Hematology PassPoint Quiz
A client is taking large doses of aspirin daily to treat RA. THe nurse should instruct the client to tell the HCP when having:
Tinnitus
The nurse is assessing a client with chronic hepatitis B who is receiving lamivudine. What information about the client is most important to communicate to the health care provider?
A 3-kg weight gain over 2 days
The nurse is assisting with a bone marrow aspiration and biopsy. Place the tasks in the order which the nurse should perform them, from highest priority to least priority.
Verify the client has signed an informed consent. Position the client in a side-lying position Clean the skin with an antiseptic solution Apply ice to the biopsy site
Which lab test should be monitored closely by the nurse while the client is receiving heparin therapy
activated partial thromboplasin time (APTT)
Which is a priority assessment for the client in shock who is receiving an IV infusion of packed red blood cells and normal saline solution>
anaphylactic reaction
A nurse plans to administer an injection of heparin to a client. Which technique for heparin administration is appropriate?
applies gentle pressure to the site for 5-10 seconds after the injection
When assessing for signs of a blood transfusion reaction in a client with dark skin, what should the nurse assess?
diaphoresis
A nurse is teaching a client who has a severe allergy to bee stings how to manage a reaction. What does the nurse encourage the client to take first after being stung by a bee?
epinephrine
Which foods should the nurse encourage the mother to offer to her child with iron-deficiency anemia?
potato, peas and chicken
A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to
sit upright, leaning slightly forward
The nurse receives shift hand-off on an assigned client who had a surgical procedure. What objective assessment suggests that the client may be developing sepsis and is at risk for septic shock?
temperature increase blood pressure decrease 32 mL of urine in 2 hours tachypnea
A nurse assesses a client shortly after living donor kidney transplant surgery. Which finding must the nurse report to the health care provider immediately>
urine output of 20 ml/hr
A nurse is preparing to administer a unit of blood to a client with anemia. After removing blood from the refrigerator, the transfusion of the blood must be completed within:
4 hours
The daily WBC count in a client with aplastic anemia drops overnight from 3,900 to 2,900ul. Which is the appropriate nursing intervention?
Call the primary care provider, and request that the client be placed in reverse isolation.
A client with allergic rhinitis asks the nurse what to do to decrease rhinorrhea. Which instruction would be appropriate for the nurse to give the client?
Keep a diary of when your symptoms occur. This can help you identify what provokes attacks.
Which is an appropriate outcome for a client with RA who is receiving inflammatory drugs and physical therapy? The client will:
Manage joint pain and fatigue to perform activities of daily living
The nurse is teaching a female client about taking folic acid supplements for folic acid deficiency anemia. What information should be included in the teaching plan?
Oral contraceptive use, pregnancy, and lactation increase daily requirements
A nurse is developing a care plan for a client with DIC. Which nursing intervention should the nurse include?
Place a pressure-reducing mattress on the client's bed.
A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?
Use the smallest needle possible for injections
A family member of a client who HIV positive is concerned about the possibility of also being HIV positive. What is the best response by the nurse?
What's your understanding about how HIV is transmitted.
Which lab test result does the nurse anticipate for a client diagnosed with a bite from a pit viper
INR of 2.3
A nurse is administering an IV antineoplastic agent when the client says, "My awm is burning at the IV site." What should the nurse do first?
Stop infusing the medication
A physician orders gentamicin sulfate, 80 mg IV every 8 hours for a client with Pseudomonas aeruginoas. The nurse should infuse this drug over at least:
30 minutes
A nurse is monitoring a client who developed facial edema after receiving a medication by tablet. What should the nurse do next?
Assess for shortness of breath
A client from a Mediterranean country is admitted with thalassemia, jaundice, splenomegaly, and hepatomegaly. Which should be the primary focus of nursing care for this client?
Decrease cardiac demands by promoting rest
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?
Pallor, tachycardia, and a sore tonge.
The nurse is planning care for a client who has an allergy to latex. What intervention is the priority for the nurse to include in the plan of care?
Place latex-free, powder-free gloves at the client's bedside.
