Multiple Myeloma — NCLEX Cheat Sheet
Plasma cell cancer → bone + Ca↑Also known as: bone marrow plasma cancer · plasma cell cancer · myeloma · bone cancer of the marrow
Use this quick-reference guide to spot, treat, and prevent Multiple Myeloma on the NCLEX. Keep it handy during review and on exam day!
🩺📒 The 1-minute cheat sheet
📌 Mech
- malignant plasma cells in marrow
- destroy bone → ↑calcium
🩺 Signs
- CRAB: ↑Ca, Renal, Anemia, Bone
- deep bone pain, pathologic fx
- fatigue, frequent infection
🧪 Labs
- ↑Ca, ↑Bence-Jones protein urine
- ↑creat, ↓Hgb, M-protein spike
✅ Do
- ↑fluids 3 L → flush Ca + protein
- ambulate (↓Ca), fall precautions
- bisphosphonates, pain control
- report ↑Ca: confusion, weakness
📚 Multiple Myeloma — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Key points
Understand these first- Bone destruction causes deep bone pain (especially back and ribs) and pathologic fractures.
- Hypercalcemia results from bone breakdown, causing confusion, constipation, and weakness.
- Anemia and bleeding occur as plasma cells crowd the marrow.
- Abnormal proteins (Bence Jones proteins) and high calcium damage the kidneys, risking renal failure.
- Recurrent infections occur because the abnormal antibodies are not protective.
- Bone marrow biopsy shows excess plasma cells; X-rays show 'punched-out' lytic lesions.
Nursing priorities
What to do, in order- Promote hydration (often 3 liters/day) to flush calcium and protein and protect the kidneys.
- Encourage gentle mobility as tolerated to reduce hypercalcemia, but AVOID strenuous or high-impact weight-bearing due to the risk of pathologic fractures and spinal cord compression.
- Manage pain and handle/move the patient gently to prevent pathologic fractures.
- Monitor for hypercalcemia and renal function and administer bisphosphonates as prescribed.
- Protect from infection and monitor blood counts.
Red flags — report now
Escalate immediately- Report signs of hypercalcemia: confusion, lethargy, muscle weakness, and cardiac dysrhythmias.
- Report decreasing urine output or rising creatinine indicating renal failure.
- Report sudden severe bone pain or signs of a pathologic fracture or spinal cord compression (new weakness, numbness, loss of bowel/bladder control).
Labs & values
Numbers to know- Serum calcium (normal 9-10.5 mg/dL) elevated
- Creatinine and BUN elevated (renal impairment)
- Hemoglobin (normal 12-18 g/dL) decreased
- Bence Jones protein present in urine
Patient teaching
What patients must know- Drink at least 3 liters of fluid daily unless contraindicated to protect the kidneys.
- Stay gently active as tolerated but avoid high-impact or strenuous weight-bearing; use safe movement to prevent fractures and report new bone pain.
- Avoid infection exposure and report fever, and report numbness, leg weakness, or loss of bladder/bowel control immediately.
❓ Multiple Myeloma: NCLEX FAQs
What are the priority nursing interventions for Multiple Myeloma?
Promote hydration (often 3 liters/day) to flush calcium and protein and protect the kidneys. Encourage gentle mobility as tolerated to reduce hypercalcemia, but AVOID strenuous or high-impact weight-bearing due to the risk of pathologic fractures and spinal cord compression. Manage pain and handle/move the patient gently to prevent pathologic fractures. Monitor for hypercalcemia and renal function and administer bisphosphonates as prescribed.
What are the warning signs of Multiple Myeloma a nurse must report?
Report signs of hypercalcemia: confusion, lethargy, muscle weakness, and cardiac dysrhythmias. Report decreasing urine output or rising creatinine indicating renal failure. Report sudden severe bone pain or signs of a pathologic fracture or spinal cord compression (new weakness, numbness, loss of bowel/bladder control).
What do I need to know about Multiple Myeloma for the NCLEX?
Bone destruction causes deep bone pain (especially back and ribs) and pathologic fractures. Hypercalcemia results from bone breakdown, causing confusion, constipation, and weakness. Anemia and bleeding occur as plasma cells crowd the marrow. Abnormal proteins (Bence Jones proteins) and high calcium damage the kidneys, risking renal failure.
What patient teaching is important for Multiple Myeloma?
Drink at least 3 liters of fluid daily unless contraindicated to protect the kidneys. Stay gently active as tolerated but avoid high-impact or strenuous weight-bearing; use safe movement to prevent fractures and report new bone pain. Avoid infection exposure and report fever, and report numbness, leg weakness, or loss of bladder/bowel control immediately.
Quick Tip
Bone destruction causes deep bone pain (especially back and ribs) and pathologic fractures.
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