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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.
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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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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
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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.
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D)
Its important to reduce other factors that increase the risk of second cancers.
Ans:
D
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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
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
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
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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:
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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
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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
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C)
Hematologic cancers
D)
Genitourinary cancers
Ans:
C
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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
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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.