Deck 28: Nursing Care of Patients With Hematologic and Lymphatic Disorders

Question 1

A patient is diagnosed with anemia and asks the nurse what nutrients are important for red blood cell (RBC) formation. The nurse bases an answer on the understanding that which of the following nutrients are essential for production of healthy red cells?

A)Vitamin C, vitamin D, and selenium
B)Iron, folic acid, and vitamin B₁₂
C)Vitamin A, calcium, and phosphorus
D)Aluminum, vitamin E, and beta carotene

Answer 1

Iron, folic acid, and vitamin B₁₂

Question 2

A patient with thrombocytopenia is having pain. If each of the following medications is ordered, which should the nurse choose to administer?

A)Acetaminophen with codeine (Tylenol no. 3) PO
B)Meperidine (Demerol) IM
C)Oxycodone with aspirin (Percodan) PO
D)Morphine SQ

Answer 2

Acetaminophen with codeine (Tylenol no. 3) PO

Question 3

A patient with iron-deficiency anemia was placed on oral iron therapy. Which of the following tests would the nurse review to determine the effectiveness of this intervention?

A)Electrolytes, blood urea nitrogen (BUN), and creatinine
B)Thrombin clotting time (TCT) and prothrombin time (PT)
C)White blood cell (WBC) and platelet counts
D)Hemoglobin and hematocrit

Answer 3

Hemoglobin and hematocrit

Question 4

A patient is admitted in sickle cell crisis with symptoms of dyspnea and leg pain. The patient's significant other asks, "I don't really understand why he is hurting so badly." Which of the following responses by the nurse is best?

A)"The pain is due to a disturbance in cellular metabolism."
B)"The bone marrow is expanding with the sickled cells and that causes pain."
C)"Clumping of abnormal red blood cells blocks the flow of blood through the capillaries."
D)"Bleeding in the joints occurs because red blood cells are being rapidly destroyed by the bone marrow."

Question 5

Which nursing intervention is most likely to cause acute complications in a patient with disseminated intravascular coagulation?

A)Administering intramuscular meperidine (Demerol) for pain
B)Placing the patient on strict bedrest
C)Providing a diet that is high in fat and sodium
D)Allowing a family member with a respiratory infection to visit

Question 6

The nurse is preparing to give an injection of iron (Imferon) to a patient with anemia. What is the rationale for using the Z-track method for injection?

A)To prevent tissue damage at the site
B)To prevent pain at the site
C)To prevent discoloration of tissue at the site
D)To promote absorption of the medication

Question 7

Which nursing diagnosis is most common in a patient with anemia?

A)Ineffective Airway Clearance related to dyspnea
B)Activity Intolerance related to tissue hypoxia
C)Risk for Infection related to reduction in circulating white blood cells
D)Chronic Pain related to bone marrow dysfunction

Question 8

A patient is admitted to the hospital with hypertension and vertigo related to polycythemia vera. For which of the following treatments should the nurse prepare the patient?

A)Injection of colony-stimulating factors
B)Therapeutic phlebotomy
C)Splenectomy
D)Myelogram

Question 9

A patient with aplastic anemia is to receive an injection of erythropoietin (Epogen). The patient asks what the injection is intended to do. Which of the following responses by the nurse is best?

A)"It works like a blood transfusion to give you extra red blood cells."
B)"It will inhibit the protein that is attacking your blood cells."
C)"It will stimulate your body to produce more of its own red blood cells."
D)"It will increase your energy while your body is recovering from the anemia."

Question 10

Which laboratory study does the nurse monitor to help evaluate the effectiveness of treatment for polycythemia vera (PV)?

A)Total protein
B)White blood cell (WBC) differential
C)Blood urea nitrogen (BUN)
D)Hematocrit

Question 11

Which of the following manifestations might first alert the nurse to the possibility of disseminated intravascular coagulation?