A client takes prednisone, as ordered, for rheumatoid arthritis. During follow-up visits, the nurse should assess the client for common adverse reactions to this drug, such as:
fluid retention and weight gain
A client with severe arthritis has been receiving maintenance therapy of prednisone 10mg/day for the past 6 weeks. The nurse should instruct the client to immediately report which symptom?
respiratory infection
A client with toxic shock has been receiving ceftriaxone sodium (Rocephin), 1 g every 12 hours. In addition to culture and sensitivity studies, which other laboratory findings should the nurse monitor? 1. Serum creatinine. 2. Spinal fluid analysis. 3. Arterial blood gases. 4. Serum osmolality.
serum creatinine
What should the nurse teach the client with neutropenia to avoid?
using suppositories or enemas
The nurse is performing a preoperative assessment on a client who is having surgery for the first time. When assessing allergies, which food allergies could indicate an association with allergy to latex?
Kiwi, avocado, banana
Which nursing interventions help parents of a child with hemophilia provide a safe home environment for their child?
Pad the corners of coffee tables when your child is a toddler. Establish a written emergency plan including what to do in specific situation and the names and phone numbers of emergency contacts. Be sure your child wears a helmet when riding a bike. Talk with your child about home safety and problem-solve hypothetical situations about your childs health.
The nurse explains to the client that a biopsy of the enlarged lymph node is important because, if Hodgkin's disease is present, the histologic examination will reveal which of the following?
Reed-Sternberg cells
The nurse is teaching a client about preventing toxic shock syndrome (TSS). Which action is a risk factor for toxic shock syndrome?
Using only tampons at night
A client who is receiving a blood transfusion begins to have difficulty breathing. The nurse notes an elevated blood pressure and a cough. Based on these signs, the nurse should prepare to manage which complication?
circulatory overload
Which clients will the nurse place in reverse isolation?
client w/ WBC of 600 with granulocyte count of 100 client with a burn injury involving >30% of TBSA
A client with chronic progressive multiple sclerosis is learning to use a walker. What instructions best ensure the client's safety?
"Place the walker directly in front of you and step into it as you move it forward."
A client with ITP, an immune disorder, is admitted to an acute care facility. Concerned about hemorrhage, the nurse monitors the clients platelet count and observes closely for signs of bleeding. The client is at greatest risk for hemorrhage when the platelet count falls below:
10,000
A 35-year-old female client is diagnosed with aplastic anemia. Which is the most importnat nursing measure to incorporate into the client's plan of care?
Alternate periods of activity with rest to decrease fatigue
A client with a pleural effusion has a diagnostic thoracentesis. The nurse notifies the healthcare provider immediately upon discovering what assessment finding?
Asymmetrical chest expansion
The teaching plan for the client with RA includes rest promotion. What position of the involved joints should the nurse tell the client to avoid when at rest?
Maintaining the joints in a flexed position
On the fourth day after surgery, a client's incision is red and inflamed. There is moderate drainage from the incision. The client has a temperature of 102° F (38.9° C). The total white blood count (WBC) 10,000/mm3 (10 × 109/L). The nurse should first:
Notify the HCP
A nurse is providing care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis?
Risk for impaired skin integrity
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?
Risk for injury
The nurse is administering PRBCs to a client. What should the nurse do first?
Stay with the client during the first 15 minutes of infusion.
A clinical nurse specialist is orienting a new grad RN to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new grad knows that the likelihood of an acute hemolytic reaction would occur when giving:
A-positive blood to an A-negative client
The nurse examines the lab results for a client and notes a WBC cell of 112,000 mm3. What condition does the nurse review the client's medical record for to best explain this abnormal result?
Chronic myelogenous leukemia
After one week in the hospital for chemotherapy treatment related to lymphocytic leukemia, a client develops abdominal pain, fever, and foul-smelling diarrhea. What priority recommendation does the nurse make to the health care provider?
Collect stool sample for C.Diff
Which is the best nursing repsonse when a client asks why the glucose is higher on days when the client sleeps less?
Cortisol levels remain high when you sleep less, since cortisol is inhibited during sleep
The client with RA tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my health care provider let me try that? Which response for the nurse would be the most appropriate?
Every person is different. What works for one client may not always be effective for another.
The nurse should assess a client for which complications associated with DIC?
PE
A client being treated for leukemia has an absolute neutrophil count of 400cells/mm3. What precautions would the nurse include in the plan of care?
Place sign on clients door reminding all persons to wash hands prior to entering
A client infected with HIV has a low CD4+ level. What intervention should the nurse implement?
Place the client in reverse isolation
A multidisciplinary oncology team of health care providers, nurses, and the social worker notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the lab data, which values support this diagnosis?
