VN 36 Test 9 lymph

Question 1

1. Hodgkin’s patho & manifestations (ch.32 pp slide 11)

Answer 1

Patho:
 Reed-Steenberg cells

Manifestations:
 Weight loss, anorexia, fatigue, weakness
 Anemia, thrombocytopenia
 Poor Resistance to infection
 Painless lymph node enlargement
 Low grade fever, pruritus, night sweats
 Epigastric pain, fullness

Question 2

1. Hodgkin’s Diagnosis/planning & Interventions (ch.32 pp slide 11)

Answer 2

Diagnosis & planning:
 Risks: ineffective airway clearance, impaired gas exchange, infection, impaired skin integrity
 Goal: to cure the disease
Interventions:
 Hx Assessment: sx, mononucleosis, physical assessment (lymph nodes)
 Assess respiratory status
 Administer O2
 Prepare for intubation
 Infections disease precautions
 Support & protect bony prominences

Question 3

2. Iron supplementation client education (pg.397)

Answer 3

 Dilute liquid forms of iron w/juice & drink w/a straw to avoid staining the teeth
 Take iron on an empty stomach (unless gastric upset occurs, take immediately after meals)
 Don’t take Iron w/antiacid (interferes w/absorption)
 Check w/PCP about combining iron with other OTC or prescribed meds
 Drink orange juice or other forms of vitamin C to promote absorption
 Expect dark green/black stools
 Notify provider if constipation(stool softener ok) or diarrhea develops
 Keep iron meds out of reach of children (risk for poisoning)

Question 4

3. Iron-rich foods(pg. 397)

Answer 4

 Egg yolks
 Spinach
 Oysters
 Red meats
 Dark meat of poultry
 Dried fruit
 Lentils/beans
 PB

Question 5

4. Sickle cell client Education (ch.31 pp slide 7)

Answer 5

 Narcotic analgesia
 O2
 Bed rest
 IV fluids & medications
 risk for infection (avoid large crowds)

Question 6

4. Sickle Cell nursing interventions (ch.31 pp slide 8):

Answer 6

 Administer prescribed analgesics
 Provide 3,000ml of daily fluid (hydration is priority!)
 Administer oxygen

Question 7

5. Beta-thalassemia manifestations (ch.31 pp slide 10)

Answer 7

 Cooley’s anemia (bronzing of skin)
 Listlessness
 Anorexia
 Fever
 Pallor in beta

Question 8

6. Pernicious anemia treatment/teaching (ch.31 pp slide 12)

Answer 8

 Glossitis & stomatitis: soft, bland diet, small & frequent meals, good oral care
 Permanent neurologic deficit: Encourage & assist w/ambulation, supervision
 Teaching: administration of vitamin B12, diet

Question 9

7. Leukemia priority & manifestations (ch.31 pp slide 16)

Answer 9

Priority: risk for hemorrhage, infection, activity intolerance, disturbed body image, anxiety & fear

Manifestations (ch.31 pp slide 14):

 Bone pain
 Enlarged spleen & lymph nodes
 Joint swelling
 Infections
 Fatigue
 Fever
 Internal or external bleeding
 Easy bruising
 Severe anemia

Question 10

7. Leukemia Nursing care/Interventions(ch.31 pp slide 16)

Answer 10

 Neutropenic precautions
 Monitor PLT counts (hemorrhage-greatest risk of bleeding), bleeding precautions: no razors, soft toothbrushes
 Implement transmission precautions (private room, mask for transport)
 Assess for signs of bruising & petechiae
 Report hematuria or epistaxis

Question 11

8. Hypovolemic anemia manifestations acute and chronic (ch.31 pp slide 3)

Answer 11

Acute hypovolemic anemia manifestations:
 Reduced urine output
 Altered consciousness
 Extreme pallor

Chronic hypovolemic anemia manifestations:
 Pallor, fatigue, chills
 Tachycardia
 Postural hypotension
 Rapid RR

Question 12

9. Chemotherapy dietary changes (ch.31 pp slide 16,17)

Answer 12

 Limit liquids @ mealtime
 SF gum or mints for better taste
 Low fat foods
 Small frequent meals

Question 13

10. Bone marrow aspiration client education (ch.31 pp slide 16)

Answer 13

 Very little discomfort mostly pressure & short lived
 No baths until site heals
 No ASA products

Question 14

11. Neutropenic precautions (ch.31 pp slide 17)

Answer 14

 Wear mask when being transported to radiology
 No fresh fruits or flowers
 No salad bars
 Private room