A)Weakness or paralysis on one side
B)Increasing blood pressure and pulse
C)Petechiae
D)Absence of pulses in extremities

Question 12

The nurse is caring for a patient with a bleeding disorder. Which of the following medication orders should the nurse question?

A)Digoxin (Lanoxin)
B)Thyroid hormone (Synthroid)
C)Morphine
D)Aspirin

Question 13

The nurse is caring for a patient with thrombocytopenia. Which activity should be avoided?

A)Visits from family members
B)Intramuscular injections
C)Eating fresh fruits and vegetables
D)Ambulation

Question 14

Which of the following individuals is most likely to present with signs or symptoms of sickle cell anemia?

A)A 5-year-old girl of Hispanic origin
B)A 1-year-old boy who is African American
C)A 1-month-old boy who is Hispanic
D)A 3-month-old girl who is African American

Question 15

Which blood component is deficient in a patient with anemia?

A)Red blood cells
B)White blood cells
C)Platelets
D)Plasma

Question 16

Which nursing intervention best helps prevent complications in a patient with polycythemia?

A)Encourage 3 L of water intake daily.
B)Monitor intake and output.
C)Avoid use of injections for pain.
D)Maintain bedrest during treatment.

Question 17

The nurse is caring for a patient with a clotting disorder. Which of the following blood products would the nurse anticipate being ordered?

A)Normal saline
B)Albumin
C)Packed white blood cells
D)Cryoprecipitates

Question 18

The nurse is providing dietary teaching to an individual with iron-deficiency anemia. Which of the following statements, if made by the patient, indicates that teaching has been effective?

A)"I'm going to drink orange juice for breakfast and increase red meats in my diet."
B)"I know I need to eat more green vegetables and dairy products."
C)"Yellow vegetables and green tea will be important to help build up my blood levels."
D)"Berries and natural cereals are good for me because of my low iron levels."

Question 19

The nurse is teaching a patient with sickle cell anemia how to prevent crises. Which foods should the nurse teach the patient to avoid?

A)Alcoholic beverages
B)Citrus fruits
C)Chocolates and colas
D)Whole grain products

Question 20

What is the rationale for providing warm compresses and blankets for a patient with sickle cell crisis?

A)Sickle cell crisis causes shivering and discomfort.
B)Heat prevents vasoconstriction and impaired circulation.
C)Heat helps prevent the cells from becoming sickled.
D)Heat speeds production of new healthy red blood cells.

Question 21

The nurse is assessing a patient with a bleeding disorder and finds large purplish areas in the skin and oral mucosa. Which term should the nurse use to document this finding?

A)Petechiae
B)Purpura
C)Hemorrhage
D)Bleeding

Question 22

A patient is being tested for possible leukemia. With which of the following diagnostic tests should the nurse anticipate assisting?

A)Bone marrow biopsy
B)Thoracentesis
C)Liver biopsy
D)Arterial blood gas analysis

Question 23

A patient with multiple myeloma is at risk for hypercalcemia. Which of the following nursing interventions is most important for the patient with hypercalcemia?

A)Encourage fluids.
B)Offer citrus juices and fruits.
C)Place the patient on a low-sodium diet.
D)Discourage intake of alcoholic beverages.

Question 24

A nurse is assisting with data collection on a newly admitted patient with a history of hemophilia. Which assessment finding indicates that the patient has experienced some severe episodes of bleeding in the past?

A)Ecchymoses on the extremities
B)Joint deformities
C)Elevated white blood cell count
D)Distended abdomen

Question 25

Which of the following beverages should a patient with Hodgkin's disease be instructed to avoid?

A)Coffee
B)Orange juice
C)Wine
D)Ginger ale

Question 26

Why is it important for the nurse to institute measures to protect a patient with leukemia from infection?

A)The drugs needed to fight infection have life-threatening side effects.
B)Leukemia seriously impairs the leukocytes and the body's ability to fight infection.
C)Infection can precipitate hemorrhage in the patient with leukemia.
D)Infection in the patient with leukemia can lead to permanent neurological damage.

