Question 1

A 42-year-old patient is admitted to the hospital with idiopathic aplastic anemia.What is an appropriate collaborative problem for the nurse to identify for the patient?

Accepted Answer

A potential complication for a patient with idiopathic aplastic anemia is hemorrhage, as their platelet count is low and they are at risk for bleeding. Seizures, neurogenic shock, and pulmonary edema are not typical complications of this disorder.

Question 2

A patient with chronic lymphocytic leukemia is hospitalized for treatment of severe hemolytic anemia.What is an appropriate nursing intervention for the patient?

Accepted Answer

The patient is hospitalized for treatment of severe hemolytic anemia, which is a complication of chronic lymphocytic leukemia. Patients with this condition often experience fatigue and weakness, so planning care to alternate periods of rest and activity is an appropriate nursing intervention. Providing a diet high in vitamin K and folic acid is more appropriate for patients with other types of anemia. Isolating the patient from visitors and other patients is not necessary unless there is a concern about infection control. Encouraging increased intake of fluid and fiber in the diet is important, but may not be the most appropriate intervention for this patient's current condition.

Question 3

During discharge teaching for the patient with neutropenia,which of the following issues should the nurse include?

Accepted Answer

Neutropenia is a condition characterized by a low number of neutrophils, which are the white blood cells responsible for fighting infections. Patients with neutropenia are at an increased risk of infection, and exposure to crowds can increase the risk of acquiring an infection. Therefore, it is important to educate the patient to avoid exposure to crowds to minimize the risk of infection. The other options, such as caffeine and alcohol intake, excessive dietary iron intake, and limiting fluids, are not directly related to the management of neutropenia. However, it is important to provide general education on a healthy diet and fluid intake.

Question 4

After teaching the patient about taking oral iron preparations for a moderate iron-deficiency anemia,which of the following patient statements indicates to the nurse that additional instruction is needed?

Accepted Answer

Black stools are a common and expected side effect of taking oral iron supplements due to the iron not being fully absorbed by the body. This does not typically indicate a need for medical intervention, so the patient's statement suggests a misunderstanding that requires further education.

Question 5

A 21-year-old patient is having a sickle cell crisis for the first time in many years.He asks the nurse why the sickling causes such pain.The nurse should explain that the pain of sickling is caused by which of the following?

Accepted Answer

The pain of sickling is caused by tissue hypoxia resulting from occlusion of small blood vessels by the sickled cells. This lack of oxygenation causes ischemia and pain in the affected tissues.

Question 6

The physician orders transfusion with packed RBCs for a patient who has severe anemia resulting from a bleeding peptic ulcer.What is the most important nursing action to prevent a transfusion reaction when administering the blood?

Accepted Answer

Verifying and documenting patient identification is crucial to ensure that the correct blood is given to the correct patient, thereby preventing a transfusion reaction.

Question 7

A patient receiving a transfusion of whole blood develops chills and fever,headache,and anxiety 30 minutes after the transfusion is started.Which of the following does the nurse implement after stopping the transfusion?

Accepted Answer

The answer of A patient receiving a transfusion of whole...

Question 8

A 52-year-old patient has pernicious anemia with long-standing weakness and paraesthesia of the feet and hands.The nurse determines that expected outcomes related to knowledge of the therapeutic regimen have been met when the patient states which of the following?

Accepted Answer

Pernicious anemia is a condition in which the body can't make enough healthy red blood cells because it doesn't have enough vitamin B12. The treatment for pernicious anemia is regular injections of vitamin B12, also known as cobalamin. Therefore, the expected outcome related to knowledge of the therapeutic regimen is for the patient to understand that they will need regular cobalamin injections for the rest of their life. Option B is incorrect because increasing dietary sources of cobalamin is not effective in the treatment of pernicious anemia. Option C is incorrect because although the feeling in the hands and feet may improve with treatment, it is not necessarily related to the hemoglobin level returning to normal. Option D is incorrect because chronic fatigue is a symptom of pernicious anemia but is not an expected outcome related to knowledge of the therapeutic regimen.

Question 9

A patient who has experienced an acute blood loss exhibits a normal supine blood pressure and pulse at rest but complains of postural hypotension and has a pulse of 110 beats/min when exercising.The nurse knows that these signs and symptoms are manifestations of what percentage of blood loss?

Accepted Answer

The patient's normal supine blood pressure and pulse at rest indicate that they have likely lost less than 10% of their blood volume. However, the development of postural hypotension and an elevated pulse during exercise suggest that they have lost at least 30% of their blood volume. This is because with significant blood loss, the body is unable to compensate for changes in position or increased activity, leading to a decrease in blood pressure and compensatory increase in heart rate.

Question 10

When the nurse discusses foods high in iron with a patient who has iron-deficiency anemia,the patient tells the nurse that she prepares low-cholesterol foods for her family and probably does not eat enough meat to meet her iron requirements.It is an appropriate goal for the patient to increase dietary intake of which of the following?

