Adult Health Unit 7 Exam prep: PrepU practice questions

The nurse begins a routine blood transfusion of packed red blood cells (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely transfused by what time? a)1500 b)1115 c)1530 d)1600

a) 1500 explanation: Administration time for PRBCs should not exceed 4 hours because of the increased risk of bacterial proliferation. For the first 15 minutes, the transfusion should be run slowly- no faster than 5 mL/min. page 917

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? a)Platelet count of 9,000/mm3 b)WBC count of 4,200 cells/mcL c)Hematocrit of 38% d)Creatinine level of 1.0 mg/dL

a) platelet count of 9,000/mm3 explanation: Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3. page 972

A client with a history of congestive heart failure has an order to receive 1 unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed? a)3:00 pm b)4:00 pm c)6:00 pm d)2:00 pm

b) 4:00pm explanation: When packed red blood cells (PRBCs) or whole blood is transfused, the blood should be administered within a 4-hour period because warm room temperatures promote bacterial growth. page 920

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? a)Kidney b)Liver c)Pancreas d)Large intestine

b) liver explanation: Albumin is produced by the liver. Albumin is not produced in the pancreas, kidney, or large intestine. page 908

A client with sickle cell anemia has a: a)normal blood smear. b)low hematocrit. c)high hematocrit. d)normal hematocrit.

b) low hematocrit explanation: A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear. page 937

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? a)The client with a painful sore throat. b)The client with enlarged lymph nodes in the neck. c)The client with painful lymph nodes under the arm. d)The client with painful lymph nodes in the groin.

b) the client with enlarged lymph nodes in the neck. explanation: Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder. page 989

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event? a)Monocytes b)Basophils c)Neutrophils d)Eosinophils

c) neutrophils explanation: Neutrophils, the most abundant type of white blood cell, are the first of the WBCs to respond to infection or inflammation. The normal value is 3,000 to 7,000/cmm (males) and 1,800 to 7,700/cmm (females). page 903

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? a)Hyperkalemia b)Hypernatremia c)Hypermagnesemia d)Hypercalcemia

d) hypercalcemia explanation: Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels. page 994

A client verbalizes fear of infection from a blood transfusion. What is the nurse's best response? a)"Every unit of donated blood is typed and tested for antibodies to infections." b)"The risk of transmission of HIV is so low, there's no need to worry." c)"Blood typing is more important than testing for infection." d)"There is no need for testing unless you have a history of a transfusion reaction."

a) "every unit of donated blood is typed and tested for antibodies to infections" explanation: Each blood donation is always tested for antibodies to bloodborne pathogens. Blood typing is equally as important as testing for infections. The risk of HIV transmission has decreased in recent years, but telling the client there's no need to worry discredits the client's fears and is not the best response. page 916

A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is: a)Albumin. b)Prothrombin. c)Globulin. d)Fibrinogen.

a) albumin explanation: Albumin, only produced in the liver, is essential for maintaining oncotic pressure in the vascular system. A decrease in oncotic pressure due to low albumin causes fluid to leak into the peritoneal cavity. page 908

A patient with End Stage Kidney Disease is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication? a)Hemoglobin level b)Potassium level c)Folate levels d)Creatinine level

a) hemoglobin level explanation: When using recombinant erythropoietin, the hemoglobin must be checked at least monthly (more frequently until a maintenance dose is established) and the dose titrated to ensure the hemoglobin level does not exceed 12 g/dL. page 931

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? a)Observe stools for blood. b)Observe the gums for bleeding after the client brushes teeth. c)Observe client for facial droop. d)Observe the sputum for signs of blood.

a) observes stools for blood explanation: Iron-deficiency anemia is unusual in older adults. Normally, the body does not eliminate excessive iron, causing total body iron stores to increase with age and necessitating maintenance of hydration. If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tracts is suspected. Observing the stool for blood will help detect blood from GI loss. Bleeding gums may indicate periodontal disease, or anticoagulation from medication is not related to age. Blood in sputum can be an indicator of various lung disorders that may affect all age groups. Facial droop may indicate an impending stroke or Bell's palsy and would not be a reason for blood loss page 932

The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for? a)Monocytes b)T lymphocytes c)Basophils d)Plasma cells

b) T lymphocytes explanation: T lymphocytes are responsible for cell-mediated immunity, in which they recognize material as "foreign," acting as a surveillance system. page 907

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? a)A general reduction in neutrophils and basophils b)A general reduction in all white blood cells c)Too many erythrocytes d)A decrease in granulocytes

b) a general reduction in all white blood cells explanation: Leukopenia is a general reduction in all WBCs. Leukopenia does not have anything to do with erythrocytes. page 970

Which of the following is the most common hematologic condition affecting elderly patients a)Thrombocytopenia b)Anemia c)Leukopenia d)Bandemia

b) anemia explanation: Anemia is the most common hematologic condition affecting elderly patients: with each successive decade of life, the incidence of anemia increases. Thrombocytopenia is a low platelet count. Leukopenia is a low leukocyte count. Bandemia is an increased number of band cells. page 927

