Deck 33: Nursing Care of Patients with Hematologic Disorders

Question 1

A patient is being treated for acquired hemolytic anemia. Which of the following assessment findings would suggest that the condition is severe?

A)misshapen limbs due to pathological fractures
B)enlarged spleen
C)jaundice
D)bradycardia

Answer 1

misshapen limbs due to pathological fractures

Question 2

A patient with chronic gastritis is experiencing "tingling" in his hands. The nurse realizes that this patient might be demonstrating signs of which of the following?

A)iron deficiency anemia
B)acute blood loss anemia
C)folic acid deficiency anemia
D)vitamin B₁₂ deficiency anemia

Answer 2

vitamin B₁₂ deficiency anemia

Question 3

Upon analysis, a patient's red blood cells (RBCs) appear microcytic and hypochromic. The nurse interprets this information to mean that this patient is demonstrating signs of which of the following?

A)iron deficiency anemia
B)acute blood loss anemia
C)chronic blood loss anemia
D)vitamin B₁₂ deficiency anemia

Answer 3

chronic blood loss anemia

Question 4

The nurse is preparing an analgesic for a patient with leukemia. Which of the following routes is preferred for this patient?

A)intramuscular
B)intravenous
C)oral
D)subcutaneous

Question 5

After several doses of chemotherapy, a patient complains of fatigue, pallor, progressive weakness, exertional dyspnea, headache, and tachycardia. Which NANDA nursing diagnosis would the nurse list as the first priority?

A)Imbalanced Nutrition: Less than Body Requirements
B)Activity Intolerance
C)Powerlessness
D)Ineffective Coping

Question 6

A middle-aged female is experiencing numbness and tingling in her lower extremities as well as difficulty ambulating. The patient's recent complete blood count indicates large, oval-shaped macrocytic red blood cells with thin membranes. Which therapy would the nurse anticipate including in the discharge plan?

A)a diet high in green, leafy vegetables; broccoli; wheat germ; and asparagus
B)a daily multivitamin with extra iron
C)instructions about subcutaneous injections of erythropoietin for a few weeks
D)instructions about intramuscular parenteral injections of vitamin B₁₂ for the rest of her life

Question 7

What would be the priority NANDA approved nursing diagnosis for a patient receiving a stem cell transplant? Select all that apply.

A)Ineffective Coping
B)Fatigue
C)Interrupted Family Processes
D)Risk for Infection
E)Excess Fluid Imbalance

Question 8

A patient is prescribed an oral iron preparation. Which of the following would be appropriate for the nurse to instruct this patient about this medication? Select all that apply.

A)Take with orange juice.
B)Nausea is expected with this medication.
C)Take with an antacid.
D)Take two hours before a scheduled tetracycline dose.
E)Take with vitamin E replacements.

Question 9

A patient recently diagnosed with chronic myeloid leukemia (CML) is discussing how he does not want to leave his wife alone with all of the household finances. Which response by the nurse would not be appropriate at this time? Select all that apply.

A)"I would encourage you to discuss your feelings with your wife so that she can be a part of the decision making process."
B)"I would like to make a referral for you and your wife to a support group that may be helpful with some of the issues you are having."
C)"It must be very difficult for you to think of your wife having to be alone with the household decisions."
D)"You had better get your affairs in order now before it is too late."

Question 10

A 17-year-old patient with edematous lymph nodes and headaches is diagnosed with leukemia. The nurse suspects that this patient most likely has which of the following?

A)acute lymphocytic leukemia (ALL)
B)chronic lymphocytic leukemia (CLL)
C)acute myeloid leukemia (AML)
D)chronic myeloid leukemia (CML)

Question 11

A patient in sickle cell crisis is experiencing edema of the hands and feet. The nurse realizes that this edema is caused by which of the following?

A)fluid overload
B)poor venous return
C)small vessel infarction
D)dehydration

Question 12

A patient diagnosed with acute myeloid leukemia (AML) has an absolute neutrophil count of 200. What actions by the nurse would minimize the risk of complications from neutropenia?

A)Strict aseptic technique should be used when performing all procedures.
B)Additional nutrition should be spaced frequently throughout the day to increase caloric intake.
C)Restrict fluids and salts to decrease edema.
D)Regulate the thermostat for a cooler environment.

Question 13

The nurse would determine, after instructing a patient on dietary management of deficiency anemia, that which of the following statements would indicate a need for additional teaching?

A)"I will eat more fruits, vegetables, especially green, leafy ones, to get more B₁₂ in my diet."
B)"I will take vitamins with extra iron in addition to eating a balanced diet with meat to correct my anemia."
C)"I will add food high in vitamin C to improve my absorption of iron in both my vitamins."
D)"I will need to include more protein foods in my diet such as meats, dried beans, and whole-grain breads."

