Deck 40: Care of Patients with Hematologic Problems

Question 1

The family of a neutropenic client reports the client "is not acting right." What action by the nurse is the priority?

A) Ask the client about pain.
B) Assess the client for infection.
C) Delegate taking a set of vital signs.
D) Look at today's laboratory results.

Answer 1

Assess the client for infection.

Question 2

The nurse is caring for a client with leukemia who has the priority problem of fatigue.What action by the client best indicates that an important goal for this problem has been met?

A) Doing activities of daily living (ADLs) using rest periods
B) Helping plan a daily activity schedule
C) Requesting a sleeping pill at night
D) Telling visitors to leave when fatigued

Answer 2

Doing activities of daily living (ADLs) using rest periods

Question 3

A nurse is caring for a client who is about to receive a bone marrow transplant.To best help the client cope with the long recovery period,what action by the nurse is best?

A) Arrange a visitation schedule among friends and family.
B) Explain that this process is difficult but must be endured.
C) Help the client find things to hope for each day of recovery.
D) Provide plenty of diversionary activities for this time.

Answer 3

Help the client find things to hope for each day of recovery.

Question 4

A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells.What action by the nurse is best?

A) Encourage high-protein foods.
B) Perform a Hemoccult test on the client's stools.
C) Offer frequent oral care.
D) Prepare to administer cobalamin (vitamin B₁₂).

Question 5

A nurse is preparing to administer a blood transfusion.What action is most important?

A) Correctly identifying client using two identifiers
B) Ensuring informed consent is obtained if required
C) Hanging the blood product with Ringer's lactate
D) Staying with the client for the entire transfusion

Question 6

A nursing student is struggling to understand the process of graft-versus-host disease.What explanation by the nurse instructor is best?

A) "Because of immunosuppression, the donor cells take over."
B) "It's like a transfusion reaction because no perfect matches exist."
C) "The client's cells are fighting donor cells for dominance."
D) "The donor's cells are actually attacking the client's cells."

Question 7

A client presents to the emergency department in sickle cell crisis.What intervention by the nurse takes priority?

A) Administer oxygen.
B) Apply an oximetry probe.
C) Give pain medication.
D) Start an IV line.

Question 8

A nurse is caring for a young male client with lymphoma who is to begin treatment.What teaching topic is a priority?

A) Genetic testing
B) Infection prevention
C) Sperm banking
D) Treatment options

Question 9

A nurse caring for a client with sickle cell disease (SCD)reviews the client's laboratory work.Which finding should the nurse report to the provider?

A) Creatinine: 2.9 mg/dL
B) Hematocrit: 30%
C) Sodium: 147 mEq/L
D) White blood cell count: 12,000/mm³

Question 10

A client with multiple myeloma demonstrates worsening bone density on diagnostic scans.About what drug does the nurse plan to teach this client?

A) Bortezomib (Velcade)
B) Dexamethasone (Decadron)
C) Thalidomide (Thalomid)
D) Zoledronic acid (Zometa)

Question 11

A nurse is preparing to hang a blood transfusion.Which action is most important?

A) Documenting the transfusion
B) Placing the client on NPO status
C) Placing the client in isolation
D) Putting on a pair of gloves

Question 12

A client has been admitted after sustaining a humerus fracture that occurred when picking up the family cat.What test result would the nurse correlate to this condition?

A) Bence-Jones protein in urine
B) Epstein-Barr virus: positive
C) Hemoglobin: 18 mg/dL
D) Red blood cell count: 8.2/mm³

Question 13

A nurse in a hematology clinic is working with four clients who have polycythemia vera.Which client should the nurse see first?

A) Client with a blood pressure of 180/98 mm Hg
B) Client who reports shortness of breath
C) Client who reports calf tenderness and swelling
D) Client with a swollen and painful left great toe

Question 14

A client receiving a blood transfusion develops anxiety and low back pain.After stopping the transfusion,what action by the nurse is most important?

