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98 Cards in this Set

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A pt with a hemoglobin level of 7.8 g/dl has cardiac palpations, a heart rate of 102, and an increased reticulocyte count. At this severeity of anemia, the nurse would also expect the patient to manifest:
a. pallor
b. dyspnea
c. a smooth tongue
d. sensitivity to cold
b. The pt's Hb level indicates a moderate anemia, and at this severity, additional findings ususally include dyspnea and fatigue. Pallor, smooth tongue, and sensitivity to cold usually manifest in severe anemia when the Hb level is below 6 gm/dl.
A 76-yr-old woman has an Hb of 7.3 g/dl and is experiencing ataxia and confusion. During assessment of the pt, it is most important for the nurse to ask about:
a. food and drug intake
b. a family hx of anemia
c. any exposure to chemical toxins
d. the presence of postmenopausal bleeding
a. Nutritional deficiencies account for the majority of anemia seen in older adults, and the drugs that many older adults use for chronic illness may contribute to anemia. Anemias that are familial usually manifest before older adulthood, and exposure to chemical toxins as a source of anemia is not as common as nutritional deficiencies. Although postmenopausal bleeding can contribute to anemia in a susceptible older woman, it is rarely significant.
On physical assessment of the pt with severe anemia, the nurse would expect to find:
a. nervousness and agitation
b. fever and tenting of the skin
c. systolic murmurs and tachycardia
d. bluish mucous membranes and reddened skin
c. Tachycardia occurs in severe anemia as the body compensates for hypoxemia and the low viscosity of the blood contributes to the development of systolic murmurs and bruits. Depression of the CNS is common with fatigue, lethargy, and malaise. Poor skin turgor may be present, but fever is not associated with anemia. The skin and mucous membranes are pale, with a bluish tinge to the sclera.
A nursing diagnosis that is appropriate for pts with moderate to severe anemia of any etiology is:
a. impaired skin integrity r/t edema and pruritis
b. disurbed body image r/t changes in appearance and body function
c. imbalanced nutrition: less than body requirements r/t lack of knowledge of adequate nutrition
d. activity intolerance r/t decreased Hgb and imbalance between oxygen supply and demand
d. Pts with any type of anemia have decreased hemoglobin and symptoms of hypoxemia, leading to activity intolerance. Impaired skin integrity and body image disturbance may be appropriate for pts with jaundice from hemolytic anemias, and altered nutrition is indicated when iron, folic acid, or vitamin B intake is deficient.
Etiologic and morphologic classification for...

Acute trauma

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
2
4
Etiologic and morphologic classification for...

Malaria

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
3
4
Etiologic and morphologic classification for...

Anemia of gastritis

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
2
4
Etiologic and morphologic classification for...

Anemia of renal failure

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
1
4
Etiologic and morphologic classification for...

Aplastic anemia

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
1
4
Etiologic and morphologic classification for...

G6PD

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
3
4
Etiologic and morphologic classification for...

Iron deficiency anemia

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
1
6
Etiologic and morphologic classification for...

Thalassemia

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
1
6
Etiologic and morphologic classification for...

Pernicious anemia

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
1
5
Etiologic and morphologic classification for...

Sickle cell anemia

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
3
4
Etiologic and morphologic classification for...

Anemia of leukemia

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
1
4
Etiologic and morphologic classification for...