The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for? a)Gradual muscle paralysis b)Debilitating fatigue c)Bone pain in the back of the ribs d)Severe thrombocytopenia

c) bone pain in the back of the ribs explanation: Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; clients may report that they have less pain on awakening but the pain intensity increases during the day. page 994

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result? a)Elevated creatinine b)Elevated erythrocyte concentration c)Decreased hematocrit d)Critically low arterial oxygen saturation

c) decreased hematocrit explanation: The added intravenous solutions used in hemodilution dilute the concentration of erythrocytes and lower the hematocrit. Adverse outcomes include tissue ischemia, particularly in the kidneys. These adverse outcomes can be manifested as low arterial oxygen saturation and elevated creatinine levels. page 916

The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing diagnosis to help prevent fractures in this client? a)Increased mobility b)Adequate nutrition c)Safety d)Adequate hydration

c) safety explanation: Safety is paramount because any injury, no matter how slight, can result in a fracture. page 997

The nurse began transfusing the first unit of packed red blood cells (PRBCs) fifteen minutes ago. The client reports shortness of breath, nausea, and is restless. What is the nurse's priority action? a)Notify the primary health care provider. b)Discontinue the intravenous line. c)Stop the infusion. d)Flush the blood tubing with normal saline.

c) stop the infusion explanation: The client's symptoms are consistent with a possible blood transfusion reaction. The infusion should be stopped immediately, then the primary health care provider should be notified. The intravenous line should not be discontinued in case the client needs any emergency intravenous medications. Flushing the blood tubing with normal saline would allow the blood in the tubing to be infused; the IV line should be maintained with normal saline through brand new tubing. page 917

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? a)"In acute leukemia there are not many undifferentiated cells." b)"Acute leukemia develops slowly." c)"In chronic leukemia, the majority of leukocytes are mature." d)"Chronic leukemia develops slowly."

d) "chronic leukemia develops slowly" explanation: Chronic leukemia develops slowly, and the majority of leukocytes produced are mature. Acute leukemia develops quickly and the majority of leukocytes are undifferentiated cells. page 971

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? a)Itching, rash, and jaundice b) Nights sweats, weight loss, and diarrhea c)Nausea, vomiting, and anorexia d)Dyspnea, tachycardia, and pallor

d) dyspnea, tachycardia, and pallor explanation: Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction. page 928

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 a nutritional assessment for this patient? a)It will determine what type of anemia the patient has. b)It is part of the required assessment information. c)It is important for the nurse to determine what type of foods the patient will eat. d)It may indicate deficiencies in essential nutrients.

d) it may indicate deficiencies in essential nutrients. explanation: A nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folate. page 929

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a client with leukemia? a)Applying prolonged pressure to needle sites or other sources of external bleeding b)Eliminating direct contact with others who are infectious c)Monitoring temperature at least once per shift d)Implementing neutropenic precautions

a) applying prolonged pressure to needle sites or other sources of external bleeding. explanation: The interventions for a client with thrombocytopenia are the same as those for a client with cancer who is at risk for bleeding. For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection. page 960

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? a)Assess the client's hemoglobin and platelets. b)Assess the client's pulse and blood pressure. c)Check the client's history. d)Assess the client's skin.

a) assess the clients hemoglobin and platelets explanation: Clients with AML may develop pallor from anemia and a tendency to bleed because of a low platelet count. Assessing the client's hemoglobin and platelets will help to determine whether this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin. page 972

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure? a)Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. b)Ask if taking a blood pressure has ever produced pain in the upper arm. c)Ask if taking a blood pressure has ever caused bruising in the hand and wrist. d)Ask if taking a blood pressure has ever produced the need for medication.

b) ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. explanation: Before taking a blood pressure, the nurse asks the client if the use of a blood-pressure cuff has ever produced bleeding under the skin or in the arm joints. Options B, C, and D are incorrect. page 951-953

Which is a symptom of hemochromatosis? a)Inflammation of the mouth b)Bronzing of the skin c)Inflammation of the tongue d)Weight gain

b) bronzing of the skin explanation: Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color. page 944

A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells? a)Filgrastim b)Eltrombopag c)Epoetin alfa d)Sargramostim

c) epoetin alfa explanation: Erythropoietin (epoetin alfa) is an effective alternative treatment for clients with chronic anemia secondary to diminished levels of erythropoietin. This medication stimulates erythropoiesis. Filgratism ( Neupogen) and Sagramostim stimulate granulocytosis( increasing WBC count) , Eltrombopag (Promacta) is used to treat aplastic anemia and thrombocytopenia. page 923

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called: a)blast cells. b)mast cells. c)megaloblasts. d)monocytes.

c) megaloblasts explanation: Megaloblasts are abnormally large erythrocytes. Blast cells are primitive white blood cells (WBCs). Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues. Page 933

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? a)Menstrual history b)Lifestyle assessments, such as exercise routines c)Age and gender d)Health history, such as bleeding, fatigue, or fainting

d) health history, such as bleeding, fatigue, or fainting explanation: When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system. page 909

