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Chapter 34: Management of Patients With Hematologic Neoplasms An oncology nurse is providing health education for a patient who has recently been diagnosed withleukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia? A) The different leukemias al...

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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter34:ManagementofPatientsWithHematologicNeoplasms  1.

Anoncologynurseisprovidinghealtheducationforapatient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 Feedback: 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.

2.

Anurseiscaringforapatientwhohasadiagnosisofacuteleukemia.Whatassessmentmostdirectly addressesthemostcommoncauseofdeathamongpatientswithleukemia?

A)

Monitoringforinfection

B)

Monitoringnutritionalstatus

C)

Monitorelectrolytelevels

D)

Monitoringliverfunction

Ans:

A Feedback: Inpatientswithacuteleukemia,deathtypicallyoccursfrominfectionorbleeding.Compromised nutrition,electrolyteimbalances,andimpairedliverfunctionareallplausible,butnoneisamongthe mostcommoncausesofdeathinthispatientpopulation.

3.

Anoncologynurseiscaringforapatientwithmultiplemyelomawhoisexperiencingbonedestruction. Whenreviewingthepatientsmostrecentbloodtests,thenurseshouldanticipatewhatimbalance?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Hypercalcemia

B)

Hyperproteinemia

C)

Elevatedserumviscosity

D)

ElevatedRBCcount

Ans:

A

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Feedback: Hypercalcemiamayresultwhenbonedestructionoccursduetothediseaseprocess.Elevatedserum viscosityoccursbecauseplasmacellsexcreteexcessimmunoglobulin.RBCcountwillbedecreased. Hyperproteinemiawouldnotbepresent. 4.

Anurseisplanningthecareofapatientwhohasbeenadmittedtothemedicalunitwithadiagnosisof multiplemyeloma.Inthepatientscareplan,thenursehasidentifiedadiagnosisofRiskforInjury.What pathophysiologiceffectofmultiplemyelomamostcontributestothisrisk?

A)

Labyrinthitis

B)

Leftventricularhypertrophy

C)

Decreasedbonedensity

D)

Hypercoagulation

Ans:

C Feedback: Clientswithmultiplemyelomaareatriskforpathologicbonefracturessecondarytodiffuseosteoporosis andosteolyticlesions.Labyrinthitisisuncharacteristic,andpatientsdonotnormallyexperience hypercoagulationorcardiachypertrophy.

5.

Apatientwithadvancedleukemiaisrespondingpoorlytotreatment.Thenursefindsthepatienttearful andtryingtoexpresshisfeelings,butheisclearlyhavingdifficulty.Whatisthenursesmostappropriate action?

A)

Tellhimthatyouwillgivehimprivacyandleavetheroom.

B)

Offertocallpastoralcare.

C)

Askifhewouldlikeyoutositwithhimwhilehecollectshisthoughts.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Tellhimthatyoucanunderstandhowhesfeeling.

Ans:

C

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Feedback: Providingemotionalsupportanddiscussingtheuncertainfuturearecrucial.Leavingisincorrectbecause leavingthepatientdoesntshowacceptanceofhisfeelings.Offeringtocallpastoralcaremaybehelpful forsomepatientsbutshouldbedoneafterthenursehasspenttimewiththepatient.Tellingthepatient thatyouunderstandhowhesfeelingisinappropriatebecauseitdoesnthelphimexpresshisfeelings. 6.

Anursingstudentiscaringforapatientwithacutemyeloidleukemiawhoispreparingtoundergo inductiontherapy.Inpreparingaplanofcareforthispatient,thestudentshouldassignthehighest prioritytowhichnursingdiagnoses?

A)

ActivityIntolerance

B)

RiskforInfection

C)

AcuteConfusion

D)

RiskforSpiritualDistress

Ans:

B Feedback: Inductiontherapyplacesthepatientatriskforinfection,thusthisistheprioritynursingdiagnosis. Duringthetimeofinductiontherapy,thepatient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patients mostacutephysiologicthreat.

7.

A77-year-oldmaleisadmittedtoaunitwithasuspecteddiagnosisofacutemyeloidleukemia(AML). Whenplanningthispatientscare,thenurseshouldbeawareofwhatepidemiologicfact?

A)

Earlydiagnosisisassociatedwithgoodoutcomes.

B)

Five-yearsurvivalforolderadultsisapproximately50%.

C)

Five-yearsurvivalforpatientsover75yearsoldislessthan2%.