Anemia associated with prosthetic heart valve

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
3
4
To prevent a common side effect of oral iron supplements, the nurse teaches the pt to:
a. take the iron preparations with meals
b. increase fluid and dietary fiber intake
c. report the presence of black stools to the physician
d. use enteric-coated preparations taken with orange juice
b. Constipation is a common side effect of oral iron supplementation, and increased fluids and fiber should be consumed to prevent this effect. Because iron can be bound in the GI tract by food, it should be taken before meals unless gastric side effects of the supplements necessitate its ingestion with food. Black stools are an expected result of oral iron preparations. Taking iron with ascorbic acid or orange juice enhances absorption of the iron, but enteric-coated iron often is ineffective because of unpredictable release of the iron in areas of the GI tract where it can be absorbed.
To administer iron IM, the nurse should:
a. use a short, fine needle to avoid pain
b. massage the site after the injection to promote absorption
c. include 0.5 ml of air in the syringe to clear the iron from the needle
d. administer the injection in the vastus lateralis to prevent nerve damage
c. Parenteral iron is very irritating and can stain the skin, so needles are changed between withdrawing and administering the medication; 0.5 ml of air is left in the syringe to completely clear the solution from the syringe during administration; it is administered Z-track in the large upper outer quad of the buttocks; and the site is not massaged after administration.
The nurse evaluates that teaching for the pt with iron deficiency anemia has been effective when the pt states:
a. "I will need to take the iron supplements the rest of my life"
b. "I will increase my dietary intake of milk and milk products"
c. "I should increase my activity to increase my aerobic capacity"
d. "I should take the iron for several months after my blood is normal"
d. To replace the body's iron stores, iron supplements should be continued for 2 to 3 months after the hemoglobin (Hb) level returns to normal, but if the cause of the iron deficiency is corrected, the supplements do not need to be taken for a lifetime. Milk and milk products are poor sources of dietary iron. Activity should be gradually increased as Hb levels return to normal since aerobic capacity can only be increased when adequate Hb is available.
In teaching the pt with pernicious anemia about the disease, the nurse explains that it results from a lack of:
a. folic acid
b. intrinsic factor
c. extrinsic factor
d. cobalamine intake
b. Pernicious anemia is a type of cobalamin (vit B12) deficiency that results when parietal cells in the stomach fail to secrete enough intrinsic factor to absorb ingested cobalamin. Extrinsic factor IS cobalamin and may be a factor in some cobalamin deficiencies but not in pernicious anemia.
In addition to the general symptoms of anemia, the pt with pernicious anemia also manifests:
a. neurologic symptoms
b. coagulation deficiencies
c. cardiovascular disturbances
d. a decreased immunologic response
a. Neurologic manifestations of weakness, paresthesias of the feet and hands, and impaired thought processes are characteristic of pernicious anemia. Cardiovascular effects are most common with acute blood loss, and aplastic anemias include a leukopenia that leads to decreased immunologic response.
The nurse explains to the pt with pernicious anemia that:
a. death can be prevented by cobalamin supplementation for the rest of the pt's life
b. the syptoms of the disease can be completely reversed with cobalamin (vit B12) therapy
c. bone marrow transplantation to change the defective marrow cells is an alternative therapy for pernicious anemia
d. dietary intake of foods high in cobalamin is the most inexpensive and convenient treatment of pernicious anemia
a. Without cobalamin replacement, individuals with pernicious anemia will die in 1 to 3 years, but the disease can be controlled with cobalamin supplements for life. Hematologic manifestations can be completely reveresed with therapy, but long-standing neuromuscular complications may not be reversed. Since pernicious anemia results from an inability to absorb cobalamin, dietary intake of the vitamin is not a treatment option, nor is a bone marrow transplant.
Lab and diagnostic findings the nurse would expect in an anemic pt with chronic alcoholism include:
a. achlorhydria and macrocytic erythrocytes
b. decreased serum folate and increased MCHC
c. increased indirect bilirubin and increased reticulocytes
d. decreased total iron binding capacity and increased MCH
b. A common cause of folic acid deficiency is chronic alcohol abuse. Lab results in folic acid deficiency include decreased serum folate levels and increased mean corpuscular hemoglobin concentration (MCHC) due to the large cell size. Achlorhydria and macrocytic RBCs are characteristic of pernicious anemia, and increased indirect bilirubin and increased reticulocytes are characteristic of thalassemia and sickle cell anemia.
The strict vegetarian is at highest risk for the development of:
a. thalassemias
b. iron deficiency anemia
c. folic acid deficiency anemia
d. cobalamin deficiency anemia
d. Because red meats are the primary dietary source of cobalamin, a strict vegetarian is most at risk for cobalamin-deficiency anemia. Meats are also an important source of iron and folic acid, but whole grains, legumes, and green leafy vegetables also supply these nutrients. Thalassemia is not related to dietary deficiencies.
A nursing diagnosis that is appropriate for the effects of the deficiency of all of the cells associated with aplastic anemia is:
a. risk for injury: falls
b. impaired physical mobility
c. risk for impaired skin integrity
d. risk for impaired oral mucous membrane
d. The anemia of aplastic anemia may cause an inflamed, painful tongue; the thrombocytopenia may contribute to blood-filled bullae in the mouth and gingival bleeding; and the leukopenia may lead to stomatitis and oral ulcers and infections.
Nursing interventions for the pt with aplastic anemia are directed toward the prevention of the complications of:
a. fatigue and dyspnea
b. hemorrhage and infection
c. thromboemboli and gangrene
d. cardiac arrhythmias and heart failure
b. Hemorrhage from thrombocytopenia and infection from neutropenia are the greatest risks for the pt with aplastic anemia. The pt will experience fatigue from anemia, but bleeding and infection are the major causes of death in aplastic anemia.
True or False?

