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32 Cards in this Set
- Front
- Back
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In a severely anemic patient, the nurse would expect to find a. dyspnea and tachycardia. b. cyanosis and pulmonary edema. c. cardiomegaly and pulmonary fibrosis. d. ventricular dysrhythmias and wheezing
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Correctanswer: a Rationale:Patientswith severe anemia (hemoglobin level, less than 6 g/dL) exhibit thefollowing cardiovascular and pulmonary manifestations:
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When caring for a patient with thrombocytopenia, the nurse instructs the patient to a. dab his or her nose instead of blowing b. be careful when shaving with a safety razor c. continue with physical activities to stimulate thrombopoiesis d. avoid aspirin because it may mask the fever that occurs with thrombocytopenia
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Correctanswer: a - dab nose instead of blowing Rationale: Blowing the nose forcefully should be avoided. The patient should gently pat the nose with a tissue if needed. Instruct patients not to shave with a blade; an electric razor should be used. Patients should not performvigorous exercise or lift weights. If a patient is weak and at risk forfalling, supervise the patient when he or she is out of bed. Patients with thrombocytopenia should avoid aspirin because it reduces platelet adhesiveness, which contributes to bleeding. |
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Priority nursing actions when caring for a hospitalized patient with a new-onset temperature of 102.2° F and severe neutropenia include (select all that apply) a. administering the prescribed antibiotic STAT b. drawing peripheral and central line blood cultures c. ongoing monitoring of the patient's vital signs for septic shock d. taking a full set of vital signs and notifying the physician immediately e. administering transfusions of WBCs treated to decrease immunogenicity
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Correctanswers: a, b, c, d Rationale: In a febrile neutropenic patient, antibiotics should be started immediately (within 1 hour). Early identification of an infective organism is a priority, and culturesshould be obtained from various sites. Serial blood cultures (at least two) orone from a peripheral site and one from a venous access device should be obtainedpromptly. Cultures of the nose, throat, sputum, urine,stool, obvious lesions, and blood may be indicated. Ongoing febrile episodes ora change in the patient’s assessment findings (or vital signs) necessitates acall to the physician for additional cultures, diagnostic tests, addition of antimicrobialtherapies, or a combination of these. |
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The most common type of leukemia in older adults is a. acute myelocytic leukemia b. acute lymphocytic leukemia c. chronic myelocytic leukemia d. chronic lymphocytic leukemia |
Correctanswer: d - CLL Rationale: Chronic lymphocytic leukemia is a disease primarily of older adults |
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Multiple drugs are often used in combinations to treat leukemia and lymphoma because a. there are fewer toxic and side effects b. the chance that one drug will be effective is increased c. the drugs are more effective without causing side effects d. the drugs work by different mechanisms to maximize killing of malignant cells
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Correctanswer: d Rationale: Combination therapy is the mainstay of treatment for leukemia. The threepurposes for using multiple drugs are to (1) decrease drug resistance (2)minimize the drug toxicity to the patient by using multiple drugs with varyingtoxic effects (3) interrupt cell growth at multiple points in the cellcycle |
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When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What should the nurse place highest priority on initiating interventions to reduce? Thirst Fatigue Headache Abdominal pain |
Correct Answer: B - Fatigue The patient with a low hemoglobin and hematocrit is anemic and would be most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Thirst, headache, and abdominal pain are not related to anemia. |
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The patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about (select all that apply)? Strict hand washing Daily nasal swabs for culture Monitor temperature every hour Daily skin care and oral hygiene Encourage eating all foods to increase nutrients Private room with a high-efficiency particulate air (HEPA) filter |
A - D - F Strict Handwashing Daily Skin Care & Oral Hygiene Private room w/high-efficiency HEPA filter Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora, other people, and uncooked meats, seafood, eggs, unwashed fruits and vegetables, and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4° F or more, but temperature is not monitored every hour. |
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A 57-year-old patient has been diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what? Leukapheresis Attaining remission One chemotherapy agent Waiting with active supportive care |
Correct Answer: B - Remission Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the WBC count and risk of leukemia–cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia (CLL), waiting may be done to attain remission, but not with AML. |
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A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? Prevent patient infection Avoid abnormal bleeding Give pneumococcal vaccine Provide companionship while isolated |
Correct Answer: A - Prevent Infection After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done, but should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation. |
