily chewed meals may be beneficial. This option would be trialed before resorting to tube feeding or TPN. The family should be encouraged to participate in care, but should not be assigned full responsibility.

Question 23

24. A client who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this client’s needs for physical activity?
    A. Teach the client about the risks of immobility and the benefits of exercise.
    B. Assist the client to a chair during awake times, as tolerated.
    C. Collaborate with the physical therapist to arrange for stair exercises.
    D. Teach the client to perform deep breathing and coughing exercises.

Answer 23

ANS: B

Rationale: Sitting up in a chair is preferable to bed rest, even if a client is experiencing severe fatigue. A client who has debilitating fatigue would not likely be able to perform stair exercises. Teaching about mobility may be necessary, but education must be followed by interventions that actually involve mobility. Deep breathing and coughing reduce the risk of respiratory complications but are not substitutes for physical mobility in preventing deconditioning.

Question 24

25. An oncology nurse recognizes a client’s risk for fluid imbalance while the client is undergoing treatment for leukemia. What related assessments should the nurse include in the client’s plan of care? Select all that apply.
    A. Monitoring the client’s electrolyte levels
    B. Monitoring the client’s hepatic function
    C. Measuring the client’s weight on a daily basis
    D. Measuring and recording the client’s intake and output
    E. Auscultating the client’s lungs frequently

Answer 24

ANS: A, C, D, E
Rationale: Assessments that relate to fluid balance include monitoring the client’s electrolytes, auscultating the client’s chest for adventitious sounds, weighing the client daily, and closely monitoring intake and output. Liver function is not directly relevant to the client’s fluid status in most cases.

Question 25

26. 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?
    A. Assess the client’s previous experience with the health care system.
    B. Reassure the client that treatment will be challenging but successful.
    C. Assess the client’s specific needs for education and support.
    D. Identify the client’s plan of medical care

Answer 25

ANS: C

Rationale: In order to meet the client’s needs, the nurse must first identify the specific nature of these needs. According to the nursing process, assessment must precede interventions. The plan of medical care is important, but not central to the provision of support. The client’s previous health care is not a primary consideration, and the nurse cannot assure the client of successful treatment.

Question 26

27. 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?
    A. “Were you ever exposed to toxic chemicals in any of the jobs that you held?”
    B. “When you were younger, did you tend to have recurrent infections of any kind?”
    C. “Have you ever smoked cigarettes or used other tobacco products?”
    D. “Would you say that you’ve had a lot of sun exposure in your lifetime?”

Answer 26

ANS: A
Rationale: MDS is idiopathic in nature due to HSC damage, although 10% to 15% of clients will develop MDS following exposure to alkylating agents, radiotherapy, or chemicals (e.g., benzene), and/or have an inherited genetic disorder, such as Fanconi anemia or trisomy 21. Genetic syndromes account for about 50% of cases (e.g., Down syndrome, trisomy 8 syndrome, neurofibromatosis type 1). MDS is not known to be caused by an infection, tobacco use, or sun exposure.

Question 27

28. A client with myelodysplastic syndrome (MDS) is being treated on a medical unit. Which priority finding should prompt the nurse to contact the client’s primary care provider?
    A. Reports of a frontal lobe headache
    B. An episode of urinary incontinence
    C. An oral temperature of 37.5°C (99.5°F)
    D. An oxygen saturation (SpO2) of 91% on room air

Answer 27

ANS: C
Rationale: Because the client with MDS is at a high risk for infection, any early signs of
infection must be reported promptly. The nurse should address each of the listed assessment findings, but none is as direct a threat to the client’s immediate health as an infection.

Question 28

29. 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?
    A. Techniques for energy conservation and activity management
    B. Emergency management of bleeding episodes
    C. Technique for the administration of bronchodilators by metered-dose inhaler
    D. Techniques for self-palpation of the lymph nodes

Answer 28

ANS: B
Rationale: Because of clients’ risks of hemorrhage, clients with MDS should be taught techniques for managing emergent bleeding episodes. Bronchodilators are not indicated for the treatment of MDS and lymphedema is not normally associated with the disease. Energy conservation techniques are likely to be useful, but management of hemorrhage is a priority because of the potential consequences

Question 29

30. A client is being treated for polycythemia vera, and the nurse is providing health education. Which practice should the nurse recommend to prevent the complications of this health problem?
    A. Avoiding natural sources of vitamin K
    B. Avoiding altitudes of 1500 feet (457 meters)
    C. Performing active range of motion exercises daily
    D. Avoiding tight and restrictive clothing on the legs

Answer 29

ANS: D
Rationale: Because of the risk of deep vein thrombosis, clients with polycythemia vera should avoid tight and restrictive clothing. There is no need to avoid foods with vitamin K or to avoid higher altitudes. Activity levels should be maintained, but there is no specific need for range of motion exercises.

Question 30

31. A clinic nurse is working with a client who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the client’s disease?
    A. Document the color of the client’s palms and face during each visit.
    B. Follow the client’s erythrocyte sedimentation rate over time.
    C. Document the client’s response to erythropoietin injections.
    D. Follow the trends of the client’s hematocrit.

Answer 30

ANS: D

Rationale: The course of polycythemia vera can be best ascertained by monitoring the client’s hematocrit, which should remain below 45%. Erythropoietin injections would exacerbate the condition. Skin tone should be observed, but is a subjective assessment finding. The client’s erythrocyte sedimentation rate is not relevant to the course of the
disease.