An older adult client presents to the health care provider's office and reports exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed? a)WBC count b)Thrombocyte count c)Levels of plasma proteins d)RBC count

d)RBC counts explanation: A decreased red blood cell count is indicative of anemia, a common condition in older adults that results in fatigue. page 909-910

A male client has a hemoglobin count of 10.2 gm/dl, a hematocrit value of 36%, and a low ferritin level. What question should the nurse ask first? a)Have you experienced abdominal pain? b)Are you taking iron supplements? c)How much alcohol do you drink? d)Can you explain your typical diet?

a) have you experienced abdominal pain? explanation: The laboratory data support that the client has iron-deficiency anemia. The most common cause of iron-deficiency anemia in men is bleeding from ulcers, gastritis, inflammatory bowel disease, or gastrointestinal tumors. People who experience these problems may report abdominal pain. The nurse will make further assessments and may ask the other questions. page 930

The nurse is screening donors for blood donation. Which client is an acceptable donor for blood? a)Reports having a cold 1 month ago that resolved quickly b)Received a blood transfusion within 1 year c)Had a dental extraction 2 days ago for caries in a tooth d)Has a history of viral hepatitis as a teenager 10 years ago

a) reports having a cold 1 month ago that resolved quickly explanation: Donors must meet certain requirements to be able to donate blood. A client should be in good health, such as the client who had a cold more than 1 month ago that resolved quickly. Those excluded from donating blood have a history of viral hepatitis, report a blood transfusion within 12 months, and had a dental extraction within 72 hours. The reason for exclusion is that they are at increased risk of transmitting an infectious disease. page unknown

The nurse is caring for a client with acute myeloid leukemia (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)Hydroxyurea c)Filgrastim d)Asparaginase

a)allopurinol explanation: Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate are seen; this process is referred to as tumor lysis (cell destruction) syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Clients require a high fluid intake, and prophylaxis with allopurinol (Zyloprim) to prevent crystallization of uric acid and subsequent stone formation. page 973

The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply. a)Educate the family about medications and side effects. b)Allow family members to express feelings. c)Suggest support for household maintenance. d)Suggest the family go to church more often. e)Suggest the prescription of antianxiety medications.

a,b, c explanation: Family members benefit from increased education on what to expect. Allowing family members to express their feelings has also been shown to relieve stress. Supporting the caregiver and family with help in household duties will also help the overburdened family. Antianxiety medications and church attendance have not been shown to reduce caregiver stress. page unknown

A nurse working in hematology reviews the characteristics of stem cells and their role in disease. Which statements does the nurse understand is true regarding stem cells? Select all that apply. a)Myeloid stem cells produce erythrocytes. b)There is a limited supply throughout the life cycle. c)Lymphoid stem cells produce lymphocytes. d)There is a continuous supply throughout the life cycle. e)They have the ability to self-replicate.

a,c,d,e explanation: The primitive cells of the bone marrow are called stem cells. Stem cells have the ability to self-replicate, ensuring a continuous supply throughout the life cycle. Stem cells have the ability to differentiate—becoming either lymphoid stem cells (which produce lymphocytes) or myeloid stem cells (which produce erythrocytes). page 903

A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity? a)Stay in bed as much as possible. b)Do not lift more than 10 pounds. c)Limit activity to once a day. d)Limit fluids to prevent going to the bathroom.

b) do not lift more than 10 pounds explanation: The client with multiple myeloma needs education about activity instructions, such as lifting no more than 10 pounds and using proper body mechanics. Braces may be needed. The clent should be active and would not be instructed to stay in bed or limit activity, as he or she would become very stiff. Limiting fluids would be contraindicated; the client needs to remain well hydrated. page 997

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies? a)Avoid vitamin C as it prevents absorption. b)Drink liquid iron preparations with a straw. c)Take iron with an antacid to avoid stomach upset. d)Taking iron pills with milk aids in absorption.

b) drink liquid iron preparations with a straw. explanation: Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption. page 929

A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client? a)Risk for falls related to complaints of dizziness b)Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit c)Fatigue related to decreased hemoglobin and hematocrit d)Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients

b) ineffective tissue perfusion related to inadequate hemoglobin and hematocrit explanation: The symptoms indicate impaired tissue perfusion due to a decrease in the oxygen-carrying capacity of the blood. Cardiac status should be carefully assessed. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema. page 928

A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse? a)"The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." b)"I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion." c)"I understand your concern. The blood is carefully screened but is 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 is not completely risk free." explanation: Despite advances in donor screening and blood testing, certain diseases can still be transmitted by transfusion of blood components (Chart 32-4). page 914

A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem? a)Vitamin C deficiency b)Vitamin A deficiency c)Folic acid deficiency d)Vitamin B12 deficiency

d)vitamin b12 deficiency explanation: Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12-intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2-4 years. This results in megaloblastic anemia. Some symptoms are a smooth, beefy red, enlarged tongue and cranial nerve deficiencies. page 911