Question 1

Sanchez visited a clinic for his timely medical check-up and brought with him his hematology result. He informed the nurse that his physician is trying to assess him for polycythemia vera. The laboratory findings for a client with polycythemia vera include major and minor criteria. What is the major or defining hematological finding?
A)Leukocytosis >12,000/mm3
B)Thrombocytosis >400,000/mm3
C)RBC count >6 million/mm3
D)Elevated leukocyte alkaline phosphatase

Accepted Answer

Polycythemia vera is a chronic myeloproliferative disorder characterized mainly by erythrocytosis (increased RBC mass). Hemoglobin and hematocrit will be elevated. Choices A, B, and D are also laboratory findings, but they are considered minor criteria in this condition.

Question 2

Which clinical presentation is consistent with chronic anemia?
A)Fatigue, dyspnea at rest, pallor, tachycardia
B)Hemarthrosis, bruising, prolonged nose bleeds, hematuria
C)Enlarged lymph nodes, night sweats, fatigue, infections
D)Fever, lymphadenopathy, sore throat, decreased appetite

Accepted Answer

Fatigue, dyspnea at rest, pallor, and tachycardia are consistent with chronic anemia. Anemia is an abnormally low hemoglobin level and/or circulating number of red blood cells. The result is a decrease in the blood's oxygen-carrying capacity. Symptoms associated with chronic anemia, which is caused by the lack of oxygen reaching the cells, include fatigue, dyspnea at rest, and tachycardia. The lack of hemoglobin results in pallor. The dyspnea and tachycardia are attempts by the body to compensate for the tissue hypoxia by increasing oxygen delivery.

Question 3

Danny, 15 years old, has hemophilia and is being discharged from the pediatric unit following a bleeding episode into a joint (hemarthrosis). Which discharge instruction, written by the pediatrician, should the nurse question?
A)"No aspirin or aspirin-related products."
B)"Tylenol 480 mg po q4-6h prn for pain."
C)"May resume adaptive physical education class upon return to school."
D)"May resume taking prophylactic antihemophilic factor at home and at H.S."

Accepted Answer

Although many children with hemophilia do take antihemophilic factor on a regular basis to prevent bleeding episodes, the factor (which has a short half-life) should be taken in the morning so that factor levels can be highest when the child is most active and prone to injury. Children with hemophilia are taught to avoid taking aspirin or aspirin related/containing products due to the natural anticoagulation properties of this medication (Choice A). Acetaminophen/Tylenol (Choice B) is ideal for mild to moderate pain. This medication does not interfere with coagulation. Children with hemophilia are restricted from regular physical education classes, which may involve contact sports that could cause injury and precipitate a bleeding episode (Choice C). Adaptive physical education classes feature non-contact sports such as swimming and golf.

Question 4

The treatment of choice for clients under age 40 with leukemia is bone marrow transplant. Which statement about bone marrow transplantation is not correct?
A)The client is under local anesthesia during the procedure.
B)The aspirated bone marrow is mixed with heparin.
C)The aspiration site is the posterior or anterior iliac rest.
D)The recipient receives cyclophosphamide (Cytoxan) for 4 consecutive days before the procedure.

Accepted Answer

During the transplant, the client is under general anesthesia-not local anesthesia. The rest of the choices are correct procedures for bone marrow transplant.

Question 5

Ana is diagnosed to have pernicious anemia. The physician orders 0.2 mg of Cyanocobalamin (Vitamin B12) IM. Available is a vial of the drug labeled 1 ml= 100 mcg. The nurse should administer:
A)0.5 ml
B)1.0 ml
C)1.5 ml
D)2.0 ml

Accepted Answer

The nurse should administer 2.0 ml. First, convert milligrams to micrograms and then use ratio and proportion (0.2 mg= 200 mcg) 200 mcg : 100 mcg= X ml : ml 100 X= 200 X = 2 ml. Inject 2 ml. to give 0.2 mg of Cyanocobalamin.

Question 6

Clara is a 37-year-old cook. She is admitted for treatment of partial and full-thickness burns of her entire right lower extremity and the anterior portion of her right upper extremity. Her respiratory status is compromised and she is in pain and anxious. Performing an immediate appraisal, using the rule of nines, the nurse estimates the percent of Clara's body surface that is burned is:
A)4.5%
B)9%
C)18 %
D)22.5%

Accepted Answer

The nurse estimates that 22.5% of Clara's body surface is burned. The entire right lower extremity is 18% the anterior portion of the right upper extremity is 4.5% giving a total of 22.5%.

Question 7

The nurse applies mafenide acetate (Sulfamylon cream) to Clara, who has second and third degree burns on the right upper and lower extremities, as ordered by the physician. This medication will:
A)Inhibit bacterial growth
B)Relieve pain from the burn
C)Prevent scar tissue formation
D)Provide chemical debridement

Accepted Answer

Mafenide acetate will inhibit bacterial growth. Sulfamylon is effective against a wide variety of gram positive and gram negative organisms, including anaerobes.

