Deck 33: Nursing Management: Hematological Problems

Question 1

A 42-year-old patient is admitted to the hospital with idiopathic aplastic anemia.What is an appropriate collaborative problem for the nurse to identify for the patient?

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

Answer 1

Potential complication: hemorrhage

Question 2

A patient with chronic lymphocytic leukemia is hospitalized for treatment of severe hemolytic anemia.What is an appropriate nursing intervention for the patient?

A) Provide a diet high in vitamin K and folic acid.
B) Plan care to alternate periods of rest and activity.
C) Isolate the patient from visitors and other patients.
D) Encourage increased intake of fluid and fibre in the diet.

Answer 2

Plan care to alternate periods of rest and activity.

Question 3

During discharge teaching for the patient with neutropenia,which of the following issues should the nurse include?

A) Caffeine and alcohol intake
B) Excessive dietary iron intake
C) Limiting fluids to 2 L per day
D) Exposure to crowds

Answer 3

Exposure to crowds

Question 4

After teaching the patient about taking oral iron preparations for a moderate iron-deficiency anemia,which of the following patient statements indicates to the nurse that additional instruction is needed?

A) "I will contact my doctor if my stools start to turn black."
B) "I will call the doctor if the tablets cause a lot of stomach upset."
C) "I will increase my fluid intake if the iron tablets make me constipated."
D) "I should take the iron tablets with orange juice about an hour before meals."

Question 5

A 21-year-old patient is having a sickle cell crisis for the first time in many years.He asks the nurse why the sickling causes such pain.The nurse should explain that the pain of sickling is caused by which of the following?

A) Spasms of the blood cells as they change shape
B) Deposition of sickled red cells in the bone marrow
C) Tissue hypoxia caused by small blood vessel occlusion
D) Bacterial or viral infections of organs that caused the sickling

Question 6

The physician orders transfusion with packed RBCs for a patient who has severe anemia resulting from a bleeding peptic ulcer.What is the most important nursing action to prevent a transfusion reaction when administering the blood?

A) Verify and document patient identification.
B) Keep the blood chilled during administration.
C) Administer the blood at a rate of no more than 2 mL/min.
D) Stay with the patient during the first 15 minutes of the transfusion.

Question 7

A patient receiving a transfusion of whole blood develops chills and fever,headache,and anxiety 30 minutes after the transfusion is started.Which of the following does the nurse implement after stopping the transfusion?

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

Question 8

A 52-year-old patient has pernicious anemia with long-standing weakness and paraesthesia of the feet and hands.The nurse determines that expected outcomes related to knowledge of the therapeutic regimen have been met when the patient states which of the following?

A) "I will need to have cobalamin (B₁₂)injections regularly for the rest of my life."
B) "I will increase sources of cobalamin (B₁₂),such as muscle meats and liver,in my diet."
C) "The feeling in my hands and feet will return when my hemoglobin level returns to normal."
D) "I should plan for only part-time employment because of the chronic fatigue that pernicious anemia causes."

Question 9

A patient who has experienced an acute blood loss exhibits a normal supine blood pressure and pulse at rest but complains of postural hypotension and has a pulse of 110 beats/min when exercising.The nurse knows that these signs and symptoms are manifestations of what percentage of blood loss?

A) 10%
B) 20%
C) 30%
D) 40%

Question 10

When the nurse discusses foods high in iron with a patient who has iron-deficiency anemia,the patient tells the nurse that she prepares low-cholesterol foods for her family and probably does not eat enough meat to meet her iron requirements.It is an appropriate goal for the patient to increase dietary intake of which of the following?

A) Eggs and fish
B) Nuts and cornmeal
C) Milk and milk products
D) Legumes and dried fruit

Question 11

For which one of the following lab results would the nurse expect to see abnormal results in a patient who has hemophilia?

A) Thrombin time
B) Platelet count
C) Prothrombin time
D) Partial thromboplastin time

Question 12

A patient with a history of iron-deficiency anemia who has not taken iron supplements for several years is experiencing increased fatigue and dizziness.What would the nurse expect the patient's laboratory findings to include?

A) Hematocrit 0.38 (38%)
B) Red blood cell (RBC)count 4,500,000/µL
C) Hemoglobin (Hb)86 g/L
D) Normal RBC indices

Question 13

A patient who has been receiving a heparin infusion and warfarin (Coumadin)for a deep-vein thrombosis is diagnosed with heparin-induced thrombocytopenia and thrombosis syndrome (HITTS).What does the nurse anticipate that the physician will order?

A) Use saline for flushing intravenous (IV)lines.
B) Give low-molecular weight (LMW)heparin.
C) Discontinue the warfarin.
D) Administer platelet transfusions.