Question 27

A patient with terminal lymphoma says to the nurse, "I'm tired of being so fatigued all the time. Can't you just give me a big shot of morphine and help me end this suffering?" Which of the following responses by the nurse is most appropriate?

A)"You have orders for morphine 10 to 15 mg. I don't think that's enough to end your suffering."
B)"You sound frustrated. It must be difficult to feel so tired all the time."
C)"That is really not appropriate to ask. Would you like a shot just to take away the pain?"
D)"Are you sure that is what you want me to do? Maybe you should think about it first."

Question 28

A 54-year-old patient is admitted to the hospital in the final stage of chronic lymphocytic leukemia (CLL). Which of the following manifestations of CLL would the nurse expect to find while collecting admission data?

A)Nausea and vomiting
B)Hypotension and alopecia
C)Cervical lymphadenopathy and chest pain
D)Fever and abnormal bleeding

Question 29

The nurse is emptying the bedside commode of a patient with chronic leukemia and notes that the stool is very dark. Which assumption should guide the nurse's action?

A)The patient ate something that turned the stool a dark color.
B)The patient is most likely on iron supplements.
C)The patient may be bleeding.
D)The patient may be dehydrated.

Question 30

A patient with Hodgkin's disease has cervical lymph node enlargement. Which symptom should the nurse attend to first?

A)Fever
B)Stridor
C)Fatigue
D)Pain

Question 31

A patient walks into the urgent care clinic, stating that he has hemophilia and that he is bleeding. The triage nurse does a quick assessment and sees no signs of active bleeding. Several patients are already in the waiting area. Which of the following actions by the nurse is most appropriate?

A)Place the patient in an examination room and tell the physician that the patient may be bleeding.
B)Ask the patient to sit in the waiting room until his name is called.
C)Send the patient for routine x-rays according to clinic protocol to look for a source of bleeding, and then place him in an examination room.
D)Palpate the suspected area for tenderness and edema.

Question 32

A patient is being prepared for splenectomy. What is the purpose of the order for a vitamin K injection?

A)It corrects clotting factor deficiencies.
B)It replaces vitamin K lost during night sweats.
C)It corrects a dietary deficiency.
D)It helps correct underlying anemia.

Question 33

When assessing the patient with stage III Hodgkin's disease, where would the nurse expect to find enlarged lymph nodes?

A)In the neck only
B)Above the diaphragm only
C)Below the diaphragm only
D)Generalized throughout the body

Question 34

A patient with lymphoma wants to attend a family member's wedding but is extremely fatigued. The nurse develops a plan for Activity Intolerance related to symptoms of lymphoma. How will the nurse know if the plan has been effective?

A)The patient is able to sleep 8 hours at night.
B)The patient can list three ways to combat fatigue.
C)The patient attends the family member's wedding.
D)The patient verbalizes understanding of the importance of gradually increasing activity.

Question 35

A patient receiving chemotherapy for chronic myelocytic leukemia has irritated mucous membranes. Which of the following mouth care interventions would the nurse include in the plan of care?

A)Swab teeth and mucous membranes four times daily with lemon-glycerin swabs.
B)Brush teeth twice a day with a firm toothbrush.
C)Use sponge Toothettes to clean teeth after meals.
D)Use waxed floss between meals and at bedtime.

Question 36

The nurse is providing care for a patient who has had a splenectomy. Which of the following nursing actions has the highest priority?

A)Assess pain every shift.
B)Encourage the patient to look at the incision during dressing changes.
C)Teach the patient to cough and deep breathe every hour.
D)Provide a diet rich in fruits and vegetables.

Question 37

A comatose patient is admitted to the emergency department after an automobile accident. The nurse notes a Medic-Alert identification bracelet that states the patient has hemophilia. What should the nurse do first?

A)Notify the physician of the bracelet.
B)Remove the bracelet, and give it to the patient's family member.
C)Tape the bracelet to the patient's arm.
D)Call the phone number on the bracelet.

