TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)
657
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
658
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.
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D)
Tellhimthatyoucanunderstandhowhesfeeling.
Ans:
C
659
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:
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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statusforthefirstfewweeksfollowingherdiagnosisbutisnowexhibitingearly
signsandsymptomsofmalnutrition.Incollaborationwiththedietitian,thenurseshouldimplement
whatintervention?
A)
Arrangefortotalparenteralnutrition(TPN).
B)
Facilitateplacementofapercutaneousendoscopicgastrostomy(PEG)tube.
C)
Providethepatientwithseveralsmall,soft-texturedmealseachday.
D)
Assignresponsibilityforthepatientsnutritiontothepatientsfriendsandfamily.
Ans:
C
Feedback:
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Forpatientsexperiencingdifficultieswithoralintake,theprovisionofsmall,easilychewedmealsmay
bebeneficial.ThisoptionwouldbetrialedbeforeresortingtotubefeedingorTPN.Thefamilyshouldbe
encouragedtoparticipateincare,butshouldnotbeassignedfullresponsibility.
24. Apatientwhoisundergoingconsolidationtherapyforthetreatmentofleukemiahasbeenexperiencing
debilitatingfatigue.Howcanthenursebestmeetthispatientsneedsforphysicalactivity?
A)
Teachthepatientabouttherisksofimmobilityandthebenefitsofexercise.
B)
Assistthepatienttoachairduringawaketimes,astolerated.
C)
Collaboratewiththephysicaltherapisttoarrangeforstairexercises.
D)
Teachthepatienttoperformdeepbreathingandcoughingexercises.
Ans:
B
Feedback:
Sittingisachairispreferabletobedrest,evenifapatientisexperiencingseverefatigue.Apatientwho
hasdebilitatingfatiguewouldnotlikelybeabletoperformstairexercises.Teachingaboutmobilitymay
benecessary,buteducationmustbefollowedbyinterventionsthatactuallyinvolvemobility.Deep
breathingandcoughingreducetheriskofrespiratorycomplicationsbutarenotsubstitutesforphysical
mobilityinpreventingdeconditioning.
25. Anoncologynurserecognizesapatientsriskforfluidimbalancewhilethepatientisundergoing
treatmentforleukemia.Whatrelevantassessmentsshouldthenurseincludeinthepatientsplanofcare?
Selectallthatapply.
A)
Monitoringthepatientselectrolytelevels
B)
Monitoringthepatientshepaticfunction
C)
Measuringthepatientsweightonadailybasis
D)
Measuringandrecordingthepatientsintakeandoutput
E)
Auscultatingthepatientslungsfrequently
Ans:
A,C,D,E
Feedback:
Assessmentsthatrelatetofluidbalanceincludemonitoringthepatientselectrolytes,auscultatingthe
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patientschestforadventitioussounds,weighingthepatientdaily,andcloselymonitoringintakeand
output.Liverfunctionisnotdirectlyrelevanttothepatientsfluidstatusinmostcases.
26. Afterreceivingadiagnosisofacutelymphocyticleukemia,apatientisvisiblydistraught,stating,Ihave
noideawheretogofromhere.Howshouldthenursepreparetomeetthispatientspsychosocialneeds?
A)
Assessthepatientspreviousexperiencewiththehealthcaresystem.
B)
Reassurethepatientthattreatmentwillbechallengingbutsuccessful.
C)
Assessthepatientsspecificneedsforeducationandsupport.
D)
Identifythepatientsplanofmedicalcare.
Ans:
C
Feedback:
Inordertomeetsthepatientsneeds,thenursemustfirstidentifythespecificnatureoftheseneeds.
Accordingtothenursingprocess,assessmentmustprecedeinterventions.Theplanofmedicalcareis
important,butnotcentraltotheprovisionofsupport.Thepatientsprevioushealthcareisnotaprimary
consideration,andthenursecannotassurethepatientofsuccessfultreatment.
27. Apatienthascompletedthefullcourseoftreatmentforacutelymphocyticleukemiaandhasfailedto
respondappreciably.Whenpreparingforthepatientssubsequentcare,thenurseshouldperformwhat
action?
A)
Arrangeameetingbetweenthepatientsfamilyandthehospitalchaplain.
B)
Assessthefactorsunderlyingthepatientsfailuretoadheretothetreatmentregimen.
C)
Encouragethepatienttovigorouslypursuecomplementaryandalternativemedicine(CAM).
D)
Identifythepatientsspecificwishesaroundend-of-lifecare.
Ans:
D
Feedback:
Shouldthepatientnotrespondtotherapy,itisimportanttoidentifyandrespectthepatientschoices
abouttreatment,includingmeasurestoprolonglifeandotherend-of-lifemeasures.Thepatientmayor
maynotbeopentopursuingCAM.Unsuccessfultreatmentisnotnecessarilytheresultoffailureto
adheretothetreatmentplan.Assessmentshouldprecedemeetingswithachaplain,whichmayormay
notbebeneficialtothepatientandcongruentwiththefamilysbeliefsystem.
