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Flashcards in Hematological Disorders Deck (131)
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1

The nurse is caring for clients on an oncology unit. Which neutropenia precautions should be implemented? 1. Hold all venipuncture sites for at least five (5) minutes. 2. Limit fresh fruits and flowers. 3. Place all clients in reverse isolation. 4. Have the client use a soft-bristle toothbrush.

2. Fresh fruits and flowers may carry bacteria or insects on the skin of the fruit or dirt on the flowers and leaves, so they are restricted around clients with low white blood cell counts.

2

The nurse is assessing a client diagnosed with acute myeloid leukemia. Which assessment data support this diagnosis? 1. Fever and infections. 2. Nausea and vomiting. 3. Excessive energy and high platelet counts. 4. Cervical lymph node enlargement and positive acid-fast bacillus.

1. Fever and infection are hallmark symptoms of leukemia. They occur because the bone marrow is unable to produce white blood cells of the number and maturity needed to fight infection.

3

The client diagnosed with leukemia has central nervous system involvement. Which instructions should the nurse teach? 1. Sleep with the head of the bed elevated to prevent increased intracranial pressure. 2. Take an analgesic medication for pain only when the pain becomes severe. 3. Explain that radiation therapy to the head may result in permanent hair loss. 4. Discuss end-of-life decisions prior to cognitive deterioration.

3. Radiation therapy to the head and scalp area is the treatment of choice for central nervous system involvement of any cancer. Radiation therapy has longer-lasting side effects than chemotherapy. If the radiation therapy destroys the hair follicle, the hair will not grow back.

4

The client diagnosed with leukemia is scheduled for a bone marrow transplant. Which interventions should be implemented to prepare the client for this procedure? Select all that apply. 1. Administer high-dose chemotherapy. 2. Teach the client about autologous transfusions. 3. Have the family members’ HLA typed 4. Monitor the complete blood cell count daily. 5. Provide central line care per protocol.

1. All of the bone marrow cells must be destroyed prior to “implanting” the healthy bone marrow. High-dose chemotherapy and full-body irradiation therapy are used to accomplish this. 3. The best bone marrow donor comes from an identical twin; next best comes from a sibling who matches. The most complications occur from a matched unrelated donor (MUD). The client’s body recognizes the marrow as foreign and tries to reject it, resulting in graft-versus-host disease (GVHD). 4. The CBC must be monitored daily to assess for infections, anemia, and thrombocytopenia. 5. Clients will have at lest one multiple-line central venous access. These clients are seriously ill and require multiple transfusions and antibiotics.

5

The client is diagnosed with chronic lymphocytic leukemia (CLL) after routine laboratory tests during a yearly physical. Which is the scientific rationale for the random nature of discovering the illness? 1. CCL is not serious, and clients die from other causes first. 2. There are no symptoms with this form of leukemia. 3. This is a childhood illness and is self-limiting. 4. In early stages of CLL the client may be asymptomatic.

4. In this form of leukemia the cells seem to escape apoptosis (programmed cell death), which results in many thousands of mature cells clogging the body. Because the cells are mature, the client may be asymptomatic in the early stages.

6

The client diagnosed with leukemia is being admitted for an induction course of chemotherapy. Which laboratory values indicate a diagnosis of leukemia? 1. A left shift in the white blood cell count differential. 2. A large number of WBCs that decreases after the administration of antibiotics. 3. An abnormally low hemoglobin (Hgb) and hematocrit (Hct) level. 4. Red blood cells that are larger than normal.

1. A left shift indicates that immature white blood cells are being produced and released into the circulating blood volume. This should be investigated for the malignant process of leukemia.

7

Which medication is contraindicated for a client diagnosed with leukemia? 1. Bactrim, a sulfa antibiotic. 2. Morphine, a narcotic analgesic. 3. Epogen, a biologic response modifier. 4. Gleevec, a genetic blocking agent.

3. Epogen is a biologic response modifier that stimulates the bone marrow to produce red blood cells. The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow would be generally ineffective for the desired results and would have the potential to stimulate malignant growth.

