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
Preventing bone injury
When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict his fluid intake.
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
A general reduction in all white blood cells
Leukopenia is a general reduction in all WBCs. Leukopenia does not have anything to do with 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.
Increase the lung expansion.
For a patient with Hodgkin disease who is at a risk for an ineffective airway clearance and an impaired gas exchange, the nurse keeps the neck in midline and places the patient in a high Fowler's position if respiratory distress develops. Avoiding unnecessary pressure on the trachea and positioning for an increased lung expansion improve the air exchange. The nurse administers oxygen as per the physician's orders to reduce the deficits in the blood oxygen level. The nurse assesses the respiratory status in each shift to detect compromised ventilation. The nurse places an endotracheal tube, a laryngoscope, and a bag-valve mask at the bedside for intubation if the need for the airway management arises.
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
Hemoglobin A (HbA) normally replaces fetal hemoglobin (HbF) about 6 months after birth. In people with sickle cell anemia, however, an abnormal form of hemoglobin, hemoglobin S (HbS), replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions.
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.
Assess for signs of injury.
A patient with hypothesia of the feet will have decreased sensation and numbness. The nurse should assess for signs of injury. If the patient has injured himself, he will not be able to feel it and this could lead to the development of infection. Ambulation will not help the patient and elevation of the legs may make the problem worse as blood flow to the feet would be decreased. Keeping the feet cold will also decrease blood flow.
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 bone marrow stem cell line is dysfunctional
There are four general types of leukemia, classified according to the bone marrow stem cell line that is dysfunctional. This makes options A, B, and C incorrect.
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.
Apply prolonged pressure to needle sites or other sources of external bleeding.
For a patient with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.
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.
• Suggest support for household maintenance.
• Allow family members to express feelings.
• Educate the family about medications and side effects.
Family members benefit from increased education on what to expect. Allowing family members to express their feelings has also been shown to relieve stress. Supporting the caregiver and family with help in household duties will also help the over-burdened family. Anti-anxiety medications and church attendance have not been shown to reduce caregiver stress.
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.
Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.
Isometric exercise induce contraction of skeletal muscle so that it compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. Isometric exercises do not have an aerobic effect and should not increase the heart rate; although, it may increase blood pressure. Isometric exercise does not decrease the workload of the heart. Arterial flow moves blood flow away from the heart after being oxygenated.
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.
Observe stools for blood.
Iron-deficiency anemia is unusual in older adults. Normally, the body does not eliminate excessive iron, causing total body iron stores to increase with age and necessitating maintenance of hydration. If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tracts is suspected. Observing the stool for blood will help detect blood from GI loss. Bleeding gums may indicate periodontal disease, or anticoagulation from medication is not related to age. Blood in sputum can be an indicator of various lung disorders that may affect all age groups. Facial droop may indicate an impending stroke or Bell's palsy and would not be a reason for blood loss.
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."
"I do not understand why this happened to me."
The statement "I do not understand why this happened to me" indicates that the client is not accepting of the consequences of his health problems and impending death. The other statements indicate the client has plans that would result in spiritual well-being or harmony.
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.
c) chronic liver failure.
d) pathologic bone fractures.
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.
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
Health history, such as bleeding, fatigue, or fainting
When assessing a patient with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the patient's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.
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.
Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.
Before taking a blood pressure, the nurse asks the client if the use of a blood-pressure cuff has ever produced bleeding under the skin or in the arm joints. Options B, C, and D are incorrect.
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
Erythrocytes that are microcytic and hypochromic
A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia. An increase in the number of erythrocytes would indicate polycythemia vera.
Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents?
An RBC that has pale or lighter cellular contents is hypochromic. A normocytic RBC is normal or average in size. A microcytic RBC is smaller than normal. Hyperchromic is used to describe an RBC that has darker cellular contents.
Which of the following is the only curative treatment for chronic myeloid leukaemia (CML)?
d) Allogeneic stem cell transplant
Allogeneic stem cell transplant
Allogeneic stem cell transplantation remains the only curative treatment for CML. The efficacy of Imatinib as first-line treatment and the treatment-related mortality of stem cell transplant limits use of transplant to patients with high risk or relapsed disease, or in those patients who did not respond to therapy with TKI. Cytarabine and idarubicin are part of induction therapy for acute myeloid leukemia (AML).
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.
Do not lift more than 10 pounds.
The patient with multiple myeloma needs education about activity instructions such as lifting no more than 10 pounds and using proper body mechanics. Braces may be needed. The patient should have activity and would not be instructed to stay in bed or limit activity as he or she would become very stiff. Limiting fluids would be contraindicated. The patient needs to remain well hydrated.
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
d) Adequate nutrition
Safety is paramount because any injury, no matter how slight, can result in a fracture.
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 child must inherit two defective genes, one from each parent."
Sickle cell disease is a hereditary disorder. To manifest this disorder, a person must inherit two defective genes, one from each parent, in which case all the hemoglobin is inherently abnormal. If the person inherits only one gene, he or she carries sickle cell trait. The hemoglobin of those who have sickle cell trait is about 40% affected. The other distractors are incorrect due to these factors.
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."
"I have difficulty breathing when walking 30 feet."
Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. The client would feel cold and not hot. The client is fatigue and able to sleep often with a decrease in appetite, not an increase.
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.
Obtain the pain medication and delay the bath and position change until the medication reaches its peak.
When pain is severe, the nurse delays position changes and bathing until an administered analgesic has reached its peak concentration level and the client is experiencing maximum pain relief. Pain medication should never be delayed to assist in the control of the level of pain. Pain will not be relieved by a bath and clean sheets, only analgesics at this point in the client's illness.
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.
The patient with enlarged lymph nodes in the neck.
Lymph node enlargement in Hodgkin lymphoma is not painful. The patient with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.
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
Bence Jones protein in the urine
Presence of Bence Jones protein in the urine almost always confirms multiple myeloma; however, absence of the protein doesn't rule out the disease. Serum creatinine level may be increased (above 1.2 mg/dl in men and 0.9 mg/dl in women). Serum calcium levels are above 10.2 mg/dl in multiple myeloma because calcium is lost from the bone and reabsorbed in the serum. The serum protein level is increased in multiple myeloma, not decreased.
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?
c) Chest radiograph
Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased.
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
c) Seizure activity
Because of the lack of mature and normal granulocytes that help fight infection, patients with leukemia are prone to infection. The likelihood of infection increases with the degree and duration of neutropenia; neutrophil counts that persist at less than 100/mm3 dramatically increase the risk of systemic infections.
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.
Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.
The person with sickle cell disease repeatedly suffers from two major problems: (1) episodes of sickle cell crisis from vascular occlusion, which develops rapidly under hypoxic conditions, and (2) chronic hemolytic anemia. During a sickle cell crisis, the sickle-shaped cells lodge in small blood vessels, where they block the flow of blood and oxygen to the affected tissue. The vascular occlusion induces severe pain in the ischemic tissue. The client may have increased tolerance for pain due to the chronic nature of the illness. Bone marrow increases the erythrocyte production. Underhydration increases the client's risk of developing a vaso-occlusive crisis.
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.
• Encourage the client to take deep breaths every 4 hours while awake.
• Auscultate lung sounds every shift and prn.
• Assess skin and mucus membranes every shift.
Interventions for risk for infection include assessing skin and mucus membranes every shift, auscultating lung sounds every shift and prn, and encouraging deep breaths every 4 hours while the client is awake. No fresh flowers are allowed in the room because of germs found in stagnant water. Oral hygiene should be provided after meals and every 4 hours while the client is awake.
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
To detect the abnormal sounds suggestive of acute chest syndrome and heart failure
The nurse auscultates the lungs and heart to detect abnormal sounds that indicate pneumonia, acute chest syndrome, and heart failure. The nurse assesses vital signs to detect evidence of infection, such as fever and tachycardia. During the physical examination, the nurse observes the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. The nurse assesses mental status, verbal ability, and motor strength to detect stroke-related signs and symptoms.
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
In clients with pernicious anemia, numbness and tingling in the arms and legs, and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms.
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.
They produce all blood cells.
All blood cells are produced from undifferentiated precursors called pluripotential stem cells in the bone marrow. Other cells produced from the pluripotential stem cells help defend against bacterial infection, produce antibodies against foreign antigens, and are active against hypersensitivity reactions.