Question 14

The nurse is providing dietary instructions to a vegetarian patient with iron deficiency anemia. Which of the following should be included in these instructions?

A)Consider adding animal sources of iron and protein to the diet.
B)Ensure an adequate intake of vitamin C when consuming non-animal-based proteins.
C)Drink at least 12 glasses of water every day.
D)Avoid exercise at least 30 minutes after completing a meal or snack.

Question 15

Which of the following should the nurse do when a young female patient's laboratory values indicate microcytic and hypochromic red blood cells?

A)Enforce "nothing by mouth" in anticipation of emergency surgery.
B)Insert an intravenous access line for fluids.
C)Consult with the dietitian for a diet high in iron.
D)Assess the past history for risks of bleeding or menstrual changes.

Question 16

Which of the following would be the appropriate nursing intervention for the patient diagnosed with heparin-induced thrombocytopenia with the nursing diagnosis of Risk for Bleeding?

A)Avoid invasive procedures, such as rectal temperatures, urinary catheterizations, and parenteral injections.
B)Apply pressure to puncture sites for 3-5 minutes for arterial blood gases aspiration.
C)Give enemas to avoid straining when having a bowel movement.
D)Encourage patient to brush teeth thoroughly and rinse with alcohol-based mouthwash after each meal.

Question 17

A patient who is undergoing treatment for leukemia is scheduled for a bone marrow transplant. The nurse determines that this patient is in which phase of treatment for the disorder?

A)induction
B)maintenance
C)rehabilitative
D)postremission

Question 18

The nurse is planning to instruct a patient with secondary polycythemia about ways to prevent blood stasis. Which of the following should be included in these instructions?

A)Leg pain is normal.
B)Elevate feet and legs when sitting.
C)Restrict fluids.
D)Black stools are to be expected.

Question 19

A patient with aplastic anemia is demonstrating signs of blood cell production. Which of the following should be done to support this patient?

A)Continue with blood transfusions as prescribed.
B)Report the finding.
C)Plan to discontinue blood transfusions.
D)Plan to administer fresh frozen plasma.

Question 20

A patient diagnosed with leukemia says, "If I have too many white blood cells and white blood cells fight infections, why do I have to be careful not to be exposed to germs?" An appropriate response for the nurse to make is which of the following?

A)"Leukemia means you have the wrong kind of white blood cells."
B)"That's not what leukemia is."
C)"The white blood cells with leukemia aren't effective to fight infections."
D)"Your bone marrow can become infected."

Question 21

A patient with disseminated intravascular coagulation is not responding to infusions of fresh-frozen plasma and platelets. Which of the following interventions might be indicated for this patient? Select all that apply.

A)Begin heparin injections.
B)Begin heparin infusion.
C)Give factor VIII infusion.
D)Begin normal saline infusion.
E)Prepare for a bone marrow biopsy.

Question 22

The patient is experiencing acute blood loss after a motor vehicle accident and has been taken to the emergency department. Draw an arrow to the organ in the patient's body that will constrict to allow for increased blood volume. [Insert MSE 11-1, remove labels and lines]

Question 23

A patient who is undergoing chemotherapy for lymphoma says, "I thought I was ugly before this all started. Now I know for sure I'm disgusting to look at." Which of the following is this patient most at risk for developing related to her comments?

A)changed body image perception
B)reduced sexual response
C)altered taste sensation
D)inability to cope with the diagnosis and treatment

Question 24

The nurse is reviewing information about the patient who was admitted to the hospital three days ago with urosepsis. The nurse reviews the information regarding recent assessments and diagnostic testing that have been completed. Which of the following physician orders would be expected? $$\begin{array} { | l | l | } \hline \text { Diagnostic Tests and Assessment } & \text { Results } \\\hline \text { Apical pulse } & 132 \mathrm { bpm } \\\hline \text { Respirations } & 26 \text { per minute } \\\hline \text { Blood pressure } & 88 / 46 \\\hline \text { Level of Consciousness } & \text { Obtunded } \\\hline \text { Urinary output } & \begin{array} { l } 25 \mathrm {~mL} \text { of cherry-colored urine produced in } \\\text { Foley catheter drainage bag during the last } \\\text { two hours }\end{array} \\\hline \text { Assessment of respiratory system } & \begin{array} { l } \text { New moist cough with expectoration of } \\\text { bloody sputum, complaints of dyspnea }\end{array} \\\hline \text { Assessment of cardiovascular system } & \begin{array} { l } \text { Cool, dry extremities with thready } \\\text { peripheral pulses }\end{array} \\\hline\end{array}$$

A)Administer oxygen to keep oxygen saturation levels above or equal to 95%.
B)Ambulate patient three times each day as tolerated.
C)Apply hot compresses to painful joints.
D)Consult physical therapy for active range of motion exercises.