8

The laboratory results for a male client diagnosed with leukemia include RBC count 2.1 mm 106, WBC 150 mm 103, platelets 22 103, K 3.8 mEq/L, Na 139mEq/L. Based on these results, which interventions should the nurse teach the client? 1. Encourage the client to eat foods high in iron. 2. Instruct the client to use an electric razor when shaving. 3. Discuss the importance of limiting sodium in the diet. 4. Instruct the family to limit visits to once a week.

2. The platelet count of 22 103 indicates a platelet count of 22,000. The definition of thrombocytopenia is a count less than 100,000. This client is at risk for bleeding. Bleeding precautions include decreasing the risk by using soft-bristle toothbrushes and electric razors and holding all venipuncture sites for a minimum of five (5) minutes.

9

The nurse writes a nursing problem of “altered nutrition” for a client diagnosed with leukemia who has received a treatment regimen of chemotherapy and radiation. Which nursing intervention should be implemented? 1. Administer an antidiarrheal medication prior to meals. 2. Monitor the client’s serum albumin levels. 3. Assess for signs and symptoms of infection. 4. Provide skin care to irradiated areas,

2. Serum albumin is a measure of the protein content in the blood that is derived from the foods eaten; albumin monitors nutritional status.

10

The nurse and licensed practical nurse (LPN) are caring for clients on an oncology floor. Which client should not be assigned to the LPN? 1. The client newly diagnosed with chronic lymphocytic leukemia. 2. The client who is four (4) hours post-procedure bone marrow biopsy. 3. The client who received two (2) units of PRBCs on the previous shift. 4. The client who is receiving multiple intravenous piggyback medications.

1. The newly diagnosed client will need to be taught about the disease and about treatment options. The registered nurse cannot delegate teaching to a an LPN.

11

The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed? 1. Infection. 2. Anemia. 3. Nutrition. 4. Grieving.

4. Grieving is an independent problem, and the nurse can assess and treat this problem with or without collaboration.

12

The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assessment data warrant immediate intervention? 1. T 99, P 102, R 22, and BP 132/68. 2. Hyperplasia of the gums. 3. Weakness and fatigue. 4. Pain in the left upper quadrant.

4. Pain is expected, but it is a priority, and pain control measures should be implemented.

13

The client diagnosed with non-Hodgkin’s lymphoma is scheduled for a lymphangiogram. Which information should the nurse teach? 1. The scan will identify any malignancy in the vascular system. 2. Radiopaque dye will be injected between the toes. 3. The test will be done similar to a cardiac angiogram. 4. The test will be completed in about five (5) minutes.

2. Dye is injected between the toes of both feet and then scans are performed in a few hours, at 24 hours, and then possibly once a day for several days.

14

The client asks the nurse, “They say I have cancer. How can they tell if I have Hodgkin’s disease from a biopsy?” The nurse’s answer is based on which scientific rationale? 1. Biopsies are nuclear medicine scans that can detect cancer. 2. A biopsy is a laboratory test that detects cancer cells. 3. It determines which kind of cancer the client has. 4. The HCP takes a small piece out of the tumor and looks at the cells.

4. A biopsy is the removal of cells from a mass and examination of the tissue under a microscope to determine if the cells are cancerous. Reed-Sternberg cells are diagnostic for Hodgkin’s disease. If these cells are not found in the biopsy, the HCP can rebiopsy to make sure the specimen provided the needed sample or, depending on involvement of the tissue, diagnose a non- Hodgkin’s lymphoma.

15

The nurse is admitting a client with rule-out Hodgkin’s lymphoma. When the nurse assesses the client, which data would support this diagnosis? 1. Night sweats and fever without “chills.” 2. Edematous lymph nodes in the groin. 3. Malaise and complaints of an upset stomach. 4. Pain in the neck area after a fatty meal.

1. Clients in late stages of Hodgkin’s disease experience drenching diaphoresis, especially at night; fever without chills; and unintentional weight loss. Early-stage disease is indicated by a painless enlargement of a lymph node on one side of the neck (cervical area). Pruritus is also a common symptom.

16

Which client is at the highest risk for developing a lymphoma? 1. The client diagnosed with chronic lung disease who is taking a steroid. 2. The client diagnosed with breast cancer who has extensive lymph involvement. 3. The client who received a kidney transplant several years ago. 4. The client who has had ureteral stent placements for a neurogenic bladder.