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What is the most important method for ID:g the presence of infection in a neutropenic pt? A. Freq: temperature monitoring B. Routine blood & sputum cultures C. Assessing for redness & swelling D. Monitoring WBC count |
A - Freq: temperature monitoring An elev:d temp is of most significance in recognizing the presence of an infection in the neutropenic pt, b/c there is no leukocytic response to injury. When the WBC is depressed, the normal phagocytic mechanisms of infection are impaired and the classic signs of inflammation may not occur. Cultures are indicated if the temp is elev:d, but are not used to monitor for infection |
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What is the major method of preventing infection in the pt w/neutropenia? A. Prophylactic ABX B. Diet that eliminates fruits/veg:s C. HEPA filtration rooms D. Strict handwashing by all persons in contact with the patient |
D. Strict Handwashing Handwashing before, during, and after care is the major method to prevent transmission of harmful pathogens to the patient. IV ABX are adm:d when febrile episodes occur. Some PO ABX may be used prophylactically in some neutropenic patients. HEPA-filtration and LAF rooms may reduce the number of aerosolized pathogens, but they are expensive and LAF use is controversial |
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Which leukemia is seen in 80% adults with acute leukemia and exhibits proliferation of precursors of granulocytes? A. ALL B. CLL C. AML D. CML |
C - AML
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Which statements accurately describe chronic lymphocytic leukemia (CLL)? Select All That Apply A. Most common leukemia of adults B. Only cure is bone marrow xplant C. Neoplasm of activated B-lymphocytes D. Increased incidence in survivors of atomic bombs E. Philadelphia chromosome is a diagnostic hallmark F. Mature-appearing, but functionally-inactive lymphocytes |
A - C - F Most common leukemia of adults Neoplasm of activated B-lymphocytes Mature-appearing, but functionally-inactive lymphocytes |
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In leukemia, what is the underlying cause of - lymphadenopathy - splenomegaly - hepatomegaly A. Development of infection at these sites B. Incr:d compensatory production of blood cells by these organs C. Infiltration of the organs by incr:d numbers of WBC:s in the blood D. Normal hypertrophy of the organs in an attempt to destroy abnormal cells |
C - Infiltration of the organs by incr:d numbers of WBC:s in the blood |
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A pt w/acute myelogenous leukemia (AML) is considering a hematopoietic stem cell xplant (HSCT) and asks the nurse what is involved. What is the best response the nurse can give the patient? A. Your bone marrow is destroyed by radiation and new bone marrow cells from a matched donor are injected into your bones. B. A specimen of your bone marrow may be aspirated and treated to destroy any leukemic cells and then reinfused when your disease becomes worse. C. Leukemic cells and bone marrow stem cells are eliminated with chemotherapy and/or total-body radiation and new bone marrow cells from a donor are infused IV. D. During chemotherapy and/or total-body radiation to destroy all of your blood cells, you may be given transfusions of RBC:s and platelets to prevent complications. |
are eliminated with chemotherapy and/or total-body radiation and new bone marrow cells from a donor are infused IV. A severe pancytopenic period follows the transplant, during which the pt must be in protective isolation and during which RBC and platelet transfusions may be given |
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PEDS
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The most freq: presenting ssx:s result from infiltration of the bone marrow --> |
Infections (s/t neutropenia) Bleeding (s/t decr:d platelets) |
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Definitive Diagnosis
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Bone Marrow Aspiration or Biopsy |
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HSCT
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remission - b/c excellent results are achieved w/chemo |
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What are the complications of HSCT? |
GVHD Overwhelming Infection Severe Organ Damage |
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The nurse is developing a care plan for a pt with leukemia. The plan should include which of the following: (Select All That Apply) A. Monitor TPR & report elevation B. Recognize s/s of infection C. Avoid crowds D. Maintain integrity of skin & mucous membranes E. Take a baby aspirin each day |
A - B - C - D Aspirin is an anticoagulant; bleeding tendencies such as petechiae - ecchymosis - epistaxis - gingival bleeding - and retinal hemorrhages are likely d/t TCP |
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A pt with neutropenia has an absolute neutrophil count (ANC) of 900. What is the client's risk of infection? A. Normal B. Moderate C. High D. Extremely High |
Correct Answer: B (Moderate) 1500 - Normal < 1000 = Moderate risk < 500 = High Risk < 100 = Life-Threatening |
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A pt is about to undergo bone marrow aspiration of the sternum. Which of the following should the nurse include to provide information to the pt about what the client feel during the procedure? A. You may feel a warm solution being wiped over your entire front from your neck down to your navel and out to your shoulders B. You will not feel the local anesthetic being applied because it will be sprayed on C. You will feel a pulling type of discomfort for a few seconds D. After the needle is removed, you will feel a bandage being applied around your chest |
