Med-Surg (Blood Cancers EAQ)

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A client who has been diagnosed with acute lymphocytic leukemia Abnormalities in cardiac rhythm
will be receiving doxorubicin (Adriamycin) infusions as part of a
chemotherapy regimen. The nurse monitors the client for signs Doxorubicin is cardiotoxic, which is manifested by transient ECG
and symptoms of doxorubicin toxicity. What clinical finding indi- abnormalities. Alopecia is an expected side effect of doxorubicin,
cates that toxicity has occurred? not a toxic effect.
An adolescent who has been prescribed prednisone (Meticorten)
and vincristine (Oncovin) for leukemia tells the nurse that he is Constipation is a side effect of vincristine (Oncovin) because it
very constipated. What should the nurse cite as the probable slows gastrointestinal motility.
cause of the constipation?
Check the health care provider's prescription to notify blood bank
what product will be needed.

Obtain the client's baseline vital signs and ask if the client has had
previous transfusions and if there were any untoward effects.

Ascertaining the intravenous catheter size is at least an 18 will

A blood transfusion of packed cells has been prescribed for a
prevent hemolysis of red blood cells.
client with leukemia. The nurse will complete the following steps
in what order?
The main line solution must be normal saline 0.9 to flush the line
and use as a main line if the blood administration must occur
because of a reaction. Other solutions can affect blood, causing it
to clot.

Checking the client identification and verification of blood product

is necessary before proceeding.
Feeling different regarding changes in body image
A nurse is caring for a 15-year-old client who is undergoing
chemotherapy for leukemia. The nurse expects that adolescents The 15-year-old is preoccupied with appearance. The side effects
with health problems are most concerned about: of the antineoplastics and prednisone may result in the adolescent
feeling different, which affects body image.
Having them avoid contact with infected persons

Chemotherapy and acute lymphoblastic leukemia (ALL) cause

immunosuppression (low white blood cells), thus increasing the
What is important nursing care for clients with leukemia on
risk for infection. The client should maintain physical activity that
chemotherapeutic protocols?
can be tolerated. Although vital signs must be checked to assess
for changes in pulse or blood pressure, unless there is clinical
evidence of bleeding, it is not necessary to obtain vital signs every
two hours.
Platelet count
While providing nursing care for an adolescent undergoing
chemotherapy for leukemia, a nurse notes blood on the child's
The platelet count is reduced as a result of bone marrow depres-
pillowcase, as well as several bloody tissues. Which of the child's
sion associated with leukemia and the side effects of chemother-
laboratory test results should the nurse review?
apeutic agents. A low hematocrit level might indicate anemia, but
it does not establish its cause
Schedule laboratory blood tests to evaluate response to the med-
ication.

Blood tests indicate response to therapy; if the white blood cell

count drops precipitously, therapy may be halted temporarily.
An adolescent with leukemia is to be sent home on a protocol that
These children undergo therapy for extended periods, and pro-
includes several antineoplastics. Before discharge, what instruc-
longed separation from their peers may lead to social isola-
tions should the nurse give the parents?
tion. Contact with children who have active infections should be
avoided. Although nausea commonly occurs with this therapy,
antiemetic measures are instituted; the drug is not withdrawn
for this reason. A bone marrow aspiration is a painful procedure
and is performed selectively (e.g., to confirm the diagnosis), not
routinely.

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Melena, Purpura, Hematuria

Black, tarry feces (Melena) caused by the action of intestinal se-

cretions on blood are associated with bleeding in the gastrointesti-
nal tract; bleeding is related to a reduced number of thrombocytes,
A client is diagnosed with acute lymphoid leukemia and is re-
which are part of the coagulation process.
ceiving chemotherapy. The nurse should monitor what thrombo-
cytopenic side effects of chemotherapy? Select all that apply.
Hemorrhages into the skin and mucous membranes (purpura)
may occur with reduced numbers of thrombocytes, which are part
of the coagulation process.

Blood in the urine (hematuria) may occur with reduced number of

thrombocytes, which are part of the coagulation process.
"Your child's immune system must be destroyed before the trans-
plantation can take place."

Parents are considering a bone marrow transplant for their child

who has recurrent leukemia. The parents ask the nurse for clar- An intensive preparatory regimen is needed to destroy the child's
ification about the procedure. What is the best response by the immune system. Once the process is started, no rescue therapy
nurse? except for the transplant is provided. The procedure is performed
in children for recurrent malignancies. The child's bone marrow
must be clear of all cells before transfusion of the stem cells is
performed.
Assess the client's readiness to learn.

