ADV Med-Surg Hematology Questions (2018)
A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse's first response? A) Assess for potential abuse B) Check for diminished sensations C) Document the findings D) Clean and dress the area
B) Check for diminished sensations Rationale: Macrocytic anemias can result from deficiencies in vitamin B12 or ascorbic acid. Only vitamin B12 deficiency causes diminished sensations of peripheral nerve endings. The nurse should assess for peripheral neuropathy and instruct the client in self-care activities for her diminished sensation to heat and pain.
Which of the following cells is the precursor to the red blood cell (RBC)? A) B cell B) Macrophage C) Stem cell D) T cell
C) Stem cell
The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? A) Whole grains B) Green leafy vegetables C) Meats and dairy products D) Broccoli and Brussels sprouts
C) Meats and dairy products Rationale: Good sources of vitamin B12 include meats and dairy products.
The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? A) Autoimmune reaction complicated by hypoxia B) Lack of oxygen in the red blood cells C) Obstruction to circulation D) Elevated serum bilirubin concentration
C) Obstruction to circulation Rationale: Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis.
A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection? A) Hematocrit B) Partial thromboplastin time C) Hemoglobin concentration D) Prothrombin time
A) Hematocrit Rationale: Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked.
Which of the following symptoms is expected with hemoglobin of 10 g/dl? A) None B) Pallor C) Palpitations D) Shortness of breath
A) None Rationale: Mild anemia usually has no clinical signs. Palpitations, SOB, and pallor are all associated with severe anemia.
A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response? A) "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid." B) "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." C) "The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction." D) "The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."
B) "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." Rationale: Most clients with pernicious anemia have deficient production of intrinsic factor in the stomach.
A mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following? A) Little is known about iron-deficiency anemia and its relationship to infection in children B) Children with iron deficiency anemia are more susceptible to infection than are other children C) Children with iron-deficiency anemia are less susceptible to infection than are other children D) Children with iron-deficient anemia are equally as susceptible to infection as are other children.
B) Children with iron deficiency anemia are more susceptible to infection than are other children Rationale: Children with iron-deficiency anemia are more susceptible to infection because of marked decreases in bone marrow functioning with microcytosis.
Which of the following diagnostic findings are most likely for a client with aplastic anemia? A) Decreased production of T-helper cells B) Decreased levels of white blood cells, red blood cells, and platelets C) Increased levels of WBCs, RBCs, and platelets D) Reed-Sternberg cells and lymph node enlargement
B) Decreased levels of white blood cells, red blood cells, and platelets Rationale: In aplastic anemia, the most likely diagnostic findings are decreased levels of all the cellular elements of the blood (pancytopenia)
A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching? A) "I have been drinking plenty of fluids." B) "I have been gargling with warm salt water for my sore tongue." C) "I have 3 to 4 loose stools per day." D) "I take a vitamin B12 tablet every day."
D) "I take a vitamin B12 tablet every day." Rationale: Vitamin B12 combines with intrinsic factor in the stomach and is then carried to the ileum, where it is absorbed in the bloodstream. In this situation, vitamin B12 cannot be absorbed regardless of the amount of oral intake of sources of vitamin B12 such as animal protein or vitamin B12 tablets.
A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan? A) "Take the medication with an antacid." B) "Take the medication with a glass of milk." C) "Take the medication with cereal." D) "Take the medication on an empty stomach."
D) "Take the medication on an empty stomach." Rationale: Preferably, ferrous gluconate should be taken on an empty stomach. Ferrous gluconate should not be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption.
When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions? A) Bleeding tendencies B) Intake and output C) Peripheral sensation D) Bowel function
A) Bleeding tendencies Rationale:Aplastic anemia decreases the bone marrow production of RBCs, WBCs, and platelets. The client is at risk for bruising and bleeding tendencies.
The nurse is teaching a client with polycythemia vera about potential complications from this disease. Which manifestations would the nurse include in the client's teaching plan? Select all that apply. A) Hearing loss B) Visual disturbance C) Headache D) Orthopnea E) Gout F) Weight loss
B) Visual disturbance C) Headache D) Orthopnea E) Gout Rationale: Subsequently, the client can experience dizziness, tinnitus, visual disturbances, headaches, or a feeling of fullness in the head.
Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-deficiency anemia? Select all that apply. A) "He drinks over 3 cups of milk per day." B) "I can't keep enough apple juice in the house; he must drink over 10 ounces per day." C) "He refuses to eat more than 2 different kinds of vegetables." D) "He doesn't like meat, but he will eat small amounts of it." E) "He sleeps 12 hours every night and take a 2-hour nap."
