Deck 33: Nursing Management Hematological Problems

Question 1

The nurse is caring for a client who is hospitalized for treatment of severe hemolytic anemia. Which of the following actions should the nurse implement?

A)Provide a diet high in vitamin K.
B)Place the client on protective isolation.
C)Alternate periods of rest and activity.
D)Teach the client how to avoid injury.

Answer 1

Alternate periods of rest and activity.

Question 2

The nurse is teaching a client with a new diagnosis of pernicious anemia about the disorder. Which of the following client statements indicates that the teaching has been effective?

A)"I need to start eating more red meat or liver."
B)"I will stop having a glass of wine with dinner."
C)"I will need to take a proton pump inhibitor like omeprazole."
D)"I would rather use the nasal spray than have to get injections of vitamin B12."

Answer 2

"I would rather use the nasal spray than have to get injections of vitamin B12."

Question 3

The nurse is caring for a client with anemia who is experiencing increased fatigue and occasional palpitations at rest. Which of the following laboratory findings should the nurse expect?

A) Normal red blood cell (RBC) indices
B) Hematocrit (Hct) of 38%
C) Hemoglobin (Hb) of 86 g/L
D) RBC count of 4.5 * 10¹²/L

Answer 3

Hemoglobin (Hb) of 86 g/L

Question 4

The nurse is caring for a client with von Willebrand disease who is admitted to the hospital for minor knee surgery. Which of the following laboratory information should the nurse assess?

A)Platelet count
B)Bleeding time
C)Thrombin time
D)Prothrombin time

Question 5

Which of the following laboratory tests should the nurse use to determine whether the prescribed filgrastim is effective in the treatment of a client who is receiving chemotherapy for acute lymphocytic leukemia?

A)Platelet count
B)Reticulocyte count
C)Total lymphocyte count
D)Absolute neutrophil count

Question 6

Which of the following actions should the nurse include in the care plan for a hospitalized client who is neutropenic?

A)Avoid any IM or subcutaneous injections.
B)Check the oral temperature every 4 hours.
C)Omit all fruits or vegetables from the diet.
D)Place a "No Visitors" sign on the client door.

Question 7

The nurse is caring for a client who has been receiving a heparin infusion and warfarin for a deep vein thrombosis (DVT) with a diagnosis of heparin-induced thrombo-cytopenia (HIT). Which of the following actions should the nurse include in the plan ofcare?

A)Use low-molecular-weight heparin (LMWH) only.
B)Flush all intermittent IV lines using normal saline.
C)Administer the warfarin at the scheduled time.
D)Teach the client about the purpose of platelet transfusions.

Question 8

The nurse has finished teaching a client about taking oral ferrous sulphate. Which of the following client statements indicates that additional instruction is needed?

A)"I will call the doctor if my stools start to turn black."
B)"I will take a stool softener if I feel constipated occasionally."
C)"I should take the iron with orange juice about an hour before eating."
D)"I should increase my fluid and fibre intake while I am taking the iron tablets."

Question 9

The nurse is caring for a client with idiopathic aplastic anemia. Which of the following collaborative problems should the nurse include when developing the care plan?

A)Potential complication: seizures
B)Potential complication: infection
C)Potential complication: neurogenic shock
D)Potential complication: pulmonary edema

Question 10

The nurse is caring for a client with an acute exacerbation of polycythemia vera. Which of the following actions should the nurse implement during treatment?

A)Place the client on bed rest.
B)Administer iron supplements.
C)Avoid use of Aspirin products.
D)Monitor fluid intake and output.

Question 11

The nurse is planning discharge teaching for a client who was admitted with neutropenia. Which of the following instructions should the nurse include?

A)Limit fluids to 2-3 litres a day.
B)Include eggs and fish in the diet.
C)Avoid exposure to crowds as much as possible.
D)Drink only one or two caffeinated beverages daily.

Question 12

Which of the following nursing interventions should be included in the care plan for a client with immune thrombo-cytopenic purpura (ITP)?

A)Assign the client to a private room.
B)Avoid intramuscular (IM) injections.
C)Use rinses rather than a toothbrush for oral care.
D)Restrict activity to passive and active range of motion.

Question 13

The nurse is admitting a client with hemolytic anemia and notes jaundice of the sclerae. Which of the following laboratory results should the nurse assess?

A)Schilling test
B)Bilirubin level
C)Stool occult blood test
D)Gastric analysis testing

Question 14

Which of the following statements by a client with sickle cell anemia indicates good understanding of the nurse's teaching about prevention of sickle cell crisis?

A)"Home oxygen therapy is frequently used to decrease sickling."
B)"There are no effective medications that can help prevent sickling."
C)"Routine continuous dosage narcotics are prescribed to prevent a crisis."
D)"Risk for a crisis can be lowered by having an annual influenza vaccination."

Question 15

The nurse is caring for a client who is receiving methotrexate and develops a megaloblastic anemia. Which of the following nutrients should the nurse include in the teaching plan?

A)Iron
B)Folic acid
C)Cobalamin (vitamin B??)
D)Ascorbic acid (vitamin C)

Question 16

A routine complete blood count indicates that a client may have myelodysplastic syndrome. At this time, which of the following information should the nurse include in the teaching plan?

A)Packed red blood cells (PRBCs) transfusion
B)Bone marrow biopsy
C)Filgrastim administration
D)Erythropoietin administration

Question 17

The nurse is admitting a client with type A hemophilia who has severe pain and swelling in the right knee. Which of the following actions should the nurse implement initially?

A)Immobilize the knee
B)Apply heat to the joint
C)Assist the client with light weight bearing
D)Perform passive range of motion to the knee

Question 18

The nurse is caring for a client with a sickle cell crisis. While caring for the client during the crisis, which of the following actions is priority?

A)Limit the client's intake of oral and IV fluids.
B)Evaluate the effectiveness of opioid analgesics.
C)Encourage the client to ambulate as much as tolerated.
D)Teach the client about high-protein, high-calorie foods.

Question 19

Which of the following laboratory information should the nurse monitor to detect heparin-induced thrombo-cytopenia (HIT) in a client who is receiving a continuous heparin infusion?

A)Prothrombin time
B)Erythrocyte count
C)Fibrinogen degradation products
D)Activated partial thromboplastin time

Question 20

Which of the following menu choices indicate that the client understands the nurse's teaching about best dietary choices for iron-deficiency anemia?

A)Omelette and whole wheat toast
B)Cantaloupe and cottage cheese
C)Strawberry and banana fruit plate
D)Cornmeal muffin and orange juice

Question 21

Which of the following nursing actions should the nurse include in the plan of care for a client admitted with multiple myeloma?

A)Monitor fluid intake and output.
B)Administer calcium supplements.
C)Assess lymph nodes for enlargement.
D)Limit weight bearing and ambulation.

Question 22

The nurse is caring for a client receiving a transfusion of packed red blood cells who develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, which of the following actions is priority?

A)Draw blood for a new crossmatch
B)Send a urine specimen to the laboratory
C)Give the PRN diphenhydramine
D)Administer the PRN acetaminophen

Question 23

The nurse is caring for a client with immune thrombo-cytopenic purpura (ITP) who has a prescription for a platelet transfusion. Which of the following client information indicates that the nurse should consult with the health care provider before administering platelets?

A)The platelet count is 42 * 109/L.
B)Blood pressure is 94/56 mm Hg.
C)Blood is oozing from the venipuncture site.
D)Petechiae are present on the chest and back.

Question 24

The nurse is caring for a client who has a history of a transfusion-related acute lung injury (TRALI) and is to receive a transfusion of packed red blood cells (PRBCs). Which of the following actions should the nurse take to decrease the risk for TRALIforthis client?

A)Infuse the PRBCs slowly over 4 hours.
B)Transfuse only leukocyte-reduced PRBCs.
C)Administer the scheduled oral diuretic before the transfusion.
D)Give the PRN dose of antihistamine before starting the transfusion.

Question 25

The nurse is caring for a client with non-Hodgkin's lymphoma who develops a platelet count of 38 * 109/L during chemotherapy. Which of the following actions should the nurse implement based on this finding?

A)Provide oral hygiene every 2 hours.
B)Check all stools for occult blood.
C)Assess temperature every 4 hours.
D)Encourage fluids to 3 000 mL/day.

Question 26

The nurse is caring for a client with acute myelogenous leukemia (AML) who is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT). Which of the following actions is best for the nurse to implement to assist the clientwith treatment decisions?

A)Emphasize the positive outcomes of a bone marrow transplant.
B)Discuss the need for adequate insurance to cover post-HSCT care.
C)Ask the client whether there are any questions or concerns about HSCT.
D)Explain that a cure is not possible with any other treatment except HSCT.

Question 27

Fifteen minutes after a transfusion of packed red blood cells is started, a client has symptoms of back pain and dyspnea and a pulse rate of 124 beats/minute. Which of the following actions should the nurse implement initially?

