Review Question Ch 30
c
The nurse instructs an African American man who has sickle cell disease about symptom management and prevention of sickle cell crisis. The nurse determines further teaching is necessary if the patient makes which statement? "I should avoid contact with anyone who has a respiratory infection." "I may experience severe pain during a crisis and need narcotic analgesics." "When my vision is blurred, I will close my eyes and rest for an hour." "When I take a vacation, I should not go to the mountains."
c
The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse check on first? A 50-yr-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer A 30-yr-old patient with a pulse of 112 beats/min and a white blood cell count of 14,000/µL A 40-yr-old patient with a temperature of 100.8oF (38.2oC) and a neutrophil count of 256/µL A 60-yr-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL
a
The nurse knows that hemolytic anemia can be caused by which extrinsic factors? Macroangiopathic or microangiopathic factors Abnormal hemoglobin or enzyme deficiency Chronic diseases or medications and chemicals Trauma or splenic sequestration crisis
d
The nurse receives a physician's order to transfuse fresh frozen plasma to a patient with acute blood loss. Which procedure is most appropriate for infusing this blood product? Hang the fresh frozen plasma as a piggyback to a new bag of primary IV solution without KCl. Hang the fresh frozen plasma as a piggyback to the primary IV solution. Infuse the fresh frozen plasma as a piggyback to a primary solution of normal saline. Infuse the fresh frozen plasma as rapidly as the patient will tolerate.
a
When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? 0.9% sodium chloride Lactated Ringer's 5% dextrose in water 0.45% sodium chloride
c
Which patient is most likely to experience anemia related to an increased destruction of red blood cells? A 59-yr-old man whose alcoholism has precipitated folic acid deficiency A 3-yr-old child whose impaired growth and development is attributable to thalassemia A 23-yr-old African American man who has a diagnosis of sickle cell disease A 30-yr-old woman with a history of "heavy periods" accompanied by anemia
c
14. A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate a. hyperkalemia. b. hyperuricemia. c. hypercalcemia. d. CNS myeloma.
a
5. A complication of the hyperviscosity of polycythemia is a. thrombosis. b. cardiomyopathy. c. pulmonary edema. d. disseminated intravascular coagulation (DIC).
b
The blood bank notifies the nurse that the two units of blood ordered for a patient is ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? Regulate the flow rate so that each unit takes at least 4 hours to transfuse. Infuse the blood slowly for the first 15 minutes of the transfusion. Immediately pick up both units of blood from the blood bank. Set up the Y-tubing of the blood set with dextrose in water as the flush solution.
d
The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? An unlicensed assistive personnel A physician's assistant Unit secretary Another registered nurse
c
The nurse is caring for a patient with a diagnosis of disseminated intravascular coagulation (DIC). What is the first priority of care? Administer heparin. Administer whole blood. Treat the causative problem. Administer fresh frozen plasma.
b
The nurse is caring for a patient with a diagnosis of immune thrombocytopenic purpura (ITP). What is a priority nursing action in the care of this patient? Administration of packed red blood cells Administration of oral or IV corticosteroids Maintenance of reverse isolation and application of standard precautions Administration of clotting factors VIII and IX
b
The nurse is caring for a patient with microcytic, hypochromic anemia. What teaching should the nurse provide that would be beneficial to the patient? Decrease the intake of the antiseizure medications to improve. Take the iron with orange juice one hour before meals. Take cobalamin with green leafy vegetables. Take enteric-coated iron with each meal.
d
The nurse is caring for a patient with polycythemia vera. What is an important action for the nurse to initiate? Teach the patient how to maintain a low-activity lifestyle. Perform thorough and regularly scheduled neurologic assessments. Encourage deep breathing and coughing. Assist with or perform phlebotomy at the bedside.
c
The nurse notes a physician's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? 11:45 AM 12:30 PM 12:00 noon 3:30 PM
a
The patient is admitted with hypercalcemia; polyuria; and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient? Multiple myeloma Myelodysplastic syndrome Thrombocytopenia Megaloblastic anemia
c
The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? Reduced fibrin degradation products (FDPs) Reduced prothrombin time (PT) Elevated D-dimers Elevated fibrinogen
c
When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What associated clinical manifestations does the nurse anticipate observing? Thirst Abdominal pain Fatigue Headache
a
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.