A) "He drinks over 3 cups of milk per day." B) "I can't keep enough apple juice in the house; he must drink over 10 ounces per day." Rationale: Toddlers should have between 2 and 3 cups of milk per day and 8 ounces of juice per day. If they have more than that, then they are probably not eating enough other foods, including iron-rich foods that have the needed nutrients.
A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance? A) "What activities were you able to do 6 months ago compared with the present?" B) "How long have you had this problem?" C) "Have you been able to keep up with all your usual activities?" D) "Are you more tired now than you used to be?"
A) "What activities were you able to do 6 months ago compared with the present?" Rationale: It is difficult to determine activity intolerance without objectively comparing activities from one time frame to another. Because iron deficiency anemia can occur gradually and individual endurance varies, the nurse can best assess the client's activity tolerance by asking the client to compare activities 6 months ago and at the present.
Which of the following assessments in a child with hemophilia would lead the nurse to suspect early hemarthrosis? A) Child's reluctance to move a body part B) Cool, pale, clammy extremity C) Eccymosis formation around a joint D) Instability of a long bone in passive movement
A) Child's reluctance to move a body part Rationale: Bleeding into the joints in the child with hemophilia leads to pain and tenderness, resulting in restricted movement. Therefore, an early sign of hemarthrosis would be the child's reluctance to move a body part.
Which of the following blood components is decreased in anemia? A) Erythrocytes B) Granulocytes C) Leukocytes D) Platelets
A) Erythrocytes Rationale: Anemia is defined as a decreased number of erythrocytes (red blood cells).
Because of the risks associated with administration of factor VIII concentrate, the nurse would teach the client's family to recognize and report which of the following? A) Yellowing of the skin B) Constipation C) Abdominal distention D) Puffiness around the eyes
A) Yellowing of the skin Rationale: Because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present. Clinical manifestations of hepatitis include yellowing of the skin, mucous membranes, and sclera.
The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance? A) Eat animal protein and dark leafy vegetables each day B) Avoid exposure to others with acute infection C) Practice yoga and meditation to decrease stress and anxiety D) Get 8 hours of sleep at night and take naps during the day
B) Avoid exposure to others with acute infection Rationale: Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia. Strict aseptic technique and reverse isolation are important measures to prevent infection.
A client with microcytic anemia is having trouble selecting food items from the hospital menu. Which food is best for the nurse to suggest for satisfying the client's nutritional needs and personal preferences? A) Egg yolks B) Brown rice C) Vegetables D) Tea
B) Brown rice Rationale: Brown rice is a source of iron from plant sources (nonheme iron). Other sources of non heme iron are whole-grain cereals and breads, dark green vegetables, legumes, nuts, dried fruits (apricots, raisins, dates), oatmeal, and sweet potatoes.
The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? A) Schilling's test, elevated B) Intrinsic factor, absent C) Sedimentation rate, 16 mm/hour D) RBCs 5.0 million
B) Intrinsic factor, absent Rationale: The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs.
Which of the following foods would the nurse encourage the mother to offer to her child with iron deficiency anemia? A) Rice cereal, whole milk, and yellow vegetables B) Potato, peas, and chicken C) Macaroni, cheese, and ham D) Pudding, green vegetables, and rice
B) Potato, peas, and chicken Rationale: Potato, peas, chicken, green vegetables, and rice cereal contain significant amounts of iron and therefore would be recommended.
The primary purpose of the Schilling test is to measure the client's ability to: A) Store vitamin B12 B) Digest vitamin B12 C) Absorb vitamin B12 D) Produce vitamin B12
C) Absorb vitamin B12 Rationale: Schilling's test helps diagnose pernicious anemia by determining the client's ability to absorb vitamin B12.
When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate? A) Check the dressing and drains for frank bleeding B) Call the physician C) Continue to monitor vital signs D) Start oxygen at 2L/min per NC
C) Continue to monitor vital signs Rationale: The nurse should continue to monitor the client, because this value reflects a normal physiologic response.
A vegetarian client was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client: A) Adds dried fruit to cereal and baked goods B) Cooks tomato-based foods in iron pots C) Drinks coffee or tea with meals D) Adds vitamin C to all meals
C) Drinks coffee or tea with meals Rationale: Coffee and tea increase gastrointestinal motility and inhibit the absorption of nonheme iron.
A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic reactions. What is the nurse's best response to relieve these fears? A) "Vitamin B12 will cause ringing in the eats before a toxic level is reached." B) "Vitamin B12 may cause a very mild skin rash initially." C) "Vitamin B12 may cause mild nausea but nothing toxic." D) "Vitamin B12 is generally free of toxicity because it is water soluble."