The most reliable way to evaluate the effect and degree of blood loss in a pt with hemorrhage is with __LABORATORY DATA__.
False

The most reliable way to evaluate the effect and degree of blood loss in a pt with hemorrhage is with CLINICAL SYMPTOMS.
True or False?

A pt with acute blood loss that has normal VS at rest but has increased HR and postural hypotension with exercise has lost approximately __30%__ of the total blood volume.
True
The anemia that follows acute blood loss is most frequently treated with __INCREASED DIETARY IRON INTAKE__.
False

The anemia that follows acute blood loss is most frequently treated with BLOOD TRANSFUSIONS OR IRON SUPPLEMENTS
True or False?

In addition to the general symptoms of anemia, the pt with a hemolytic anemia also manifests __JAUNDICE__.
True
True or False?

A major concern in hemolytic anemias is maintenance of __LIVER__ function.
False

A major concern in hemolytic anemias is maintenance of KIDNEY function.
True or False?

An example of an intravascular extrinsic hemolytic anemia results from __BLOOD TRANSFUSION REACTIONS__.
True
The anemia of sickle cell disease is caused by:
a. intravascular hemolysis of sickled RBCs
b. accelerated breakdown of abnormal RBCs
c. autoimmune antibody destruction of RBCs
d. isoimmune antibody-antigen reactions with RBCs
b. Because red cells are abnormal in sickle cell anemia, the mean RBC survival time is 10-15 days (rather than the normal 120 days) because of accelerated RBC breakdown by the liver and spleen. Antibody reactions with RBCs may be seen in other types of hemolytic anemias but are not present in sickle cell anemia.
A pt with sickle cell anemia asks the nurse why the sickling crisis does not stop when oxygen therapy is started. The nurse explains that:
a. sickling occurs in response to decreased blood viscosity, which is not affected by oxygen therapy
b. when red cells sickle, they occlude small vessels, which causes more local hypoxia and more sickling
c. the primary problem during a sickle cell crisis is destruction of the abnormal cells resulting in fewer RBCs to carry oxygen
d. oxygen therapy does not alter the shape of the abnormal ertythrocytes but only allows for increased oxygen concentration in hemoglobin
b. During a sickle cell crisis, the sickling cells clog small capillaries, and the resulting hemostasis promotes a self-perpetuating cycle of local hypoxia, deoxygenation of more erythrocytes, and more sickling. Administration of oxygen may help control further sickling, but additional oxygen does not reach areas of local hypoxia caused by occluded vessels.
A nursing intervention that is indicated for the pt during a sickle cell crisis is:
a. frequent ambulation
b. applicaiton of antiembolism hose
c. restriction of sodium and oral fluids
d. administration of large doses of continuous narcotic analgesics
d. Because pain usually accompanies a sickle cell crisis and may last for 4-6 days, pain control is an important part of tx. Rest is indicated to reduce metabolic needs, and fluids and electrolytes are administered to reduce blood viscosity and maintain renal function. Although thrombosis does occur in capillaries, elastic stockings that primarily affect venous circulation are not indicated.
During discharge teaching with a pt with newly diagnosed sickle cell disease, the nurse teaches the pt to decrease the risk of a sickle cell crisis by:
a. limiting fluid intake
b. avoiding hot, humid weather
c. eliminating exercise from the lifestyle
d. seeking early medical intervention for URI
d. The pt with sickle cell disease is particularly prone to infection, and infection can precipitate a sickle cell crisis. Pts should seek medical attention quickly to counteract URIs because pneumonia is the most common infection of the pt with sickle cell disease. Fluids should be increased to decrease blood viscosity, which may precipitate a crisis, and moderate activity is permitted.
True or False:

Genetic counseling and family planning is indicated for couples when one of them has __THALASSEMIA__.
True
True or False?

Immune thrombocytopenic purpura is characterized by increased platelet destruction by the __SPLEEN__.
True
True or False?

Alterations in platelet function are assessed with the use of __PROTHROMBIN__ times.
False

Alterations in platelet function are assessed with the use of BLEEDING times.
True or False?

Thrombotic thrombocytopenic purpura is characterized by __DECREASED__ platelets, __DECREASED__ RBCs, and __DECREASED__ agglutination function of platelets.
False

Thrombotic thrombocytopenic purpura is characterized by DECREASED platelets, DECREASED RBCs, and INCREASED agglutination function of platelets.
True or False?

A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical exam of the pt is __ECCHYMOSIS__.
False

A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical exam of the pt is PETECHIAE.
True or False?

Pts with platelet deficiencies usually bleed from __SUPERFICIAL SITES__ while those with diminished clotting factors experience __DEEP OR INTERNAL__ bleeding.
True
True or False?

Treatment of __HEMACHROMATOSIS__ involves weekly phlebotomy for 2 to 3 years.
True
True or False?

The nurse suspects heparin-induced thrombocytopenia and thrombosis syndrome when a pt receiving heparin requires __DECREASED__ heparin to maintain therapeutic activated thromboplastin times.
False