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?
Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.
Which of the following terms refers to a form of white blood cell involved in immune response?
Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.
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
c) Multiple myeloma
d) Polycythemia vera
The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.
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
Neutrophil and platelet counts within normal limits
Recovery from induction therapy is indicated when the neutrophil and platelet counts have returned to normal and any infection has resolved. Stable vital signs, lack of oedema, and absence of pain are not indicative of recovery from induction therapy.
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 72-year-old patient with a history of cancer
Primary MDS tends to be a disease of people older than 70 years. Because the initial findings are so subtle, the disease may not be diagnosed until later in the illness trajectory, if at all. Thus, the actual incidence of MDS is not known.
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?
b) Bone marrow depression
c) Graft-versus-host disease
d) Acute respiratory distress syndrome
Patients who undergo HSCT have a significant risk of infection, graft-versus host disease (in which the donor's lymphocytes [graft] recognize the patient's body as "foreign" and set up reactions to attack the foreign host), and other complications.
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.
Use a disposable razor when shaving.
People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Encourage behaviors that will lower the risk for bleeding. People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Avoiding contact with people who are sick reduces the risk of acquiring an infection. People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Handwashing reduces the risk of acquiring an infection. Anemia can cause fatigue and shortness of breath with even mild exertion.
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.
Maintaining nutrition is the most important goal after induction therapy because the patient experiences severe diarrhoea and can easily become nutritionally deficient as well as develop fluid and electrolyte imbalance. The patient is most likely not in pain at this point, and this is an intervention not a goal.
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
Platelets, imipenem cilastatin, amphotericin B, packed RBCs
Although the client is currently asymptomatic, a platelet count of 3,000 mm2 puts him at risk for spontaneous hemorrhage, the most immediate and serious risk he faces. A WBC count of 0 clearly indicates neutropenia; the client needs an antibiotic and antifungal therapy to prevent infection. Although the client is anemic, he's currently asymptomatic. The absence of clinical manifestations makes his need for a transfusion less urgent.
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.
Drink liquid iron preparations with a straw.
Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption.
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)
c) A crystalloid solution such as lactated Ringer's
d) Fresh frozen plasma
Fresh frozen plasma
Treatment includes transfusion of fresh blood, frozen plasma, factor VIII concentrate, and anti-inhibitor coagulant complex for hemophilia A, factor IX concentrate for hemophilia B, factor XI for hemophilia C, and the application of thrombin or fibrin to the bleeding area. Other measures used to help control bleeding are the administration of fresh frozen plasma, aminocaproic acid (Amicar) that helps to hold a clot in place once it has formed, direct pressure over the bleeding site, and cold compresses or ice packs. Hespan, lactated Ringer's, or albumin will not control the bleeding related to hemophilia.
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.
• Increase hydration.
• Administer allopurinol (Zyloprim).
• Administer rasburicase (Elitek).
Increased uric acid and phosphorus levels after chemotherapy for AML can lead to renal calculi formation. Increasing hydration and administering allopurinol (a uricosuric) will help to eliminate the uric acid. Elitek is an enzyme that can also decrease uric acid. Administration of potassium is not indicated as levels are elevated after chemotherapy. Exercise is not initially encouraged because the patient could have weakness and cramping during this time.
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
Serum calcium level 13.8 mg/dl
Excessive thirst, constipation, dehydration, confusion, and altered mental state are possible signs of hypercalcemia. Hypercalcemia is common in multiple myeloma because of the increased bone destruction. A platelet count of 300,000/mm3 is normal and wouldn't cause the client's symptoms. A sodium level of 133 mEq/L is slightly decreased but wouldn't cause confusion and excessive thirst. A hemoglobin of 9.8 g/dl level is slightly low but isn't likely responsible for the client's symptoms.
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.
Assess the patient's hemoglobin and platelets.
Patients with AML may develop pallor from anemia and bleeding tendencies from low platelet counts. Assessing the patient's hemoglobin and platelets will help to determine if this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.
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
To closely monitor the rate of administration
In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia.
