Deck 75: Management of Clients with Hematologic Disorders

Question 1

The nurse explains that the medication essential for a client with pernicious anemia is

A) ferritin.
B) ferrous gluconate.
C) vitamin B12.
D) vitamin K.

Answer 1

vitamin B12.

Question 2

The nurse is aware that the situation that would warrant administration of iron supplements to a client with pernicious anemia is

A) poor appetite.
B) increase in the total erythrocyte count in the peripheral circulation.
C) discrepancy between hemoglobin and erythrocyte levels.
D) paresthesia in the fingers.

Answer 2

discrepancy between hemoglobin and erythrocyte levels.

Question 3

A nurse is conducting a home safety check on a client with cobalamin/vitamin B?? deficiency. What inquiries should the nurse specifically make?

A) Evidence of adequate lighting
B) How many stairs the client must negotiate to get inside
C) Number and location of throw rugs
D) Temperature setting on the water heater

Answer 3

Temperature setting on the water heater

Question 4

A nurse is conducting a wellness seminar on healthy eating and prevention of iron deficiency anemia. The food the nurse would describe as being high in iron is

A) citrus fruits.
B) grains.
C) green leafy vegetables.
D) milk products.

Question 5

A client has a hemoglobin level of 8.2 g/dl. The nurse finds the client dyspneic with an O? saturation of 98%. The client has oxygen on at 2 liters per nasal cannula. Which intervention by the nurse would be best to meet this client's needs?

A) Call the physician and suggest a transfusion.
B) Find another oximeter and check another saturation.
C) Increase the O₂ to 6 liters per nasal cannula.
D) Prepare to intubate and mechanically ventilate the client.

Question 6

The nurse points out that nursing management of all individuals with anemia is primarily directed toward

A) genetic counseling.
B) identifying complications.
C) managing manifestations.
D) rehabilitative measures.

Question 7

The nursing diagnosis that would have priority in the care of a client with agranulocytosis is

A) alteration in bowel elimination: Constipation due to iron overload.
B) Impaired Gas Exchange due to low RBC count.
C) potential for Impaired Skin Integrity due to poor nutritional status.
D) Risk for Infection due to decreased leukocyte count.

Question 8

The nurse caring for a client with polycythemia vera explains the objective of phlebotomies is to decrease the hematocrit to

A) 15%.
B) 25%.
C) 35%.
D) 45%.

Question 9

A nurse is assessing a 10-year old child with severe sickle cell disease. The mother states the child used to love school but now "won't go and won't play with any friends." The nurse notes the child is very thin with an oddly-shaped head and has significant ptosis. Which nursing diagnosis best fits this client?

A) Altered family coping related to effects of disease on family
B) Anxiety related to fear of the unknown and social stressors
C) Readiness for Enhance Self Care related to disease and treatment
D) Social Isolation related to body image changes

Question 10

The statement made by a client with pernicious anemia that would indicate to the nurse a need for further teaching is

A) "I promise to have a checkup every 6 months."
B) "I'm glad my nervous problems will not get worse."
C) "Monthly injections are not so bad."
D) "Physical therapy will help get rid of my palpitations."

Question 11

The nurse would instruct an individual worried about developing iron deficiency anemia to avoid

A) citrus fruits.
B) leafy green vegetables.
C) poultry.
D) tea.

Question 12

To determine if the client has a risk factor related to iron deficiency anemia, the nurse could ask, "Has the client had a

A) blood transfusion recently?"
B) cardiac catheterization?"
C) operation involving the stomach?"
D) pregnancy terminated within the past 6 months?"

Question 13

The nurse informs a client suspected of having pernicious anemia that the lab study that will be helpful in the diagnosis is

A) clotting studies.
B) endoscopy.
C) hemoglobin levels.
D) Schilling test.

Question 14

A nurse providing wellness seminars plans which of the following primary prevention activities related to sickle cell disease?

A) Have a "sick day management" tip sheet for those with SCD.
B) Offer information on genetic counseling for SSD.
C) Plan to have a list of community resources for the families of people with SCD.
D) Provide a list of day care providers willing to care for children with SCD.

Question 15

While performing an admission assessment on a moderately anemic client, the nurse would expect to find a history of

A) blurred vision.
B) cardiac palpitations.
C) increased appetite.
D) warm, flushing sensations.

Question 16

The nurse assessing a female client with a hemoglobin level of 11 g/dl would expect the client to report

A) chronic fatigue and activity intolerance.
B) no significant manifestations.
C) shortness of breath, worse on exertion.
D) tachycardia and palpitations.

Question 17

The nurse recognizes that the laboratory finding indicative of polycythemia vera is

A) erythrocyte count of 5 million/mm3.
B) hemoglobin level of 22 g/100 ml.
C) leukocyte count of 6000/mm3.
D) platelets of 50,000/mm3.

Question 18

The statement about dietary iron made by a client with iron deficiency anemia that indicates understanding of the dietary concepts is "I

A) know that dairy products are the best source of iron."
B) know that iron from animal sources is not absorbed well."
C) should be able to change my diet so that I can get sufficient iron."
D) will not be able to obtain enough iron by just increasing my dietary intake."

Question 19

A child with hemophilia requires frequent emergency infusions of antihemophilic factor replacement therapy (AHF). The mother becomes distraught during one infusion and starts crying, saying "It's all my fault my child has to suffer so!" An appropriate intervention by the nurse would be to

A) call the social worker to come sit with the mother during the infusion.
B) explain to the mother that it was the father who gave the child hemophilia.
C) gently remind the mother that she cannot control genetics.
D) offer resources to teach the mother home AHF infusion technique.

