CH 34

Which nursing intervention is most appropriate for a client with multiple myeloma? a) Monitoring respiratory status b) Restricting fluid intake c) Balancing rest and activity d) Preventing bone injury

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

For a patient with Hodgkin disease, who is at a risk for an ineffective airway clearance and an impaired gas exchange, the nurse places the patient in a high Fowler's position to do which of the following? a) Anticipate the need for the airway management. b) Detect compromised ventilation. c) Reduce the deficits in the blood oxygen level. d) Increase the lung expansion.

A 36-year-old African American client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia? a) Hemoglobin F b) Hemoglobin M c) Hemoglobin S d) Hemoglobin A

A patient presents with peripheral neuropathy and hypothesia of the feet. What is the best nursing intervention? a) Assess for signs of injury. b) Encourage ambulation. c) Keep the feet cool. d) Have the client elevate his legs.

What is the rationale for the classification of leukemia? a) Whether it attacks younger or older people b) Whether it is acute or chronic c) Which bone marrow it arises from, red, or yellow d) Which bone marrow stem cell line is dysfunctional

Which of the following nursing interventions should be incorporated into the plan of care to manage the delayed clotting process in a patient with leukemia? a) Apply prolonged pressure to needle sites or other sources of external bleeding. b) Eliminate direct contact with others who are infectious. c) Implement neutropenic precautions. d) Monitor temperature at least once per shift.

The nurse is interacting with a family that has been caring for a patient with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply. a) Suggest support for household maintenance. b) Suggest the family go to church more often. c) Allow family members to express feelings. d) Educate the family about medications and side effects. e) Suggest the prescription of anti-anxiety medications.

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise? a) This type of exercise increases arterial circulation as it returns to the heart. b) Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. c) Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. d) Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? a) Observe client for facial droop. b) Observe stools for blood. c) Observe the sputum for signs of blood. d) Observe the gums for bleeding after the client brushes teeth.

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? a) "I have resources within myself that I can depend on." b) "I know I am going to die. I want to say good-bye to my family." c) "I do not understand why this happened to me." d) "I am going to call my clergy to pray with me."

A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: a) acute heart failure. b) hypoxemia. c) chronic liver failure. d) pathologic bone fractures.

When assessing a female patient with a disorder of the hematopoietic or the lymphatic system, which of the following assessments is most essential? a) Health history, such as bleeding, fatigue, or fainting b) Lifestyle assessments, such as exercise routines c) Age and gender d) Menstrual history

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure? a) Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. b) Ask if taking a blood pressure has ever produced pain in the upper arm. c) Ask if taking a blood pressure has ever caused bruising in the hand and wrist. d) Ask if taking a blood pressure has ever produced the need for medication.

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia? a) Erythrocytes that are microcytic and hypochromic b) Clustering of platelets with sickled red blood cells c) Erythrocytes that are macrocytic and hyperchromic d) An increased number of erythrocytes

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? a) Hypochromic b) Hyperchromic c) Normocytic d) Microcytic

Which of the following is the only curative treatment for chronic myeloid leukaemia (CML)? a) Cytarabine b) Imatinib c) Idarubicin d) Allogeneic stem cell transplant

A patient with multiple myeloma is complaining about pain. What instructions will the nurse give the patient to help to reduce pain during activity? a) Limit activity to once a day. b) Limit fluids to prevent going to the bathroom. c) Stay in bed as much as possible. d) Do not lift more than 10 pounds.

You are assisting your client with multiple myeloma to ambulate. What is the most important nursing diagnosis to help prevent fractures in this client? a) Adequate hydration b) Increased mobility c) Safety d) Adequate nutrition

Parents arrive to the clinic with their 5-year-old child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse? a) "Most likely, the father is the carrier of the gene." b) "It is an acquired, not a hereditary disorder." c) "The child must inherit two defective genes, one from each parent." d) "The trait is passed down through the mother."

The nurse is collecting data for a patient who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia? a) "I have difficulty breathing when walking 30 feet." b) "I feel hot all of the time." c) "I have an increase in my appetite." d) "I have a difficult time falling asleep at night."

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse? a) Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration. b) Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. c) Obtain the pain medication and delay the bath and position change until the medication reaches its peak. d) Inform the client that she will feel better after receiving a bath and clean sheets.

