Hematology NCLEX questions

11. The most common type of leukemia in older adults is a. acute myelocytic leukemia. b. acute lymphocytic leukemia. c. chronic myelocytic leukemia. d. chronic lymphocytic leukemia.

d. chronic lymphocytic leukemia.

2. Malignant disorders that arise from granulocytic cells in the bone marrow will have the primary effect of causing a. risk for hemorrhage. b. altered oxygenation. c. decreased production of antibodies. d. decreased phagocytosis of bacteria.

d. decreased phagocytosis of bacteria.

7. The nurse would anticipate that a patient with von Willebrand disease undergoing surgery would be treated with administration of vWF and a. thrombin. b. factor VI. c. factor VII. d. factor VIII.

d. factor VIII.

3. A nurse is monitoring a client who began receiving a unit of packed RBCs 10 min ago. Which of the following findings should the nurse identify as an indication of a febrile transfusion reaction? (Select all that apply.) A. Temperature change from 37° C (98.6° F) pretransfusion to 37.2° C (99.0° F) B. Current blood pressure 178/90 mm Hg C. Heart rate change from 88/min pretransfusion to 120/min D. Client report of itching E. Client appears flushed

A. A temperature increase of 1° F (0.5° C) is an indication of a febrile transfusion reaction. B. Hypotension is an indication of a febrile transfusion reaction. C. CORRECT: Tachycardia is an indication of a febrile transfusion reaction. D. The client's report of itching is an indication of an allergic transfusion reaction. E. CORRECT: A flushed appearance of the client can indicate a febrile transfusion reaction

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

A. An iron level of 90 mcg/dL is within the expected reference range and is not an expected finding of anemia. B. RBC count of 6.5 million/uL is above the expected reference range. A decreased RBC count is an expected finding of anemia. C. WBC count of 4800 mm3 is below the expected reference range and is not an expected finding of anemia. D. CORRECT: Hgb of 10 g/dL is below the expected reference range and is an expected finding of anemia.

A nurse is caring for a client who has DIC. Which of the following medications should the nurse anticipate administering? A. Heparin B. Vitamin K C. Mefoxin D. Simvastatin

A. CORRECT: Heparin can be administered to decrease the formation of microclots, which deplete clotting factors. B. Vitamin K promotes blood coagulation and is not prescribed for a client who has DIC. C. Mefoxin is an antibiotic given to treat bacterial infection and is not a medication that the nurse should anticipate being administered to a client who has DIC. D. Simvastatin is an antilipemic given to treat hyperlipidemia and is not a medication that the nurse should anticipate being administered to a client who has DIC.

A nurse is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following laboratory values indicates the client's clotting factors are depleted? (Select all that apply.) A. Platelets 100,000/mm3 B. Fibrinogen levels 57 mg/dL C. Fibrin degradation products 4.3 mcg/mL D. D‑dimer 0.03 mcg/mL E. Sedimentation rate 38 mm/hr

A. CORRECT: In DIC, platelet levels are decreased, causing clotting factors to become depleted. Clotting times are increased, which raises the risk for fatal hemorrhage. B. CORRECT: In DIC, fibrinogen levels are decreased, causing clotting factors to become depleted. Clotting times are increased, which raises the risk for fatal hemorrhage. C. Fibrin degradation products are increased when DIC occurs. D. A D‑dimer level is increased when DIC occurs. E. The sedimentation rate is increased, but it is not an indicator of DIC

2. 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? (Select all that apply.) A. Stop the transfusion. B. Monitor for hypertension. 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. CORRECT: The nurse should immediately stop the infusion if an allergic transfusion reaction is suspected. B. The nurse should monitor for hypotension if an allergic transfusion reaction is suspected due to the risk for shock. C. CORRECT: The nurse should administer 0.9% sodium chloride solution through new IV tubing if an allergic transfusion reaction is suspected. D. The nurse should position the client in an upright position with the feet lower than the level of the heart if a circulatory overload is suspected. E. CORRECT: The nurse should administer an antihistamine, such as diphenhydramine, if an allergic transfusion reaction is suspected.

A nurse is caring for a client who has idiopathic thrombocytopenic purpura (ITP). The nurse should notify the provider and report possible small‑vessel clotting when which of the following is assessed? A. Petechiae on the upper chest B. Hypotension C. Cyanotic nail beds D. Severe headache

A. Petechiae on the upper chest can indicate impaired clotting. B. Hypotension can indicate impaired clotting. C. CORRECT: Cyanotic nail beds indicate microvascular clotting is occurring and should be immediately reported to avoid ischemic loss of the fingers or toes. D. Severe headache can indicate cerebral bleeding.

45. A patient is receiving a transfusion of packed RBCs. Ten minutes after the infusion begins, the patient reports low back pain and a headache. Place the actions in order (15) of importance of performance. A. ___ Stop the blood infusion. B. ___ Notify the physician stat. C. ___ Obtain vital signs and assess patient. D. ___ Start the new 0.9% normal saline infusion. E. ___ Prepare a new 0.9% normal saline infusion.

A. Stop the blood infusion. C. Obtain vital signs and assess patient. B. Notify the physician stat. E. Prepare a new 0.9% normal saline infusion. D. Start the new 0.9% normal saline infusion. Low back pain and headache can be symptoms of a transfusion reaction. If symptoms of a reaction are noted, the blood transfusion is immediately stopped and agency policy for a suspected transfusion reaction is followed. A normal saline infusion with new tubing is started to keep the vein patent. The physician and blood bank are immediately notified. A nurse remains with the patient for reassurance and monitoring of symptoms and vital signs. If a blood incompatibility is suspected, the unused blood and blood tubing are returned to the blood bank for testing. A series of blood and urine specimens are collected and sent to the laboratory for analysis. The physicians orders are followed to treat the patients symptoms.

A nurse is assessing a client and suspects the client is experiencing DIC. Which of the following physical findings should the nurse anticipate? A. Bradycardia B. Hypertension C. Epistaxis D. Xerostomia

A. Tachycardia is a finding that is indicative of DIC. B. Hypotension is a finding that is indicative of DIC. C. CORRECT: Epistaxis is unexpected bleeding of the gums and nose and is a finding indicative of DIC. D. Xerostomia is dryness of the mouth and is not indicative of DIC.

4. 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 the 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 us

A. The client should donate blood for an autologous transfusion no sooner than 6 weeks prior to surgery. B. An autologous donation refers to the client's donation of blood for his own personal use. C. CORRECT: Beginning 6 weeks prior to surgery, the client can donate blood each week for autologous transfusion if his Hgb and Hct remain stable. D. An autologous donation is for use only by the client.

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 treatment." D."I will receive general anesthesia for the test."

A. The nurse should inform the client that he will be placed in a prone or side‑lying position during the test in order to expose the iliac crest. B. CORRECT: 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. C. The nurse should inform the client that a culture and sensitivity test determines the type of antibiotics needed to treat an infection. D. The nurse should inform the client that he will receive a sedative prior to the test and that a local anesthetic will be used at the site.

1. A nurse is preparing to administer packed RBCs to a client who has a Hgb of 8 g/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

A. The nurse should obtain consent from the client for the transfusion prior to initiating the transfusion. B. CORRECT: The nurse should assess for an acute hemolytic reaction during the first 15 min of the transfusion. This form of a reaction can occur following the transfusion of as little as 10 mL of blood product. C. The nurse should explain the transfusion procedure to the client prior to initiating the transfusion. D. The nurse should obtain blood culture specimens

A nurse is caring for a client who has leukemia and has developed thrombocytopenia. Which of the following actions should the nurse take first? A. Plan for the client to take rest periods throughout the day. B. Encourage the client to cough, turn, and deep breath every 2 hr. C. Assess temperature every 4 hr. D. Monitor platelet counts

A. The nurse should offer the client rest periods throughout the day. However, another action is the priority. B. The nurse should encourage the client to cough, turn and deep breathe every 2 hr. However, another action is the priority. C. The nurse should assess the client's temperature every 4 hr. However, another action is the priority D. CORRECT: The greatest risk to the client who has thrombocytopenia is injury due to bleeding. The priority action for the nurse to take is to initiate bleeding precautions, such monitoring platelet count.

5. A nurse preceptor is observing a newly licensed nurse on the unit who is preparing to administer a 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 (AP) C. Administers dextrose 5% in 0.9% sodium chloride IV with the transfusion D. Obtains vital signs every 15 min throughout the procedure.

A. The nurse should use no larger than a 19‑gauge needle in the older adult client. B. The nurse should verify the client's identity and blood compatibility, and expiration date of the blood with another nurse. This task is beyond the scope of practice for an assistive personnel. C. The nurse should administer blood products with 0.9% sodium chloride. IV solutions containing dextrose cannot be used. D. CORRECT: The nurse should check the older adult client's vital signs every 15 min throughout the transfusion to allow for early detection of fluid overload or other transfusion reaction.

A nurse is teaching a newly licensed nurse about heparin‑induced thrombocytopenia. Which of the following risk factors for this disorder should the nurse include in the teaching? A. Warfarin therapy for atrial fibrillation B. Placental abruption C. Systemic lupus erythematosus D. Heparin therapy for deep‑vein thrombosis

A. Warfarin therapy and atrial fibrillation are not related to development of HIT. B. Placental abruption is a risk factor for development of DIC. C. Systemic lupus erythematosus is an autoimmune disorder that places the client at risk for development of ITP. D. CORRECT: The client who is receiving heparin therapy for longer than 1 week is at increased risk for the development of HIT.

A nurse is caring for a client who is receiving warfarin for anticoagulation therapy. Which of the following laboratory test 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

A. aPTT is monitored for clients receiving heparin therapy. An aPTT of 38 seconds is within the expected reference range for clients not receiving heparin therapy. B. CORRECT: INR of 1.1 is within the expected reference range for a client who is not receiving warfarin. However, this value is subtherapeutic for anticoagulation therapy. The nurse should expect the client to receive an increased dosage of warfarin until the INR is 2 to 3. C. PT of 22 seconds is above the expected reference range for a client receiving warfarin therapy. This result indicates the client is at an increased risk for bleeding. D. A negative D‑dimer test indicates the absence of a pulmonary embolus or deep vein thrombosis and is not used to determine the dosage needs for warfarin therapy.

Hematologic System 8. Nursing care for a patient immediately after a bone marrow biopsy and aspiration includes (select all that apply) a. administering analgesics as necessary. b. preparing to administer a blood transfusion. c. instructing on need to lie still with a sterile pressure dressing intact. d. monitoring vital signs and assessing the site for excess drainage or bleeding. e. instructing on the need for preprocedure and postprocedure antibiotic medications.

a, c, d a. administering analgesics as necessary. c. instructing on need to lie still with a sterile pressure dressing intact. d. monitoring vital signs and assessing the site for excess drainage or bleeding.

The home health nurse assesses the patient taking ferrous sulfate (Feosol). Which patient statement alerts the nurse that teaching is necessary regarding this medication? a. It tastes better when I take my medicine with milk. b. My wife says I should take my medicine with orange juice. c. I am always careful not to break open the capsule. d. I usually take my iron with my whole-grain toast during breakfast.

a. It tastes better when I take my medicine with milk. Milk products inhibit the absorption of iron. Iron is better absorbed if vitamin C is in the GI tract at the same time, so drinking orange juice with the ferrous sulfate is beneficial. Capsules and enteric-coated iron preparations should not be opened or crushed. Whole grains are not known as inhibitors of iron absorption.

The patient with AML has a platelet count of 95,000. What interventions should be included in the plan of care for this patient? (Select all that apply.) a. Observe for melena and hematuria. b. Brush and floss at least twice daily. c. Measure abdominal girth daily. d. Apply ice and pressure to puncture sites. e. Use electric razor.

a. Observe for melena and hematuria. c. Measure abdominal girth daily. d. Apply ice and pressure to puncture sites. e. Use electric razor. A low platelet makes the patient prone to excessive bleeding. The nurse should monitor for bleeding into the stool and urine. Soft toothbrushes will decrease the likelihood of the gums bleeding. An increase in the abdominal girth will alert the nurse to the possibility of internal bleeding. Ice and pressure on puncture sites aid in stopping bleeding. An electric razor reduces the chance of the patient being cut during shaving.

15. A patient is receiving a transfusion of packed RBCs. Ten minutes after the infusion begins the patient reports low back pain and a headache. Which action should the nurse take first? a. Stop the blood infusion. b. Notify the physician STAT. c. Start the new 0.9% normal saline infusion. d. Prepare a new 0.9% normal saline infusion.

a. Stop the blood infusion. Low back pain and headache can be symptoms of a transfusion reaction. If symptoms of a reaction are noted, the blood is immediately stopped so that no more blood is infused into the patient. B. The physician should be notified after the transfusion is stopped. C. D. A new normal saline infusion with new tubing is prepared and started to keep the vein patent should medications need to be administered as ordered. New tubing must be used so that not one more drop of blood enters the patient.

Aplastic anemia has its etiology in a variety of drugs, such as: (Select all that apply.) a. antimetabolite cancer drugs. b. phenylbutazone (Butazolidin). c. oral contraception drugs. d. chloramphenicol (Chloromycetin). e. sulfonamides.

a. antimetabolite cancer drugs. b. phenylbutazone (Butazolidin). d. chloramphenicol (Chloromycetin). e. sulfonamides.

The patient with acute myelogenous leukemia (AML) asks why he is making more WBCs when he already has so many. The nurse clarifies that the large number of leukemic white cells he already has: a. are not as effective as normal white cells would be. b. protect against infection. c. attempt to take over the functions of RBCs. d. are produced by the lymphatic system.

a. are not as effective as normal white cells would be. The many leukemic white cells cannot function as normal WBCs do. The bone marrow rushes production of immature white cells (blasts) to try to create adequate protection. These cells do not protect against infection, nor do they take over the functions of the RBCs. AML originates in the bone marrow.

The patient diagnosed with non-Hodgkins lymphoma (NHL) asks the nurse about treatment options. The nurse is aware that various treatment options exist, including: (Select all that apply.) a. bone marrow transplantation. b. peripheral stem cell transplantation. c. injection of monoclonal antibodies. d. radiation therapy. e. high-dose continuous antibiotic therapy.

a. bone marrow transplantation. b. peripheral stem cell transplantation. c. injection of monoclonal antibodies. d. radiation therapy. High-dose continuous antibiotic therapy is not currently a treatment option for NHL. All other options listed are possible treatment options, as well as chemotherapy and surgery.

6. When caring for a patient with thrombocytopenia, the nurse instructs the patient to a. dab his or her nose instead of blowing. b. be careful when shaving with a safety razor. c. continue with physical activities to stimulate thrombopoiesis. d. avoid aspirin because it may mask the fever that occurs with thrombocytopenia.

a. dab his or her nose instead of blowing.

1. In a severely anemic patient, the nurse would expect to find a. dyspnea and tachycardia. b. cyanosis and pulmonary edema. c. cardiomegaly and pulmonary fibrosis. d. ventricular dysrhythmias and wheezing.

a. dyspnea and tachycardia.

The nurse explains that induction therapy for acute lymphocytic leukemia (ALL) is a(n): a. intensive protocol of chemotherapy in high doses to achieve remission. b. long-term protocol with smaller doses of chemotherapy to achieve a cure. c. 2- to 5-year low-dose chemotherapy regimen to reduce painful symptoms. d. combination of chemotherapy and radiation to achieve remission.

a. intensive protocol of chemotherapy in high doses to achieve remission. A combination of several antileukemic drugs in high doses has been found to induce a remission.

5. Significant information obtained from the patient's health history that relates to the hematologic system includes a. jaundice. b. bladder surgery. c. early menopause. d. multiple pregnancies.

a. jaundice.

The nurse recommends to a patient with iron deficiency anemia to include foods high in iron, such as: (Select all that apply.) a. liver. b. lima beans. c. prune juice. d. cabbage. e. dried apricots.

a. liver. b. lima beans. c. prune juice. e. dried apricots.

The home health nurse caring for the patient with polycythemia vera will focus care on: a. maintenance of high fluid intake. b. daily exercise to reduce weight. c. daily dose of anticoagulants. d. adequate intake of vitamin C.

a. maintenance of high fluid intake. The major focus is maintaining a high fluid intake to keep the circulating fluid well hydrated.

4. When reviewing laboratory results of an 83-year-old patient with an infection, the nurse would expect to find a. minimal leukocytosis. b. decreased platelet count. c. increased hemoglobin and hematocrit levels. d. decreased erythrocyte sedimentation rate (ESR).

a. minimal leukocytosis.

4. The nursing management of a patient in sickle cell crisis includes (select all that apply) a. monitoring CBC. b. optimal pain management and O2 therapy. c. blood transfusions if required and iron chelation. d. rest as needed and deep vein thrombosis prophylaxis. e. administration of IV iron and diet high in iron content.

a. monitoring CBC. b. optimal pain management and O2 therapy. c. blood transfusions if required and iron chelation. d. rest as needed and deep vein thrombosis prophylaxis.

3. Nursing interventions for a patient with severe anemia related to peptic ulcer disease include (select all that apply) a. monitoring stools for guaiac. b. instructions for high-iron diet. c. taking vital signs every 8 hours. d. teaching self-injection of erythropoietin. e. administration of cobalamin (vitamin B12) injections.

a. monitoring stools for guaiac. b. instructions for high-iron diet.

The nurse is conscientious in the care of the feet and legs of a patient with sickle cell anemia because: a. stasis ulcers are a constant threat. b. bleeding may occur on the soles of the feet. c. edema of the feet increases activity intolerance. d. toenails must be kept short to avoid ingrown nails

a. stasis ulcers are a constant threat. Because of the sluggish flow of blood, stasis ulcers are a constant threat and are very difficult to heal.

5. A complication of the hyperviscosity of polycythemia is a. thrombosis. b. cardiomyopathy. c. pulmonary edema. d. disseminated intravascular coagulation (DIC).

a. thrombosis.

14. A patient who developed hemolytic anemia related to the administration of penicillin asks for an explanation of this condition. What is the most appropriate response by the nurse? a. The red blood cells are being produced inappropriately. b. An antigenantibody reaction is causing destruction of red blood cells. c. An allergy to penicillin is destroying your platelets for unknown reasons. d. Allergens are invading the bone marrow and interfering with red blood cell production.

b. An antigenantibody reaction is causing destruction of red blood cells. For no known reason, autoantibodies are produced that attach to RBCs and cause them to either lyse or agglutinate (clump). A. C. D. These choices do not correctly explain the development of hemolytic anemia in this patient.

29. A patient is suspected as having a blood transfusion reaction. Which laboratory test should the nurse expect to be done to confirm this diagnosis? a. Skin testing b. Direct Coombs test c. White blood cell count d. C-reactive protein level

b. Direct Coombs test The direct Coombs test confirms the diagnosis of transfusion reaction. In the laboratory, a small amount of the patients RBCs is washed to remove any unattached antibodies. Antihuman globulin is added to see if agglutination (clumping) of the RBCs results. If agglutination occurs, an immune reaction such as a hemolytic transfusion reaction is taking place. A. Skin testing is used to determine the presence of a type I hypersensitivity reaction. C. D. These tests might be done to determine the presence of serum sickness.

7. If a lymph node is palpated, what is a normal finding? a. Hard, fixed nodes b. Firm, mobile nodes c. Enlarged, tender nodes d. Hard, nontender node

b. Firm, mobile nodes

31. The nurse is reinforcing teaching provided to a patient with pernicious anemia. Which patient statement indicates that teaching has been effective? a. I can miss a month or two of injections if I am feeling better. b. I will need to take vitamin B12 injections for the rest of my life. c. I will take the vitamin B12 injections until my strength returns. d. I can take a vitamin B12 injection when I feel tired or fatigued.

b. I will need to take vitamin B12 injections for the rest of my life. If vitamin B12 injections are prescribed, the patient must understand that this is a lifelong need to prevent the return of symptoms. A. C. Patients should not miss injections. D. Injections are not taken as needed for fatigue.

The nurse monitoring a patient who is receiving a transfusion will stop the transfusion in the event of the patient complaining of: (Select all that apply.) a. feeling cold. b. a headache. c. back pain. d. a rash. e. urticaria.

b. a headache. c. back pain. d. a rash. e. urticaria. The complaint of feeling chilled is caused by the infusion of the chilled blood. The transfusion is not stopped; the patient is given a blanket. All other options are events that indicate a reaction to the transfusion and should cause the infusion to be stopped and the saline infusion to be opened into the line to keep the IV line open.

3. An anticoagulant such as warfarin (Coumadin) that interferes with prothrombin production will alter the clotting mechanism during a. platelet aggregation. b. activation of thrombin. c. the release of tissue thromboplastin. d. stimulation of factor activation comple

b. activation of thrombin.

