Question 1

During a home visit,the nurse becomes concerned that a patient recovering from a splenectomy is at risk for infection.What did the nurse observe to come to this conclusion? (Select all that apply.)

Accepted Answer

Patient at risk for infection should be instructed to void working with dirt or soil,to avoid manicures and pedicures,to avoid hot tubs or Jacuzzis,and to wash hands after contact with pets,fresh flowers,or plants.B.Washing hands before preparing lunch decreases the risk for developing an infection.

Question 2

A patient is planning to have an allogeneic bone marrow transplant.What will the patient most likely have completed before this transplant occurs? (Select all that apply.)

Accepted Answer

Preparation for bone marrow transplant includes high-dose chemotherapy and/or total body irradiation.The goal is to destroy all of the patient's malignant bone marrow and then,at the last possible moment,replace it with a donor's clean and healthy bone marrow.A.Electrophoresis is a treatment to remove impurities from the blood stream.B.Peritoneal dialysis is a treatment for chronic renal failure.E.Massive blood transfusions are not indicated prior to bone marrow transplant.

Question 3

The nurse is preparing teaching materials for a patient with PV.How many liters of fluid should the nurse instruct the patient to consume each day?

Accepted Answer

Patients should drink 3 liters of water daily to reduce blood viscosity.A.B.One or two liters of fluid will not ensure a reduction in blood viscosity.D.Four liters of fluid is not necessary to reduce blood viscosity.

Question 4

The nurse suspects a patient has polycythemia.Which hematocrit value is causing the nurse to have this concern?

Accepted Answer

A hematocrit level greater than 55% is characteristic of polycythemia.A.B.C.A normal hematocrit is 38% to 47% for females and 40% to 54% for males.

Question 5

A patient is diagnosed with a folic acid deficiency.On what dietary changes should the nurse instruct this patient? (Select all that apply.)

Accepted Answer

Good food sources of folic acid include fortified flours,grains,cereals,wheat germ; liver; green leafy vegetables: asparagus,endive,lettuce; and legumes: peanuts,dried peas,beans,and lentils.D.Milk is not a good source of folic acid.

Question 6

The nurse is reviewing laboratory results for a patient with a blood disorder.Reduced fibrinogen and platelet levels,increased thrombin time,and reduced factor assays are laboratory results associated with which hematological disorders?

Accepted Answer

Disseminated intravascular coagulation is associated with clotting abnormalities.C.PV is associated with elevated RBCs,hemoglobin,and hematocrit.A.RBCs,WBCs,and platelets are reduced in aplastic anemia.B.Sickle cell anemia is characterized by sickle-shaped RBCs.

Question 7

The nurse is caring for a patient scheduled for tests to confirm the diagnosis of lymphoma.For which diagnostic tests should the nurse prepare the patient? (Select all that apply.)

Accepted Answer

Tests used to aid in the diagnosis of lymphoma include CT scan,lymph node biopsy,lymphangiography,and complete blood count.B.Cerebral angiogram is not a test used to diagnose lymphoma.

Question 8

A patient with anemia and a nursing diagnosis of activity intolerance due to tissue hypoxia and dyspnea is attempting to increase activity tolerance.What percentage of increase in pulse and respiratory rate should the nurse use to determine if the activity is too strenuous for the patient?

Accepted Answer

If the pulse or respiratory rate increases more than 20% from baseline during activity,the activity is too strenuous,and the level should be reduced.A.B.The activity is not too strenuous.D.The activity could cause the patient to develop cardiac or respiratory symptoms.

Question 9

The daughter of a male patient with hemophilia is concerned about transmitting the genetic disorder to any future children.What percentage of chance of transmitting the gene to future children should the nurse instruct the daughter?

Accepted Answer

The daughter of an affected father has a 50% chance of transmitting the gene to each son or daughter.Daughters who receive the gene are carriers,and sons who receive the gene are born with hemophilia.It is technically possible for daughters to be affected with hemophilia,although it is very rare.A.B.D.These are incorrect percentages for the transmission of the genetic disorder of hemophilia.

