Chapter 20: PrepU - Nursing Management: Patients With Hematologic Disorders

A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromacytosis at a much lower rate than men. What is the primary reason for this? 1- Women lose iron through menstrual cycles 2- Women rarely manifest the gene expression 3- Women have lower hemoglobin levels 4- Women require grater folic acid supplementation

1

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? 1- To closely monitor the rate of administration 2- To administer vitamin B12 injections 3- To instruct the client to rest immediately if chest pain develops 4- To assess for enlargement and tenderness over the liver and spleen

1

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? 1- Use a disposable razor when shaving. 2- Avoid contact with family/friends who are sick. 3- Encourage frequent handwashing. 4- Plan for frequent periods of rest.

1

A patient has been diagnosed with a vitamin B12 deficiency. The nurse is aware that this is a macrocytic-type anemia characterized by which of the following? 1- Increased mean corpuscular volume (MCV) 2- Increased hematocrit 3- Abnormal mean corpuscular hemoglobin (MCH) 4- Elevated hemoglobin

1

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for? 1- Essential thrombocythemia 2- Extreme leukocytosis 3- Sickle cell anemia 4- Renal transplantation

1

The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? 1- Creatinine and blood urea nitrogen (BUN) levels 2- Iron levels 3- Magnesium levels 4- Potassium levels

2

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? 1- "Acute leukemia develops slowly." 2- "Chronic leukemia develops slowly." 3- "In chronic leukemia, the majority of leukocytes are mature." 4- "In acute leukemia there are not many undifferentiated cells."

2

Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat? 1- Shrimp and tomatoes 2- Lobster and squash 3- Cheese and bananas 4- Lamb and peaches

4

induction therapy

Intense combination of chemotherapy and radiation give at time of diagnosis with the goal of achieving remission (99%)

acute lymphoid leukemia (ALL)

Malignant, immature lymphocytes multiply in the blood, bone marrow, and lymphatic system.

A health care provider orders a unit of packed red blood cells (PRBC) for a postoperative patient. The nurse is responsible for patient assessment and health care information pre- and post-transfusion. Which of the following are the guidelines that the nurse should follow? Select all that apply. a. Determine the history of any previous transfusions and possible reactions. b. Review the signs and symptoms of a transfusion reaction. c. Explain that since 1985 the supply of blood available for transfusions is risk-free. d. Report any increase of 1 degree in temperature, during or after transfusion, which falls into a febrile range. e. Explain that urticaria is a harmless, common reaction to a transfusion occurring at least 50% of the time.

a,b,d

primary thrombocythemia

overproduction of platelets

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? 1- Assesses the hemoglobin level 2- Questions the administration of both medications 3- Ensures the client has completed dialysis treatment 4- Holds the epoetin alfa if the BUN is elevated

1

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: 1- A-positive blood to an A-negative client. 2- O-negative blood to an O-positive client. 3- O-positive blood to an A-positive client. 4- B-positive blood to an AB-positive client.

1

An client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults? 1- dementia 2- stomatitis 3- glossitis 4- ataxia

1

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? 1- Allopurinol 2- Filgrastim 3- Hydroxyurea 4- Asparaginase

1

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? 1- C 2- A 3- D 4- E

1

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have? 1- Iron deficiency anemia 2- Megaloblastic anemia 3- Sickle cell anemia 4- Aplastic anemia

1

A client who is being treated for AML has bruises on both legs. What is the nurse's mostappropriate action? 1- Ask the client whether they have recently fallen. 2- Evaluate the client's INR. 3- Keep the client on bed rest. 4- Evaluate the client's platelet count.

4

A client with suspected multiple myeloma is reporting back pain. What is the priority nursing action? 1- Have the client lie on a hard surface. 2- Have the client rest. 3- Encourage ambulation. 4- Send the client for a spinal x-ray study.