The nurse suspects heparin-induced thrombocytopenia and thrombosis syndrome when a pt receiving heparin requires INCREASED heparin to maintain therapeutic activated thromboplastin times.
In planning the care of a pt hospitalized with polycythemia vera, the nurse recognizes that a nursing intervention that is most likely to prevent organ damage or death is:
a. maintaing protective isolation
b. promoting leg exercises and ambulation
c. protecting the pt from injury or falls
d. promoting hydration with a large fluid intake
b. Thrombus and embolization are the major complications of polycythemia vera because of increased hypervolemia and hyperviscosity. Active or passive leg exercises and ambulation should be implemented to prevent thrombus formation. Hydration therapy is important to decrease blood viscosity, but because the pt already has hypervolemia, a careful balance of intake and output must be maintained and fluids are not injudiciously increased.
A pt has a platelet count of 50,000 and is dx with immune thrombocytopenic purpura. The nurse would expect initial tx to include:
a. splenectomy
b. corticosteroids
c. administration of platelets
d. immunosuppresive therapy
b. Corticosteroids are used in intial tx of ITP because they suppress the phagocytic response of splenic macrophages, decreasing platelet destruction. They also depress autoimmune antibody formation and reduce capillary fragility and bleeding time. All of the other therapies may be used but only in pts who are unresponsive to corticosteroid therapy.
During the care of the pt with thrombocytopenia, the nurse:
a. takes frequent temps to assess for fever
b. maintains the pt on strict bed rest to prevent injury
c. monitors the pt for headaches, vertigo, or confusion
d. removes oral crusting and scabs with firm friction q2h
c. The major complication of thrombocytopenia is hemorrhage, and it may occur in any area of the body. Cerebral hemorrhage may be fatal, and evaluation of mental status for CNS alterations to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention, but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs.
In analyzing the lab results of a pt with classic hemophilia, the nurse would expect to find:
a. an absence of factor IX
b. a decreased platelet count
c. a prolonged bleeding time
d. a prolonged partial thromboplastin time
d. A prolonged partial thromboplastin time occurs when there is a deficiency of clotting factors, such as factor VIII associated with hemophilia A. Factor IX is deficient in hemophilia B, and prolonged bleeding time and decreased platelet counts are associated with platelet deficiencies.
Tx of hemophilia most often includes periodic administration of:
a. whole blood
b. thromboplastin
c. factor concentrates
d. fresh frozen plasma
c. Although whole blood and fresh frozen plasma contain the clotting factors that are deficient in hemophilia, specific factor concentrates have been developed that are more pure and safer in preventing infection transmission. Thromboplastin is factor III and is not deficient in pts with hemophilia.
A pt with hemophilia is hospitalized with acute knee pain and swelling. Nursing interventions for the pt include:
a. wrapping the knee with an elastic bandage
b. placing the pt on bed rest and applying ice to the joint
c. gently performing ROM exercises to the knee to prevent adhesions
d. administering nonsteroidal antiinflammatory drugs as needed for pain
b. During an acute bleeding episode in a joint, it is important to totally rest the involved joint and slow bleeding with application of ice. Drugs that decrease platelet aggregation, such as aspirin or NSAIDS, should not be used for pain. As soon as bleeding stops, mobilization of the affected area is encouraged with ROM exercises and physical therapy.
Early recognition of acute DIC by the nurse in a pt includes:
a. providing appropriate care for managing the causative problem
b. a knowledge of signs and symptoms of microvascular thrombosis
c. administering necessary blood products and anticoagulants to susceptible pts
d. astute, ongoing assessment with awareness of risk for DIC in pts with predisposing conditions
d. Both recognition of pts who are at risk for DIC and early detection of bleeding, both occult and overt, are primary nursing goals in the care of pts who could develop DIC. Management of the primary problem is important, but it does not necessarily assist in early recognition of acute DIC, and susceptible pts are not treated unless symptoms develop. Although DIC causes microvascular thrombosis, detection is usually made with signs of bleeding.
A pt has a WBC of 2300/uL and a neutrophil percentage of 40%.

Does the pt have a leukopenia?
Yes

WBC below 5000/uL
A pt has a WBC of 2300/uL and a neutrophil percentage of 40%.

What is the pt's neutrophil count?
920/uL

(2300 x 40%)
A pt has a WBC of 2300/uL and a neutrophil percentage of 40%.

Does the pt have neutropenia?
Yes

Neutrophils less than 1000 to 1500/uL
A pt has a WBC of 2300/uL and a neutrophil percentage of 40%.

What is the pt's risk for developing a bacterial infection?
Moderate

Neutropenia of 500 to 1000/uL
Neoplasm of activated B lymphocytes?

a. AML
b. ALL
c. CML
d. CLL
d. CLL
Mature-appearing, but functionally inactive lymphocytes?

a. AML
b. ALL
c. CML
d. CLL
d. CLL
85% of acute leukemia in adults?

a. AML
b. ALL
c. CML
d. CLL
a. AML
Most common in children?

a. AML
b. ALL
c. CML
d. CLL
b. ALL
Only cure is bone marrow transplant?

a. AML
b. ALL
c. CML
d. CLL
c. CML
Proliferation of immature lymphocytes in bone marrow?

a. AML
b. ALL
c. CML
d. CLL
b. ALL
Increased incidence in atomic bomb survivors?

a. AML
b. ALL
c. CML
d. CLL
c. CML
Proliferation of precursors of granulocytes?

a. AML
b. ALL
c. CML
d. CLL
a. AML
Associated with Philadelphia chromosome?

a. AML
b. ALL
c. CML
d. CLL
c. CML
CNS manifestations common?