Question 8

Clara, a burn client, receives a temporary heterograft (pig skin) on some of her burns. These grafts will:
A)Debride necrotic epithelium
B)Be sutured in place for better adherence
C)Relieve pain and promote rapid epithelialization
D)Frequently be used concurrently with topical antimicrobials

Accepted Answer

The temporary heterografts will relieve pain and promote rapid epithelialization. The graft covers nerve endings, which reduces pain and provides a framework for granulation that promotes effective healing.

Question 9

Kaitlyn, 10 years old, was diagnosed with juvenile rheumatoid arthritis. The nurse is teaching her regarding measures that would reduce the risk of activity intolerance. Which of the following actions would best indicate that Kaitlyn has understood the nurse's teachings?
A)Delaying eating breakfast until after morning medications are taken
B)Increasing fluid intake
C)Taking a warm bath prior to going to school
D)Continuing to participate in activities of daily living, despite fatigue and persistent pain

Accepted Answer

The warmth of the water will reduce the morning stiffness of the joints and thus, increase mobility. Choice A is incorrect because this action could contribute to the child being at risk for injury due to the irritating nature on the gastrointestinal tract by medications taken to treat juvenile rheumatoid arthritis. While correct in itself, Choice B is incorrect because this action correlates with reducing the risk for injury rather than activity intolerance. Increasing fluid will decrease the risk for the formation of renal calculi brought about by immobility. Choice D is incorrect because this action could contribute to the child being at risk for injury. Activities of daily living should be temporarily discontinued in the presence of fatigue and persistent pain.

Question 10

Kaitlyn, who was diagnosed with juvenile rheumatoid arthritis, must take long-term steroids. Through health teaching on the nurse's part, which adverse effect of the medications can be prevented?
A)Infection
B)Hyperglycemia
C)Hirsutism
D)Delayed growth

Accepted Answer

Infection, a common manifestation of clients taking long-term steroids due to immunosuppression, can be prevented through hand washing and staying away from others who are ill. The other choices are also adverse effects of the drug regimen; however, they are unpreventable.

Question 11

An HIV-positive client presents with a CD4 count of <200/µl and invasive cervical cancer. How would the nurse evaluate these findings in terms of current CDC guidelines?
A)The client has seroconverted.
B)The client is HIV-positive.
C)The client in the latent period of the disease process.
D)The client has AIDS.

Accepted Answer

The CDC case definition of AIDS for adults states that the two factors described in the question are diagnostic of progression of AIDS. Seroconversion and positive HIV status have already occurred. The latent period is considered to be one in which the individual is asymptomatic.

Question 12

Nursing care planning is based on the knowledge that the first 24-48 hours post-burn are characterized by:
A)An increase in the total volume of intracranial plasma
B)Excessive renal perfusion with diuresis
C)Fluid shift from interstitial space
D)Fluid shift from intravascular space to the interstitial space

Accepted Answer

Fluid shift from intravascular space to the interstitial space. This period is the burn shock stage, or the hypovolemic phase. Tissue injury causes vasodilation, which results in increased capillary permeability, making fluids shift from the intravascular to the interstitial space. This can lead to a decrease in circulating blood volume or hypovolemia which decreases renal perfusion and urine output.

Question 13

Shawn is an employee at a local factory who comes to the nurse's office with a large furuncle (boil) on his left upper arm. He has come to the office with the same complaint over the past 6 months. In addition to specific care for the boil itself, the nursing intervention should include:
A)Advising the client to bathe more regularly
B)Doing nothing else, as furuncles are not related to any other disease process
C)Calling in all employees and checking them for furuncles
D)Encouraging the client to see his family physician, as recurrent boils may be a sign of underlying disease

Accepted Answer

Sometimes, recurrent boils are symptoms of an underlying disease process such as glycosuria. Bathing (Choice A) will not influence the course of the boils and they are not communicable.

Question 14

Which of the following individuals is least likely to be at risk of developing psoriasis?
A)Kaleya, a 32-year-old African American
B)Mrs. Johnson, who is experiencing menopause
C)Mr. Sanchez, who has a family history of the disorder
D)Peter, who is experiencing a significant amount of emotional distress

Accepted Answer

Psoriasis occurs equally among women and men, although the incidence is lower in darker skinned races and ethnic groups. A genetic predisposition has been recognized in some cases. Emotional distress, trauma, systemic illness, seasonal changes, and hormonal changes are linked to exacerbations.

Question 15

Charles calls the Emergency Department and tells the nurse that he had been cleaning a wooded area in the backyard and came directly into contact with poison ivy shrubs. He tells the nurse that he cannot see anything on the skin and asks the nurse what to do. Which of the following is the appropriate nursing response?
A)"Come to the Emergency Department."
B)"Apply calamine lotion immediately to the exposed skin areas."
C)"Take a shower immediately, lathering and rinsing several times."
D)"It is not necessary to do anything if you cannot see anything on your skin."

Accepted Answer

When an individual comes in contact with a poison ivy plant, the sap from the plant forms an invisible film on the human skin. The client should be instructed to shower immediately and to lather the skin several times and rinse each time in running water. Calamine lotion is a treatment used if dermatitis develops. The client does not need to be seen in the emergency department at this time.

