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

Question 1

The nurse is assisting in the development of a care plan for a patient with anemia.Which nursing diagnosis is most common in a patient with anemia?

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

Answer 1

Activity Intolerance related to tissue hypoxia

Question 2

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

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

Answer 2

Intramuscular injections

Question 3

The nurse is reviewing the care plan for a patient with disseminated intravascular coagulation.Which nursing intervention is most likely to cause an acute complication in this patient?

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

Answer 3

Administering intramuscular meperidine (Demerol) for pain

Question 4

The nurse is caring for a patient with PV.Which laboratory study should the nurse monitor to help evaluate the effectiveness of treatment for this patient?

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

Question 5

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

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

Question 6

The nurse is caring for a patient in sickle cell crisis.What is the rationale for providing warm compresses and blankets for this patient?

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

Question 7

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

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

Question 8

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

Question 9

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) Prevent pain at the site
B) Prevent tissue damage at the site
C) Promote absorption of the medication
D) Prevent discoloration of tissue at the site

Question 10

The nurse is caring for a patient with a clotting disorder.Which blood product should the nurse anticipate being prescribed?

A) Albumin
B) Normal saline
C) Cryoprecipitates
D) Packed WBCs

Question 11

The nurse is planning discharge teaching for a patient with polycythemia.Which nursing intervention should the nurse consider to help prevent complications in this patient?

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

Question 12

The nurse is caring for a patient with anemia.Which blood component is deficient in this patient?

A) Plasma
B) Platelets
C) Red blood cells (RBCs)
D) White blood cells (WBCs)

Question 13

The nurse is caring for a patient with a bleeding disorder.Which manifestation might first alert the nurse to the possibility of disseminated intravascular coagulation?

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

Question 14

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

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

Question 15

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 response 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 16

The nurse is providing dietary teaching to an individual with iron-deficiency anemia.Which patient statement indicates that teaching has been effective?

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

Question 17

A patient with iron-deficiency anemia has been taking oral iron supplements.Which test should the nurse review to determine the effectiveness of this intervention?

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

Question 18

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

A) "It will inhibit the protein that is attacking your blood cells."
B) "It works like a blood transfusion to give you extra red 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 19

A patient is admitted to the hospital with hypertension and vertigo related to polycythemia vera (PV).For which treatment should the nurse prepare the patient?

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

Question 20

The nurse is reviewing the current patient census on a care area.Which individual is most likely to present with signs or symptoms of sickle cell anemia?

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

Question 21

The nurse is determining the effectiveness of treatment prescribed for a patient with anemia.Which question should the nurse use to make this evaluation?

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

Question 22

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

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

Question 23

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 response by the nurse is most appropriate?

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

Question 24

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

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

Question 25

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) Purpura
B) Bleeding
C) Petechiae
D) Hemorrhage

Question 26

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

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

Question 27

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

Question 28

A patient with hemophilia A is bleeding.Which treatment should the nurse anticipate being prescribed for this patient?

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

Question 29

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

Question 30

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

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

Question 31

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

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

Question 32

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 action by the nurse is most appropriate?

A) Palpate the suspected area for tenderness and edema.
B) Ask the patient to sit in the waiting room until his name is called.
C) Place the patient in an examination room and tell the physician that the patient may be bleeding.
D) 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.

Question 33

The nurse is assessing a patient with stage III Hodgkin's disease.Where should 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 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) Joint deformities
B) Distended abdomen
C) Ecchymoses on the extremities
D) Elevated WBC count

Question 36

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

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

Question 37

A patient with multiple myeloma is at risk for hypercalcemia.Which nursing intervention 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 38

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

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

Question 39

The nurse is preparing teaching for a patient with Hodgkin's disease.Which beverage should the nurse instruct this patient to avoid?

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

Question 40

The nurse is identifying approaches to reduce the risk of infection in a patient with leukemia.Why is it important for the nurse to institute infection control measures for this patient?

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

Question 41

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.)

A) Received a manicure and pedicure
B) Washed hands before preparing lunch
C) Poured a cup of tea after petting the cat
D) Had a hot tub installed on the back patio
E) Planting tomato plants in an outside garden

Question 42

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.)

A) Electrophoresis
B) Peritoneal dialysis
C) Total body irradiation
D) High-dose chemotherapy
E) Massive blood transfusions

Question 43

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?

A) 1
B) 2
C) 3
D) 4

Question 44

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

A) 38%
B) 45%
C) 47%
D) 55%

Question 45

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

A) Snack on peanuts.
B) Eat breads fortified with folic acid.
C) Add green leafy vegetables to meals.
D) Increase the intake of milk each day.
E) Prepare soups with dried peas and beans.

Question 46

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?

A) Aplastic anemia
B) Sickle cell anemia
C) PV
D) Disseminated intravascular coagulation

Question 47

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.)

A) CT scan
B) Cerebral angiogram
C) Lymph node biopsy
D) Lymphangiography
E) Complete blood count

Question 48

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?

A) 5%
B) 10%
C) 20%
D) 30%

Question 49

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?

A) 10%
B) 25%
C) 50%
D) 100%

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 action by the nurse should take priority?

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

Question 51

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.)

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

Question 52

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.)

A) HIV
B) Rubella
C) Hepatitis C
D) Chickenpox
E) Cystic fibrosis

Question 53

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 54

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

A) Assist out of bed to a chair
B) Draw another blood sample
C) Measure a rectal temperature
D) Place on bleeding precautions

Question 55

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.)

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

Question 56

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?

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

Question 57

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?

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

Question 58

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

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