A) Documenting the events in the client's medical record
B) Double-checking the client and blood product identification
C) Placing the client on strict bedrest until the pain subsides
D) Reviewing the client's medical record for known allergies

Question 15

A nursing student is caring for a client with leukemia.The student asks why the client is still at risk for infection when the client's white blood cell count (WBC)is high.What response by the registered nurse is best?

A) "If the WBCs are high, there already is an infection present."
B) "The client is in a blast crisis and has too many WBCs."
C) "There must be a mistake; the WBCs should be very low."
D) "Those WBCs are abnormal and don't provide protection."

Question 16

A client with autoimmune idiopathic thrombocytopenic purpura (ITP)has had a splenectomy and returned to the surgical unit 2 hours ago.The nurse assesses the client and finds the abdominal dressing saturated with blood.What action is most important?

A) Preparing to administer a blood transfusion
B) Reinforcing the dressing and documenting findings
C) Removing the dressing and assessing the surgical site
D) Taking a set of vital signs and notifying the surgeon

Question 17

A client hospitalized with sickle cell crisis frequently asks for opioid pain medications,often shortly after receiving a dose.The nurses on the unit believe the client is drug seeking.When the client requests pain medication,what action by the nurse is best?

A) Give the client pain medication if it is time for another dose.
B) Instruct the client not to request pain medication too early.
C) Request the provider leave a prescription for a placebo.
D) Tell the client it is too early to have more pain medication.

Question 18

A client has a platelet count of 9000/mm³.The nurse finds the client confused and mumbling.What action takes priority?

A) Calling the Rapid Response Team
B) Delegating taking a set of vital signs
C) Instituting bleeding precautions
D) Placing the client on bedrest

Question 19

A client in sickle cell crisis is dehydrated and in the emergency department.The nurse plans to start an IV.Which fluid choice is best?

A) 0.45% normal saline
B) 0.9% normal saline
C) Dextrose 50% (D₅₀)
D) Lactated Ringer's solution

Question 20

A client has Crohn's disease.What type of anemia is this client most at risk for developing?

A) Folic acid deficiency
B) Fanconi's anemia
C) Hemolytic anemia
D) Vitamin B₁₂ anemia

Question 21

A client has a sickle cell crisis with extreme lower extremity pain.What comfort measure does the nurse delegate to the unlicensed assistive personnel (UAP)?

A) Apply ice packs to the client's legs.
B) Elevate the client's legs on pillows.
C) Keep the lower extremities warm.
D) Place elastic bandage wraps on the client's legs.

Question 22

A client has been treated for a deep vein thrombus and today presents to the clinic with petechiae.Laboratory results show a platelet count of 42,000/mm³.The nurse reviews the client's medication list to determine if the client is taking which drug?

A) Enoxaparin (Lovenox)
B) Salicylates (aspirin)
C) Unfractionated heparin
D) Warfarin (Coumadin)

Question 23

A student nurse is helping a registered nurse with a blood transfusion.Which actions by the student are most appropriate? (Select all that apply.)

A) Hanging the blood product using normal saline and a filtered tubing set
B) Taking a full set of vital signs prior to starting the blood transfusion
C) Telling the client someone will remain at the bedside for the first 5 minutes
D) Using gloves to start the client's IV if needed and to handle the blood product
E) Verifying the client's identity, and checking blood compatibility and expiration time

Question 24

A client has thrombocytopenia.What client statement indicates the client understands self-management of this condition?

A) "I brush and use dental floss every day."
B) "I chew hard candy for my dry mouth."
C) "I usually put ice on bumps or bruises."
D) "Nonslip socks are best when I walk."

Question 25

A nurse working with clients with sickle cell disease (SCD)teaches about self-management to prevent exacerbations and sickle cell crises.What factors should clients be taught to avoid? (Select all that apply.)

A) Dehydration
B) Exercise
C) Extreme stress
D) High altitudes
E) Pregnancy

Question 26

A student nurse is learning about blood transfusion compatibilities.What information does this include? (Select all that apply.)

A) Donor blood type A can donate to recipient blood type AB.
B) Donor blood type B can donate to recipient blood type O.
C) Donor blood type AB can donate to anyone.
D) Donor blood type O can donate to anyone.
E) Donor blood type A can donate to recipient blood type B.