Correct Answer: C - Pulling type of discomfort for a few seconds As the bone marrow is being aspirated, the client will feel a suction or pulling type of sensation or discomfort that lasts a few secs A systemic premedication may be given to decrease this discomfort. |
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24 hours after a bone marrow aspiration, the nurse evaluates which of the following as an appropriate pt outcome? A. The pt maintains bedrest B. There is redness & swelling at the aspiration site C. The pt requests morphine sulfate for pain D. There is no bleeding at the aspiration site |
After a bone marrow aspiration, the puncture site should be checked q. 10-15 min For a short period after the procedure, bedrest may be prescribed Signs of infection (redness/swelling) are NOT anticipated at the aspiration site. A mild analgesic may be prescribed. If the pt continues to need morphine for longer than 24 hrs, the nurse should suspect that internal bleeding or increased pressure at the puncture site may be the cause of the pain and should consult the physician |
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During the induction stage for treatment of leukemia, the nurse should remove which items that the family has brought into the room? A. A Bible B. A picture C. A sachet of lavender D. A hairbrush |
Correct Answer: C (Sachet of Lavender) The induction phase is an aggressive treatment to kill leukemia cells. The client is severely immunocompromised and severely at risk for infection. Flowers, herbs, and plants should be avoided at this time. The pt's Bible, pictures, and other personal belongings can be cleaned before being brought into the room to prvt client contact w/pathogenic and non-pathogenic org:s |
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The goal of nursing care for a pt w/AML is to prevent: A. Cardiac dysrhythmias B. Liver failure C. Renal failure D. Hemorrhage |
Bleeding and Infection are the major complications and causes of death for clients w/AML. Bleeding is r/t the degree of TCP Infection is r/t the degree of neutropenia Cardiac dysrhythmias rarely occur as a result of AML Liver or Renal failure may occur, but neither is a major cause of death in AML |
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The nurse is assessing a pt for CML. The nurse should assess the pt for: A. Lymphadenopathy B. Hyperplasia of the gum C. Bone pain from expansion of marrow D. SOB |
Although s/s vary, pt:s usually have confusion and SOB r/t decreased capillary perfusion to the brain and lungs Lymphadenopathy is rare in CML Hyperplasia and bone pain are s/s of AML |
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The pt with ALL is at r/f infection. The nurse should: A. Place the pt in a private room B. Have the pt wear a mask C. Have staff wear gowns and gloves D. Restrict visitors |
Clients with ALL are at r/f infection d/t granulocytopenia. The nurse should place the pt in a private room. It is not necessary to have the pt wear a mask. The pt is not contagious, and the staff does not need to wear gloves The pt can have visitors; however, they should be screened for infection and use hand-washing procedures. |
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In assessing a pt in the early stages of CLL, the nurse should determine if the pt has: A. Enlarged, painless lymph nodes B. Headache C. Hyperplasia of the gums D. Unintentional weight loss |
Correct Answer: D (Weight Loss) CLL pt:s develop - unintentional weight loss - fever and drenching night sweats - enlarged, painFUL lymph nodes-spleen-liver - anergy (decr:d rxn: to skin sensitivity tests) - susceptibility to viral infections Enlarged painLESS lymph nodes are s/s of Hodgkin's lymphoma Headache would not be an early s/s of CLL because CLL does not cross the BBB and would not irritate the meninges Hyperplasia of the gums is assoc:d with AML |
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The nurse is planning care w/a client with acute leukemia who has mucositis. The nurse should advise the pt that every meal and every 4 hrs while awake, the pt should use: A. Lemon-glycerin swabs B. Commercial mouthwash C. Saline solution D. Commercial toothpaste and brush |
Simple rinses w/saline or baking soda and water solution are effective and moisten the oral mucosa. Commercial mouthwashes and lemon glycerin swabs contain glycerin and alcohol, which are drying to the mucosa and should be avoided. Brushing after each meal is recc:d, but q. 4hr may be traumatic. During acute leukemia, the neutrophil and platelet counts are often low and a soft bristle toothbrush, instead of the pt's usual brush, should be used to prvt: bleeding gums |
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The nurse is evaluating the pt's learning about combination chemotherapy. Which of the following statements by the pt about reasons for using combination chemo indicates the need for further explanation? A. Combination chemotherapy is used to interrupt the cell growth cycle at different points B. Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously C. Combination chemotherapy is used to decrease resistance D. Combination chemotherapy is used to minimize the toxicity from using high doses of a single agent |
Correct Answer: B Combination chemotherapy does not mean two groups of drugs, one to kill the cancer cells and one to treat the adverse efx of the chemotherapy. The other options are correct |
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In providing care to a pt with leukemia who has developed TCP, the nurse assesses the most common sites for bleeding. Which of the following is not a common site? A. Biliary system B. GI tract C. Brain and meninges D. Pulmonary system |
The biliary system is not especially prone to hemorrhage. |