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
Rich sources of vitamin C
Sources of vitamin C such as citrus fruits and juices, strawberries, green peppers, and tomatoes enhance the absorption of nonheme iron. To maximize nonheme iron absorption, the client should consume a rich source of vitamin C at every meal. Meat, egg yolks, oysters, and shellfish are the sources of heme iron whose absorption is influenced by body need. Vitamin E and sources of vitamin B12 do not promote the absorption of iron.
Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and platelets?
Pancytopenia may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.
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
d) Aplastic anemia
Clients with a plastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client's blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. The blood cell count shows insufficient numbers of blood cells. A bone marrow aspiration confirms that the production of stem cells is suppressed. This scenario does not describe a client with pernicious anemia, iron-deficiency anemia, or agranulocytosis.
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
Performs a neurologic assessment with vital signs
With platelets less than 10,000/mm³ there is a risk for spontaneous bleeding, including within the cranial vault. The nurse performs a neurologic examination to assess for this possibility. Though the client is receiving immunosuppressants, it is not necessary to use contact precautions with this client. Contact precautions are used with clients who have known or suspected transmittable illnesses. Diphenoxylate/atropine can cause constipation and inhibit accurate assessment of the client's gastrointestinal bleeding. If the client strains when having a bowel movement, the client could bleed even more. The client is not to floss vigorously; doing so can cause bleeding.
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
For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).
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
e) Inadequate formed white blood cells
• Destruction of normally formed red blood cells
• Abnormal erythrocyte production
• Blood loss
Most anemias result from (1) blood loss, (2) inadequate or abnormal erythrocyte production, or (3) destruction of normally formed red blood cells. The most common types include hypovolemic anemia, iron-deficiency anemia, pernicious anemia, folic acid deficiency anemia, sicklecell anemia, and hemolytic anemias. Although each form of anemia has unique manifestations, all share a common core of symptoms. Anemia does not result from infection or 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
Employs the Z-track technique
When iron medications are given intramuscularly, the nurse uses the Z-track technique to avoid local pain and staining of the skin. The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 189- or 20-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)
Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate are seen; this process is referred to as tumor lysis (cell destruction) syndrome (see Chapter 15). The increased uric acid and phosphorus levels make the patient vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Patients require a high fluid intake, and prophylaxis with allopurinol (Zyloprim) to prevent crystallization of uric acid and subsequent stone formation.
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?
Pernicious anemia may be accompanied by a dementia with symptoms similar to Alzheimer's disease. Therefore, clients experiencing cognitive changes should be screened because early detection of pernicious anemia is critical to prevent neurologic damage.
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.
The patient can 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. Careful assessment for this complication should be conducted and a thorough evaluation of the patient's dentition should be performed prior to initiating bisphosphonate therapy, including panoramic dental x-rays.
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.
Evaluate the patient's platelet count.
Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000 x mm 3. The bleeding is usually unrelated to falling. Keeping the patient on bed rest will not prevent bleeding when the patient has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.
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%
Platelet count of 9,000/mm3
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 (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.
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
c) Tissue infarction
d) Pulmonary embolus
Congestive heart failure
The symptoms exhibited by this client are indicative of congestive heart failure. Complications include hypertension, congestive heart failure, stroke, tissue and organ infarction, and hemorrhage. Stroke would present with headache, aphasia, and/or numbness in extremities. Tissue infarction would involve extremity discoloration or an organ failure. Pulmonary embolism would be associated with chest pain.
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."
"Chronic leukemia develops slowly."
Chronic leukemia develops slowly, and the majority of leukocytes are still maturing. Acute leukemia develops quickly and the majority of leukocytes are undifferentiated cells.
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.
Drink at least 8 glasses of water every day.
During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7.
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.
Osteoclasts break down bone cells so pathologic fractures occur.
The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This in turn causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a 'punched-out' or 'honeycombed' appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. Options A, C, and D are distractors for this question.
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
Blood loss from the gastrointestinal or genitourinary tract
If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tract is suspected. This is because iron deficiency anemia is unusual in older adults as the body does not eliminate excessive iron, causing total body iron stores to increase with age. Excessive consumption of coffee or tea is not a causative factor for anemia in older adults.
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.
• Support painful joints on pillows.