Question 14

During treatment of the patient with an acute exacerbation of polycythemia vera,what is a critical nursing intervention?

A) Administer oxygen.
B) Evaluate fluid balance.
C) Administer anticoagulants.
D) Administer parenteral iron.

Question 15

While a patient with severe acquired thrombocytopenia is receiving platelet transfusions,the nurse recognizes that a platelet transfusion reaction may be present when the patient experiences which of the following signs?

A) Flushing,itching,and urticaria
B) Sudden onset of chills and fever
C) Urticaria,wheezing,and hypotension
D) Tachycardia,tachypnea,and hemoglobinuria

Question 16

Of the following patients waiting to be admitted by the emergency department nurse,which one requires the most rapid assessment and care by the nurse?

A) The patient with a history of sickle cell anemia who has had nausea and diarrhea for 24 hours
B) The patient who has chemotherapy-induced neutropenia and a temperature of 38°C
C) The patient with thrombocytopenia who has oozing after having a tooth extracted
D) The patient with hemophilia A who has ankle swelling after twisting the ankle

Question 17

During the admission assessment of a patient who has an Hb of 4.7 mmol/L (7.6 g/dL)and jaundice of the sclera,what laboratory results would the nurse assess?

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

Question 18

Fifteen minutes after a transfusion of packed RBCs is started,a patient develops tachycardia and tachypnea,and complains of back pain and feeling warm.What is the nurse's priority action?

A) Discontinue transfusion,and infuse normal saline.
B) Administer oxygen therapy at a high flow rate.
C) Slow the transfusion rate,and reassess the patient in 15 minutes.
D) Stop the blood,and discard the used bag and tubing in a biohazard container.

Question 19

A patient with sickle cell anemia is admitted to the hospital in crisis with severe abdominal pain.While caring for the patient,what is it most important for the nurse to do?

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

Question 20

Which one of the following groups of people is at an increased risk for developing iron-deficiency anemia?

A) Postmenopausal women
B) Middle-class people
C) Pregnant women
D) School-aged males

Question 21

A 45-year-old woman with chronic myelogenous leukemia is considering the possibility of treatment with a bone marrow transplant from a human leukocyte antigen-matched sibling.To assist the patient with treatment decisions,what is the best approach for the nurse to use?

A) Emphasize the positive outcomes of a bone marrow transplant.
B) Ensure that the patient understands the risks of treatment-related death or treatment failure.
C) Explain that a cure is not possible with any other type of treatment except a bone marrow transplant.
D) Encourage the patient to ask the physician about new,experimental treatments for leukemia that do not involve total body irradiation.

Question 22

The nurse identifies a nursing diagnosis of risk for injury related to medical interventions for a patient with immune thrombocytopenic purpura.What is an appropriate nursing intervention that addresses the etiology of this nursing diagnosis?

A) Use a soft-bristled toothbrush and cotton swabs for mouth care.
B) Limit the number of venipunctures by using an intermittent-infusion device.
C) Assess the patient during the platelet transfusion for symptoms of transfusion reactions.
D) Assess the patient's mucous membranes and skin each shift to detect the presence of bleeding.

Question 23

A patient's family member asks the nurse what caused the patient to develop disseminated intravascular coagulation (DIC).What does the nurse tell the family member about DIC?

A) It is caused by an abnormal activation of clotting.
B) It occurs when the immune system attacks platelets.
C) It is a complication of cancer chemotherapy.
D) It is caused when hemolytic processes destroy erythrocytes.

Question 24

During treatment of the patient who has sepsis-induced DIC with moderate bleeding,on what would the nurse expect the initial collaborative care will focus?

A) Administration of heparin to reduce intravascular clotting
B) Treatment of the infectious process with IV antibiotics
C) Infusion of whole blood to replace clotting factors and RBCs
D) Supportive management of symptoms until the DIC is resolved

Question 25

What is the most appropriate nursing intervention to assess for the presence of infection in a patient with neutropenia?

A) Monitor WBCs daily.
B) Monitor temperature every 4 hours.
C) Monitor the skin for temperature and diaphoresis.
D) Monitor the mouth and perianal area every shift for signs of redness and swelling.

Question 26

A patient with type A hemophilia has been admitted to the hospital with severe pain and swelling in his right knee.To prevent joint deformity during the initial care of the patient,what should the nurse do?

A) Immobilize the knee.
B) Elevate the right lower limb on pillows.
C) Perform passive range of motion to the knee.
D) Have the patient perform isometric exercises of the affected leg against a footboard.

