Heme/Onc

A client has emergency surgery for a ruptured appendix. After assessing that the client is manifesting symptoms of shock, the nurse should: A. Prepare for a blood transfusion B. Notify the physician immediately C. Elevate the head of the bed 30 degrees D. Increase the liter flow of the oxygen being administered

B

A client who has had bone pains of insidious onset for four months is suspected of having multiple myeloma. The nurse understands that one of the diagnostic findings specific for multiple myeloma would be: A. Low serum calcium levels B. Bence-Jones protein in the urine C. Occult and frank blood in the stool D. Positive bacterial culture of sputum

B

A client with acquired immunodeficiency syndrome (AIDS) and Cryptococcus pneumonia is incontinent of feces and urine and is producing copious sputum. When providing care for this client the nurse's priority should be to: A. Wear goggles when suctioning the client's airway B. Use gown, mask, and gloves when bathing the client C. Use gloves to administer oral medications to the client D. Wear a gown when assisting the client with the bedpan

B

Immediately after giving an injection, a nurse is accidentally stuck with the needle when a client becomes agitated. When is the best time for the employer to test the nurse for human immunodeficiency virus (HIV) antibodies to determine if she became infected as a result of the needle stick? A. Immediately and then again in 6 weeks B. Immediately and then again in 3 months C. In 2 weeks and then again in 6 months D. In 2 weeks and then again in 1 year

B

The nurse is reviewing a client's laboratory values. Which of the following is most consistent with a diagnosis of aplastic anemia? A. Decreased production of T-helper cells B. Decreased levels of white blood cells (WBCs), red blood cells (RBCs), and platelets C. Increased levels of WBCs, RBCs, and platelets D. Reed-Sternberg cells and lymph node enlargement

B

When protective isolation isn't indicated, which activity is recommended for a client receiving chemotherapy? A. Bed rest B. Activity as tolerated C. Walk to bathroom only D. Out of bed for brief periods

B

Which statement shows that a client needs further teaching about the cause of an exacer- bation of systemic lupus erythematosus (SLE)? A. I need to stay away from sunlight." B. "I don't have to worry if I get a strep throat." C. "I need to work on managing stress in my life." D. "I don't have to worry about changing my diet."

B

A Schilling test is ordered for a client who is suspected of having pernicious anemia. The nurse recognizes that the primary purpose of the Schilling test is to determine the client's ability to: A. Store vitamin BI2 B. Digest vitamin B12 C. Absorb vitamin BI2 D. Produce vitamin B12

C

A client arrives at the emergency department with chest and stomach pain and a report of black, tarry stools for several months. Which order should the nurse anticipate? A. Cardiac monitor, oxygen, creatine kinase, and lactate dehydrogenase (LD) levels B. Prothrombin time CPT), partial thromboplastin time (P1T), fibrinogen, and fibrin split product values C. ECG, complete blood count, testing for occult blood, and comprehensive serum metabolic panel D. EEG, alkaline phosphatase and aspartate aminotransferase levels,(liver panel), and basic serum metabolic panel

C

A client with a gunshot wound requires an emergency blood transfusion. His blood type is AB negative. Which blood type would be the safest for him to receive? A. AB Rh-positive B. A Rh-positive C. A Rh-negative D. 0 Rh-positive

C

A client with anemia may be tired due to a tissue deficiency of which substance? A. Carbon dioxide B. Factor VIII C. Oxygen D. T-cell antibodies

C

A pregnant client arrives at the emergency department with abruptio placentae at 34 weeks' gestation. She is at risk for which blood dyscrasia? A. Thrombocytopenia B. Idiopathic thrombocytopenic purpura (ITP) C. Disseminated intravascular coagulation (DIC) D. Heparin-associated thrombosis and thrombocytopenia (HATT)

C

According to a standard staging classification of Hodgkin's disease, which criterion reflects stage II? A. Involvement of extralymphatic organs or tissues B. Involvement of a single lymph node region or structure C. Involvement of two or more lymph node regions or structures D. Involvement of lymph node regions or structures on both sides of the diaphragm

C

After abdominal surgery a client develops internal hemorrhaging. During further assessments, the nurse should expect the client to exhibit: A. Polyuris B. Bradypnea C. Tachycardia D. Hypertension

C

During discharge teaching for corticosteroids, the client asks the nurse what the drugs suppress. Which of the following responses by the nurse would be the most accurate? A. Sympathetic response B. Pain receptors C. Immune response D. Neural transmission

C

During the progressive stage of shock, anaerobic metabolism occurs. The nurse must be aware that initially this causes: A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

C

In addition to Pneumocystis carinii, a client with AIDS also has a 4cm leg ulcer. Considering the client's total health status, the most critical nursing diagnosis would be: A. Social isolation B. Impaired skin integrity C. Impaired gas exchange D. Imbalanced nutrition: less than body requirements

C

The same client has a hematocrit value of 25. The nurse should anticipate that the physician will order: A. Ringer's lactate B. Serum albumin C. Blood replacement D. High molecular dextran

C

When assessing for hemorrhage after a client has a total hip replacement, the most important nursing action would be to: A. Measure the girth of the thigh B. Check the vital signs every four hours C. Examine the bedding under the client D. Observe for ecchymosis at the operative site

C

Which intervention is stressed in teaching about multiple myeloma? A. Maintain bed rest. B. Enforce fluid restriction. C. Drink 3 qt (3 L) of fluid daily. D. Keep the lower extremities elevated.