A)Administer oxygen therapy at a high flow rate.
B)Obtain a urine specimen to send to the laboratory.
C)Notify the health care provider about the symptoms.
D)Disconnect the transfusion and infuse normal saline.

Question 28

When a febrile episode occurs in a client with neutropenia, at what time should antibiotic therapy be initiated?

A)Within 1 hour
B)After the causative agent is identified from the culture
C)Once the fever drops below 38°C (100.4°F)
D)For long-term therapy over 3 months

Question 29

After receiving change-of-shift report for the following four clients with neutropenia, which client should the nurse assess first?

A)66-year-old who has white pharyngeal lesions
B)35-year-old who has a fever of 38.2°C (100.8°F)
C)56-year-old who has frequent explosive diarrhea
D)23-year old who is complaining of severe fatigue

Question 30

The hemophilia clinic nurse receives a call from a client with hemophilia to discuss all of these problems. Which of the following problems is most important to communicate to the health care provider?

A)Skin abrasions
B)Bleeding gums
C)Multiple bruises
D)Dark tarry stools

Question 31

All of these clients call the outpatient clinic and ask to make an appointment as soon as possible. Which of the following clients should the nurse schedule to be seen first?

A)19-year-old with no previous health problems who has a nontender lump in the axilla
B)46-year-old with sickle cell anemia who says "that my eyes always look sort of yellow"
C)21-year-old with hemophilia who wants to learn how to self-administer factor VII replacement
D)50-year-old with early-stage chronic lymphocytic leukemia who has complaints of chronic fatigue

Question 32

The nurse is caring for a client with septicemia who develops prolonged bleeding from venipuncture sites and blood in the stools. Which of the following actions is most important for the nurse to take?

A)Notify the client's health care provider.
B)Avoid unnecessary venipunctures.
C)Apply sterile dressings to the sites.
D)Give prescribed proton-pump inhibitors.

Question 33

The nurse is caring for a client with neutropenia who is started on a cephalosporin. Which of the following common adverse effects should the nurse observe for in the client? (Select all that apply.)

A)Nephrotoxicity
B)Rash
C)Ototoxicity
D)Fever
E)Pruritus

Question 34

Which of the following assessment data obtained by the nurse when caring for a client with thrombo-cytopenia should be immediately communicated to the health care provider?

A)The platelet count is 52 * 109/L.
B)The client is difficult to arouse.
C)There are large bruises on the back.
D)There are purpura on the oral mucosa.

Question 35

The nurse is caring for a client with acute myelogenous leukemia (AML) who has induction therapy prescribed and the client asks the nurse whether the planned chemotherapy will be worth undergoing. Which of the following responses by the nurse is best?

A)"If you do not want to have chemotherapy, there are other options for treatment such as stem cell transplantation."
B)"The decision about chemotherapy is one that you and the doctor need to make rather than asking what I would do."
C)"You don't need to make a decision about treatment right now since leukemias in adults tend to progress quite slowly."
D)"The adverse effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy."

Question 36

Which of the following newly admitted clients should the nurse assign as a roommate for a client who has aplastic anemia?

A)A client with severe heart failure
B)A client who has viral pneumonia
C)A client who has right leg cellulitis
D)A client with multiple abdominal drains

Question 37

All of these clients are waiting to be admitted by the emergency department nurse. Which one of the following requires the most rapid assessment and care by the nurse?

A)The client with hemochromatosis who has symptoms of abdominal pain
B)The client with thrombo-cytopenia who has blood oozing after having a tooth extracted
C)The client with chemotherapy-induced neutropenia who has a temperature of 38.2°C (100.8°F)
D)The client with a history of sickle cell anemia who has had nausea and diarrhea for 24 hours

Question 38

The nurse is caring for a client with acute myelogenous leukemia who is receiving outpatient chemotherapy and develops an absolute neutrophil count of 0.9 * 10?/L. Which of the following actions by the nurse in the outpatient clinic is best?

A)Discuss the need for hospital admission to treat the neutropenia.
B)Plan to discontinue the chemotherapy until the neutropenia resolves.
C)Teach the client how to administer filgrastim injections at home.
D)Obtain a high-efficiency particulate air (HEPA) filter for the client for home use.

Question 39

The nurse is caring for a client with myelodysplastic syndrome who has 20% blasts in marrow and the health care provider has prescribed high-intensity treatment. Which of the following treatments should the nurse prepare the client to receive?

A)Antibiotics
B)Antifungals
C)Chemotherapy
D)A blood transfusion