4

A patient with polycythemia vera has a high red blood cell (RBC) count and is at risk for the development of thrombosis. What treatment is important to reduce blood viscosity and to deplete the patient's iron stores? 1- Blood transfusions 2- Radiation 3- Chelation therapy 4- Phlebotomy

4

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? 1- A 24-year-old female taking oral contraceptives 2- A 40-year-old patient with a history of hypertension 3- A 52-year-old patient with acute kidney injury 4- A 72-year-old patient with a history of cancer

4

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? 1- Pancytopenia 2- Anemia 3- Leukopenia 4- Thrombocytopenia

1

While asessing a client, the nurse will recognize what as the most obvious sign of anemia? 1- Pallor 2- Tachycardia 3- Flow murmurs 4- Jaundice

1

Which assessment findings support the client's diagnosis of acute myeloid leukemia? Select all that apply. 1- Petechiae 2- Enlarged lymph nodes 3- Weakness and fatigue 4- Enlarged heart 5- Bone pain

1,2,3,5

A client with polycythemia vera reports severe itching. What triggers does the nurse know can cause this distressing symptom? Select all that apply. 1- Temperature change 2- Allergic reaction to the red blood cell increase 3- Alcohol consumption 4- Exposure to water of any temperature 5- Aspirin

1,3,4

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called 1- blast cells. 2- megaloblasts. 3- mast cells. 4- monocytes.

2

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. 1- Infection 2- Blood loss 3- Abnormal erythrocyte production 4- Destruction of normally formed red blood cells 5- Inadequate formed white blood cells

2,3,4

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: 1- to the bathroom. 2- to the bedside commode. 3- onto the bedpan. 4- to a standing position so he can urinate.

3

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? 1- "I'll watch my gums for bleeding when I brush my teeth." 2- "I'll use an electric razor to shave." 3- "I'll eat four servings of fresh, dark green vegetables every day." 4- "I'll report unexplained or severe bruising to my doctor right away."

3

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? 1- Decreased level of erythropoietin 2- Decreased total iron-binding capacity 3- Increased mean corpuscular volume 4- Increased reticulocyte count

1

A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching? 1- "My family will donate blood, because it's safer." 2- "I should expect blood withdrawal to take about 15 minutes." 3- "Donated blood is tested for blood type and infections." 4- "I could donate my own blood in case I need a transfusion."

1

The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis? 1- Polycythemia vera 2- Sickle cell disease 3- Aplastic anemia 4- Pernicious anemia

1

A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron? 1- Vitamin E 2- Meat, egg yolks, oysters, and shellfish 3- Rich sources of vitamin C 4- Sources of vitamin B12

3

A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage? 1- Iron chelation therapy 2- Oxygen therapy 3- Therapeutic phlebotomy 4- Anticoagulation therapy

1

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? 1- Anemia 2- Leukopenia 3- Thrombocytopenia 4- Neutropenia

3

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? 1- Elevation of the extremity 2- Pressure point control 3- Direct pressure 4- Application of a tourniquet

3

The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client? 1- The client is having an allergic reaction to the blood. 2- The client is experiencing vascular collapse. 3- The client is having decrease in tissue perfusion from a shock state. 4- The client is having a febrile nonhemolytic reaction.

4

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? 1- WBC count of 4,200 cells/mcL 2- Hematocrit of 38% 3- Platelet count of 9,000/mm3 4- Creatinine level of 1.0 mg/dL

3

A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea. What does the nurse inform the patient will be the benefits of treatment with this medication? Select all that apply. 1- Fewer painful episodes of sickle cell crisis 2- Lower incidence of acute chest syndrome 3- Decreased need for blood transfusions 4- Decreased need for other analgesic medications 5- Ability to reverse the damage done from sickling of cells

1,2,3

The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding? 1- White sclera 2- Jugular venous distention 3- Strong pedal pulses 4- Absence of tenting skin turgor

2

A woman's routine complete blood count (CBC) revealed a highly elevated platelet level, and subsequent diagnostic testing has resulted in a diagnosis of primary thrombocythemia. The nurse has begun the relevant health education with the patient. What should the nurse teach this woman about her health problem? 1- "Primary thrombocythemia creates potential problems at both ends of the clotting spectrum: inappropriate clotting or inappropriate bleeding." 2- "Your doctor will likely order a series of blood transfusions for you over the next several months." 3- "It's very important that you try to adopt a diet that's high in organ meats and leafy green vegetables." 4- "Primary thrombocythemia makes you quite vulnerable to hemorrhage, so you'll need regular injections of some important clotting factors."

1

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? 1- Potassium level 2- Creatinine level 3- Hemoglobin level 4- Folate levels

3

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? 1- Do not take medication with orange juice because it will delay absorption of the iron. 2- Iron may cause indigestion and should be taken with an antacid such as Mylanta. 3- Dilute the liquid preparation with another liquid such as juice and drink with a straw. 4- Discontinue the use of iron if your stool turns black.

3