a. AML
b. ALL
c. CML
d. CLL
b. ALL
Most common leukemia of adults?

a. AML
b. ALL
c. CML
d. CLL
d. CLL
A pt with acute myelogenous leukemia is to start chemo. During the induction stage of chemo, the nurse can expect the pt to:
a. experience mild side effects of the drugs
b. experience additive bone marrow suppression
c. receive high-dose treatment daily for several months
d. regain energy and become more resistant to infection
b. Induction therapy is aggressive tx with chemotherapeutic agents, which often causes the pt to become devastatingly ill and predisposed to complications because the bone marrow is even further suppressed by the drugs. Induction therapy is usually administered for 10 days and may be followed by intensification therapy that involves high-dose therapy for several months.
Lymphadenopathy, splenomegaly, and hepatomegaly are common clinical manifestations of leukemia that are due to:
a. the development of infection at these sites
b. increased compensatory production of blood cells by these organs
c. infiltration of the organs by increased numbers of WBCs in the blood
d. normal hypertrophy of the organs in an attempt to destroy abnormal cells
c. Almost all leukemias cause some degree of hepatosplenomegaly because of infiltration of these organs as well as the bone marrow, lymph nodes, bones, and CNS by excessive WBCs in the blood.
Nursing diagnoses that are appropriate for the pt with newly diagnosed chronic lymphocytic leukemia include:
a. pain and hopelessness
b. anxiety and risk for infection
c. self-care deficit and ineffective health maintenance
d. decisional conflict: tx options and risk for injury
b. A pt newly diagnosed with leukemia is most likely to respond with anxiety about the effects and outcome of the disease, and the risk of infection from altered WBCs is always present, even if other blood cells are not yet affected by the disease.
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Multiple histopathologic classifications
non-Hodgkin's lymphoma
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Presence of Reed-Sternberg cells
Hodgkin's disease
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Treated with radiation and chemotherapy
both
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Affects all ages
non-Hodgkin's lymphoma
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Originates in lymph nodes in most patients
Hodgkin's disease
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Often widely disseminated at time of diagnosis
non-Hodgkin's lymphoma
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Alcohol-induced pain at site of disease
Hodgkin's disease
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Primary initial clinical manifestation is painless lymph node enlargement
both
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Over 90% cure rate in stage I disease
Hodgkin's disease
Characteristic associated with Hodgkin's disease, non-Hodgkin's lymphoma, or both?

Associated with Epstein-Barr virus
Hodgkin's disease
The nurse prepares to administer IV GM-CSF (Leukine) to a pt with neutropenia resulting from chemo for non-Hodgkin's lymphoma. The nurse explains to the pt that this preparation:
a. can stimulate the production and function of neutrophils and monocytes
b. is a type of interferon that may inhibit DNA and protein synthesis in tumor cells
c. is a chemotherapeutic agent that is less toxic to the bone marrow than other chemotherapeutic agents
d. is a monoclonal antibody linked to a radioactive isotope that will directly deliver radiation to malignant cells
a. GM-CSF is a type of colony-stimulating factor that is a naturally produced protein which stimulates proliferation and differentiation of granulocytes and monocytes. It is used to hasten recovery from bone marrow depression after chemo or decrease bone marrow suppression associated with chemo administration. Monoclonal antibodies, such as rituximab and ibritumomab tiuxetan, as well as interferons may be used to destroy malignant cells of NHL.
True or False?

Staging of lymphomas is important to __PREDICT PROGNOSIS__.
False

Staging of lymphomas is important to DETERMINE TREATMENT.
True or False?

Nursing management of the pt undergoing tx for Hodgkin's disease includes measures to prevent __INFECTION__.
True
True or False?

Multiple myeloma is characterized by proliferation of malignant activated __T CELLS__ that destroy the __KIDNEYS__.
False

Multiple myeloma is characterized by proliferation of malignant activated B CELLS that destroy the BONE.
True or False?