d
10. Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow, laboratory results the nurse would expect to find include a(n) a. excess of T cells. b. excess of platelets. c. deficiency of granulocytes. d. deficiency of all cellular blood components.
d
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
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.
c
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.
d
15. When reviewing the patient's hematologic laboratory values after a splenectomy, the nurse would expect to find a. leukopenia. b. RBC abnormalities. c. decreased hemoglobin. d. increased platelet count.
d
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.
b
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.
a, c,
3. Nursing interventions for a patient with severe anemia related to peptic ulcer disease include (select all that apply) a. instructions for high-iron diet. b. taking vital signs every 8 hours. c. monitoring stools for occult blood. d. teaching self-injection of erythropoietin. e. administration of cobalamin (vitamin B12) injections.
a, b, c, d
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
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.
d
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.
c
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.
a, b, c, d
9. Priority nursing actions when caring for a hospitalized patient with a new-onset temperature of 102.2° F (39° C) and severe neutropenia include (select all that apply) a. administering the prescribed antibiotic STAT. b. drawing peripheral and central line blood cultures. c. ongoing monitoring of the patient's vital signs for septic shock. d. taking a full set of vital signs and notifying the physician immediately. e. administering transfusions of WBCs treated to decrease immunogenicity.
c
A patient has anemia related to inadequate intake of essential nutrients. Which intervention would be appropriate for the nurse to include in the plan of care for this patient? Instruct the patient to select soft, bland, and nonacidic foods. Give the patient a list of medications that inhibit iron absorption. Encourage foods high in protein, iron, vitamin C, and folate. Plan for 30 minutes of rest before and after every meal.
a
A patient has been diagnosed with acute myelogenous leukemia (AML). What should the nurse educate the patient that care will focus on? Attaining remission Waiting with active supportive care Leukapheresis One chemotherapy agent
b
A patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? Brentuximab vedotin (Adcetris) Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine
a
A patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? Treatment type and expected side effects Gastrointestinal tract effects of treatment Skin care that will be needed Method of obtaining the treatment
c
A patient who has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient? Start IV fluids. Maintain distal warmth. Maintain oxygenation. Check peripheral pulses.
d
A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? Avoid abnormal bleeding. Give pneumococcal vaccine. Provide companionship while isolated. Prevent patient infection.
c
A patient with a diagnosis of hemophilia had a fall down an escalator earlier in the day and is now experiencing bleeding in the left knee joint. What should be the emergency nurse's immediate action? Immediate transfusion of platelets Range-of-motion exercises to prevent thrombus formation Resting the patient's knee to prevent hemarthroses Assistance with intracapsular injection of corticosteroids
c
A patient with an acute peptic ulcer and major blood loss requires an immediate transfusion with packed red blood cells. Which task is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? Double check the patient identity and verify the blood product. Confirm the IV solution is 0.9% saline. Obtain the vital signs before the transfusion is initiated. Monitor the patient for shortness of breath and back pain.
a, c, e
A patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about (select all that apply.)? Select all that apply. Private room with a high-efficiency particulate air (HEPA) filter Daily nasal swabs for culture Strict hand washing Encourage eating all foods to increase nutrients. Daily skin care and oral hygiene Monitor temperature every hour.
a
A patient with leukemia is admitted for severe hypovolemia after prolonged diarrhea has a platelet count of 43,000/µL. It is most important for the nurse to take which action? Check stools for presence of frank or occult blood. Insert two 18-gauge IV catheters. Administer prescribed enoxaparin. Monitor the patient's temperature every 2 hours.
b
Before beginning a transfusion of packed red blood cells (PRBCs), which action by the nurse would be of highest priority to avoid an error during this procedure? Add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow. Check the identifying information on the unit of blood against the patient's ID bracelet. Select new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction.
a
Before starting a transfusion of packed red blood cells for an older anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion? 15 30 60 5