Question 15

12. Multiple myeloma patho, complications(ch.31 pp slide 18)

Answer 15

Patho:
 Malignancy involving plasma cells
 Osteoclasts break down bone cells, resulting in increased blood calcium & pathologic fx
 Osteolytic tumors: “punched-out” or “honeycombed” appearance in bones

Complications:
 Fractures

Question 16

12. multiple myeloma diagnostic tests (ch.31 pp slide 18)

Answer 16

Diagnostic Tests:
 Skeletal radiographic studies (bone lesions)
 Elevated serum calcium levels
 Bone marrow aspiration

Question 17

13. Thrombocytopenic nursing actions (ch.31 pp slide 22)

Answer 17

 Manage/minimize bleeding (soft toothbrushes, no razors)

Question 18

14. hemophilia manifestations (ch.31 pp slide 23)

Answer 18

 Oozing
 Severe bleeding
 Bleeding in joints
 Joint pain

Question 19

14. Hemophilia client education during bleeds(ch.31 pp slide 23)

Answer 19

 Conserve energy
 Ways to prevent further episodes
 Rest during bleeds
 Elevate area, apply ice

Question 20

15. Aplastic anemia manifestations (ch.31 pp slide 20)

Answer 20

 Weakness, fatigue, opportunistic infections
 Unusual bleeding, petechiae, ecchymosis
 Enlarged spleen/abdominal pain

Question 21

16. Mononucleosis client education/nursing management (ch.32 pp slide 8)

Answer 21

 Inspect throat, palpate lymph nodes
 Encourage fluids, soft bland foods, cool liquids
 Emotional support
 Rest, withhold donating blood, avoid contact sports

Question 22

17. Lymphedema manifestations complications(ch.32 pp slide 3)

Answer 22

Manifestations:
 Swelling of affected area
 Skin is tight, firm, shiny, brawny(swollen & hardened skin)
 Weeping or oozing

Complications:
 Infection
 Ulcers

Question 23

17. Lymphedema nursing management (ch.32 pp slide 3)

Answer 23

 Skin assessment
 Exercises
 Elevation
 Elastic garments
 Mechanical devices
 Emotional support

Question 24

18. Iron deficiency anemia clients at risk & nursing management (ch.31 pp slide 5)

Answer 24

 Clients w/malabsorption disease
 Clients w/an unhealthy diet
 Lack of education or financial ability regarding nutrition

  Iron deficiency nursing management: 	Increase iron intake 	Collab w/dietitian to ID foods high in iron 	Administer iron supplements (Z-track method)

Question 25

19. Know lab values for HCT, WBC, PLT (pg.395):

Answer 25

a. HCT: 40-54 g/dL(men); 38-47 g/dL (women)
b. WBC: 5,000-13,000 mm3 (men); 5,000-10,000mm3 (women)
c. Platelets: 150,000-450,000mm3

Question 26

20. droplet precautions(funds ATI pg.56)

Answer 26

(Streptococcal pharyngitis or pneumonia, Influenza type B, scarlet fever, rubella, pertussis, mumps, sepsis, pneumonic plague)
 Private room or room w/other clients who have the same infectious diseases (ensure that clients have their own equipment)
 Masks for providers & visitors
 Clients should wear masks while outside room/home.

Question 27

20. contact precautions (funds ATI pg.56)

Answer 27

(Respiratory syncytial virus, shigella, enteric diseases caused by micro-organisms, wound infections, herpes simplex, impetigo, scabies, multidrug-resistant organisms)
 Private room or a room w/others that have the same infections
 Gloves & gowns worn by the caregivers & visitors
 Disposal of infectious dressing material into a single, nonporous bag w/out touching the outside of the bag.

Question 28

20.Airborne precautions:

Answer 28

(Measles, varicella, pulmonary or laryngeal TB)
 Private room
 Masks & respiratory protection devices (N95)
 Negative pressure airflow exchange
 If splashing or spraying is a possibility wear full face (eyes, nose, mouth)
 Client should wear a mask while outside of the room/home

Question 29

Protective environment precautions:

Answer 29

(Clients who are immunocompromised)
 Private room
 Positive airflow 12 or more air exchanges/hr
 HEPA filtration for incoming air
 Mask for the client when out of room

Question 30

21. Hemolytic Anemia Medical management(ch.31 pp slide 9):

Answer 30

 Removing the cause
 Blood transfusions
 Corticosteroids
 Surgical Management: Splenectomy

Question 31

21. Hemolytic Anemia Nursing management(ch.31 pp slide 9):

Answer 31

 Health HX
 Supportive care
 Medication
 Teaching measures of self-care
 Arrange follow up evals