Hematology

A pt with polycythemia vera is complaining of severe itching. What triggers does the nurse know can cause distressing sx? (select all that apply) A. Temp change B. Allergic reaction to the RBC increase C. Alcohol consumption D. Exposure to water of any temp E. Aspirin

A. Temp change C. Alcohol consumption D. Exposure to water of any temp

Which pt assessed by the nurse is most likely to develop MDS? A 24yr old female taking oral contraceptives B. 40yr old pt with hx of hypertension C. 52yr old pt with AKI D. 72yr old pt with hx of cancer

B. 40yr old pt with hx of hypertension

A nurse is preparing to administer packed RBCs to a client who has a Hgb of 8g/dL. Which of the following actions should the nurse plan to take during the first 15 min of the transfusion? A. Obtain consent from the client for the transfusion B. Assess for an acute hemolytic reaction. C. Explain the transfusion procedure to the client D. Obtain blood culture specimens to send to the lab.

B. Assess for an acute hemolytic reaction.

An older adult patient presents to the physician's office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed? A. WBC B. RBC C. Thrombocyte count D. Levels of plasma proteins

B. RBC

Which pt does the nurse recognize as being the most likely to be affected by sickle cell anemia? A. 14yr old African American boy B. 26yr old Eastern European Jewish woman C. 18yr old Chinese woman D. 28yr old Israeli man

A. 14yr old African American boy

A female pt has a hemoglobin of 6.4g/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain info about the pts hx of pregnancy prior to the transfusion? A. A high number of pregnancies can increase the risk of infection B. If the pt has never been pregnant, it increased the risk of infection C. Obtaining info about gravidity and parity is routine info for all female pts D. If the pt has been pregnant, she may have developed allergies.

A. A high number of pregnancies can increase the risk of infection

A nurse is caring for a client who is receiving a blood transfusion. Which of the following actions should the nurse expect if an allergic transfusion reaction is suspected? A. Stop the transfusion B. Monitor for hypertenstion C. Maintain an IV infusion with 0.9% sodium chloride D. Position the client in an upright position with the feet lower than the heart E. Administer diphenhydramine.

A. Stop the transfusion C. Maintain an IV infusion with 0.9% sodium chloride E. Administer diphenhydramine.

A pt is taking prednisone 60mg per day for the tx of an acute exacerbation of Crohn's disease. The pt has developed lymphopenia with a lymphocyte count of less than 1,500. What should the nurse monitor the client for? A. The onset of a bacterial infection B. Bleeding C. Abdominal pain D. Diarrhea

A. The onset of a bacterial infection

A nurse is providing discharge teaching to a client who had a gastrectomy for stomach cancer. Which of the following information should the nurse include in the teaching? (Select all that apply) A. You will need a monthly injection of vit B12 for the rest of your life. B. Using the nasal spray form of vitamin B12 on a daily basis can be an option C. An oral supplement of vit B12 on a daily basis can be an option D. You should increase your intake of animal proteins, legumes, and dairy products to increase vit B12 in your diet. E. Add soy milk fortified with vit B12 to your diet to decrease the risk of pernicious anemia.

A. You will need a monthly injection of vit B12 for the rest of your life. B. Using the nasal spray form of vitamin B12 on a daily basis can be an option

A pt with sickle cell disease is brought to the ER by a parent. The pt has a fever of 101.6F, heart rate of 116, and a RR of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this pt is experiencing? A. Pneumocystis pneumonia B. Acute chest syndrome C. An exacerbation of asthma D. Pulmonary edema

B. Acute chest syndrome

A patient with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this patient? A. GM-CSF (Leukine) B. Erythropoietin (Epogen) C. Eltrombopag (Promacta) D. Thrombopoietin (TPO)

B. Erythropoietin (Epogen)

A pt with AML is having a HSCT with radiation therapy. With which complication does the nurse know that the donor's lymphocytes recognize the pt's body as foreign and set up reactions to attack the foreign host? A. Acute respiratory distress syndrome B. Graft vs host disease C. Remission D. Bone marrow depression

B. Graft vs host disease

A nurse is providing teaching for a client who is scheduled for a bone marrow biopsy of the iliac crest. Which of the following statements made by the client indicates an understanding of the teaching? A. This test will be performed while I am lying flat on my back B. I will need to stay in bed for about an hour after the test. C. This test will determine which antibiotic I should take for tx. D. I will receive general anesthesia for the test

B. I will need to stay in bed for about an hour after the test. The nurse should inform the client of the need to stay on bed rest for 30 to 60 min following the test to reduce the risk for bleeding.