3. Clients who have received a transplant must take immunosuppressive medications to prevent rejection of the organ. This immunosuppression blocks the immune system from protecting the body against cancers and other diseases. There is a high incidence of lymphoma among transplant recipients.

17

The female client recently diagnosed with Hodgkin’s lymphoma asks the nurse about her prognosis. Which is the nurse’s best response? 1. Survival for Hodgkin’s disease is relatively good with standard therapy. 2. Survival depends on becoming involved in an investigational therapy program. 3. Survival is poor, with more than 50% of clients dying within six (6) months. 4. Survival is fine for primary Hodgkin’s, but secondary cancers occur within a year.

1. Up to 90% of clients responds well to standard treatment with chemotherapy and radiation therapy, and those that relapse usually respond to a change of chemotherapy medications. Survival depends on the individual client and the stage of disease at diagnosis.

18

The nurse writes the problem of “grieving” for a client diagnosed with non-Hodgkin’s lymphoma. Which collaborative intervention should be included in the plan of care? 1. Encourage the client to talk about feelings of loss. 2. Arrange for the family to plan a memorable outing. 3. Refer the client to the American Cancer Society’s (ACS) Dialogue group. 4. Have the chaplain visit with the client.

4. Collaborative interventions involve other departments of the health-care facility. A chaplain is a referral that can be made, and the two disciplines should work together to provide the needed interventions

19

Which test is considered diagnostic for Hodgkin’s lymphoma? 1. A magnetic resonance image (MRI) of the chest. 2. A computed tomography (CT) scan of the cervical area. 3. An erythrocyte sedimentation rate (ESR). 4. A biopsy of the cervical lymph nodes.

4. Cancers of all types are definitively diagnosed through biopsy procedures. The pathologist must identify Reed-Sternberg cells for a diagnosis of Hodgkin’s disease

20

Which client should be assigned to the experienced medical-surgical nurse who is in the first week of orientation to the oncology floor? 1. The client diagnosed with non-Hodgkin’s lymphoma who is having daily radiation treatments. 2. The client diagnosed with Hodgkin’s disease who is receiving combination chemotherapy. 3. The client diagnosed with leukemia who has petechiae covering both anterior and posterior body surfaces. 4. The client diagnosed with diffuse histolytic lymphoma who is to receive two (2) units of packed red blood cells.

4. This client is receiving blood. The nurse with experience on a medical-surgical floor should be able to administer blood and blood products.

21

Which information about reproduction should be taught to the 27-year-old female client diagnosed with Hodgkin’s disease? 1. The client’s reproductive ability will be the same after treatment is completed. 2. The client should practice birth control for at least two (2) years following therapy. 3. All clients become sterile from the therapy and should plan to adopt. 4. The therapy will temporarily interfere with the client’s menstrual cycle.

2. The client should be taught to practice birth control during treatment and for at least two (2) years after treatment has ceased. The therapies used to treat the cancer can cause cancer. Antineoplastic medications are carcinogenic, and radiation therapy has proved to be a precursor toleukemia. A developing fetus would be subjected to the internal conditions of the mother.

22

Which clinical manifestation of Stage I non-Hodgkin’s lymphoma would the nurse expect to find when assessing the client? 1. Enlarged lymph tissue anywhere in the body. 2. Tender left upper quadrant. 3. No symptom in this stage. 4. Elevated B cell lymphocytes on the CBC.

3. Stage I lymphoma presents with no symptoms; for this reason, clients are usually not diagnosed until the later stages of lymphoma.

23

The nurse and an unlicensed assistive personnel (UAP) are caring for clients in a bone marrow transplant unit. Which nursing task should the nurse delegate? 1. Take the hourly vital signs on a client receiving blood transfusions. 2. Monitor the infusion of antineoplastic medications. 3. Transcribe the doctor’s orders onto the Medication Administration Record (MAR). 4. Determine the client’s response to the therapy.

1. After the first 15 minutes during which the client tolerates the blood transfusion, it is appropriate to ask the unlicensed nursing assistant to take the vital signs as long as the assistant has been given specific parameters for the vital signs. Any vital sign outside the normal parameters must have an intervention by the nurse.