Decreased WBC Decreased platelets Decreased RBCs
A client with RA arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of RA?
My finger joints are oddly shaped
Which symptom is an early indication that the client's serum potassium level is below normal?
muscle weakness in the legs
The nurse is assessing a client who is postoperative abdominal surgery with reports of pain in the left gastrocnemius area, which is cool and edematous with pulses that are difficult to palpate. The most likely cause of this complication is which condition?
venous thrombus in the left leg with resultant congestion
A client who follows a vegetarian diet was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client needs further nutritional counseling?
The client drinks coffee or tea with meals.
A client with granulocytopenia has many visitors. To prevent infection what is the most important thing the nurse should tell the visitors to do?
Wash their hands
A client with the beta-thalassemia trait plans to marry a person of Italian ancestry who also has the trait. Which client statement indicates understanding of the teaching provided by the nurse?
We'll need more genetic counseling in the future.
What informatino should a nurse plan to teach a client newly diagnosed with an infection who has AIDS?
You are more susceptible to infection due to damage to your immune system
A client with lymphoma tells the nurse that a holistic practitioner has offered to treat the client with coffee enemas. How does the nurse repsond?
You should speak with your oncologist about this treatment.
A client is about to undergo bone marrow aspiration of the sternum. What should the nurse tell the client?
You will feel a pulling type of discomfort for a few seconds.
A client undergoing antineoplastic therapy is prescribed subcutaneous epoetin. What indicates to the nurse that the drug has been effective?
Hemoglobin levels rise
A nurse is providing discharge teaching to a client who is immunosuppressed. WHich statement by the client indicates the need for additional teaching?
I can eat whatever I want as long as it's low in fat.
A client with iron-deficiency anemia is prescribed liquid iron supplements. The nurse evaluates the client's understanding of how to take this drug. Which statement indicates the client has adequate knowledge?
I will dilute the medication and drink it with a straw.
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?
I will receive parenteral vitamin b12 therapy for the rest of my life.
A nurse is caring for a client receiving radiation for Hodgkin's lymphoma who begins to exhibit confusion. Upon further assessment, the nurse notes that hte client has warm, flushed skin and a heart rate of 110 beats per minute, and a temp of 101.8f. Which is the next best action?
Notify the healthcare provider
A home health care nurse is making the initial home visit to a client with lung cancer who had a peripherally inserted central catheter placed during hospitalization for an upper respiratory infection. During the visit, the nurse must administer an antibiotic, teach the client how to care for the catheter, and provide information about when to notify the home care agency and physician. When the nurse arrives at the client's home, the client's face is flushed and he complains of feeling tired. Which actions should the nurse take first?
Obtain the clients vital signs and assess breath sounds.
A nurse is preparing to discharge a child with leukemia observes a family member who has a cold sharing a meal with the child. How should the nurse approach the situation?
Offer a face mask to the person with the cold and use this as an opportunity for teaching.
A client withe AIDS is admitted with Pneumocystis jiroveci pneumonia. The client begins to cry and says, "My friends and relatives have stopped visiting and calling". What is the nurse's best repsonse?
That sounds very difficult. How are you coping with this?
When a nurse removes an IV from an client with AIDS , blood splashes into the nurse's eyes. WHat should the nurse do next?
Rinse their eyes with water, report the incident, and go to Employee Health
An RN preceptor is assisting a new grad to access a port-a-cath with a Huber needle. Which action by the new grad would require intervention by the RN preceptor?
Rotating the needle immediately after access
A client with pernicious anemia asks why she must take vitamin B12 injections forever. Which is the nurse's best response?
The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient amounts of a factor that allows the vitamin to be absorbed
A young adult has been bitten by a human, and the skin on the forearm is broken. Their last tetanus shot was about 8 years ago. What should the nurse tell the client about the anticipated treatment plan?
You'll need an injection of tetanus toxoid.
A client with thrombocytopenia has just had a bone marrow aspirate performed to monitor for treatment effectiveness. Which nursing intervention takes priority?
applying pressure to the puncture site for a full 10 minutes
The nurse is assessing a client with anemia. In order to plan nursing care, the nurse should focus the assessment on which sign or symptom?
cold intolerance
A client with AIDS develops a fever, severe headache, and stiff neck and begins ot vomit. Family states they have noticed that the client does not seem to be as alert and oriented as before. What is the nurse's priority intervention?
protecting the client's airway
After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first?
