Chapter 30 Flashcards
(44 cards)
The nurse is caring for a client 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?
Allopurinol
Explanation:
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. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Clients require a high fluid intake, and prophylaxis with allopurinol or rasburicase to prevent crystallization of uric acid and subsequent stone formation
A client with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse’s best understanding of the pathophysiological reason for this symptom?
The dead red blood cells release excess uric acid.
Explanation:
There is a rapid proliferation of red blood cells from the marrow in polycythemia vera. However, these red blood cells die sooner than normal and the dead red blood cells release potassium and uric acid. This build up of uric acid in the blood leads to gouty arthritis symptoms.
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan?
“Consolidation therapy is administered to reduce the chance of leukemia recurrence.”
Explanation:
Consolidation therapy is administered to eliminate residual leukemia 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.
A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess?
A leukocyte count >100,000/mm3
Explanation:
Although there is an increase in the production of blast cells and the client may have an enlarged liver and tender spleen, it is the high leukocyte count that is diagnostic. Lymphadenopathy is rare.
The nurse is administering packed red blood cell (RBC) transfusions for a client with myelodysplastic syndrome (MDS). The client has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions?
Iron levels
Explanation:
For most clients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These clients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).
An oncology nurse is providing health education for a client who has recently been
diagnosed with leukemia. What should the nurse explain about commonalities between
all of the different subtypes of leukemia?
A. The different leukemias all involve unregulated proliferation of white blood cells.
B. The different leukemias all have unregulated proliferation of red blood cells and
decreased bone marrow function.
C. The different leukemias all result in a decrease in the production of white blood
cells.
D. The different leukemias all involve the development of cancer in the lymphatic
system.
ANS: A
Rationale: Leukemia commonly involves unregulated proliferation of white blood cells.
Decreased production of red blood cells is associated with anemias. Decreased
production of white blood cells is associated with leukopenia. The leukemias are not
characterized by their involvement with the lymphatic system.
A nurse is caring for a client who has a diagnosis of acute myelocytic leukemia (AML).
Assessment of which factor most directly addresses the most common cause of death
among clients with leukemia?
A. Infection status
B. Nutritional status
C. Electrolyte levels
D. Liver function
ANS: A
Rationale: Because of the lack of mature and normal granulocytes that help fight
infection, clients with leukemia are prone to infection. In clients with AML, death typically
occurs from infection or bleeding. Symptoms of AML include weight loss, fever, night
sweats, and fatigue, which would guide the nurse to monitor the client’s nutrition and
electrolytes. Gastrointestinal problems (nausea and vomiting) and electrolyte
imbalances (hyperkalemia and hypocalcemia) may result from chemotherapy use. The
liver is responsible for metabolism and metabolic detoxification, so monitoring liver
function is important for the client who is receiving chemotherapy. These problems may
contribute to and/or result in death but are not the most common cause.
An oncology nurse is caring for a client with multiple myeloma who is experiencing
bone destruction. When reviewing the client’s most recent blood tests, the nurse should
anticipate which imbalance?
A. Hypercalcemia
B. Hyperproteinemia
C. Elevated serum viscosity
D. Elevated red blood count (RBC)
ANS: A
Rationale: Hypercalcemia may result when bone destruction occurs due to the disease
process. Elevated serum viscosity occurs because plasma cells excrete excess
immunoglobulin but would not result from bone destruction. The RBC count will decrease,
not increase, resulting in anemia due to the abnormal protein produced from the
malignant cells. Hyperproteinemia is defined as high protein in the blood and is
commonly seen in clients with dehydration but would not result from bone destruction.
A nurse is planning the care of a client who has been admitted to the medical unit with
a diagnosis of multiple myeloma. In the client’s care plan, the nurse has identified a
diagnosis of Risk for Injury, which should be attributed to which factor?
A. Labyrinthitis
B. Left ventricular hypertrophy
C. Decreased bone density
D. Hypercoagulation
ANS: C
Rationale: Clients with multiple myeloma are at risk for pathologic bone fractures
secondary to diffuse osteoporosis (decreased bone density) and osteolytic lesions.