D) "Vitamin B12 is generally free of toxicity because it is water soluble." Rationale: When water-soluble vitamins are taken in excess of the body's needs, they are filtered through the kidneys and excreted. Vitamin B12 is considered to be nontoxic.
A pediatric nurse health educator provides a teaching session to the nursing staff regarding hemophilia. Which of the following information regarding this disorder would the nurse plan to include in the discussion? A) Hemophilia is a Y linked hereditary disorder B) Males inherit hemophilia from their fathers C) Females inherit hemophilia from their mothers D) Hemophilia A results from a deficiency of factor VIII
D) Hemophilia A results from a deficiency of factor VIII Rationale: Males inherit hemophilia from their mothers, and females inherit the carrier status from their fathers. Hemophilia is inherited in a recessive manner via a genetic defect on the X-chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX.
The nurse is assessing a client's activity intolerance by having the client walk on a treadmill for 5 minutes. Which of the following indicates an abnormal response? A) Pulse rate increased by 20 bpm immediately after the activity B) Respiratory rate decreased by 5 breaths/minute C) Diastolic blood pressure increased by 7 mm Hg D) Pulse rate within 6 bpm of resting phase after 3 minutes of rest
B) Respiratory rate decreased by 5 breaths/minute Rationale: The decrease in respiratory rate indicates that the client is not strong enough to complete the mechanical cycle of respiration needed for gas exchange.
The nurse implements which of the following for the client who is starting a Schilling test? A) Administering methylcellulose (Citrucel) B) Starting a 24- to 48 hour urine specimen collection C) Maintaining NPO status D) Starting a 72 hour stool specimen collection
B) Starting a 24- to 48 hour urine specimen collection Rationale: Urinary vitamin B12 levels are measured after the ingestion of radioactive vitamin B12. A 24-to 48- hour urine specimen is collected after administration of an oral dose of radioactively tagged vitamin B12 and an injection of non-radioactive vitamin B12.
A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions? A) Infection B) Trauma C) Fluid overload D) Stress
C) Fluid overload Rationale: The mother of a child with sickle cell disease should encourage fluid intake of 1 ½ to 2 times the daily requirement to prevent dehydration.
Which of the following disorders results from a deficiency of factor VIII? A) Sickle cell disease B) Christmas disease C) Hemophilia A D) Hemophilia B
C) Hemophilia A Rationale: Hemophilia A results from a deficiency of factor VIII. Sickle cell disease is caused by a defective hemoglobin molecule. Christmas disease, also called hemophilia B, results in a factor IX deficiency.
A client with anemia may be tired due to a tissue deficiency of which of the following substances? A) Carbon dioxide B) Factor VIII C) Oxygen D) T-cell antibodies
C) Oxygen Rationale: Anemia stems from a decreased number of red blood cells and the resulting deficiency in oxygen and body tissues.
Which of the following would the nurse identify as the priority nursing diagnosis during a toddler's vaso-occlusive sickle cell crisis? A) Ineffective coping related to the presence of a life-threatening disease B) Decreased cardiac output related to abnormal hemoglobin formation C) Pain related to tissue anoxia D) Excess fluid volume related to infection
C) Pain related to tissue anoxia Rationale: For the child in a sickle cell crisis, pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusion and subsequent tissue ischemia
Which of the following nursing assessments is a late symptom of polycythemia vera? A) Headache B) Dizziness C) Pruritus D) Shortness of breath
C) Pruritus Rationale: Pruritus is a late symptom that results from abnormal histamine metabolism
The physician has ordered several laboratory tests to help diagnose an infant's bleeding disorder. Which of the following tests, if abnormal, would the nurse interpret as most likely to indicate hemophilia? A) Bleeding time B) Tourniquet test C) Clot retraction test D) Partial thromboplastin time (PTT)
D) Partial thromboplastin time (PTT) Rationale: PTT measures the activity of thromboplastin, which is dependent on intrinsic clotting factors. In hemophilia, the intrinsic clotting factor VIII (antihemophilic factor) is deficient, resulting in a prolonged PTT.
Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia? A) An elevated hemoglobin level B) A decreased reticulocyte count C) An elevated RBC count D) Red blood cells that are microcytic and hypochromic
D) Red blood cells that are microcytic and hypochromic Rationale: The results of a CBC in children with iron deficiency anemia will show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.
A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the lab results, knowing that which of the following would be increased in this disease? A) Platelet count B) Hematocrit level C) Reticulocyte count D) Hemoglobin level
C) Reticulocyte count Rationale: Increased reticulocyte counts occur in children with sickle cell disease because the life span of their sickled red blood cells is shortened.