28. Followinganextensivediagnosticworkup,anolderadultpatienthasbeendiagnosedwithasecondary
myelodysplasticsyndrome(MDS).Whatassessmentquestionmostdirectlyaddressesthepotential
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etiologyofthispatientshealthproblem?
A)
Wereyoueverexposedtotoxicchemicalsinanyofthejobsthatyouheld?
B)
Whenyouwereyounger,didyoutendtohaverecurrentinfectionsofanykind?
C)
Haveyourparentsorsiblingshadanydiseaselikethis?
D)
Wouldyousaythatyouvehadalotofsunexposureinyourlifetime?
Ans:
A
Feedback:
SecondaryMDScanoccuratanyageandresultsfrompriortoxicexposuretochemicals,including
chemotherapeuticmedications.Familyhistory,sunexposure,andpreviousinfectionsareunrelatedto
thepathophysiologyofsecondaryMDS.
29. Apatientwithamyelodysplasticsyndromeisbeingtreatedonthemedicalunit.Whatassessment
findingshouldpromptthenursetocontactthepatientsprimarycareprovider?
A)
Thepatientisexperiencingafrontallobeheadache.
B)
Thepatienthasanepisodeofurinaryincontinence.
C)
Thepatienthasanoraltemperatureof37.5C(99.5F).
D)
ThepatientsSpO2is91%onroomair.
Ans:
C
Feedback:
BecausethepatientwithMDSisatahighriskforinfection,anyearlysignsofinfectionmustbe
reportedpromptly.Thenurseshouldaddresseachofthelistedassessmentfindings,butnoneisasdirect
athreattothepatientsimmediatehealthasaninfection.
30. Anurseispreparinghealtheducationforapatientwhohasreceivedadiagnosisofmyelodysplastic
syndrome(MDS).Whichofthefollowingtopicsshouldthenurseprioritize?
A)
Techniquesforenergyconservationandactivitymanagement
B)
Emergencymanagementofbleedingepisodes
C)
Techniquefortheadministrationofbronchodilatorsbymetered-doseinhaler
TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)
D)
Techniquesforself-palpationofthelymphnodes
Ans:
B
670
Feedback:
Becauseofpatientsrisksofhemorrhage,patientswithMDSshouldbetaughttechniquesformanaging
emergentbleedingepisodes.BronchodilatorsarenotindicatedforthetreatmentofMDSand
lymphedemaisnotnormallyassociatedwiththedisease.Energyconservationtechniquesarelikelytobe
useful,butmanagementofhemorrhageisaprioritybecauseofthepotentialconsequences.
31. Aclinicpatientisbeingtreatedforpolycythemiaveraandthenurseisprovidinghealtheducation.What
practiceshouldthenurserecommendinordertopreventthecomplicationsofthishealthproblem?
A)
B)
AvoidingnaturalsourcesofvitaminK
Avoidingaltitudesof1500feet(457meters)
C)
Performingactiverangeofmotionexercisesdaily
D)
Avoidingtightandrestrictiveclothingonthelegs
Ans:
D
Feedback:
BecauseoftheriskofDVT,patientswithpolycythemiaverashouldavoidtightandrestrictiveclothing.
ThereisnoneedtoavoidfoodswithvitaminKortoavoidhigheraltitudes.Activitylevelsshouldbe
maintained,butthereisnospecificneedforROMexercises.
32. Aclinicnurseisworkingwithapatientwhohasalong-standingdiagnosisofpolycythemiavera.How
canthenursebestgaugethecourseofthepatientsdisease?
A)
Documentthecolorofthepatientspalmsandfaceduringeachvisit.
B)
Followthepatientserythrocytesedimentationrateovertime.
C)
Documentthepatientsresponsetoerythropoietininjections.
D)
Followthetrendsofthepatientshematocrit.
Ans:
D
Feedback:
TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)
671
Thecourseofpolycythemiaveracanbebestascertainedbymonitoringthepatientshematocrit,which
shouldremainbelow45%.Erythropoietininjectionswouldexacerbatethecondition.Skintoneshould
beobserved,butisasubjectiveassessmentfinding.ThepatientsESRisnotrelevanttothecourseofthe
disease.
33. Anurseisplanningthecareofapatientwhohasbeendiagnosedwithessentialthrombocythemia(ET).
Whatnursingdiagnosisshouldthenurseprioritizewhenchoosinginterventions?
A)
RiskforIneffectiveTissuePerfusion
B)
RiskforImbalancedFluidVolume
C)
RiskforIneffectiveBreathingPattern
D)
RiskforIneffectiveThermoregulation
Ans:
A
Feedback:
PatientswithETareatriskforhypercoagulationandconsequentineffectivetissueperfusion.Fluid
volume,breathing,andthermoregulationarenotnormallyaffected.