Labyrinthitis is uncharacteristic, and clients do not normally experience hypercoagulation
or cardiac hypertrophy as a result of multiple myeloma.
A client with a new diagnosis of leukemia is about to start treatment and expresses
fear and anxiety with the prognosis. Which action is the nurse’s most appropriate?
A. Communicate to the health care provider the need to provide more information
to the client and family.
B. Assess how much information is desired from the client in terms of illness,
treatment, and complications.
C. Offer to call pastoral services and review hospice and/or palliative care so the
client can have a quiet, dignified death.
D. Encourage the client to call their family and discuss immediate role restructuring
in both their family and professional life.
ANS: B
Rationale: As with any client exhibiting anxiety and fear about a prognosis, listening
should come first in order to assess how much information the client wants to have
regarding the illness, treatment and potential complications. This is an ongoing
assessment, since needs and interest in information changes throughout the course of
treatment. Managing a client’s care is a team effort, so involving the primary care
provider and family is important, but not the nurse’s priority action. Offering pastoral
services and role restructuring has its place in treatment but should be discussed after an
assessment of the client’s needs. A discussion about palliative care and hospice is not
appropriate at this time. Offering realistic hope is important and only after all treatment
options are exhausted, or the client is diagnosed as terminal, should palliative and/or
hospice care be considered.
A nurse is caring for a client with acute myeloid leukemia who is preparing to undergo
induction therapy. In preparing a plan of care for this client, the nurse should assign the
highest priority to which nursing diagnosis?
A. Activity intolerance
B. Risk for infection
C. Acute confusion
D. Risk for spiritual distress
ANS: B
Rationale: Induction therapy places the client at risk for infection, thus this is the priority
nursing diagnosis. During the time of induction therapy, the client is very ill, with
bacterial, fungal, and occasional viral infections; bleeding and severe mucositis, which
causes diarrhea; and marked decline in the ability to maintain adequate nutrition.
Supportive care consists of administering blood products and promptly treating
infections. Immobility, confusion, and spiritual distress are possible, but infection is the
client’s most acute physiologic threat.
A nurse is providing care to a client with multiple myeloma with reports of nausea,
diarrhea, alopecia, and red urine. The client’s recent interventions include
electrocardiogram (ECG), multigated acquisition scan (MUGA), and a central line venous
access placed on the right chest wall. Which medication is the client most likely
receiving?
A. Dexamethasone
B. Lenalidomide
C. Doxorubicin
D. Etoposide
ANS: C
Rationale: Doxorubicin is a chemotherapeutic drug and typically part of a combination
regimen. Side effects of this medication include nausea, vomiting, alopecia (hair loss),
and orange or red urine. Red urine is not listed as a side effect on any other of the
medications listed. Doxorubicin can have a cardiotoxic effect (cardiomyopathy &
arrhythmias), so ECG and MUGA scans (evaluate pumping function of the ventricles)
are
done before and periodically throughout treatment. This drug is a vesicant (causes
blistering) and can result in tissue necrosis if the medication leaks into the tissues
surrounding a vein due to an infiltrate. A central line is placed to avoid that complication.
Etoposide and lenalidomide are both chemotherapy drugs without the typical adverse
effect of cardiotoxicity Etoposide is an irritant with a low vesicant potential.
Dexamethasone is a steroid that does not have the side effect of alopecia nor requires
central venous access.
A 35-year-old client is admitted to the hospital reporting severe headaches, vomiting,
and testicular pain. The client’s blood work shows reduced numbers of platelets,
leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring
for this client suspects which diagnosis?
A. Acute myeloid leukemia (AML)
B. Chronic myeloid leukemia (CML)
C. Myelodysplastic syndromes (MDS)
D. Acute lymphocytic leukemia (ALL)
ANS: D
Rationale: In acute lymphocytic leukemia (ALL), manifestations of leukemic cell
infiltration into other organs are more common than with other forms of leukemia, and
include pain from an enlarged liver or spleen, as well as bone pain. The central nervous
system is frequently a site for leukemic cells; thus, clients may exhibit headache and
vomiting because of meningeal involvement. Other extranodal sites include the testes
and breasts. All the listed types of leukemia, depending on severity and stage, can have
the same blood work results. The difference is the client’s signs and symptoms, which are
closely associated with ALL. A large number of clients when first diagnosed with any type
of leukemia are asymptomatic or have nonspecific symptoms It is discovered on routine
lab work.