The nurse is assessing several patients. Which patient does the nurse determine is most likely to have Hodgkin lymphoma? a) The patient with painful lymph nodes in the groin. b) The patient with a painful sore throat. c) The patient with enlarged lymph nodes in the neck. d) The patent with painful lymph nodes under the arm.

A client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include: a) Serum creatinine level 0.5 mg/dl b) Bence Jones protein in the urine c) Serum calcium level of 7.5 mg/dl d) Serum protein level 5.8 g/dl

A client reports feeling tired, cold, and short of breath at times. Your assessment reveals tachycardia and reduced energy. What would you expect the physician to order? a) Antibiotic b) CBC c) Chest radiograph d) ECG

A patient with acute myeloid leukemia (AML) has a neutrophil count that persists at less than 100/mm3. What should the nurse cautiously monitor this patient for? a) Abdominal cramps b) Hypotension c) Seizure activity d) Infection

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client? a) Overhydration enlarges the red blood cells. b) The client has a decreased tolerance of pain related to the chronic nature of the illness. c) Vascular occlusion in small vessels decreasing blood and oxygen to the tissues. d) Bone marrow decreases the erythrocyte production causing decrease in hypoxia.

A 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 answers that apply. a) Encourage the client to take deep breaths every 4 hours while awake. b) Auscultate lung sounds every shift and prn. c) Place fresh flowers on a shelf on the opposite wall from the client. d) Assess skin and mucus membranes every shift. e) Provide oral hygiene once daily.

The Pediatric Nurse Practitioner is doing a physical examination of a client with sickle cell anemia. Why would the nurse practitioner auscultate the lungs and heart? a) To detect the evidence of dehydration that might have triggered a sickle cell crisis b) To detect the abnormal sounds suggestive of acute chest syndrome and heart failure c) To detect the motor strength and stroke-related signs and symptoms d) To detect the evidence of infection such as fever and tachycardia

A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in their arms and legs. What do these symptoms indicate? a) Neurologic involvement b) Loss of vibratory and position senses c) Insufficient intake of dietary nutrients d) Severity of the disease

Which of the following statements best describes the function of stem cells in the bone marrow? a) They defend against bacterial infection. b) They are active against hypersensitivity reactions. c) They produce all blood cells. d) They produce antibodies against foreign antigens.

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? a) Hypercalcemia b) Hypermagnesemia c) Hyperkalemia d) Hypernatremia

Which of the following terms refers to a form of white blood cell involved in immune response? a) Spherocyte b) Granulocyte c) Lymphocyte d) Thrombocyte

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) Leukemia c) Multiple myeloma d) Polycythemia vera

What assessment findings best indicate that the patient has recovered from induction therapy? a) No evidence of oedema b) Absence of bone pain c) Vital signs within normal ranges d) Neutrophil and platelet counts within normal limits

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? a) A 72-year-old patient with a history of cancer b) A 52-year-old patient with acute kidney injury c) A 40-year-old patient with a history of hypertension d) A 24-year-old female taking oral contraceptives

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) Remission b) Bone marrow depression c) Graft-versus-host disease d) Acute respiratory distress syndrome

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which of the following would not be included in the client's discharge instructions? a) Plan for frequent periods of rest. b) Encourage frequent handwashing. c) Use a disposable razor when shaving. d) Avoid contact with family/friends who are sick.

A patient has completed induction therapy and has diarrhoea and severe mucositis. What is the appropriate nursing goal? a) Administer pain medication. b) Place client in reverse isolation. c) Address issues of negative body image. d) Maintain nutrition.

A nurse is caring for an asymptomatic client with acute myelogenous leukemia. The client has a total white blood cell (WBC) count of 0 ?l, a platelet count of 3,000 mm2, and a hemoglobin level of 9 mg/dl. He has a single lumen central venous catheter in place and the physician has ordered the nurse to administer imipenem cilastatin (Primaxin) 500 mg every 8 hours, transfuse 1 unit packed red blood cells (RBCs), give amphotericin B (Fungizone) 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) Amphotericin B, imipenem cilastatin, platelets, packed RBCs b) Packed RBCs, amphotericin B, imipenem cilastatin, platelets c) Platelets, imipenem cilastatin, amphotericin B, packed RBCs d) Packed RBCs, platelets, imipenem cilastatin, amphotericin B

An 89-year-old client is preparing to leave the physician's office. The nurse is discussing with the client some strategies for ingesting iron to combat her iron-deficiency anemia. Which of the following are among the nurse's strategies? a) Avoid vitamin C—it prevents absorption. b) Taking iron pills with milk aids in absorption. c) Take iron with an antacid to avoid stomach upset. d) Drink liquid iron preparations with a straw.