The nurse is administering packed RBC transfusions for a pt with MD. The pt has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? A. Creatinine and BUN B. Iron levels C. Mag levels D. Potassium levels

B. Iron levels

The nurse is preparing the pt for a test to determine the cause of vit B deficiency. The pt will receive a small oral dose of radioactive vit B12 followed by a large parenteral dose of nonradioactive dose of B12. What test is the pt being prepared for? A. Bone marrow aspiration B. Schilling test C. Bone marrow biopsy D. Magnetic resonance imaging (MRI) study

B. Schilling test

The nurse is educating a pt taking imatinib mesylate for tx of leukemia. What should the nurse be sure to include when educating the pt on the best way to take the medication to optimize absorption? A. Take the medication with a source of Vit C to enhance absorption B. Take antacids if needed for gastrointestinal upset 2 hours after taking imatinib mesylate. C. Take the medication with food to enhance absorption D. Take the medication with acetaminophen to prevent the decreased absorption and GI upset

B. Take antacids if needed for gastrointestinal upset 2 hours after taking imatinib mesylate.

A nurse in a clinic receives a phone call from a client seeking information about a new prescription for erythropoietin. Which of the following information should the nurse review with the client? A. The client needs an erythrocyte sedimentation rate (ESR) test weekly. B. The client should have his hemoglobin checked twice a week. C. Oxygen saturation levels should be monitored D. Folic acid production will increase.

B. The client should have his hemoglobin checked twice a week. The nurse should include in the teaching that hemoglobin and hematocrit are monitored twice a week until the targeted levels are reached.

The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this pt is at risk for? A. Iron deficiency anemia B. Aplastic anemia C. Megaloblastic anemia D. Sickle cell anemia

C. Megaloblastic anemia

The nurse is caring for a pt with CML who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission? A. Chronic B. Transformational C. Accelerate D. Blast crisis

D. Blast crisis

The physician believes that the pt has a deficiency in the leukocyte responsible for cell mediated immunity. What should the nurse check the WBC count for? A. Basophils B. Monocytes C. Plasma Cells D. T lymphocytes

D. T lymphocytes

The nurse is administering a blood transfusion to a pt over 4 hours. After 2 hours, the patient complains of chills and has a fever of 101F, an increase from a previous temp of 99.2F. What does the nurse recognize is occurring with this pt? A. The pt is having an allergic reaction B. The pt is experiencing vascular collapse. C. The pt is having decrease in tissue perfusion from a shock state. D. the pt is having a febrile nonhemolytic reaction

D. the pt is having a febrile nonhemolytic reaction

A pt with chronic kidney disease is being examined by the NP for anemia. The nurse has reviewed the lab data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? A. Decreased level of erythropoietin B. Decreased total iron binding capacity C. Increased mean corpuscular volume D. Increased reticulocyte count

A. Decreased level of erythropoietin

A nurse is caring for a client who is receiving warfarin for anticoagulation therapy. Which of the following laboratory results indicates to the nurse that the client needs an increase in the dosage? A. aPTT 38 seconds B. INR 1.1 C. PT 22 seconds D. D-dimer negative

B. INR 1.1 is within the expected reference range for a client who is not receiving warfarin. However, this value is subthreapeutic for anticoagulation therapy. The nurse should expect the client to receive an increased dosage of warfarin until the INR is 2 to 3.

The nurse is assesing a pt who comes to the clinic complaining of feeling constantly tired and very weak. The pt also has a very sore tongue, and upon observing the pt's oral cavity, the nurse notices the tongue is beefy red. What type of anemia does the nurse know these sx indicate? A. Iron deficiency anemia B. Megaloblastic anemia C. Sickle cell anemia D. Aplastic anemia

B. Megaloblastic anemia

A nurse is completing an integumentary assessment of a client who has anemia. Which of the following findings should the nurse expect? A. Absent turgor B. Spoon shaped nails C. Shiny, hairless legs D. Yellow mucous membranes

B. Spoon shaped nails

A pt describes numbness in the arms and hands with a tingling sensation. The pt also frequently stumbles when walking. What vit deficiency does the nurse determine may cause some of these sx? A. Thiamine B. Folate C. B12 D. Iron

C. B12

A pt with ESRD is taking recombinant erythropoietin for the tx of anemia. What lab study does the nurse understand will have to be assessed at least monthly related to this medication? A. K+ level B. Creatinine level C. Hemoglobin level D. Folate level

C. Hemoglobin level

The nurse is caring for a pt with AML with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? A. Allopurinol B. Filgrastim C. Hydroxyurea D. Asparaginase

C. Hydroxyurea

The nurse is performing an assessment on a pt with AML and observes multiple areas of ecchymosis and petechiae. What lab study should the nurse be concerned about? A. WBC count of 4,200 cells B. Hematocrit of 38% C. Platelet count of 9,000 D. Creatinine level of 1.0

C. Platelet count of 9,000

A pt with end stage kidney disease has developed anemia. What laboratory values does the nurse understand to be significant in this stage of anemia? A. K+ 5.2 B. Mag 2.5 C. Ca 9.4 D. Creatinine level of 6

D. Creatinine level of 6

A pt with chronic anemia has had many blood transfusions over the last 3 years. What type of transfusion reaction should the nurse monitor for that is commonly found in pt who frequently receive blood transfusions? A. Allergic reactions B. Acute hemolytic reaction C. Circulatory overload D. Febrile nonhemolytic reactions

D. Febrile nonhemolytic reactions

A nurse in a clinic is caring for a client who has suspected anemia. Which of the following laboratory test results should the nurse expect? A. Iron 90 mcg/dL B. RBC 6.5 million/uL C. WBC 4,800 mm3 D. Hgb 10 g/dL

D. Hgb 10 g/dL is below the expected reference range and is an expected finding of anemia.

A pt with AML has a neutrophil count that persists at less than 100. What should the nurse cautiously monitor this pt for? A. Abdominal cramps B. Hypotension C. Seizure activity D. Infection

D. Infection

A nurse preceptor is observing a newly licensed nurse on the unit who is preparing to administer blood transfusion to an older adult client. Which of the following actions by the newly licensed nurse indicates an understanding of the procedure? A. Inserts an 18 gauge IV catheter in the client B. Verifies blood compatibility and expiration date of the blood with an assistive personnel C. Administers dextrose 5% in 0.9% sodium chloride IV with the transfusion D. Obtains VS Q15min throughout the procedure

D. Obtains VS Q15min throughout the procedure

The nurse is caring for a pt who will begin taking long term biphosphate therapy. Why is it important for the nurse to encourage the pt to receive a thorough evaluation of dentition, including panoramic dental x-rays? A. The pt is at risk for tooth decay B. The pt will develop gingival hyperplasia C. The pt can develop osteonecrosis of the jaw D. The pt can develop loosening of the teeth.

The pt can develop osteonecrosis of the jaw

A pt who has long term packed RBC transfusions has developed sx of iron toxicity that affect liver function. What immediate tx should the nurse anticipate preparing the pt for that can help prevent organ damage? A. Iron chelation therapy B. Oxygen therapy C. Therapeutic phlebotomy D. Anticoagulation therapy

A. Iron chelation therapy

A pt with polycythemia vera has a high RBC count and is at risk for the development of thrombosis. What tx is important to reduce the viscosity and to deplete the pt's iron stores? A. Blood transfusions B. Radiation C. Chelation therapy D. Phlebotomy

D. Phlebotomy

The nurse is educating a pt with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods What can the nurse inform the client would enhance the absorption? A. Eating calf's liver with a glass of orange juice B. Eating leafy green vegetables with a glass of water C. Eating apple slices with carrots D. Eating a steak with mushrooms

A. Eating calf's liver with a glass of orange juice

A pt is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the pt is being tx for? A. Essential thrombocythemia B. Extreme leukocytosis C. Sickle Cell anemia D. Renal transplantation

A. Essential thrombocythemia

A pt with sickle cell anemia is to begin tx for the disease with hydroxyurea. What does the nurse inform the pt will be the benefits of tx with this medication? (Select all that apply) A. Fewer painful episodes of sickle cell crisis B. Lower incidence of acute chest syndrome C. Decreased need for blood transfusion D. Decreased need for other analgesic medications E. Ability to reverse the damage done from sickling of cells

A. Fewer painful episodes of sickle cell crisis B. Lower incidence of acute chest syndrome C. Decreased need for blood transfusion

A nurse is caring for a pt who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the pt for? A. Hemorrhage B. Infection C. Shock D. Splintering of bone fragments

A. Hemorrhage

A pt with AML is having aggressive chemotherapy to attempt to achieve remission. The Pt is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the pt will receive? A. Induction therapy B. Supportive therapy C. Antimicrobial therapy D. Standard therapy

A. Induction therapy

The nurse observe a co worker who always seems to be eating a cup of ice. The nurse encourages the co worker to have an examination and dx workup with the Dr. What type of anemia is the nurse concerned the co worker may have? A. Iron deficiency anemia B. Megaloblastic anemia C. Sickle cell anemia D. Aplastic anemia

A. Iron deficiency anemia

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the pt in? A. Lateral position with one leg flexed B. Lithotomy postion C. Supine with head of the bed elevated 30 degrees D. Jackknife postition

A. Lateral position with one leg flexed

A pt is taking hydroxyurea for the tx of primary myelofibrosis. While the pt is taking this medication, what will the nurse monitor to determine effectiveness? A. Leukocyte and platelet count B. BUN and Creatinine levels C. Aspartat aminotransferase (AST) and alanine transaminase (ALT) levels D. Hemoglobin and hematocrit

A. Leukocyte and platelet count

A nurse is planning care for a client who has Hgb 7.5 g/dL and Hct 21.5%. Which of the following actions should the nurse include in the plan of care? (Select all that apply) A. Provide assistance with ambulation B. Monitor oxygen saturation C. Weigh the client weekly D. Obtain stool specimen for occult blood E. Schedule daily rest periods

A. Provide assistance with ambulation B. Monitor oxygen saturation D. Obtain stool specimen for occult blood E. Schedule daily rest periods

The nurse is caring for a pt with Hodgkin lymphoma in the hospital and preparing discharge planning education. Knowing that this pt is at risk for the development of a second malignancy, what education should the nurse include? (select all that apply) A. Reduce exposure to excessive sunlight B. Smoking cessation C. Decrease alcohol intake D. Decrease intake of antipyretic medication E. Decrease fat intake

A. Reduce exposure to excessive sunlight B. Smoking cessation C. Decrease alcohol intake

A pt receiving plasma develops transfusion related acute lung injury 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the pt will receive to prevent death from the injury? (Select all that apply) A. Serial chest X-rays B. Oxygen C. Fluid support D. Intubation and mechanical ventilation E. Intra-aortic balloon pump

B. Oxygen C. Fluid support D. Intubation and mechanical ventilation

The nurse is administering 2 units of packed RBC's to an older adult pt who has a bleeding duodenal ulcer. the pt begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, jugular vein distention, and an increase in blood pressure. What action by the nurse is necessary if the reaction is severe (select all that apply) A. Continue the infusion but slow the rate down B. Place the pt in an upright position with feet dependent C. Administer diuretics as prescribed D. Discontinue the transfusion E. Administer oxygen

B. Place the pt in an upright position with feet dependent C. Administer diuretics as prescribed D. Discontinue the transfusion E. Administer oxygen

A nurse is teaching a client who has a new prescription for ferrous sulfate. Which of the following information should the nurse include in the teaching? A. Stools will be dark red. B. Take with a glass of milk if gastrointestinal distress occurs C. Foods high in Vitamin C will promote absorption D. Take for 14 days

C. Foods high in Vitamin C will promote absorption

A nurse is monitoring a client who began receiving a unit of packed RBCs 10 mins ago. Which of the following findings should the nurse identify as an indication of a febrile transfusion reaction? A. Temperature change from 39C pretransfustion to 37.2C B. Current blood pressure 178/90 C. Heart rate change from 88 to 120/ min D. Client reports itching E. Client appears flushed

C. Heart rate change from 88 to 120/ min E. Client appears flushed

A pt will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The pt states, "That stuff isn't safe!" What is the best response from the nurse? A. I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion. B. The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood. C. I understand your concern. The blood is carefully screened but it not completely risk free. D. You will have to decide if refusing the blood transfusion is worth the risk to your health.

C. I understand your concern. The blood is carefully screened but it not completely risk free.

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include nutritional assessment for this pt? A. It is part of the required assessment information B. It is important for the nurse to determine what type of foods the pt will eat. C. It may indicate deficiencies in essential nutrients D. It will determine what type of anemia the pt has

C. It may indicate deficiencies in essential nutrients

A pt develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? (Select all that apply) A. Administer diphenhydramine B. Begin iron chelation therapy C. Obtain appropriate blood specimens D. Collect a urine sample to detect hemoglobin E. Document the reaction according to policy

C. Obtain appropriate blood specimens D. Collect a urine sample to detect hemoglobin E. Document the reaction according to policy

The nurse is assessing a pt with polycytheia vera. What skin assessment data would the nurse determine is a normal finding for this pt? A. Pale skin and mucous membranes B. Bronze skin tone C. Ruddy complexion D. Jaundice skin and sclera

C. Ruddy complexion

A pt with sickle cell disease comes to the ER complaining of severe pain in the back, right hip, and right arm. What intervention is important that the nurse provide? A. Administer aspirin B. Administer ibprofen C. Start an intravenous line with dextrose 5% in 0.24 normal saline D. Begin oxygen at 2L/min

C. Start an intravenous line with dextrose 5% in 0.24 normal saline

A nurse is providing preoperative teaching for a client who requests autologous donation in preparation for a scheduled orthopedic surgical procedure. Which of the following statements should the nurse include in the teaching? A. You should make an appointment to donate blood 8 weeks prior to surgery. B. If you need an autologous transfusion, the blood your brother donates can be used. C. You can donate blood each week if your hemoglobin is stable D. Any unused blood that is donated can be used for other clients.

C. You can donate blood each week if your hemoglobin is stable Beginning 6wks prior, to the surgery the client can donate blood each week for autologous transfusion if his Hgb and Hct remain stable.

A pt had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The pt takes pantoprazole (protonix) for the tx of frequent heart burn. What type of anemia is the pt at risk for? A. Aplastic anemia B. Iron deficiency anemia C. Sickle cell anemia D. Pernicious anemia

D. Pernicious anemia