2. When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would question the patient about a. folic acid intake. b. dietary intake of iron. c. a history of gastric surgery. d. a history of sickle cell anemia

b. dietary intake of iron.

The nurse anticipates that the patient with iron deficiency anemia will have red cells that are: a. normochromic and normocytic. b. hypochromic and microcytic. c. hyperchromic and macrocytic. d. normochromic and microcytic.

b. hypochromic and microcytic. Iron deficiency anemia causes the RBCs to be small and have less color.

1. An individual who lives at a high altitude may normally have an increased RBC count because a. high altitudes cause vascular fluid loss, leading to hemoconcentration. b. hypoxia caused by decreased atmospheric oxygen stimulates erythropoiesis. c. the function of the spleen in removing old RBCs is impaired at high altitudes. d. impaired production of leukocytes and platelets leads to proportionally higher red cell counts.

b. hypoxia caused by decreased atmospheric oxygen stimulates erythropoiesis.

The nurse stresses to the patient with sickle cell anemia that one of the most elementary home interventions to help prevent sickle cell crisis is to: a. take iron supplements daily. b. maintain adequate fluid intake. c. engage in daily exercise. d. eat leafy green vegetables.

b. maintain adequate fluid intake. The maintenance of an adequate fluid intake keeps the circulating blood volume hydrated, which discourages clumping of the sickle cells

The nurse cautions the 79-year-old male who had a gastrectomy a month ago that he is at risk for _____ anemia. a. aplastic b. pernicious c. iron deficiency d. nutritional

b. pernicious Pernicious anemia will result from the lack of the intrinsic factor found in the stomach lining. Without the intrinsic factor, the body is unable to absorb vitamin B12. Aplastic anemia is related to bone marrow suppression. Iron deficiency anemia is often related to a deficiency of iron in the diet.

32. A patient is being started on a blood transfusion. For how many minutes should the nurse stay with the patient during this transfusion? a. 5 b. 10 c. 15 d. 20

c. 15 The nurse should stay at the bedside with a patient for the first 15 minutes of any blood transfusion to detect signs of a reaction. A. B. The nurse needs to stay longer than 5 or 10 minutes. D. The nurse does not need to stay beyond 15 minutes.

25. The nurse has been caring for a patient with pernicious anemia. Which finding should indicate to the nurse that treatment has been successful? a. Decreased folic acid level and an increase in enlarged RBCs b. A decrease in intrinsic factor and increased vitamin B12 excreted in the urine c. An increase in vitamin B12 levels and decrease in number of enlarged RBCs d. A decrease in hydrochloric acid levels in gastric secretion and decrease in production of RBCs

c. An increase in vitamin B12 levels and decrease in number of enlarged RBCs Macrocytic (enlarged RBCs) anemia, and low vitamin B12 levels are indicators of pernicious anemia, so increased vitamin B12 levels and decreased enlarged RBCs would indicate successful treatment. A. B. D. These findings would not support treatment for pernicious anemia as being successful.

The nurse is assessing a patients lymph nodes. Which finding would alert the nurse to the possibility of the patient having non-Hodgkins lymphoma (NHL)? a. Enlarged lymph nodes that form an adjacent line of enlargement b. Painful widespread enlarged lymph nodes c. Noncontiguous enlarged lymph nodes d. Enlarged lymph nodes primarily in the neck and axillary region

c. Noncontiguous enlarged lymph nodes NHL typically manifests as enlargement in one node, then one or more nodes are skipped, and then another node is affected (noncontiguous). These enlarged nodes are usually painless with NHL.

16. A patient is to receive a transfusion of packed RBCs. Before administering the transfusion, which action should the nurse take? a. Verify the patients kidney function. b. Verify the patients hematocrit level. c. Verify blood type of the patient and donor. d. Verify the patients admitting medical diagnosis.

c. Verify blood type of the patient and donor. Prevention of hemolytic reactions is crucial. At the bedside, double-check the patients name and identification number on the chart, unit of blood, and patients identification bracelet, as well as check the patients blood type in the chart, on the unit of blood, and paperwork with the unit of blood. A. B. D. These actions will not help prevent the development of a transfusion reaction.

9. You are taking care of a male patient who has the following laboratory values from his CBC: WBC 6.5 × 103/µL, Hgb 13.4 g/dL, Hct 40%, platelets 50 × 103/µL. What are you most concerned about? a. Your patient is neutropenic. b. Your patient has an infection. c. Your patient is at risk for bleeding. d. Your patient is at fall risk due to his anemia

c. Your patient is at risk for bleeding.

8. DIC is a disorder in which a. the coagulation pathway is genetically altered, leading to thrombus formation in all major blood vessels. b. an underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic episodes and infarcts. c. a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage. d. an inherited predisposition causes a deficiency of clotting factors that leads to overstimulation of coagulation processes in the vasculature.

c. a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage.

Because of a deficiency of iron, the person with iron deficiency anemia is unable to make sufficient: a. plasma. b. WBCs. c. hemoglobin. d. antibodies.

c. hemoglobin. Deficiency of iron causes reduced production of hemoglobin.

The nurse assessing a patient with polycythemia vera would anticipate: a. pale complexion. b. low blood pressure. c. high hemoglobin. d. normal energy level.

c. high hemoglobin. The person with polycythemia vera will have high hemoglobin and hematocrit related to the large number of red cells. The complexion is ruddy with blue lips; there is fatigue and weakness and high blood pressure.

6. While assessing the lymph nodes, the nurse should a. apply gentle, firm pressure to deep lymph nodes. b. palpate the deep cervical and supraclavicular nodes last. c. lightly palpate superficial lymph nodes with the pads of the fingers. d. use the tips of the second, third, and fourth fingers to apply deep palpation.

c. lightly palpate superficial lymph nodes with the pads of the fingers.

13. The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that a. Hodgkin's lymphoma occurs only in young adults. b. Hodgkin's lymphoma is considered potentially curable. c. non-Hodgkin's lymphoma can manifest in multiple organs. d. non-Hodgkin's lymphoma is treated only with radiation therapy.

c. non-Hodgkin's lymphoma can manifest in multiple organs.

12. Multiple drugs are often used in combinations to treat leukemia and lymphoma because a. there are fewer toxic and side effects. b. the chance that one drug will be effective is increased. c. the drugs are more effective without causing side effects. d. the drugs work by different mechanisms to maximize killing of malignant cells.

d. the drugs work by different mechanisms to maximize killing of malignant cells.

The nurse instructs the 20-year-old female patient with sickle cell trait that: a. the condition will evolve into sickle cell anemia as she ages. b. all of her children will have sickle cell anemia. c. the trait will be transmitted to male children only. d. the trait can be passed on to all children.

d. the trait can be passed on to all children. A person who has the trait can pass it on to male or female children, even if there are no symptoms. Fifty percent of the patients total hemoglobin may be affected. Age does not increase the chance of the trait evolving into the disease.

16. Complications of transfusions that can be decreased by the use of leukocyte depletion or reduction of RBC transfusion are a. chills and hemolysis. b. leukostasis and neutrophilia. c. fluid overload and pulmonary edema. d. transmission of cytomegalovirus and fever

d. transmission of cytomegalovirus and fever

The nurse evaluates a need for further instruction to the patient with sickle cell anemia when he says: a. I know Im not supposed to drink iced drinks. b. I surely do miss my three beers in the afternoon. c. I walk every day rather than doing other strenuous exercise. d. I am looking forward to my annual ski trip to Colorado

d. I am looking forward to my annual ski trip to Colorado People with sickle cell anemia should avoid cold temperatures and high altitudes, which can bring on a crisis due to thickening of the blood. Avoidance of iced drinks, alcohol, and strenuous exercise is beneficial

The patient has been diagnosed with Hodgkins lymphoma. The nurse is aware that this patient has which type of cells present in the blood? a. Abnormal B cells b. Abnormal T cells c. Cytotoxic T cells d. Reed-Sternberg (R-S) cells

d. Reed-Sternberg (R-S) cells If Reed-Sternberg (R-S) cells are present, the patient has Hodgkins lymphoma. If the R-S cells are not present, the patient is diagnosed as having non-Hodgkins lymphoma. Non-Hodgkins lymphoma is then identified as either B-cell or T-cell lymphoma.