A 15-year-old client with hemophilia sustains a leg laceration after falling off of his skateboard and is brought to the emergency department. The laceration is bleeding profusely even with direct pressure to the site. What does the nurse anticipate will be ordered for administration to control bleeding? a) A colloid solution such as hetastarch (Hespan) b) Albumin c) A crystalloid solution such as lactated Ringer's d) Fresh frozen plasma

After chemotherapy for AML, what interventions will best help to prevent renal complications? Select all that apply. a) Administer rasburicase (Elitek). b) Increase hydration. c) Administer allopurinol (Zyloprim). d) Encourage exercise. e) Administer potassium therapy.

A client with 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 laboratory value is most likely responsible for this client's symptoms? a) Serum calcium level 13.8 mg/dl b) Serum sodium level of 133 mEq/L c) Hemoglobin of 9.8 g/dl d) Platelet count 300,000/mm3

A patient with AML has pale mucous membranes and bruises on his legs. What is the primary nursing intervention? a) Assess the patient's hemoglobin and platelets. b) Assess the patient's skin. c) Assess the patient's pulses and blood pressure. d) Check the patient's history.

You are caring for a client with thalassemia who is being transfused. What your role during a transfusion? a) To instruct the client to rest immediately if chest pain develops b) To administer vitamin B12 injections c) To closely monitor the rate of administration d) To assess for enlargement and tenderness over the liver and spleen

A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron? a) Meat, egg yolks, oysters, and shellfish b) Sources of vitamin B12 c) Vitamin E d) Rich sources of vitamin C

Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and platelets? a) Leukopenia b) Anemia c) Pancytopenia d) Thrombocytopenia

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, you find evidence of petechiae and ecchymoses. You note that the spleen appears enlarged. What would you suspect is wrong with this client? a) Iron-deficiency anemia b) Pernicious anemia c) Agranulocytosis d) Aplastic anemia

The hospitalized client is experiencing gastrointestinal bleeding. Laboratory test results show that the client's platelets are 9000/mm³. The client is receiving prednisone and azathioprine (Imuran). The nurse a) Performs a neurologic assessment with vital signs b) Teaches the client to vigorously floss the teeth to prevent infections c) Uses contact precautions with this client d) Requests a prescription of diphenoxylate/atropine (Lomotil) for loose stools

The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? a) Creatinine and blood urea nitrogen (BUN) levels b) Potassium levels c) Magnesium levels d) Iron levels

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. a) Destruction of normally formed red blood cells b) Abnormal erythrocyte production c) Blood loss d) Infection e) Inadequate formed white blood cells

The client is a young, thin woman who is prescribed iron dextran intramuscularly. The nurse, when administering the medication, a) Rubs the site vigorously b) Injects into the deltoid muscle c) Employs the Z-track technique d) Uses a 23-gauge needle

The nurse is caring for a patient with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? a) Asparaginase (Elspar) b) Hydroxyurea (Myleran) c) Filgrastim (Neupogen) d) Allopurinol (Zyloprim)

An 82-year-old client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults? a) Stomatitis b) Dementia c) Ataxia d) Glossitis

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 is at risk for tooth decay. b) The patient can develop osteonecrosis of the jaw. c) The patient will develop gingival hyperplasia. d) The patient can develop loosening of the teeth.

A patient who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? a) Keep the patient on bed rest. b) Evaluate the patient's platelet count. c) Evaluate the patient's INR. d) Ask the patient if he has been falling recently.

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) Creatinine level of 1.0 mg/dL b) WBC count of 4,200 cells/mcL c) Platelet count of 9,000/mm3 d) Hematocrit of 38%

A client diagnosed with polycythemia vera has come into the clinic because he has developed a nighttime cough, fatigue, and shortness of breath. What complication would you suspect in this client? a) Congestive heart failure b) Stroke c) Tissue infarction d) Pulmonary embolus

The nurse is teaching a patient about the development of leukemia. What statement should be included in the teaching plan? a) "Chronic leukemia develops slowly." b) "In acute leukemia there are not many undifferentiated cells." c) "Acute leukemia develops slowly." d) "In chronic leukemia, the majority of leukocytes are mature."