Question 27

A client has received a bone marrow transplant and is waiting for engraftment.What actions by the nurse are most appropriate? (Select all that apply.)

A) Not allowing any visitors until engraftment
B) Limiting the protein in the client's diet
C) Placing the client in protective precautions
D) Teaching visitors appropriate hand hygiene
E) Telling visitors not to bring live flowers or plants

Question 28

A client has frequent hospitalizations for leukemia and is worried about functioning as a parent to four small children.What action by the nurse would be most helpful?

A) Assist the client to make "sick day" plans for household responsibilities.
B) Determine if there are family members or friends who can help the client.
C) Help the client inform friends and family that they will have to help out.
D) Refer the client to a social worker in order to investigate respite child care.

Question 29

A client has heparin-induced thrombocytopenia (HIT).The student nurse asks how this is treated.About what drugs does the nurse instructor teach? (Select all that apply.)

A) Argatroban (Argatroban)
B) Bivalirudin (Angiomax)
C) Clopidogrel (Plavix)
D) Lepirudin (Refludan)
E) Methylprednisolone (Solu-Medrol)

Question 30

A nurse is preparing to administer a blood transfusion to an older adult.Understanding age-related changes,what alterations in the usual protocol are necessary for the nurse to implement? (Select all that apply.)

A) Assess vital signs more often.
B) Hold other IV fluids running.
C) Premedicate to prevent reactions.
D) Transfuse smaller bags of blood.
E) Transfuse each unit over 8 hours.

Question 31

The nurse assesses a client's oral cavity and makes the discovery shown in the photo below:

What action by the nurse is most appropriate?

A) Encourage the client to have genetic testing.
B) Instruct the client on high-fiber foods.
C) Place the client in protective precautions.
D) Teach the client about cobalamin therapy.

Question 32

A client with chronic anemia has had many blood transfusions.What medications does the nurse anticipate teaching the client about adding to the regimen? (Select all that apply.)

A) Azacitidine (Vidaza)
B) Darbepoetin alfa (Aranesp)
C) Decitabine (Dacogen)
D) Epoetin alfa (Epogen)
E) Methylprednisolone (Solu-Medrol)

Question 33

A nurse is caring for four clients with leukemia.After hand-off report,which client should the nurse see first?

A) Client who had two bloody diarrhea stools this morning
B) Client who has been premedicated for nausea prior to chemotherapy
C) Client with a respiratory rate change from 18 to 22 breaths/min
D) Client with an unchanged lesion to the lower right lateral malleolus

Question 34

A client has a platelet count of 25,000/mm³.What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

A) Assist with oral hygiene using a firm toothbrush.
B) Give the client an enema if he or she is constipated.
C) Help the client choose soft foods from the menu.
D) Shave the male client with an electric razor.
E) Use a lift sheet when needed to re-position the client.

Question 35

A client admitted for sickle cell crisis is distraught after learning her child also has the disease.What response by the nurse is best?

A) "Both you and the father are equally responsible for passing it on."
B) "I can see you are upset.I can stay here with you a while if you like."
C) "It's not your fault; there is no way to know who will have this disease."
D) "There are many good treatments for sickle cell disease these days."

Question 36

A client has Hodgkin's lymphoma,Ann Arbor stage Ib.For what manifestations should the nurse assess the client? (Select all that apply.)

A) Headaches
B) Night sweats
C) Persistent fever
D) Urinary frequency
E) Weight loss

Question 37

A student studying leukemias learns the risk factors for developing this disorder.Which risk factors does this include? (Select all that apply.)

A) Chemical exposure
B) Genetically modified foods
C) Ionizing radiation exposure
D) Vaccinations
E) Viral infections

Question 38

A client with sickle cell disease (SCD)takes hydroxyurea (Droxia).The client presents to the clinic reporting an increase in fatigue.What laboratory result should the nurse report immediately?

A) Hematocrit: 25%
B) Hemoglobin: 9.2 mg/dL
C) Potassium: 3.2 mEq/L
D) White blood cell count: 38,000/mm³