A client with leukemia has developed stomatitis and is experiencing a nutritional
deficit. An oral anesthetic has consequently been prescribed. What health education
should the nurse provide to the client?
A. Chew with care to avoid inadvertently biting the tongue.
B. Use the oral anesthetic 1 hour prior to mealtime.
C. Brush teeth before and after eating.
D. Swallow slowly and deliberately.
ANS: A
Rationale: If oral anesthetics are used, the client must be warned to chew with extreme
care to avoid inadvertently biting the tongue or buccal mucosa. An oral anesthetic would
be metabolized by the time the client eats if it is used 1 hour prior to meals. There is no
specific need to warn the client about brushing teeth or swallowing slowly because an oral
anesthetic has been used.
A client diagnosed with acute myeloid leukemia has just been admitted to the
oncology unit. When writing this client’s care plan, which potential complication should
the nurse address?
A. Pancreatitis
B. Hemorrhage
C. Arteritis
D. Liver dysfunction
ANS: B
Rationale: Complications of AML include bleeding and infection, which are the major
causes of death. The risk of bleeding correlates with the level and duration of platelet
deficiency. The low platelet count can cause ecchymoses and petechiae. Major
hemorrhages also may develop when the platelet count drops to less than 10,000/mm3
.
The most common bleeding sources include gastrointestinal (GI), pulmonary, vaginal,
and intracranial. Pancreatitis, arteritis, and liver dysfunction are generally not
complications of leukemia.
An emergency department nurse is triaging a 77-year-old client who presents with
uncharacteristic fatigue as well as back and rib pain. The client denies any recent injuries.
The nurse should recognize the need for this client to be assessed for which health
problem?
A. Hodgkin disease
B. Non-Hodgkin lymphoma
C. Multiple myeloma
D. Acute thrombocythemia
ANS: C
Rationale: Back pain, which is often a presenting symptom in multiple myeloma, should
be closely investigated in older clients. The lymphomas and bleeding disorders do not
typically present with the primary symptom of back pain or rib pain.
A home health nurse is caring for a client with multiple myeloma. What intervention
should the nurse prioritize when addressing the client’s severe bone pain?
A. Implementing distraction techniques
B. Educating the client about the effective use of hot and cold packs
C. Teaching the client to use NSAIDs effectively
D. Helping the client manage the opioid analgesic regimen
ANS: D
Rationale: For severe pain resulting from multiple myeloma, opioids are likely necessary.
NSAIDs would likely be ineffective and are associated with significant adverse effects.
Hot and cold packs as well as distraction would be insufficient for severe pain, though
they may be useful as adjuncts.
A nurse is caring for a client with Hodgkin lymphoma at the oncology clinic. The nurse
should identify what main goal of care?
A. Cure of the disease
B. Enhancing quality of life
C. Controlling symptoms
D. Palliation
ANS: A
Rationale: The goal in the treatment of Hodgkin lymphoma is cure. Palliation is thus not
normally necessary. Quality of life and symptom control are vital, but the overarching
goal is the cure of the disease.
A client with Hodgkin lymphoma is receiving information from the oncology nurse.
The client asks the nurse why it is necessary to stop drinking and smoking and stay out
of the sun. Which response by the nurse would be best?
A. “Avoiding these factors can reduce the risk of Reed-Sternberg cells developing.”
B. “These behaviors can reduce the effectiveness of your chemotherapy.”
C. “Engaging in these activities increases your risk of hemorrhage.”
D. “It’s important to reduce other factors that increase the risk of second cancers.”
ANS: D
Rationale: The nurse should encourage clients to reduce other factors that increase the
risk of developing second cancers, such as use of tobacco and alcohol and exposure to
environmental carcinogens and excessive sunlight. The presence of Reed-Sternberg cells
is the pathologic hallmark and essential diagnostic criterion for Hodgkin lymphoma, so
avoiding these behaviors will not reduce the risk of Reed-Sternberg cells developing.