Question 10

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 action by the nurse should take priority?

Accepted Answer

D.Fever in the post-splenectomy period signals overwhelming post-splenectomy infection.This can be deadly if not recognized and treated quickly,so notifying the physician is essential.B and C can be done after the physician has been contacted.D.102°F is not low-grade fever.

Question 11

The nurse is collecting information about sickle cell disease for an upcoming seminar.What should the nurse include as common triggers for a sickle cell crisis? (Select all that apply.)

Accepted Answer

Factors that contribute to the development of a sickle cell crisis include those related to decreased oxygenation.Some examples include pneumonia with hypoxia,strenuous exercise,exposure to cold,diabetic acidosis,and severe infection.E.Use of oxygen will increase,not decrease,oxygenation.B.Chemotherapy should not affect oxygenation.

Question 12

During a home visit,the nurse becomes concerned that a child is developing idiopathic thrombocytopenic purpura (ITP).Which health problems could have precipitated the development of this disorder in the child? (Select all that apply.)

Accepted Answer

Acute ITP usually affects children between ages 2 and 6 and usually occurs after an acute viral illness such as rubella or chickenpox.Hepatitis C virus and human immunodeficiency virus (HIV)can also be triggers.E.ITP is not associated with cystic fibrosis.

Question 13

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.

Accepted Answer

The answer of The recommended dose of filgrastim (Neupogen)is 10...

Question 14

A patient has a platelet count of 20,000/mm³.What action should the nurse take?

Accepted Answer

A platelet count of less than 20,000/mm³ (nl 150,000 to 450,000/mm³)places the patient at risk for bleeding.A.B.C.Because the patient is at risk for bleeding,the patient most likely should not be transferred to a chair.The patient is at risk for bleeding after a venipuncture.C.Rectal temperatures increase the risk for bleeding and should not be done.

Question 15

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

Accepted Answer

Factors that contribute to the development of a sickle cell crisis include those related to decreased oxygenation.At high altitudes or in scuba diving,there is less oxygen available,making skiing in the mountains or scuba diving unsafe for someone with sickle cell anemia.B.C.D.F.Sexual activity,driving,standing,and contact sports should not alter oxygenation.

Question 16

The nurse is collaborating on discharge teaching needed for a patient recovering from a splenectomy.What follow-up care is most important for the nurse to emphasize with this patient?

Accepted Answer

Without a spleen to assist in the immune response,the patient is at risk for infection,making flu vaccination important.A.D.Coagulation studies and transfusions are not necessary.C.Oral analgesics may be needed for a short time but are not as essential as preventing infection.

Question 17

The nurse is preparing to provide care to a patient recovering from surgery.What nursing action is the best way to prevent infection in a postoperative patient?

Accepted Answer

Hand washing is the best defense against infection.D.Assessing vital signs will detect,not prevent,infection.C.Hanging dressings is important,but without hand washing,this is not helpful in preventing infection.B.Fluids prevent dehydration but do not directly affect infection risk.

Question 18

The nurse suspects a patient is experiencing manifestations of Hodgkin's disease.Which are characteristics of this health disorder? (Select all that apply.)

Accepted Answer

Hodgkin's disease is a lymphoma,which is a cancer of the lymph system.Its distinguishing feature is Reed-Sternberg cells,which make it different from all the other forms of lymphoma.Of all the lymphomas,Hodgkin's disease is the most curable type,even when the disease is widely spread at the time of diagnosis.Painless swelling in one or more of the common lymph node chains is a usual presentation.Swelling can range from barely perceptible to the size of a softball,occasionally even larger.F.Chronic myelogenous leukemia is characterized by the Philadelphia chromosome.C.Skeletal pain is a symptom of leukemias and multiple myeloma.A.Visual changes are associated with PV.

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