Administer epinephrine.
A client with macrocytic anemia has a burn on her foot and reports watching television while lying a heating pad. Which action should the nurse's first response?
Check for diminished sensations
A client with AIDS has developed mycobacteriumium avium complex. Which interventions should be included in the nursing plan of care?
Daily weights Intake and output Hemoglobin level
What are expected client outcomes the nurse would include in a plan of care for a client with allergic rhinitis?
Damped mask if dust is a problem Reports no symptoms of peripheral tingling Controls outdoor precipitating factors
A client with acute lymphocytic leukemia is receiving vincristine. Prior to infusing the drug, the nurse administers diphenhydramine. What should the nurse tell the client about the purpose of taking diphenhydramine?
Decreases incidence of a reaction to the vincristine.
The nurse is planning care for a client with HIV. Which statement by the nurse indicates understanding of HIV transmission.
I will wear a mask, goggles, gown, and gloves when splashing bodily fluids I will wash my hands after client care
When developing the plan of care for a client with aplastic anemia, the nurse should include which goal?
Perform activities of daily liviing without excessive fatigue or dyspnea.
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?
Platelet count, prothrombin time, and partial thromboplastin time
A 25-year-old client taking hydroxychloroquine for RA reports difficulty seeing out of the left eye. What does this finding indicate?
Possible retinal degeneration
A client is diagnosed with HIV. What information does the nurse best provide to best protect the client from advancing to the AIDS phase of this infection?
Strictly adhere to antiviral medication therapy
A client has moved into the AIDs phase of the HIV positive infection. The nurse advises the client to avoid which recreational activity?
Swimming in rivers or lakes
A client with thrombocytopenia has developed a hemorrhage. The nurse should assess for which finding?
Tachycardia
The RN must assign an UAP to help care for an oncology client who is on neutropenic precautions. Which factor is most important in making this assignment?
The UAP has had cold symptoms for the last 2 days.
A nurse is caring for several clients on an oncology unit. Which client should the nurse see first?
client with WBC of 2000 uL
The nurse admits a 1-year-old child to the hospital with the diagnosis of sickle cell crisis. The nurse explains to the parents that which condition leads to local tissue damage during a sickle cell crisis?
obstruction to circulation
When a client is diagnosed with aplastic anemia, the nurse should assess the client for which physiologic functions?
Bleeding tendencies
A client with RA reports gastrointestinal irritation after taking piroxicam. To prevent gastrointestinal upset, the nurse should provide which instruction?
Take with food or an antacid
A nurse applies standard precautions when caring for a client with HIV. The nurse takes what action when applying standard precautions?
wearing gloves for providing mouthcare
The nurse is preparing to administer 500 mL of whole blood to a client. The blood is to be infused over 4 hours. The infusion tubing delivers 10gtt/mL. How many drops of blood per minute must the nurse infuse to complete the infusion in 4 hours?
21
When obtaining the diet history from a client with anemia, the nurse should include questions specifically about which vitamins or minerals that are most likely missing in this client's diet?
vitamin b6 vitamin b12 iron
A client with RA tells the nurse, "I know its important to exercise my joints so I don't lose mobility, but my joints are so stiff and painful that exercising is difficult. Which repsonse by the nurse would be most appropriate?
Take a warm tub bath or shower before exercising. This may help with your discomfort.
The nurse is educating a client with SLE about self-management. For what S&S does the nurse tell the client to seek immediate medical attention?
having decreased urine output
A client is to receive a blood transfusion of packed RBCs for severe anemia. Place the following steps in the order the nurse would follow to administer this product. 1. verify the blood bag identification, ABO group, and Rh compatibility against the client 2. Put on gloves, a gown and a face shield 3. Record baseline vital signs 4. Checked the packed cells for abnormal color, clumping, gas bubbles, and expiration date. 5. flush the intravenous tubing with NS solution. Begin blood administration. 6. Remain with the client and watch for signs of a transfusion reaction.
1. Record baseline vitals 2. Check the packed cells for abnormal color, clumping, gas bubbles, and expiration date. 3. Verify the blood identification, ABO group, and Rh compatibility against the client information. 4. Put on gloves, a gown and a face shield 5. FLush the IV tubing with normal saline solution. Begin blood administration. 6. Remain with the client and watch for signs of a transfusion reaction.