Question 25

The patient has been included in a study along with other 369 other patients who have all been diagnosed with extranodal marginal zone lymphoma, a subtype of non-Hodgkin's lymphoma. Based on research regarding this condition, what is the expected number of people included in this study who will still be alive in five years? Round your answer to the nearest whole number. ______

Question 26

A patient with hemophilia is admitted with acute bleeding. Until the cause of the bleeding is determined, the nurse should be prepared to do which of the following interventions?

A)Infuse packed red blood cells.
B)Infuse normal saline.
C)Infuse heparin.
D)Infuse fresh-frozen plasma.

Question 27

A patient who is being treated for malignant lymphoma is experiencing pruritis. Which of the following interventions would be appropriate for this patient? Select all that apply.

A)Bathe with cool water.
B)Vigorously rub the skin after bathing.
C)Apply lavender-scented body lotion.
D)Keep room temperature above normal.
E)Cleanse bedding and clothing in mild detergent with a second rinse cycle.

Question 28

The patient has been experiencing manifestations associated with pernicious anemia because of an inability to make an adequate amount of intrinsic factor. Draw an arrow indicating the organ that is malfunctioning.

Question 29

A college-age patient who is in the hospital for Hodgkin's disease treatment is visited by friends who bring a pizza and cola to the patient's room. Which of the following can the nurse do to ensure the patient's comfort?

A)Ask the visitors to leave.
B)Ask the visitors to eat the pizza in the lounge.
C)Encourage the patient to eat as much pizza as possible.
D)Provide the patient with an antiemetic and suggest something else for the patient to eat with the visitors.

Question 30

The patient was recently diagnosed with Hodgkin's disease. The nurse provided education for the patient and the patient's spouse. Which of the following statements made by the patient indicate the need for further education? Select all that apply.

A)"So, the physician is ordering radiation therapy for me."
B)"My white blood cell count was low and my red blood cell count was high and that helped the physician diagnose me."
C)"The doctor has classified my Hodgkin's disease as stage III because I have involved lymph nodes in my liver and in my spleen."
D)"One out of every four patients without symptoms of Hodgkin's disease die of this disease."
E)"Because I have had a heart attack in the past, the physician will most likely prescribe rituximab for me."

Question 31

The patient has developed folic acid deficiency anemia. The nurse notes that the patient weighed 52.72 kilograms one year ago and weighs 44.23 kilograms today. Calculate the patient's weight loss in pounds. Round to the tenths place. _______

Question 32

A patient is diagnosed with stage II A Hodgkin's lymphoma. The nurse interprets this information to mean that the extent of this disorder is limited to which of the following?

A)a single lymph node with systemic symptoms
B)two or more lymph nodes on the same side without systemic symptoms
C)upper abdominal lymph nodes without systemic symptoms
D)an extranodal site involvement with systemic symptoms

Question 33

The nurse is reviewing the patient's the results from recent diagnostic tests and an assessment. Based on the information included in the chart above, which of the following would be consistent with the most likely diagnosis? $$\begin{array} { | l | l | } \hline \text { Diagnostic Tests and Assessment } & \text { Results } \\\hline \text { Apical pulse } & 122 \mathrm { bpm } , \text { soft murmur auscultated } \\\hline \text { Respirations } & 26 \text { per minute } \\\hline \text { Blood pressure } & 92 / 54 \\\hline \text { Level of Consciousness } & \text { Confused and lethargic } \\\hline \text { Red blood cells } & 3.3 \times 10 ^ { 6 } / \mathrm { mm } ^ { 3 } \\\hline\end{array}$$

A)The patient was just transported from the scene of a high-speed motorcycle accident.
B)The patient was recently diagnosed with a chronic gastrointestinal bleed.
C)The patient had a gastrectomy performed 22 years ago as a result of stomach cancer.
D)The patient is an alcoholic.

Question 34

The patient has developed multiple ecchymoses and there is the presence of occult blood in the patient's stool. The patient's factor assays are assessed and factor VIII is found to be decreased. Based on the nurse's understanding of hematoligic disorders, which of the following are commonly associated with this patient's condition? Select all that apply. Select all that apply.

A)The patient's platelet count is normal.
B)The patient's prothrombin time is elevated.
C)The physician diagnoses the patient with hemophilia B.
D)The nurse administers fresh-frozen plasma to the patient per physician's orders.
E)The patient's bleeding time is within normal limits.

Question 35

A patient with idiopathic thrombocytopenia purpura continues to experience symptoms of the disease after completing several courses of prednisone (Meticorten) therapy. The nurse anticipates that which of the following will most likely be indicated for this patient?

A)life-long prednisone therapy
B)splenectomy
C)aspirin therapy
D)weekly platelet transfusions