D)

Survivalratesarewhollydependentonthepatientspre-illnesslevelofhealth.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

660

C Feedback: The5-yearsurvivalrateforpatientswithAMLwhoare50yearsofageoryoungeris43%;itdropsto 19%forthosebetween50and64years,anddropsto1.6%forthoseolderthan75years.Earlydiagnosis isbeneficial,butisnonethelessnotassociatedwithgoodoutcomesorhighsurvivalrates.Preillness healthissignificant,butnotthemostimportantvariable.

8.

A35-year-oldmaleisadmittedtothehospitalcomplainingofsevereheadaches,vomiting,andtesticular pain.Hisbloodworkshowsreducednumbersofplatelets,leukocytes,anderythrocytes,withahigh proportionofimmaturecells.Thenursecaringforthispatientsuspectsadiagnosisofwhat?

A)

AML

B)

CML

C)

MDS

D)

ALL

Ans:

D Feedback: 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,patientsmay exhibitheadacheandvomitingbecauseofmeningealinvolvement.Otherextranodalsitesincludethe testesandbreasts.Thisparticularpresentationisnotcloselyassociatedwithacutemyeloidleukemia (AML),chronicmyeloidleukemia(CML),ormyelodysplasticsyndromes(MDS).

9.

Apatient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 patient?

A)

Chewwithcaretoavoidinadvertentlybitingthetongue.

B)

Usetheoralanesthetic1hourpriortomealtime.

C)

Brushteethbeforeandaftereating.

D)

Swallowslowlyanddeliberately.

Ans:

A Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

661

Iforalanestheticsareused,thepatient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patienteats ifitisused1hourpriortomeals.Thereisnospecificneedtowarnthepatientaboutbrushingteethor swallowingslowlybecauseanoralanesthetichasbeenused. 10. Apatientdiagnosedwithacutemyelogenousleukemiahasjustbeenadmittedtotheoncologyunit. Whenwritingthispatientscareplan,whatpotentialcomplicationshouldthenurseaddress? A)

Pancreatitis

B)

Hemorrhage

C)

Arteritis

D)

Liverdysfunction

Ans:

B Feedback: Pancreatitis,arteritis,andliverdysfunctionaregenerallynotcomplicationsofleukemia.However,the patientfacesahighriskofhemorrhage.

11. Anemergencydepartmentnurseistriaginga77-year-oldmanwhopresentswithuncharacteristicfatigue aswellasbackandribpain.Thepatientdeniesanyrecentinjuries.Thenurseshouldrecognizetheneed forthispatienttobeassessedforwhathealthproblem? A)

Hodgkindisease

B)

Non-Hodgkinlymphoma

C)

Multiplemyeloma

D)

Acutethrombocythemia

Ans:

C Feedback: Backpain,whichisoftenapresentingsymptominmultiplemyeloma,shouldbecloselyinvestigatedin olderpatients.Thelymphomasandbleedingdisordersdonottypicallypresentwiththeprimary symptomofbackpainorribpain.

12. Ahomehealthnurseiscaringforapatientwithmultiplemyeloma.Whichofthefollowinginterventions shouldthenurseprioritizewhenaddressingthepatientsseverebonepain?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Implementingdistractiontechniques

B)

Educatingthepatientabouttheeffectiveuseofhotandcoldpacks

C)

TeachingthepatienttouseNSAIDseffectively

D)

Helpingthepatientmanagetheopioidanalgesicregimen

Ans:

D

662

Feedback: 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. 13. AnurseiscaringforapatientwithHodgkinlymphomaattheoncologyclinic.Thenurseshouldbe awareofwhatmaingoalofcare? A)

Cureofthedisease

B)

Enhancingqualityoflife

C)

Controllingsymptoms

D)

Palliation

Ans:

A Feedback: 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thedisease.

14. Apatientwithnon-Hodgkinslymphomaisreceivinginformationfromtheoncologynurse.Thepatient asksthenursewhysheshouldstopdrinkingandsmokingandstayoutofthesun.Whatwouldbethe nursesbestresponse? A)

Everyoneshoulddothesethingsbecausetheyrehealthpromotionactivitiesthatapplytoeveryone.

B)

Youdontwanttodevelopasecondcancer,doyou?

C)

Youneedtodothisjusttobeonthesafeside.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Itsimportanttoreduceotherfactorsthatincreasetheriskofsecondcancers.

Ans:

D

663

Feedback: Thenurseshouldencouragepatients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otheroptionsdonotanswerthepatientsquestion,andalsomakelightofthepatients question. 15. Anadultpatienthaspresentedtothehealthclinicwithacomplaintofafirm,painlesscervicallymph node.Thepatientdeniesanyrecentinfectiousdiseases.Whatisthenursesmostappropriateresponseto thepatientscomplaint? A)

Call911.

B)

Promptlyreferthepatientformedicalassessment.