Two important nursing interventions in the care of pts with multiple myeloma are increasing fluids to manage __HYPERCALCEMIA__ and careful handling of the pt to prevent __PATHOLOGIC FRACTURES__.
True
When analyzing lab results of a pt with multiple myeloma, the nurse would expect to find:
a. lymphopenia and myeloma protein
b. neutrophilic leukocytosis and anemia
c. decreased serum creatinine and BUN
d. hyperuricemia and increased immunoglobulinemia
d. The lab results typical in multiple myeloma reflect the excessive production of plasma cells that produce abnormal and excessive amounts of immunoglobulin, known as myeloma protein, and the results of bone destruction by these cells and substances. Bone destruction results in increased serum levels of calcium and uric acid, and excretion of excessive uric acid and myeloma protein can result in kidney damage. Bone marrow damage results in neutropenia, anemia, and thrombocytopenia. A neutrophilic leukocytosis and anemia are seen in Hodgkin's disease.
Following a splenectomy for tx of immune thrombocytopenic purpura, the nurse would expect the pt's lab results to reveal:
a. decreased RBCs
b. decreased WBCs
c. increased platelets
d. increased immunoglobulins
c. Splenectomy may be indicated for tx for ITP, and when the spleen is removed, platelet counts increase significantly in most pts. In any of the disorders in which the spleen removes excessive blood cells, splenectomy will most often increase peripheral RBC, WBC, and platelet counts.
While receiving a unit of packed RBCs, the pt develops chills and a temp of 102.2F. The nurse:
a. notifies the physician and the blood bank
b. stops the transfusion and removes the IV catheter
c. adds a leukocyte reduction filter to the blood administration set
d. recognizes this as a mild allergic transfusion reaction and slows the transfusion
a. Chills and fever are symptoms of acute hemolytic or febrile transfusion reaction, and if these develop, the transfusion should be stopped, saline infused through the IV line, the physician and blood bank notified immediately, the ID tags rechecked, and VS and urine output monitored. Addition of a leukocyte reduction filter may prevent a febrile reaction but is not helpful once the reaction has occurred. Mild and transient allergic reactions indicated by itching and hives might permit restarting of the transfusion after treatment with antihistamines.
A pt with thrombocytopenia with active bleeding has 2 units of platelets prescribed. To administer the platelets, the nurse:
a. checks for ABO compatibility
b. agitates the bag periodically during the transfusion
c. takes VS q15min during the procedure
d. refrigerates the second unit until the first unit has transfused
b. Because platelets adhere to the plastic bags, the bag should be gently agitated throughout the transfusion. Platelets do not have A, B, or Rh antibodies, and ABO compatibility is not a consideration. Baseline VS should be taken before the transfusion is started, and the nurse should stay with the pt during the first 15 minutes. Platelets are stored at room temp and should not be refrigerated.
Characteristic of what transfusion reaction?

May restart transfusion with antihistamine therapy in mild cases

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
3. allergic reaction
Characteristic of what transfusion reaction?

May be avoided by leukocyte reduction filters

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
2. febrile reaction
Characteristic of what transfusion reaction?

Acute renal failure may occur

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
1. acute hemolytic reaction
Characteristic of what transfusion reaction?

Destruction of donor RBCs

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
1. acute hemolytic reaction
Characteristic of what transfusion reaction?

Hypothermia common

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
5. massive blood transfusion reaction
Characteristic of what transfusion reaction?

Leukocyte or plasma protein incompatibilitiy

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
2. febrile reaction
Characteristic of what transfusion reaction?

ABO incompatibility

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
1. acute hemolytic reaction
Characteristic of what transfusion reaction?

Hypocalcemia and hyperkalemia

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
5. massive blood transfusion reaction
Characteristic of what transfusion reaction?

Epinephrine used for severe reaction

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
3. allergic reaction
Characteristic of what transfusion reaction?

May occur in cardiac and renal insufficiency

1. acute hemolytic reaction
2. febrile reaction
3. allergic reaction
4. circulatory overload
5. massive blood transfusion reaction
4. circulatory overload