Question 20

The manifestation that would require immediate investigation in a client with infectious mononucleosis is

A) abdominal pain.
B) joint discomfort.
C) leukocyte count of 12,000/mm3.
D) sore throat.

Question 21

The nurse counsels a client with idiopathic thrombocytopenic purpura (ITP) that if medication therapy is not effective, the surgical procedure most likely to be used in the treatment is

A) bone marrow transplant.
B) exploratory laparotomy.
C) hepatic shunt.
D) splenectomy.

Question 22

The nurse can decrease the danger of transfusion reactions in a client by

A) adding sterile saline to the blood transfusion.
B) forcing fluids.
C) infusing the blood slowly during the first 15 minutes.
D) monitoring the urine output.

Question 23

The nurse planning care of a client with multiple myeloma includes the intervention of

A) administering frequent mouth care.
B) encouraging ingestion of dairy products.
C) forcing fluids.
D) maintaining reverse isolation.

Question 24

A client is recovering from mononucleosis but is upset that 12 weeks after diagnosis she is still too weak to resume normal household and work chores. The client states that the spouse and children are getting very tired of "doing everything" while the client "just sits around." The most appropriate response by the nurse is to tell the client

A) convalescence is lengthy and people often report fatigue as late as 6 months later.
B) further diagnostic testing may be necessary to determine the cause of the fatigue.
C) it has been long enough now to start resuming normal activities.
D) medications exist that can boost strength and endurance after mononucleosis.

Question 25

When teaching a client who has multiple myeloma about self-care in the home, the nurse should advise the client and family take appropriate precautions to

A) alleviate diarrhea.
B) prevent fractures.
C) prevent seizures.
D) protect visitors.

Question 26

A client has folic acid deficiency anemia. Which information in the nursing history would be of concern to the nurse? The client

A) cooks in cast iron skillets.
B) does not like to eat fish.
C) has one alcoholic drink a week.
D) takes metformin.

Question 27

The nurse assessing a client with sickle cell anemia would recognize the common manifestation of the disease is

A) confusion.
B) diarrhea.
C) hypertension.
D) leg ulcers.

Question 28

When a client experiences an adverse reaction to a blood transfusion, the nurse should initially

A) administer oxygen via nasal prongs.
B) discontinue the transfusion.
C) notify the physician.
D) raise the head of the bed.

Question 29

A client presents to the emergency department having a severe sickle cell crisis. The nurse should be prepared to do which of the following interventions? (Select all that apply.)

A) Administer oxygen.
B) Offer heat therapy.
C) Order hydroxyurea from the pharmacy.
D) Prepare to give IV morphine.
E) Start an IV with normal saline.

Question 30

A client who has hemophilia A and his wife, who is not a carrier of the disease, wish to start a family. In discussing the risk factors of transmitting hemophilia to his children, it is important to explain that

A) none of his children are likely to have hemophilia.
B) all of his children will be carriers.
C) all of his sons will have hemophilia.
D) 50% of his children are at risk for developing the disease.

Question 31

To increase the safety of a blood transfusion, which of the following actions should the nurse take? The nurse should prepare to administer the blood with (Select all that apply)

A) a second nurse to take the vital signs.
B) a tubing set designed for blood products.
C) an IV of D5W.
D) an IV of normal saline.

Question 32

An important self-care measure the nurse teaches a client who has sickle cell disease is to

A) avoid crowds and people who are sick.
B) eat a well-balanced diet with plenty of fiber.
C) get plenty of vigorous exercise daily.
D) have genetic testing done if contemplating children.

Question 33

The nursing intervention that is the priority when preparing to administer blood is

A) administration of pretransfusion antihistamines.
B) asking a second health care professional to confirm blood acceptability.
C) establishing baseline vital signs.
D) obtaining a written order for the transfusion.

Question 34

When assessing the client with multiple myeloma, the nurse would expect to find the manifestation of

A) bone pain.
B) ecchymosis of the skin.
C) painless enlarged lymph nodes.
D) shortness of breath.

Question 35

When administering a blood transfusion to a client, which tasks can the nurse delegate to the experienced unlicensed personnel? (Select all that apply.)

A) Assisting the client to a comfortable position
B) Reporting any complaints to the physician
C) Taking the client's vital signs
D) Verifying the client's identity with the nurse

Question 36

The nurse recognizes that manifestations seen in a client with agranulocytosis are the result of

A) elevated granulocytes.
B) hypoprothrombinemia.
C) profound neutropenia.
D) thrombocytosis.

Question 37

A client has been newly diagnosed with multiple myeloma and is going to be followed up with frequent, close monitoring. The client states "I'm glad at least that this disease is not so bad. I was really worried they'd find something really wrong." What response by the nurse is most appropriate?

A) Agree with the client that he/she is quite lucky.
B) Ask the client what the physician has told him/her about the disease.
C) Explain the complicated drug regimen that will start once the client has symptoms.
D) Warn the client that there will be days when he/she feels really bad.

Question 38

The nurse explains that the definitive laboratory finding confirming the diagnosis of sickle cell anemia is

A) folate deficiency.
B) hemoglobin level of less than 9 g/dl.
C) increase in hemoglobin G (Hgb G).
D) presence of hemoglobin S (Hgb S).