Question 1

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?

Accepted Answer

Large purplish areas in the skin and oral mucosa are characteristic of purpura, which is a bleeding disorder characterized by bleeding into the skin and mucous membranes, causing purplish or reddish-brown patches or spots. Petechiae are small pinhead-sized red or purple spots on the skin or mucous membranes caused by bleeding under the skin, while hemorrhage refers to heavy bleeding from a blood vessel. Bleeding is a general term that does not specify the location or extent of the bleeding.

Question 2

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

Accepted Answer

A bone marrow biopsy is a diagnostic test commonly used in the diagnosis of leukemia. In this test, a small sample of bone marrow is removed and examined for abnormal cells. Thoracentesis is a procedure used to remove excess fluid from the pleural space around the lungs. Liver biopsy is used to diagnose liver disease, and arterial blood gas analysis is used to measure the levels of oxygen and carbon dioxide in the blood.

Question 3

A patient with multiple myeloma is at risk for hypercalcemia. Which of the following nursing interventions is most important for the patient with hypercalcemia?

Accepted Answer

Encouraging fluids is the most important nursing intervention for hypercalcemia, as it helps to promote renal excretion of calcium and prevent further elevations in serum calcium levels. Citrus juices and fruits contain vitamin C, which may increase calcium absorption, and should be avoided in hypercalcemia. A low-sodium diet may be appropriate for some patients, but it is not the most important intervention for hypercalcemia. Discouraging intake of alcoholic beverages may be important for other reasons, but it is not directly related to hypercalcemia.

Question 4

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?

Accepted Answer

Joint deformities are a common complication of hemophilia due to repeated episodes of bleeding into the joints. Ecchymoses (bruising) on the extremities are also common, but on their own may not necessarily indicate the severity of past bleeding episodes. An elevated white blood cell count and a distended abdomen are not specific to hemophilia and may indicate other medical issues.

Question 5

Which of the following beverages should a patient with Hodgkin's disease be instructed to avoid?

Accepted Answer

Patients with Hodgkin's disease should avoid alcohol, and therefore wine should be avoided. Coffee, orange juice, and ginger ale are all acceptable beverages for patients with Hodgkin's disease to consume in moderation.

Question 6

Why is it important for the nurse to institute measures to protect a patient with leukemia from infection?

Accepted Answer

Leukemia seriously impairs the leukocytes and the body's ability to fight infection. Patients with leukemia have a weakened immune system, and even minor infections can become life-threatening. Instituting measures to protect the patient from infection is crucial in preventing complications and improving outcomes.

Question 7

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 of the following responses by the nurse is most appropriate?

Accepted Answer

Option B shows empathy and acknowledges the patient's frustration without making any judgments or assumptions about the patient's request. This allows for further exploration of the patient's feelings and concerns. Option A would be assuming what the patient needs and potentially unsafe because of the patient's specific orders. Option C is dismissive and judgmental, and option D is not a helpful response because it does not address the patient's concerns or offer support.

Question 8

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

Accepted Answer

In the final stage of CLL, patients often experience fever and abnormal bleeding due to the disease's impact on the immune system and blood cell production.

Question 9

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?

Accepted Answer

Dark stool may indicate gastrointestinal bleeding, which is a common complication in patients with chronic leukemia due to their decreased platelet and clotting factor levels. The nurse should report this finding to the healthcare provider and continue to monitor for signs of bleeding. Options A, B, and D do not provide an adequate explanation for the dark stool color in this context.

Question 10

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

Accepted Answer

Stridor is a medical emergency that requires immediate attention as it indicates compromised airway due to lymph node enlargement. An obstructed airway can lead to respiratory distress and eventually respiratory failure. Fever, fatigue, and pain are common symptoms in Hodgkin's disease and can be managed with appropriate treatment.

Question 11

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 of the following actions by the nurse is most appropriate?

Accepted Answer

Hemophilia is a bleeding disorder where the clotting factors are deficient. Even if there are no apparent signs of bleeding, the patient may still be at risk for internal bleeding or bleeding into the joints. Therefore, it is best to place the patient in an examination room to be assessed by a physician as soon as possible. This allows for prompt evaluation and treatment, reducing the risk of further bleeding complications.

Question 12

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

Accepted Answer

Vitamin K plays a key role in the production of clotting factors in the liver. Patients undergoing splenectomy are at risk for bleeding because the spleen is important in removing damaged or old blood cells and supporting clotting. The vitamin K injection helps correct any clotting factor deficiencies and reduce the risk of bleeding during and after the surgery.

Question 13

When assessing the patient with stage III Hodgkin's disease, where would the nurse expect to find enlarged lymph nodes?

Accepted Answer

Stage III Hodgkin's disease involves lymph node regions on both sides of the diaphragm, which means there can be generalized lymph node enlargement throughout the body.

Question 14

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?

Accepted Answer

The goal of the plan is for the patient to attend the family member's wedding despite feeling fatigued. If the patient is able to attend the wedding, it demonstrates that the plan was effective in managing their activity intolerance. The other options may be indicators of progress but do not specifically address the goal of the plan.

Question 15

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

Accepted Answer

Sponge Toothettes would be the best choice as they are soft and gentle on irritated mucous membranes. Lemon-glycerin swabs and a firm toothbrush may further irritate the mucous membranes, and flossing may be difficult and uncomfortable for the patient.

Question 16

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

Accepted Answer

Teaching the patient to cough and deep breathe every hour is crucial after a splenectomy to prevent atelectasis and pneumonia, which are common postoperative complications. This action helps maintain clear airways and promotes lung expansion, reducing the risk of respiratory complications, which is a priority in postoperative care.

Question 17

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?

Accepted Answer

The nurse should notify the physician of the hemophilia alert immediately so that appropriate measures can be taken to prevent and treat any bleeding complications. The physician may also need to order specific medications or blood products to manage the hemophilia. Removing the bracelet or calling the phone number on the bracelet would not address the immediate concern of potential bleeding complications. Taping the bracelet to the patient's arm may be done for documentation purposes, but the priority is to inform the physician.

Question 18

A patient with hemophilia A is bleeding. Which of the following treatments should the nurse anticipate?

Accepted Answer

Hemophilia A is a deficiency of factor VIII, and therefore the best treatment option would be an IV infusion of factor VIII to replace the missing clotting factor. IM injections are not preferred as they may cause bleeding at the injection site and take longer to produce therapeutic effects. Factor IX would not be effective in treating hemophilia A, as it is a clotting factor that is deficient in hemophilia B.

Question 19

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

Accepted Answer

Multiple myeloma can weaken the bones, leading to a risk of fractures and injury. Teaching the family about safe handling techniques, fall prevention, and ways to modify the home environment to reduce the risk of injury is essential. The other options are not as relevant to care for a patient with multiple myeloma.

Question 20

Which question by the nurse helps evaluate the patient's response to treatment for anemia?

Accepted Answer

Evaluating if the patient is keeping up with their work schedule can help assess improvements in energy levels and overall functioning, which are directly related to the treatment of anemia.

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