Accepted Answer

Legumes (such as lentils, peas, and beans) and dried fruit (such as raisins and apricots) are good sources of iron and can be included in a low-cholesterol diet. Eggs and fish may contain some iron but may not be enough to meet the patient's needs. Nuts and cornmeal are not significant sources of iron. Milk and milk products do not contain much iron at all.

Question 11

For which one of the following lab results would the nurse expect to see abnormal results in a patient who has hemophilia?

Accepted Answer

Patients with hemophilia have a deficiency in clotting factors, specifically factors VIII or IX, which are involved in the intrinsic pathway of coagulation. The partial thromboplastin time (PTT) is a test that evaluates the functioning of the intrinsic pathway. In hemophilia, the PTT is typically prolonged due to the lack of clotting factors. Therefore, abnormal results are expected in the partial thromboplastin time for patients with hemophilia. The other lab values listed do not necessarily reflect abnormalities related to hemophilia.

Question 12

A patient with a history of iron-deficiency anemia who has not taken iron supplements for several years is experiencing increased fatigue and dizziness.What would the nurse expect the patient's laboratory findings to include?

Accepted Answer

Iron-deficiency anemia typically results in low hemoglobin levels, as iron is crucial for hemoglobin production. Hemoglobin levels of 86 g/L are below the normal range for adults, indicating anemia.

Question 13

A patient who has been receiving a heparin infusion and warfarin (Coumadin)for a deep-vein thrombosis is diagnosed with heparin-induced thrombocytopenia and thrombosis syndrome (HITTS).What does the nurse anticipate that the physician will order?

Accepted Answer

The nurse should anticipate the physician will order to use saline for flushing IV lines to avoid further exposure to heparin, as the patient has developed HITTS.

Question 14

During treatment of the patient with an acute exacerbation of polycythemia vera,what is a critical nursing intervention?

Accepted Answer

Evaluation of fluid balance is a critical nursing intervention during treatment of a patient with an acute exacerbation of polycythemia vera, as these patients are at risk for thrombosis due to increased blood viscosity. Maintaining hydration and monitoring for signs of fluid overload or dehydration is essential to prevent complications. Administering oxygen, anticoagulants, or parenteral iron may also be appropriate interventions, but they are not the most critical in this situation.

Question 15

While a patient with severe acquired thrombocytopenia is receiving platelet transfusions,the nurse recognizes that a platelet transfusion reaction may be present when the patient experiences which of the following signs?

Accepted Answer

Sudden onset of chills and fever is a common sign of a transfusion reaction, indicating a possible febrile non-hemolytic reaction.

Question 16

Of the following patients waiting to be admitted by the emergency department nurse,which one requires the most rapid assessment and care by the nurse?

Accepted Answer

The answer of Of the following patients waiting to be...

Question 17

During the admission assessment of a patient who has an Hb of 4.7 mmol/L (7.6 g/dL)and jaundice of the sclera,what laboratory results would the nurse assess?

Accepted Answer

A bilirubin level would be appropriate to assess for the patient's jaundice, as bilirubin is a pigment produced by the breakdown of red blood cells and accumulates in the body when there is a problem with its metabolism or elimination. Stool occult blood, Schilling test, and gastric analysis testing would not be as relevant to the patient's presentation of anemia and jaundice.

Question 18

Fifteen minutes after a transfusion of packed RBCs is started,a patient develops tachycardia and tachypnea,and complains of back pain and feeling warm.What is the nurse's priority action?

Accepted Answer

The patient is displaying signs of a transfusion reaction, and the priority action should be to stop the transfusion immediately and administer normal saline to maintain intravascular volume. Oxygen therapy may also be beneficial, but it is not the priority action. Slowing the transfusion rate is not appropriate in this situation. Discarding the used bag and tubing is important, but it is not the priority action.

Question 19

A patient with sickle cell anemia is admitted to the hospital in crisis with severe abdominal pain.While caring for the patient,what is it most important for the nurse to do?

Accepted Answer

The most important action for the nurse is to evaluate the effectiveness of narcotic analgesics for pain management. Pain control is the priority in a sickle cell crisis, as uncontrolled pain can lead to vaso-occlusive crises and further complications. Limiting oral fluids is not indicated unless specifically ordered by the healthcare provider. Encouraging activity may not be appropriate during a crisis due to increased pain and fatigue. While a high-protein, high-calorie diet is important for overall health in patients with sickle cell anemia, it is not the priority in the immediate management of a crisis.

Question 20

Which one of the following groups of people is at an increased risk for developing iron-deficiency anemia?

Accepted Answer

Pregnant women are at an increased risk for developing iron-deficiency anemia due to the increased demand for iron to support the growth and development of the fetus. This is especially true in the third trimester when the fetus has the highest rate of iron accumulation.

Quiz 33: Nursing Management: Hematological Problems