34. Anurseatalong-termcarefacilityisamendingthecareplanofaresidentwhohasjustbeendiagnosed
withessentialthrombocythemia(ET).Thenurseshouldanticipatetheadministrationofwhat
medication?
A)
Dalteparin
B)
Allopurinol
C)
Hydroxyurea
D)
Hydrochlorothiazide
Ans:
C
Feedback:
HydroxyureaiseffectiveinloweringtheplateletcountforpatientswithET.Dalteparin,allopurinol,and
HCTZdonothavethistherapeuticeffect.
35. Anurseiswritingthecareplanofapatientwhohasbeendiagnosedwithmyelofibrosis.Whatnursing
diagnosesshouldthenurseaddress?Selectallthatapply.
DisturbedBodyImage
TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)
672
A)
B)
ImpairedMobility
C)
ImbalancedNutrition:LessthanBodyRequirements
D)
AcuteConfusion
E)
RiskforInfection
Ans:
A,B,C,E
Feedback:
Theprofoundsplenomegalythataccompaniesmyelofibrosiscanimpactthepatientsbodyimageand
mobility.Aswell,nutritionaldeficitsarecommonandthepatientisatriskforinfection.Cognitive
effectsarelesscommon.
36. Anadultpatientsabnormalcompletebloodcount(CBC)andphysicalassessmenthavepromptedthe
primarycareprovidertoorderadiagnosticworkupforHodgkinlymphoma.Thepresenceofwhat
assessmentfindingisconsidereddiagnosticofthedisease?
A)
Schwanncells
B)
Reed-Sternbergcells
C)
Lewybodies
D)
LoopsofHenle
Ans:
B
Feedback:
ThemalignantcellofHodgkinlymphomaistheReed-Sternbergcell,agigantictumorcellthatis
morphologicallyuniqueandthoughttobeofimmaturelymphoidorigin.Itisthepathologichallmark
andessentialdiagnosticcriterion.SchwanncellsexistintheperipheralnervoussystemandLewybodies
aremarkersofParkinsondisease.LoopsofHenleexistinnephrons.
37. AyoungadultpatienthasreceivedthenewsthathertreatmentforHodgkinlymphomahasbeendeemed
successfulandthatnofurthertreatmentisnecessaryatthistime.Thecareteamshouldensurethatthe
patientreceivesregularhealthassessmentsinthefutureduetotheriskofwhatcomplication?
A)
Iron-deficiencyanemia
B)
Hemophilia
TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)
C)
Hematologiccancers
D)
Genitourinarycancers
Ans:
C
673
Feedback:
SurvivorsofHodgkinlymphomahaveahighriskofsecondcancers,withhematologiccancersbeingthe
mostcommon.Thereisnoconsequentriskofanemiaorhemophilia,andhematologiccancersaremuch
morecommonthanGUcancers.
38. Theclinicalnurseeducatorispresentinghealthpromotioneducationtoapatientwhowillbetreatedfor
non-Hodgkinlymphomaonanoutpatientbasis.Thenurseshouldrecommendwhichofthefollowing
actions?
A)
Avoidingdirectsunexposureinexcessof15minutesdaily
B)
Avoidinggrapefruitjuiceandfreshgrapefruit
C)
Avoidinghighlycrowdedpublicplaces
D)
Usinganelectricshaverratherthanarazor
Ans:
C
Feedback:
Theriskofinfectionissignificantforthesepatients,notonlyfromtreatment-relatedmyelosuppression
butalsofromthedefectiveimmuneresponsethatresultsfromthediseaseitself.Limitinginfection
exposureisthusnecessary.Theneedtoavoidgrapefruitisdependentonthepatientsmedication
regimen.Sunexposureandtheuseofrazorsarenotnecessarilycontraindicated.
39. Apatienthasadiagnosisofmultiplemyelomaandthenurseispreparinghealtheducationinpreparation
fordischargefromthehospital.Whatactionshouldthenursepromote?
A)
Dailyperformanceofweight-bearingexercisetopreventmuscleatrophy
B)
Closemonitoringofurineoutputandkidneyfunction
C)
Dailyadministrationofwarfarin(Coumadin)asordered
D)
Safeuseofsupplementaryoxygeninthehomesetting
TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)
Ans:
674
B
Feedback:
Renalfunctionmustbemonitoredcloselyinthepatientwithmultiplemyeloma.Excessiveweightbearingcancausepathologicfractures.Thereisnodirectindicationforanticoagulationor
supplementaryoxygen.
40. Anurseiscaringforpatientwhosediagnosisofmultiplemyelomaisbeingtreatedwithbortezomib.The
nurseshouldassessforwhatadverseeffectofthistreatment?
A)
Stomatitis
B)
Nephropathy
C)
Cognitivechanges
D)
Peripheralneuropathy
Ans:
D
Feedback:
Asignificanttoxicityassociatedwiththeuseofbortezomibformultiplemyelomaisperipheral
neuropathy.Stomatitis,cognitivechanges,andnephropathyarenotnotedtobeadverseeffectsofthis
medication.