• Encourage client to use a soft toothbrush and rinse the mouth with warm water between and after meals.
Interventions are implemented to reduce pain and discomfort and to prevent further bleeding episodes. NSAIDs and aspirin are eliminated because these drugs can increase bleeding tendencies. The nurse takes the temperature over the temporal artery or tympanically to avoid oral or rectal injuries and checks the urine and stools for signs of bleeding.
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
Notify the physician
Thrombocytopenia is evidenced by purpura, small hemorrhages in the skin, mucous membranes, or subcutaneous tissues. Bleeding from other parts of the body, such as the nose, oral mucous membrane, and the gastrointestinal tract, also occurs. Internal hemorrhage, which can be severe and even fatal, is possible. This nurse should notify the physician of the suspected disorder.
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.
Assist the client to sit in a chair for meals.
Fatigue is a common symptom with clients who have leukemia. Despite the fatigue, clients still need to maintain some physical activity. An example of physical activity is having the client sit in a chair for meals. The nurse does not want to encourage complete bedrest or sedentary activities, such as watching television, due to possible deconditioning. The nurse has not discussed with the client about limiting family visits. The client may want some family to visit.
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
Stem cells may differentiate into myeloid or lymphoid stem cells. A band cell is a slightly immature neutrophil. A spherocyte is a red blood cell without central pallor. A reticulocyte is a slightly immature red blood cell.
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.
Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.
Neutropenia occurs when the absolute neutrophil count falls below 1,000/mm3, reflecting a severe risk of infection. The nurse should provide a low-bacterial diet, which means eliminating fresh fruits and vegetables, avoiding invasive procedures such as enemas, and practicing frequent hand washing. Using a soft toothbrush, avoiding straight-edged razors and enemas, and monitoring for bleeding are precautions for clients with thrombocytopenia. Putting on a mask, gown, and gloves when entering the client's room are reverse isolation measures. A neutropenic client doesn't need a clear liquid diet or sodium restrictions.
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
Maintaining adequate blood pressure control
The client with polycythaemia vera needs to control blood pressure, because of the increased risk for thrombosis or haemorrhage. Iron supplements can stimulate red blood cell production. Ingestion of alcohol may cause bleeding. Bathing in cool or tepid water may control itching, but this is not as high a priority as preventing thrombosis or haemorrhage
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
Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.
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."
"I will be in the hospital for several weeks."
Induction therapy involves high doses of several medications and the patient is usually admitted into the hospital for several weeks. The treatment is started quickly and the goal is to cure or put the patient into remission.
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."
"Consolidation therapy is administered to reduce the chance of leukaemia recurrence."
Consolidation therapy is administered to eliminate residual leukaemia cells that are not clinically detectable and reduce the chance for recurrence. It is also termed post-remission therapy. It is not a side effect of chemotherapy, but the administration of chemotherapy.
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.
c) Calcified bones
d) Pathologic fractures
Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and 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
Despite advances in understanding of the biology of AML, substantive advances in treatment response rates and survival rates have not occurred for decades, with the exception of advances made in treating APL (see later discussion). Even for patients with subtypes that have not benefited from advances in treatment, cure is still possible. The overall objective of treatment is to achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow. Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks.
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
The term coagulopathy refers to conditions in which a component that is necessary to control bleeding is missing or inadequate.
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
Side effects of radiation therapy are limited to the area being irradiated. Clients who have abdominal radiation therapy may experience diarrhoea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal oedema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.
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.
Send the patient for x-ray study of the spine.
The patient with myeloma can have bone pain, especially in the back and ribs. The pain will decrease with rest and increase with activity. Lying on a hard surface will not relieve the pain. The priority action is to make certain the patient does not have a fracture of the spine, as the bone destruction in this disease is sufficiently severe to cause vertebral collapse.
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.
Assess renal function.
Chemotherapy results in the destruction of cells and tumor lysis syndrome. There is an increase in uric acid and phosphorus levels and the patient is susceptible to renal failure. The nurse should assess renal function if the patient complains of lower back pain as this could be indicative of a kidney stone formation. Heating pads, pain medication, and referrals could be instituted once the cause of the pain is determined. The priority is further assessment to rule out priority problems.
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