Question 16

Mikaela, 25 years old, is scheduled for a skin biopsy and asks the nurse how painful the procedure is. The appropriate response by the nurse is:
A)"There is no pain associated with this procedure."
B)"The local anesthetic may cause a burning or stinging sensation."
C)"A preoperative medication will be given so you will be sleeping and will not feel any pain."
D)"There is some pain, but the physician will prescribe an opioid analgesic following the procedure."

Accepted Answer

Depending on the size and location of the lesion, a biopsy is usually a quick and also painless procedure. The most common source of pain is the initial local anesthetic, which can produce a burning or stinging sensation. Preoperative medication is not necessary with this procedure.

Question 17

Luis, 32 years old, obtained a third-degree circumferential arm burn after a pot of boiling oil was accidentally turned over. Escharotomy procedure was ordered for Luis. The nurse understands that the anticipated therapeutic outcome of the escharotomy is:
A)Return of distal pulses
B)Brisk bleeding from the site
C)Decreasing edema formation
D)Formation of granulation tissue

Accepted Answer

Escharotomies are performed to relieve the compartment syndrome that can occur when edema forms under nondistensible eschar in a circumferential third-degree burn. Escharotomies are performed through avascular eschar to subcutaneous fat. Although bleeding may occur from the site, it is considered a complication rather than an anticipated therapeutic outcome. Usually, direct pressure with a bulky dressing and elevation will control the bleeding, but occasionally an artery is damaged and may require ligation. Formation of granulation tissue is not the intent of an escharotomy. Escharotomy will not affect the formation of edema.

Question 18

The nurse is administering fluids intravenously as prescribed to a client who sustained superficial partial-thickness burn injuries of the back and legs. In evaluating the adequacy of fluid resuscitation, the nurse understands that which of the following would provide the most reliable indicator for determining the adequacy?
A)Vital signs
B)Urine output
C)Mental status
D)Peripheral pulses

Accepted Answer

The most reliable indicator for determining adequacy of fluid resuscitation is the urine output. For an adult, the hourly urine volume should be 30-50 ml.

Question 19

Swanson is admitted with full-thickness burns of the back and posterior thighs. Multiple dressing changes to the burns will be performed as part of the patient's care and the expected client outcome while hospitalized is absence of a wound infection. Which intervention is appropriate in meeting this outcome?
A)Gloves, gowns, masks, and caps must be worn during the care of this client and sterile gloves must be worn for the dressing changes.
B)The use of good hand washing technique is the only intervention that is needed.
C)Intubation and aggressive ventilatory management are needed to reverse the effects of an inhalation burn injury.
D)Prophylactic antibiotics must be administered to prevent an infection and colonization of wounds.

Accepted Answer

When providing direct care to a burn client, staff must wear gloves, caps, gowns, and masks to prevent an infection. Although burn clients are susceptible to infections, administration of antibiotics is not ordered until specific cultures and organisms are identified.

Quiz 5: Hematological

Which clinical presentation is consistent with chronic anemia?

Danny, 15 years old, has hemophilia and is being discharged from the pediatric unit following a bleeding episode into a joint (hemarthrosis) . Which discharge instruction, written by the pediatrician, should the nurse question?

The treatment of choice for clients under age 40 with leukemia is bone marrow transplant. Which statement about bone marrow transplantation is not correct?

Ana is diagnosed to have pernicious anemia. The physician orders 0.2 mg of Cyanocobalamin (Vitamin B12) IM. Available is a vial of the drug labeled 1 ml= 100 mcg. The nurse should administer:

The nurse applies mafenide acetate (Sulfamylon cream) to Clara, who has second and third degree burns on the right upper and lower extremities, as ordered by the physician. This medication will:

Clara, a burn client, receives a temporary heterograft (pig skin) on some of her burns. These grafts will:

Kaitlyn, 10 years old, was diagnosed with juvenile rheumatoid arthritis. The nurse is teaching her regarding measures that would reduce the risk of activity intolerance. Which of the following actions would best indicate that Kaitlyn has understood the nurse's teachings?

Kaitlyn, who was diagnosed with juvenile rheumatoid arthritis, must take long-term steroids. Through health teaching on the nurse's part, which adverse effect of the medications can be prevented?

An HIV-positive client presents with a CD4 count of <200/µl and invasive cervical cancer. How would the nurse evaluate these findings in terms of current CDC guidelines?

Nursing care planning is based on the knowledge that the first 24-48 hours post-burn are characterized by:

Shawn is an employee at a local factory who comes to the nurse's office with a large furuncle (boil) on his left upper arm. He has come to the office with the same complaint over the past 6 months. In addition to specific care for the boil itself, the nursing intervention should include:

Which of the following individuals is least likely to be at risk of developing psoriasis?

Mikaela, 25 years old, is scheduled for a skin biopsy and asks the nurse how painful the procedure is. The appropriate response by the nurse is:

Luis, 32 years old, obtained a third-degree circumferential arm burn after a pot of boiling oil was accidentally turned over. Escharotomy procedure was ordered for Luis. The nurse understands that the anticipated therapeutic outcome of the escharotomy is: