CH 29: Management of Patients with Nonmalignant Hematologic Disorders

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? A) Thrombocytopenia B) Anemia C) Leukopenia D) Neutropenia

A

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 may indicate deficiencies in essential nutrients. C) It is part of the required assessment information. D) It is important for the nurse to determine what type of foods the patient will eat.

B

The nurse provides care for an older adult client, diagnosed with anemia, who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine the cause of the client's blood loss, which is the priority nursing action? A) Evaluate the client's dietary intake. B) Observe the client's stools for blood. C) Monitor the client's body temperature. D) Monitor the client's blood pressure.

B

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? A) C B) Folate C) B12 D) A

C

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) Nausea, vomiting, and anorexia C) Nights sweats, weight loss, and diarrhea D) Dyspnea, tachycardia, and pallor

D

A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition? A) Takes 60 grams of protein each day B) Eliminates use of alcohol C) Takes a daily multiple vitamin pill D) Takes over-the-counter iron supplements

D

Which medication is the antidote to warfarin? A) Protamine sulfate B) Aspirin C) Clopidogrel D) Vitamin K

D

Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse? A) "The child must inherit two defective genes, one from each parent." B) "The trait is passed down through the mother." C) "It is an acquired, not a hereditary disorder." D) "Most likely, the father is the carrier of the gene."

A

Which of the following is considered an antidote to heparin? A) Protamine sulfate B) Vitamin K C) Narcan D) Ipecac

A

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? A) Pancytopenia B) Anemia C) Thrombocytopenia D) Leukopenia

A

Place the pathophysiological processes in order for how sickle cell disease leads to fatigue. A) Decreased hemoglobin in RBC B) Inflamed vascular endothelium C) Increased inflammatory cytokines D) Decreased muscle strength

A, B, C, then D

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. A) Destruction of normally formed red blood cells B) Abnormal erythrocyte production C) Infection D) Inadequate formed white blood cells E) Blood loss

A, B, and E

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: A) to the bathroom. B) onto the bedpan. C) to a standing position so he can urinate. D) to the bedside commode.

B

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

B

Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. A) Bradypnea B) Epistaxis C) Hypertension D) Bleeding gums E) Hematemesis

B, D, and E

A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy? A) It will increase red blood cell (RBC) production to compensate for blood loss. B) It will reduce the destruction of platelets by macrophages. C) It will remove the major site of red blood cell (RBC) destruction. D) It will increase production of platelets by the bone marrow.

C

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? A) There is a weak correlation between iron stores and hemoglobin levels. B)There is an inverse relationship between iron stores and hemoglobin levels. C) There is a strong correlation between iron stores and hemoglobin levels. D) There is a strong correlation between iron stores and hemoglobin characteristics.

C

A client with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective? A) The client's PT is within reference ranges. B) Arterial blood sampling tests positive for the presence of factor XIII. C) The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value. D) The client's platelet level is below 100,000/mm3.

C

A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron? A) Leafy green vegetables B) Kidney beans C) Orange juice D) Milk

C

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions? A) Plan for frequent periods of rest. B) Encourage frequent handwashing. C) Use a disposable razor when shaving. D) Avoid contact with family/friends who are sick.

C

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? A) Potassium level of 5.2 mEq/L B) Magnesium level of 2.5 mg/dL C) Creatinine level of 6 mg/100 mL D) Calcium level of 9.4 mg/dL

C

A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate? A) Severity of the disease B) Loss of vibratory and position senses C) Insufficient intake of dietary nutrients D) Neurologic involvement

D

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms? A) "Eat cold, bland foods with a large amount of water." B) "Eat larger amounts of bland, soft foods less frequently." C) "Eat low-fiber blended foods only." D) "Eat small amounts of bland, soft foods frequently."

D

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? A) Monitor temperature at least once per shift B) Eliminate direct contact with others who are infectious C) Implement neutropenic precautions D) Apply prolonged pressure to needle sites or other sources of external bleeding

D

A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse? A) "I'll see a genetic counselor before starting a family." B) "I need to learn how to give myself vitamin B12 injections." C) "Thalassemia is treated with iron supplements." D) "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children."

A

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) Had a dental extraction 2 days ago for caries in a tooth C) Received a blood transfusion within 1 year D) Has a history of viral hepatitis as a teenager 10 years ago

A

The nurse should advise a client with iron deficiency anemia to take which action in order to prevent staining of the teeth? A) Use a straw or place a spoon at the back of the mouth to take the liquid supplement. B) Do not combine iron with other prescribed or over-the-counter medications. C) Avoid taking iron simultaneously with an antacid. D) Take iron with or immediately after meals.

A

When assessing a client with anemia, which assessment is essential? A) Health history, including menstrual history in women B) Age and gender C) Lifestyle assessments, such as exercise routines D) Family history

A

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? A) Osteoporosis B) Hypertension C) Muscle wasting D) Truncal obesity

A

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia? A) hemoglobin S B) hemoglobin A C) hemoglobin M D) hemoglobin F

A

Which is a symptom of hemochromatosis? A) Weight gain B) Bronzing of the skin C) Inflammation of the mouth D) Inflammation of the tongue

B

Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat? A) Shrimp and tomatoes B) Lobster and squash C) Cheese and bananas D) Lamb and peaches

D

A client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults? A) dementia B) stomatitis C) glossitis D) ataxia

A

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? A) Increased mean corpuscular volume B) Decreased level of erythropoietin C) Decreased total iron-binding capacity D) Increased reticulocyte count

B

The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action? A) Ask someone to clean the bedpan B) Notify the physician C) Put in an IV line D) Stop the nosebleed

B

While assessing a client, the nurse will recognize what as the most obvious sign of anemia? A) Tachycardia B) Pallor C) Jaundice D) Flow murmurs

B

A client in end-stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse? A) Holds the epoetin alfa if the BUN is elevated B) Ensures the client has completed dialysis treatment C) Assesses the hemoglobin level D) Questions the administration of both medications

C

A client is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met? A) Assess for edema. B) Assess the client's level of consciousness frequently. C) Closely monitor intake and output. D) Assess skin integrity frequently.

C

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

C

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? A) Berries and orange vegetables B) Fruits high in vitamin C, such as oranges and grapefruits C) Beans, dried fruits, and leafy, green vegetables D) Dairy products

C

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? A) Normocytic B) Microcytic C) Hypochromic D) Hyperchromic

C

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention? A) Encouraging the client to ambulate immediately B) Limiting the client's intake of oral and IV fluids C) Limit foods that contain folic acid D) Administering and evaluating the effectiveness of opioid analgesics

D

A nurse is caring for a client with severe anemia. The client is tachycardic and reports dizziness and exertional dyspnea. What signs and symptoms might develop if this client goes into heart failure? A) Fever B) Migraine C) Nausea and vomiting D) Peripheral edema

D

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? A) To administer vitamin B12 injections B) To instruct the client to rest immediately if chest pain develops C) To assess for enlargement and tenderness over the liver and spleen D) To closely monitor the rate of administration

D

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? A) Maintain accurate fluid intake and output records. B) Limit visits by family members. C) Encourage the client to use a wheelchair. D) Use the smallest needle possible for injections.

D

A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse? A) To detect the evidence of infection such as fever and tachycardia B) To detect the evidence of dehydration that might have triggered a sickle cell crisis C) To detect the motor strength and stroke-related signs and symptoms D) To detect the abnormal sounds suggestive of acute chest syndrome and heart failure

D

The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse A) Allows unlicensed assistive personnel who reports having a sore throat to provide care B) Changes the water in the humidifier for oxygen therapy every 48 hours C) Places the client in isolation and allows no visitors D) Assigns the client to a private room

D

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) Take iron with an antacid to avoid stomach upset. C) Taking iron pills with milk aids in absorption. D) Drink liquid iron preparations with a straw.

D

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? A) "I will receive parenteral vitamin B12 therapy for the rest of my life." B) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." C) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." D) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."

A

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving: A) A-positive blood to an A-negative client. B) B-positive blood to an AB-positive client. C) O-positive blood to an A-positive client. D) O-negative blood to an O-positive client.

A

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for? A) The onset of a bacterial infection B) Diarrhea C) Bleeding D) Abdominal pain

A

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? A) Vitamin K B) Vitamin A C) Vitamin D D) Vitamin E

A

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? A) Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels B) Low levels of urine constituents normally excreted in the urine C) Electrolyte imbalance that could affect the blood's ability to coagulate properly D) Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels

A

The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give. A) Use compression stockings when walking to prevent deep vein thrombosis (DVT). B) Take aspirin daily to prevent clot formation. C) Take antiplatelets on a regular basis. D) Participate in regular phlebotomy procedures to decrease blood viscosity.

D

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take? A) Monitor partial thromboplastin (PTT) time. B) Administer the prescribed enoxaparin (Lovenox). C) Encourage a diet high in vitamin K. D) Have the client limit physical activity.

B

When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature? A) Increased blood viscosity, resulting from an overproduction of white cells B) Compensatory polycythemia stimulated by thrombocytopenia C) Reduced plasma volume in response to a reduced production of cellular elements D) Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

D

A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse A) Checks the client's BUN and creatinine B) Questions the physician about the use of both medications C) Teaches the client to bend at the back when lifting objects D) Instructs the client not to lift more than 20 pounds

A

The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions? A) Assisting in prioritizing activities. B) Determining what days to be active. C) Keeping long activity periods to build client stamina. D) Encouraging early and frequent activities.

A

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client? A) Vascular occlusion in small vessels decreasing blood and oxygen to the tissues. B) Overhydration enlarges the red blood cells. C) Bone marrow decreases the erythrocyte production causing decrease in hypoxia. D) The client has a decreased tolerance of pain related to the chronic nature of the illness.

A

A client with anemia is prescribed an oral iron supplement. Which statement indicates that teaching about this supplement has been effective? A) "I will take it in the morning with orange juice." B) "I will stop taking it if my stool turns black." C) "I will be sure to take this medication with food." D) "I will limit my intake of raw fruit and vegetables."

A

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) Potassium level B) Creatinine level C) Hemoglobin level D) Folate levels

C

A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client? A) Exhibits a temperature more than 100.3°F B) Describes the importance of staying cool C) Reports joint pain less than 3 on a scale of 0 to 10 D) Takes hydroxyurea during her pregnancy

C

The couple with the lowest risk of having a child with sickle cell anemia disease is the one in which the: A) father is HbS and the mother is HbS. B) father is HbS and the mother is HbAS. C) father is HbA and the mother is HbS. D) father is HbAS and the mother is HbAS.

C

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? A) Elevated hematocrit concentration B) Low ferritin level concentration C) Elevated red blood cell (RBC) count D) Enlarged mean corpuscular volume (MCV)

B

A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority? A) Activity intolerance B) Impaired tissue integrity C) Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI D) Impaired oral mucous membranes

C

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.

A

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? A) Direct pressure B) Elevation of the extremity C) Pressure point control D) Application of a tourniquet

A

The nurse is educating a patient 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 leafy green vegetables with a glass of water B) Eating calf's liver with a glass of orange juice C) Eating apple slices with carrots D) Eating a steak with mushrooms

B

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take? A) Administer the unit of blood B) Check with the blood bank first and then administer the blood with their permission C) Ask the client if he was ever known as Donald A. Smith D) Refuse to administer the blood

D

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem? A) A hemolytic allergic reaction caused by an antigen reaction B) A hemolytic reaction caused by bacterial contamination of donor blood C) A hemolytic reaction to Rh-incompatible blood D) A hemolytic reaction to mismatched blood

A

A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this? A) Women lose iron through menstrual cycles B) Women have lower hemoglobin levels C) Women require grater folic acid supplementation D) Women rarely manifest the gene expression

A

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse? A) Obtain the pain medication and delay the bath and position change until the medication reaches its peak. B) Inform the client that she will feel better after receiving a bath and clean sheets. C) Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. D) Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration.

A

A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC? A) "DIC is a complication of an autoimmune disease that attacks the body's own cells." B) "DIC occurs when the immune system attacks platelets and causes massive bleeding." C) "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." D) "DIC is caused when hemolytic processes destroy erythrocytes."

C

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? A) Fibrinogen level, WBC, and platelet count B) Platelet count, blood glucose levels, and white blood cell (WBC) count C) Platelet count, prothrombin time, and partial thromboplastin time D) Thrombin time, calcium levels, and potassium levels

C