Nokea
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
Correct Answer: B
Rationale: 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.
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A nurse is caring for a 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
Correct Answer: D
Rationale: 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.
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.
- D. Its important to reduce other factors that increase the risk of second cancers.
Correct Answer: D
Rationale: 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.
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
- D. Techniques for self-palpation of the lymph nodes
Correct Answer: B
Rationale: 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.
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?
- 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
Correct Answer: D
Rationale: 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.
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.
- A. Disturbed Body Image
- B. Impaired Mobility
- C. Imbalanced Nutrition: Less than Body Requirements
- D. Acute Confusion
- E. Risk for Infection
Correct Answer: A,B,C,E
Rationale: 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.