C

Which laboratory test result supports the diagnosis of systemic lupus erythematosus (SLE)? A. Elevated serum complement level B. Thrombocytosis, elevated sedimentation rate C. Pancytopenia, elevated antinuclear antibody (ANA) titer D. Leukocytosis, elevated blood urea nitrogen (BUN) and creatinine levels

C

Which statement is correct about the rate of cell growth in relation to chemotherapy? A. Faster growing cells are less susceptible to chemotherapy. B. Nondividing cells are more susceptible to chemotherapy. C. Faster growing cells are more susceptible to chemotherapy. D. Slower growing cells are more susceptible to chemotherapy.

C

Which symptoms are classic for thrombocytopenia? A. Weakness and fatigue B. Dizziness and vomiting C. Bruising and petechiae D. Light-headedness and nausea

C

A client receiving chemotherapy is considered at high risk for developing lysis syndrome. Which tests would the nurse expect to monitor for 48 to 72 hours after the infusion? A. Complete blood count, prothrombin time, and partial thromboplastin time B. Myoglobin, troponin, and creatine kinase C. Glucose, bilirubin, and alanine aminotransferase D. Electrolytes, blood urea nitrogen (BUN), and creatinine

D

A client with leukemia has neutropenia. Which function must be frequently assessed? A. Blood pressure B. Bowel sounds C. Heart sounds D. Breath sounds

D

For an adult client to be diagnosed with acquired immunodeficiency syndrome (AIDS), which condition must be present? A. Infection with human immunodeficiency virus (HIV), tuberculosis, and cytomeg- alovirus infection B. Infection with HIV, an alternative lifestyle, and a T-cell count above 200 cells/ul C. Cytomegalovirus infection, CD4+ count below 200 cells/ul, and a T-cell count above 400 cells/pl D. Infection with HIV, a history of acute HIV infection, and a CD4+ T-cell count below 200 cells/ul

D

Polycythemia is frequently associated with chronic obstructive pulmonary disease (COPD). When assessing for this complication, the nurse should observe for: A. Pallor and cyanosis B. Dyspnea on exertion C. A decreased hematocrit D. An elevated hemoglobin

D

The nurse is aware that nutritional support of a client's natural defense mechanisms would indicate the need for a diet high in: A. The essential fatty acids B. Dietary cellulose and fiber C. The amino acid, tryptophan D. Vitamins A, C, E, and selenium

D

Which blood test is used first to identify a response to human immunodeficiency virus (H1V) infection? A. Western blot B. CD4+ T-cell count C. Erythrocyte sedimentation rate D. Enzyme-linked immunosorbent assay (ELISA)

D

Which precautions should the nurse include in the care plan for a neutropenic client with lymphoma? A. Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. B. Put on a mask, gown, and gloves when entering the client's room. C. Provide a clear liquid, low-sodium diet. D. Eliminate fresh fruits and vegetables; avoid using enemas, and practice frequent hand washing.

D

A 19-year-old client admitted with heat stroke begins to show signs of disseminated intravascular coagulation (DIC). Which laboratory finding is most consistent with DIC? A. Low platelet count B. Elevated fibrinogen levels C. Low levels of fibrin degradation products D. Reduced prothrombin time (PT)

A

A 73-year-old client is about to receive a blood transfusion to treat severe anemia. She asks the nurse how long the procedure will take. Which of the following statements by the nurse is the most correct? A. No longer than 4 hours B. Around 8 hours C. At least 12 hours D. At least 24 hours

A

A client with esophageal varices is admitted with hematemesis, and two units of blood are ordered. Halfway through the first unit of blood the client complains of flank pain. The nurse's first action should be to: A. Stop the transfusion B. Obtain the vital signs C. Assess the pain further D. Monitor the hourly urinary output

A

A nurse is reviewing the laboratory results of a client with anemia. In which blood component would she expect to see a reduced value? A. Erythrocytes B. Granulocytes C. Leukocytes D. Platelets

A

After sustaining multiple internal injuries from being hit by a car, the client's blood pressure suddenly drops to 80/60 mm Hg. The nurse should realize that this is probably caused by: A. A reduction in the circulating blood volume B. Diminished vasomotor stimulation to the arterial wall C. Vasodilation resulting from diminished vasoconstrictor tone D. Cardiac decompensation resulting from electrolyte imbalance

A

The nurse is teaching a client with systemic lupus erythematosus (SLE). Which response by the client indicates understanding about which tissues in the body are primarily attacked by SLE? A. Connective B. Heart C. Lung D. Nerve

A

The nurse knows that a positive diagnosis for HIV infection is made based on: A. Positive ELISA and Western blot tests B. A history of high-risk sexual behaviors C. Evidence of extreme weight loss and high fever D. Identification of an associated opportunistic infection

A

The nurse understands that the most definitive test to confirm a diagnosis of multiple myeloma is: A. Bone marrow biopsy B. Serum test for hypercalcemia C. Urine test for Bence-Jones protein D. X-ray films of the ribs, spine, and skull

A

Which explanation about the action of heparin should the nurse provide to a client who has just started being administered this drug? A. It slows the time it takes for the blood to clot. B. It stops the blood from clotting. C. It thins the blood. D. It dissolves clots in the arteries of the heart.

A

Which substance has abnormal values early in the course of multiple myeloma? A. Immunoglobulins B. Platelets C. Red blood cells (RBCs) D. White blood cells (WBCs)

A