24

The 33-year-old client diagnosed with Stage IV Hodgkin’s lymphoma is at the five (5)- year remission mark. Which information should the nurse teach the client? 1. Instruct the client to continue scheduled screenings for cancer. 2. Discuss the need for follow-up appointments every five (5) years. 3. Teach the client that the cancer risk is now the same as for the general population. 4. Have the client talk with the family about funeral arrangements.

1. The five (5)-year mark is a time for celebration for clients diagnosed with cancer, but the therapies can cause secondary malignancies and there may be a genetic predisposition for the client to develop cancer. The client should continue to be tested regularly.

25

The nurse is admitting a 24-year-old African American female client with a diagnosis of rule-out anemia. The client has a history of gastric bypass surgery for obesity four (4) years ago. Current assessment findings include height 55 ; weight 75 kg; P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of anemia would the nurse suspect the client has developed? 1. Vitamin B12 deficiency. 2. Folic acid deficiency. 3. Iron deficiency. 4. Sickle cell anemia.

1. The rugae in the stomach produce intrinsic factor, which allows the body to use vitamin B12 from the foods eaten. Gastric bypass surgery reduces the amount of rugae drastically. Clients develop pernicious anemia (vitamin B12 deficiency). Other symptoms of anemia include dizziness and the tachycardia and dyspnea listed in the stem.

26

The client diagnosed with menorrhagia complains to the nurse of feeling listless and tired all the time. Which scientific rationale would explain why these symptoms occur? 1. The pain associated with the menorrhagia does not allow the client to rest. 2. The client’s symptoms are unrelated to the diagnosis of menorrhagia. 3. The client probably has been exposed to a virus that causes chronic fatigue. 4. Menorrhagia has caused the client to have decreased levels of hemoglobin.

4. Menorrhagia is excessive blood loss during menses. If the blood loss is severe, then the client will not have the blood’s oxygencarrying capacity needed for daily activities. The most frequent symptom and complication of anemia is fatigue. It frequently has the greatest impact on the client’s ability to function and quality of life.

27

The nurse writes a diagnosis of altered tissue perfusion for a client diagnosed with anemia. Which interventions should be included in the plan of care? Select all that apply. 1. Monitor the client’s Hb and Hct. 2. Move the client to a room near the nurse’s desk. 3. Limit the client’s dietary intake of green vegetables. 4. Assess the client for numbness and tingling. 5. Allow for rest periods during the day for the client.

1. The nurse should monitor the hemoglobin and hematocrit in all clients diagnosed with anemia. 2. Because decreased oxygenation levels to the brain can cause the client to become confused, a room where the client can be observed frequently—near the nurse’s desk—is a safety issue. 4. Numbness and tingling may occur in anemia as a result of neurological involvement. 5. Fatigue is the number-one presenting symptom of anemia.

28

The client diagnosed with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client? 1. Take Imodium, an antidiarrheal, OTC for diarrhea. 2. Limit exercise for several weeks until a tolerance is achieved. 3. The stools may be very dark, and this can mask blood. 4. Eat only red meats and organ meats for protein.

3. The stool will be a dark green–black and can mask the appearance of blood in the stool.

29

The nurse and unlicensed nursing assistant are caring for clients on a medical unit. Which task should the nurse delegate to the unlicensed nursing assistant? 1. Check on the bowel movements of a client diagnosed with melena. 2. Take the vitals signs of a client who received blood the day before. 3. Evaluate the dietary intake of a client who has been noncompliant with eating. 4. Shave the client diagnosed with severe hemolytic anemia.

2. The unlicensed nursing assistant can take the vital signs of a client who is stable; this client received the blood the day before.

30

The client is diagnosed with congestive heart failure and anemia. The HCP ordered a transfusion of two (2) units of packed red blood cells. The unit has 250 mL of red blood cells plus 45 mL of additive. At what rate should the nurse set the IV pump to infuse each unit of packed red blood cells?____________________

74 mL/hour. Pumps are set at an hourly rate. The client in congestive heart failure should receive blood at the slowest possible rate to prevent the client from further complications of fluid volume overload. Each unit of blood must be infused within four (4) hours of initiation of the infusion. 250 mL 45 mL 295 ml 295 mL ÷ 4 73 3/4 mL/hour, which rounded is 74 mL/hour