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client? a) Avoid any sports that tire you out. b) Stay on oxygen therapy 24/7. c) Avoid any activity that makes you short of breath. d) Drink at least 8 glasses of water every day.

You are 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) Osteosarcomas form producing pathologic fractures. d) Osteolytic activating factor weakens bones producing fractures.

You are caring for an 87-year-old female who has been admitted to your unit with iron-deficiency anemia. What would you suspect? a) Elimination of iron by the body b) Decrease in the total body iron stores with age c) Excessive consumption of coffee or tea d) Blood loss from the gastrointestinal or genitourinary tract

Jeremiah, a 10-year-old boy with hemophilia, is a patient on the pediatric unit where you practice nursing. Jeremiah was admitted to your floor via the ED after sustaining an injury while playing outdoors with friends. Initially, he presented with severe bleeding but has since stabilized. Which of the following interventions will the nurse include in her care plan for Jeremiah? Select all that apply. a) Eliminate aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). b) Obtain an oral temperature to ensure accuracy. c) Encourage client to use a soft toothbrush and rinse the mouth with warm water between and after meals. d) Support painful joints on pillows.

The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action? a) Put in an IV line b) Ask someone to clean the bedpan c) Stop the nosebleed d) Notify the physician

An elderly client is hospitalized for induction of chemotherapy to treat leukemia. The client reports fatigue to the nurse. What nursing intervention would best address the client's fatigue? a) Provide sedentary activities only, such as watching television. b) Have the client maintain complete bedrest. c) Talk to the family about not visiting so the client can obtain rest. d) Assist the client to sit in a chair for meals.

The term that is used to refer to a primitive cell, capable of self-replication and differentiation, is which of the following? a) Stem cell b) Band cell c) Spherocyte d) Reticulocyte

Which precautions should a nurse include in the care plan for a client with leukaemia and neutropenia? a) Put on a mask, gown, and gloves when entering the client's room. b) Provide a clear liquid, low-sodium diet. c) Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. d) Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding.

A client has been diagnosed with polycythaemia vera. It is most important for the nurse to teach the client about a) Drinking alcohol to decrease blood viscosity b) Bathing in tepid or cool water to control itching c) Maintaining adequate blood pressure control d) Taking a daily multivitamin with iron supplement

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) Ruddy complexion b) Pale skin and mucous membranes c) Bronze skin tone d) Jaundice skin and sclera

Which statement indicates the patient understands teaching about induction therapy for leukemia? a) "I will start slowly with medication treatment." b) "I will need to come every week for treatment." c) "I know I can never be cured." d) "I will be in the hospital for several weeks."

The nurse is teaching the patient about consolidation. What statement should be included in the teaching plan? a) "Consolidation occurs as a side effect of chemotherapy." b) "Consolidation is the term for when a patient does not tolerate chemotherapy." c) "Consolidation of the lungs is an expected effect of induction therapy." d) "Consolidation therapy is administered to reduce the chance of leukaemia recurrence."

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. Which of the following is the most common complication of the pathology resulting from this process? a) All of the options are correct. b) Osteoporosis c) Calcified bones d) Pathologic fractures

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) Standard therapy b) Induction therapy c) Supportive therapy d) Antimicrobial therapy

A nursing instructor in a BSN program is preparing for a lecture on disorders of the hematopoietic system. Included in the lecture are conditions caused by reduced levels or absence of blood-clotting proteins. Which of the following is the instructor most likely referring to? a) Aplastic anemia b) Sickle cell disease c) Pancytopenia d) Coagulopathy

A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, the nurse now assesses for a) Adventitous lung sounds b) Laryngeal edema c) Hair loss d) Diarrheal stools

A patient with suspected multiple myeloma is complaining of pain in the back. What is the priority nursing action? a) Send the patient for x-ray study of the spine. b) Have the patient lie on a hard surface. c) Have the patient rest. d) Encourage ambulation.

A patient who is undergoing chemotherapy for AML complains of pain in his lower back. What is the nurse's first action? a) Assess renal function. b) Administer pain medication, as ordered. c) Place heating pads on the patient's back. d) Refer the client to a chiropractor.