C)

Facilitatearadiographofthepatientsneckandhavetheresultsforwardedtothepatientsprimary careprovider.

D)

Encouragethepatienttotrackthesizeofthelymphnodeandseekcarein1week.

Ans:

B Feedback: 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.Promptmedicalassessmentisnecessaryif apatienthasthispresentation.However,thereisnoacuteneedtocall911.Delayingcarefor1week couldhaveseriousconsequencesandx-raysarenotamongthecommondiagnostictests.

16. Anursepractitionerisassessingapatientwhohasafever,malaise,andawhitebloodcellcountthatis elevated.Whichofthefollowingprinciplesshouldguidethenursesmanagementofthepatientscare? A)

Thereisaneedforthepatienttobeassessedforlymphoma.

B)

Infectionisthemostlikelycauseofthepatientschangeinhealthstatus.

C)

Thepatientisexhibitingsignsandsymptomsofleukemia.

D)

Thepatientshouldundergodiagnostictestingformultiplemyeloma.

Ans:

B Feedback:

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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. 17. Diagnostictestinghasresultedinadiagnosisofacutemyeloidleukemia(AML)inanadultpatientwho isotherwisehealthy.Thepatientandthecareteamhavecollaboratedandthepatientwillsoonbegin inductiontherapy.Thenurseshouldpreparethepatientforwhichofthefollowing? 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 Feedback: 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.

18. Apatient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patients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patientsactivitiesofdailyliving

D)

Monitoringandtreatingthepatientspain

Ans:

A Feedback: Inductiontherapycausesneutropeniaandasevereriskofinfection.Thisriskmustbeaddresseddirectly inordertoensurethepatients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.

19. Anurseiscaringforapatientwhohasbeendiagnosedwithleukemia.Thenursesmostrecent assessmentrevealsthepresenceofecchymosesonthepatientssacralareaandpetechiaeinherforearms.

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Inadditiontoinformingthepatientsprimarycareprovider,thenurseshouldperformwhataction? A)

Initiatemeasurestopreventvenousthromboembolism(VTE).

B)

Checkthepatientsmostrecentplateletlevel.

C)

Placethepatientonprotectiveisolation.

D)

Ambulatethepatienttopromotecirculatoryfunction.

Ans:

B Feedback: Thepatientssignsaresuggestiveofthrombocytopenia,thusthenurseshouldcheckthepatients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.

20. A60-year-oldpatientwithchronicmyeloidleukemiawillbetreatedinthehomesettingandthenurseis preparingappropriatehealtheducation.Whattopicshouldthenurseemphasize? A)

Theimportanceofadheringtotheprescribeddrugregimen

B)

Theneedtoensurethatvaccinationsareuptodate

C)

Theimportanceofdailyphysicalactivity

D)

Theneedtoavoidshellfishandrawfoods

Ans:

A Feedback: NursesneedtounderstandthattheeffectivenessofthedrugsusedtotreatCMLisbasedontheabilityof thepatienttoadheretothemedicationregimenasprescribed.Adherenceisoftenincomplete,thusthis mustbeafocusofhealtheducation.Vaccinationsnormallywouldnotbeadministeredduringtreatment anddailyphysicalactivitymaybeimpossibleforthepatient.Dietaryrestrictionsarenotnormally necessary.

21. Anolderadultpatientisundergoingdiagnostictestingforchroniclymphocyticleukemia(CLL).What assessmentfindingiscertaintobepresentifthepatienthasCLL? A)

Increasednumbersofblastcells

B)

Increasedlymphocytelevels

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C)

Intractablebonepain

D)

Thrombocytopeniawithnoevidenceofbleeding

Ans:

B

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Feedback: Anincreasedlymphocytecount(lymphocytosis)isalwayspresentinpatientswithCLL.Eachofthe otherlistedsymptomsmayormaynotbepresent,andnoneisdefinitiveforCLL. 22. Apatienthasbeenfoundtohaveanindolentneoplasm.Thenurseshouldrecognizewhatimplicationof thiscondition? A)

Thepatientfacesasignificantriskofmalignancy.

B)

Thepatienthasamyeloidformofleukemia.

C)

Thepatienthasalymphocyticformofleukemia.

D)

Thepatienthasamajorriskfactorforhemophilia.

Ans:

A Feedback: Indolentneoplasmshavethepotentialtodevelopintoaneoplasm,butthisisnotalwaysthecase.The patientdoesnotnecessaryhave,orgoontodevelop,leukemia.Indolentneoplasmsareunrelatedtothe pathophysiologyofhemophilia.

23. Anurseiscaringforapatientwhoisbeingtreatedforleukemiainthehospital.Thepatientwasableto maintainhernutritionalsta...