Question 31

32. 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?
    A. Risk for ineffective tissue perfusion
    B. Risk for imbalanced fluid volume
    C. Risk for ineffective breathing pattern
    D. Risk for ineffective thermoregulation

Answer 31

ANS: A
Rationale: Clients with ET are at risk for hypercoagulation and consequent ineffective tissue perfusion. Fluid volume, breathing, and thermoregulation are not normally affected.

Question 32

33. A nurse at a long-term care facility is amending the care plan of a resident who has just been diagnosed with essential thrombocythemia (ET). The nurse should anticipate the administration of which medication?
    A. Dalteparin
    B. Allopurinol
    C. Hydroxyurea
    D. Hydrochlorothiazide

Answer 32

ANS: C
Rationale: Hydroxyurea is effective in lowering the platelet count for clients with ET. Dalteparin, allopurinol, and hydrochlorothiazide do not have this therapeutic effect.

Question 33

34. A nurse is writing the care plan of a client who has been diagnosed with myelofibrosis. What nursing diagnoses should the nurse address? Select all that apply.
    A. Disturbed body image
    B. Impaired mobility
    C. Imbalanced nutrition: Less than body requirements
    D. Acute confusion
    E. Risk for infection

Answer 33

ANS: A, B, C, E
Rationale: The profound splenomegaly that accompanies myelofibrosis can impact the client’s body image and mobility. As well, nutritional deficits are common and the client is at risk for infection. Cognitive effects are less common.

Question 34

35. 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?
    A. Schwann cells
    B. Reed–Sternberg cells
    C. Lewy bodies
    D. Loops of Henle

Answer 34

ANS: B
Rationale: The malignant cell of Hodgkin lymphoma is the Reed–Sternberg cell, a gigantic tumor cell that is morphologically unique and thought to be of immature lymphoid origin. It is the pathologic hallmark and essential diagnostic criterion. Schwann cells exist in the peripheral nervous system and Lewy bodies are markers of Parkinson disease. Loops of Henle exist in nephrons.

Question 35

36. 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?
    A. Iron-deficiency anemia
    B. Hemophilia
    C. Secondary malignancy
    D. Lymphedema

Answer 35

ANS: C
Rationale: Survivors of Hodgkin lymphoma have a high risk of secondary malignancies.
There is no consequent risk of anemia, lymphedema, or hemophilia.

Question 36

37. The clinical nurse educator is presenting health promotion education to a client who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions?
    A. Avoiding direct sun exposure in excess of 15 minutes daily
    B. Avoiding grapefruit juice and fresh grapefruit
    C. Avoiding highly crowded public places
    D. Using an electric shaver rather than a razor

Answer 36

ANS: C
Rationale: The risk of infection is significant for these clients, not only from
treatment-related myelosuppression but also from the defective immune response that results from the disease itself. Limiting infection exposure is thus necessary. The need to avoid grapefruit is dependent on the client’s medication regimen. Sun exposure and the use of razors are not necessarily contraindicated.

Question 37

38. A client has a diagnosis of multiple myeloma and the nurse is preparing health education in preparation for discharge from the hospital. Which action should the nurse promote?
    A. Daily performance of weight-bearing exercise to prevent muscle atrophy
    B. Close monitoring of urine output and kidney function
    C. Daily administration of warfarin, as prescribed
    D. Safe use of supplementary oxygen in the home setting

Answer 37

ANS: B
Rationale: Renal function must be monitored closely in the client with multiple myeloma. Excessive weight-bearing can cause pathologic fractures. There is no direct indication for anticoagulation or supplementary oxygen.

Question 38

39. 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?
    A. Stomatitis
    B. Nephropathy
    C. Cognitive changes
    D. Peripheral neuropathy

Answer 38

ANS: D
Rationale: A significant toxicity associated with the use of bortezomib for multiple myeloma is peripheral neuropathy. Stomatitis, cognitive changes, and nephropathy are not noted to be adverse effects of this medication.

Question 39

7. A nurse is providing care to a client with multiple myeloma with reports of nausea, diarrhea, alopecia, and red urine. The client’s recent interventions include electrocardiogram (ECG), multigated acquisition scan (MUGA), and a central line venous access placed on the right chest wall. Which medication is the client most likely receiving?
   A. Dexamethasone
   B. Lenalidomide
   C. Doxorubicin
   D. Etoposide

Answer 39

ANS: C
Rationale: Doxorubicin is a chemotherapeutic drug and typically part of a combination regimen. Side effects of this medication include nausea, vomiting, alopecia (hair loss), and orange or red urine. Red urine is not listed as a side effect on any other of the medications listed. Doxorubicin can have a cardiotoxic effect (cardiomyopathy & arrhythmias), so ECG and MUGA scans (evaluate pumping function of the ventricles) are
done before and periodically throughout treatment. This drug is a vesicant (causes blistering) and can result in tissue necrosis if the medication leaks into the tissues surrounding a vein due to an infiltrate. A central line is placed to avoid that complication. Etoposide and lenalidomide are both chemotherapy drugs without the typical adverse effect of cardiotoxicity Etoposide is an irritant with a low vesicant potential.
Dexamethasone is a steroid that does not have the side effect of alopecia nor requires central venous access.