A health care provider prescribes epoetin (Epogen) subcuta-

Readiness to learn, including attitude and physical ability to see
neously three times a week for an older adult with chronic lym-
and use equipment, must be assessed before the skill can be
phocytic leukemia (CLL) who lives alone. The nurse plans to teach
taught. Demonstrating the injection technique as an initial inter-
the client about the medication. What should the nurse do first?
vention may be overwhelming for the client. Explanations are not
as effective as a demonstration and a return demonstration when
a skill is being taught.
A client who is receiving methotrexate for acute lymphocytic
Express concern about the type of antipyretic prescribed.
leukemia (ALL) develops a temperature of 101° F. The nurse
notifies the health care provider. Aspirin 650 mg every four hours
as needed for temperature equal to or greater than 101° F is
Express concern about the type of antipyretic prescribed.
prescribed. What should the nurse do regarding this prescription?
A client who is suspected of having leukemia has a bone marrow
Apply brief pressure to site.
aspiration. Immediately after the procedure, the nurse should:
Hypermetabolic status
On admission, the laboratory results of a client with leukemia
indicate elevated blood urea nitrogen (BUN) and uric acid levels.
The nurse determines that these laboratory results may be related The hypermetabolic state associated with leukemia causes more
to: urea and uric acid (end products of metabolism) to be produced
and to accumulate in the blood.
Older adults
What group of clients should the nurse anticipate to have the
highest incidence of non-Hodgkin lymphomas?
The incidence increases with age; the median age when diag-
nosed is 67 years old.
A client's discouragement with the diagnosis of nodular, poorly
differentiated lymphocytic lymphoma continues during radiation
therapy because of the long time required for treatment and its Prognosis for this disease is more favorable than for other cancers
side effects. What should the nurse emphasize when assisting the
client to plan for the future?
Hyperkalemia occurs when large quantities of tumor cells are
destroyed, rapidly releasing potassium and purines quicker than
the body can manage them (tumor lysis syndrome). A serum

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potassium of 5.8 mEq/L is more than the expected range of 3.5 to
5.3 mEq/L, resulting in the abnormal ECG results. Hyperkalemia
Tumor Lysis Syndrome can cause a pulse in the lower range of that expected for an adult,
numbness in the extremities, flaccid paresis, hyperactive bowel
sounds, and diarrhea.
Preventing infection; the client is at risk for leukopenia
A client diagnosed with multiple myeloma has been given a poor
prognosis. After discharge, the client plans to travel on an airplane The bone marrow is impaired with multiple myeloma; the effec-
and attend sporting events with friends and family. The nurse tiveness of white blood cells and immunoglobulins is reduced,
prepares a discharge teaching plan for this client and includes: which increases susceptibility to bacterial infections. Travel can be
accomplished with careful planning and adequate rest periods.
Chemotherapy employing a combination of drugs is the treatment
The nurse expects that the plan of care for a client diagnosed with
of choice; a variety of chemotherapeutic drugs affect rapidly di-
multiple myeloma will include:
viding cells at different stages of cell division.
Handle the client with supportive movements
A client with multiple myeloma is scheduled to have a chest
x-ray examination and a bone scan. For this client, the primary
responsibility of the nurses and other members of the health care Because of bone erosion, pathological fractures are a common
team is to: complication of multiple myeloma. Although explaining the proce-
dure and its purpose is done, the priority is to prevent injury.
Bone marrow biopsy

A definite confirmation of multiple myeloma can be made only

The nurse expects that the most definitive test to confirm a diag- through a bone marrow biopsy; this is a plasma cell malignancy
nosis of multiple myeloma is: with widespread bone destruction. Although calcium is lost from
bone tissue and hypercalcemia results, this is not a confirmation
of the disease. Although Bence Jones protein is found in the urine,
it does not confirm the disease.
Increased blood viscosity
A nurse is caring for a client with a diagnosis of polycythemia vera.
The client asks, "Why do I have an increased tendency to develop
blood clots?" Which effect of the polycythemia vera should the Polycythemia vera results in pathologically high concentrations of
nurse explain increases the risk of these thromboses? erythrocytes in the blood; increased viscosity promotes thrombus
formation.
Hematocrit

A client is prescribed epoetin (Epogen) injections. To ensure the Epoetin is used to treat anemia. Epoetin is also used before and
client's safety, which lab value should the nurse assess before after certain types of surgery to decrease the chance that blood
administration? transfusions will be needed because of blood loss during surgery.
The lab value the nurse should assess before administration is the
hematocrit (HCT). HCT measures the percentage of whole blood.
White blood cells
A client who is immunosuppressed is receiving filgrastim (Neu-
pogen). When the nurse evaluates the client's response to this Filgastrin, a granulocyte colony-stimulating factor, increases the
medication, the finding that is most significant is an increase in: production of neutrophils with little effect on the production of
hematopoietic cells.

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