Question 27

A patient with non-Hodgkin's lymphoma develops a platelet count of 10,000 cells/microlitre during chemotherapy.Based on this finding,what is an appropriate nursing intervention for the patient?

A) Provide oral hygiene every 2 hours.
B) Check the temperature every 4 hours.
C) Check all stools for occult blood.
D) Encourage fluids to 3000 mL/day.

Question 28

During care of the patient with multiple myeloma,what is an important nursing intervention?

A) Limiting activity to prevent pathological fractures
B) Maintaining a fluid intake of 3 to 4 L/day to dilute calcium load
C) Assessing for changes in size and characteristics of lymph nodes
D) Administering narcotic analgesics continuously to control bone pain

Question 29

A patient with myelodysplastic syndrome has laboratory values that indicate total bone marrow suppression.The nurse identifies a nursing diagnosis of risk for infection based on which of the following findings?

A) Basophils 120 cells/mL
B) Monocytes 360 cells/mL
C) Neutrophils 4000 cells/mL
D) White blood cell (WBC)count 2.8 $\times$ 10⁹ cells/L (2800 cells/microlitre)

Question 30

A patient with chemotherapy-induced neutropenia is placed in a private room,and protective isolation is instituted.The care plan the nurse develops with the patient is based on the knowledge that which of the following sources of infection is the most common in patients with neutropenia?

A) Normally nonpathogenic microorganisms of the patient's own flora
B) Microorganisms that are not sensitive to broad-spectrum antibiotics
C) Microorganisms transmitted to the patient by the hands of health care providers
D) Microorganisms transmitted to the patient by health care providers with transmissible infections

Question 31

When caring for a patient with hemophilia,the nurse teaches the patient to seek immediate medical attention on experiencing which of the following signs?

A) Fever
B) A sore throat
C) Bleeding gums
D) Dark,tarry stools (melena)

Question 32

A patient with neutropenia has a nursing diagnosis of risk for infection.What is the most important nursing intervention in the prevention of transmission of harmful pathogens to the patient?

A) Prohibiting the oral intake of fresh fruits and vegetables
B) Maintaining strict administration schedules of prophylactic antibiotics
C) Strict and frequent handwashing by all persons having contact with the patient
D) Creating a "sterile" environment for the patient with the use of laminar airflow rooms

Question 33

Laboratory studies related to coagulation are performed on a patient with a bleeding disorder.The nurse explains to the patient that von Willebrand's disease can be differentiated from other types of hemophilia by evaluating which of the following laboratory results?

A) Bleeding time
B) Platelet count
C) Prothrombin time
D) Partial thromboplastin time

Question 34

When preparing a patient for a blood transfusion,the nurse will prepare the blood.Which IV solution would the nurse prepare to administer in a Y-type tubing adjacent to the blood?

A) Dextrose 5%
B) Lactated Ringer's
C) Normal saline
D) Dextrose 10%

Question 35

A 64-year-old patient with newly diagnosed acute myelogenous leukemia (AML)is undergoing induction therapy with chemotherapeutic agents.He tells the nurse that he is so sick from the induction therapy that he wonders if it is worth it.What is the best response to this patient?

A) "I know you feel really ill right now,but after this therapy,your disease will go into a remission,and you will feel normal again."
B) "Induction therapy is very aggressive and causes the most side effects,so when this phase is completed,you won't feel so ill."
C) "Your type of leukemia has a survival rate of up to 10 years if aggressive therapy is started,so the effects of treatment should be worth it to you."
D) "I know that this phase is very difficult for you,but the treatment is necessary to achieve control of your disease so that you will have some time to make choices about your life."

Question 36

A patient receiving chemotherapy for acute lymphocytic leukemia has pancytopenia,and filgrastim (Neupogen)is prescribed.The nurse teaches the patient that the reason for the use of the medication is which of the following?

A) Remission of the leukemia
B) Improvement in the number and function of neutrophils
C) Replacement of abnormal stem cells in the bone marrow with normal cells
D) Prevention of hemorrhage complications in patients with thrombocytopenia

Question 37

A 26-year-old patient with stage II Hodgkin's disease asks the nurse how long he probably has to live.What is the best response to the patient?

A) "No one can predict when someone will die,so try to focus on the present."
B) "It will depend on how your disease responds to chemotherapy,but most patients do well."
C) "If your initiation chemotherapy is effective,it is possible to have at least a 5-year remission."
D) "Most patients with your stage of Hodgkin's disease are treated successfully."

Question 38

Which nutrient plays a role in helping mature RBCs in erythropoiesis?

A) Iron
B) Folic acid
C) Pyridoxine
D) Ascorbic acid