There is no evidence that these behaviors will reduce the effectiveness of chemotherapy
or increase the risk of hemorrhage, which is not a typical complication of Hodgkin
lymphoma.
A 20-year-old client with no medical history arrives at a walk-in/urgent care clinic
reporting swelling on the left side of the neck. On palpation, the lymph nodes on the neck
are painless, firm but not hard. What is the next appropriate intervention for this client?
A. Recommend immediate and urgent transfer to the nearest trauma center.
B. Perform diagnostic studies to rule out any infectious origin at a hospital.
C. Refer the client to a primary health care provider for a nonurgent appointment.
D. Complete a computed tomography scan because the client has Hodgkin
lymphoma.
ANS: B
Rationale: Although a high suspicion of Hodgkin lymphoma is present, diagnosis is
premature prior to ruling out any infectious origin with diagnostic testing. This testing is
by excisional node biopsy and usually done at a surgical center or hospital. Transfer is not
an urgent manner unless the swelling is impacting the airway. Hodgkin lymphoma usually
begins as an enlargement of one or more lymph nodes on one side of the neck. The
individual nodes are painless and firm but not hard. It is also more common in males with
2 peaks in age groups. The first peak is between 15-34 and the second is after 60 years
of age. Because these findings are consistent with Hodgkin lymphoma, a hospital
admission, not a nonurgent appointment, is appropriate. Chest x-ray, computed
tomography scan, and positron emission tomography scan are all involved in staging of
Hodgkin lymphoma.
A nurse practitioner is assessing a client who has a fever, malaise, and a white blood
cell count that is elevated. What principle should guide the nurse’s management of the
client’s care?
A. There is a need for the client to be assessed for lymphoma.
B. Infection is the most likely cause of the client’s change in health status.
C. The client is exhibiting signs and symptoms of leukemia.
D. The client should undergo diagnostic testing for multiple myeloma.
ANS: B
Rationale: Leukocytosis is most often the result of infection. It is only considered
pathologic (and suggestive of leukemia) if it is persistent and extreme. Multiple myeloma
and lymphoma are not likely causes of this constellation of symptoms.
A client with a diagnosis of acute myeloid leukemia (AML) is being treated with
induction therapy on the oncology unit. What nursing action should be prioritized in the
client’s care plan?
A. Protective isolation and vigilant use of standard precautions
B. Provision of a high-calorie, low-texture diet and appropriate oral hygiene
C. Including the family in planning the client’s activities of daily living
D. Monitoring and treating the client’s pain
ANS: A
Rationale: Induction therapy causes neutropenia and a severe risk of infection. This risk
must be addressed directly in order to ensure the client’s survival. For this reason,
infection control would be prioritized over nutritional interventions, family care, and pain,
even though each of these are important aspects of nursing care
. Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an
adult client who is otherwise healthy. The client and the care team have collaborated and
the client will soon begin induction therapy. The nurse should prepare the client for:
A. daily treatment with targeted therapy medications.
B. radiation therapy on a daily basis.
C. hematopoietic stem cell transplantation.
D. an aggressive course of chemotherapy.
ANS: D
Rationale: Attempts are made to achieve remission of AML by the aggressive
administration of chemotherapy, called induction therapy, which usually requires
hospitalization for several weeks. Induction therapy is not synonymous with radiation,
stem cell transplantation, or targeted therapies.
A nurse is caring for a client who has been diagnosed with leukemia. The nurse’s most
recent assessment reveals the presence of ecchymoses on the client’s sacral area and
petechiae on the forearms. In addition to informing the client’s primary care provider, the
nurse should perform what action?
A. Initiate measures to prevent venous thromboembolism (VTE).
B. Check the client’s most recent platelet level.
C. Place the client on protective isolation.
D. Ambulate the client to promote circulatory function.
ANSANS: B
Rationale: The client’s signs are suggestive of thrombocytopenia, thus the nurse should
check the client’s most recent platelet level. VTE is not a risk and this does not constitute
a need for isolation. Ambulation and activity may be contraindicated due to the risk of
bleeding.