Question 38

A patient with hemophilia A is bleeding. Which of the following treatments should the nurse anticipate?

A)IM injection of factor VIII
B)IM injection of factor IX
C)IV infusion of factor VIII
D)IV infusion of factor IX

Question 39

A patient with multiple myeloma is being cared for at home. Which of the following nursing diagnoses should guide the nurse when teaching the family how to provide care for the patient?

A)Ineffective Airway Clearance related to cervical lymphadenopathy
B)Ineffective Tissue Perfusion related to vascular occlusion
C)Risk for Deficient Fluid Volume related to bleeding disorder
D)Risk for Injury related to compromised bone integrity

Question 40

Which question by the nurse helps evaluate the patient's response to treatment for anemia?

A)"Is your appetite improving?"
B)"Are you sleeping all night?"
C)"Are you keeping up with your work schedule?"
D)"Are you requiring many analgesics?"

Question 41

Which of the following commonly trigger a sickle cell crisis? (Select all that apply.?

A)Anesthesia
B)Blood loss during surgery
C)Use of nasal oxygen
D)Severe infection
E)Chemotherapy
F)Strenuous exercise

Question 42

Reduced fibrinogen and platelet levels, increased thrombin time, and reduced factor assays are laboratory results associated with which of the following hematological disorders?

A)Polycythemia vera
B)Disseminated intravascular coagulation
C)Aplastic anemia
D)Sickle cell anemia
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 43

The nurse is providing education to an individual with sickle cell anemia. Which of the following activities should the patient be instructed to avoid? (Select all that apply.?

A)Sexual activity
B)Long-distance driving
C)Standing for long periods
D)Skiing in the mountains
E)Scuba diving
F)Contact sports

Question 44

A patient is typically placed on bleeding precautions if the platelet count is less than ____________________/mm³.

Question 45

A patient with anemia and a nursing diagnosis of activity intolerance due to tissue hypoxia and dyspnea is attempting to increase activity tolerance. If the respiratory rate increases by more than ____________________% from baselines during activity, however, the activity level should be reduced.

Question 46

Which of the following are characteristics of Hodgkin's disease? (Select all that apply.?

A)It is the most curable of all lymphomas.
B)It is distinguished by the presence of Philadelphia chromosome.
C)It is distinguished by the presence of Reed-Sternberg cells.
D)Skeletal pain is a common symptom.
E)Painless swelling of cervical, axillary, or inguinal nodes occurs.
F)Visual changes occur.Completion
Complete each statement.

Question 47

The daughter of a man with hemophilia has a ____________________% chance of transmitting the gene to each son and daughter.

Question 48

What follow-up care is most important for the nurse to teach a patient who has had a splenectomy?

A)Monthly coagulation studies
B)Yearly influenza vaccination
C)Oral analgesics for pain control
D)Routine transfusion of packed red blood cells to prevent anemia

Question 49

The recommended dose of filgrastim (Neupogen) is 10 mcg/kg/day. It is supplied as 300 mcg/mL. A patient who weighs 132 lb should receive ________________mL.

Question 50

A patient who has had a splenectomy complains of malaise. The nurse checks the patient's temperature and finds it is 102°F (39°C). Which of the following actions by the nurse should take priority?

A)Administer acetaminophen to reduce fever and relieve discomfort.
B)Encourage fluids to reduce fever and prevent dehydration.
C)Explain to the patient that low-grade fevers are common after splenectomy because the spleen is part of the immune system.
D)Notify the physician.

Question 51

A patient diagnosed with polycythemia vera should be instructed to drink at least ________________L of water daily.

Question 52

A hematocrit of more than ____________________% is characteristic of polycythemia.

Question 53

What nursing action is the best way to prevent infection in a postoperative patient?

A)Practice good hand washing.
B)Assess vital signs every 4 hours.
C)Change wound dressings daily.
D)Encourage 2 L of fluid daily.