NUR 398 Chapter 40 Care of Patients with Hematologic Problems: Coagulation Disorders, Red & White Blood Cell Disorders

The nurse is caring for a patient with sickle cell disease (SCD). Which action is most effective in reducing the potential for sepsis in this patient? 1 Frequent and thorough handwashing 2 Administering prophylactic drug therapy 3 Taking vital signs every 4 hours, day and night 4 Monitoring laboratory values to look for abnormalities

1 Prevention and early detection strategies are used to protect the patient in sickle cell crisis from infection. Frequent and thorough handwashing is of the utmost importance. Drug therapy is a major defense against infections that develop in the patient with sickle cell disease, but is not the most effective way that the nurse can reduce the potential for sepsis. Continually assessing the patient for infection and monitoring the daily complete blood count (CBC) with differential white blood cell (WBC) count is early detection, not prevention. Taking vital signs every 4 hours will help with early detection of infection, but is not prevention.

The nurse is teaching a patient with newly diagnosed anemia about conserving energy. What should the nurse tell the patient? Select all that apply. 1 "Provide yourself with four to six small, easy-to-eat meals daily." 2 "Perform your care activities in groups to conserve your energy." 3 "Stop activity when shortness of breath or palpitations are present." 4 "Allow others to perform your care during periods of extreme fatigue." 5 "Drink small quantities of protein shakes and nutritional supplements daily." 6 "Perform a complete bath daily to reduce your chance of getting an infection."

1,3,4,5 It is critical to have others help the anemic patient who extremely tired. Although it may be difficult for him or her to ask for help, this practice should be stressed to the patient. Drinking small protein or nutritional supplements will help rebuild the patient's nutritional status. Having four to six small meals daily is preferred over three large meals; this practice conserves the body's expenditure of energy used in digestion and assimilation of nutrients. Stopping activities when strain on the cardiac or respiratory system is noted is critical. A complete bath should be performed only every other day; on days in between, the patient can be taught to take a "mini" sponge bath, which will conserve energy and still be safe in preventing the risks for infection. Care activities should be spaced every hour or so rather than in groups to conserve energy; the time just before and after meals should be avoided.

A patient is being treated for thrombotic thrombocytopenic purpura. What does the nurse anticipate administering to reduce the clumping of the platelets? Select all that apply. 1 Aspirin 2 Heparin 3 Ibuprofen 4 Alprostadil 5 Immunosuppressants

1,4 Aspirin and alprostadil both inhibit platelet clumping for a patient with thrombotic thrombocytopenic purpura. Heparin and Ibuprofen are not indicated. Immunosuppressants are given to reduce the intensity of the disease.

A patient with leukemia is undergoing hematopoietic stem cell transplantation using stem cells harvested from the patient prior to high-dose chemotherapy. Which type of transplantation procedure is being used for this patient? 1 Allogeneic 2 Syngeneic 3 Autologous 4 Engraftment

3 Patients who receive their own stem cells harvested prior to high-dose therapy are receiving autologous transplants. Allogeneic transplants are stem cells harvested from the patient's sibling or a matched unrelated donor. Engraftment refers to successful "taking" of the donor cells into the recipient. Syngeneic transplants occur when cells are harvested from an identical sibling.

A patient who had gastrointestinal surgery has an oxygen saturation of 91%, a heart rate of 98 beats/min, and dyspnea with mild exertion, but has clear breath sounds and a normal respiratory effort. The patient's nail beds are pale. Which action does the nurse take next? 1 Notify the Rapid Response Team 2 Elevate the head of the bed to 30 degrees 3 Request an order for a complete blood count 4 Suggest that the patient increase oral fluid intake

3 Postoperative patients are at risk for hemorrhage, and the first sign may be hypoxemia caused by loss of red blood cells and hemoglobin; a complete blood count (CBC) can confirm this. If hypoxemia caused by hemorrhage becomes severe, the patient should be placed in a Trendelenburg position. It is not necessary to notify the Rapid Response Team unless the patient becomes hemodynamically unstable. Intravenous (not oral) fluids may be necessary to maintain perfusion.

What clotting factor deficiencies cause hemophilia? Select all that apply. 1 I 2 II 3 V 4 VIII 5 IX

4,5 Deficiency of clotting factor VIII is hemophilia A, and deficiency of clotting factor IX leads to hemophilia B. Clotting factor I is fibrinogen, clotting factor II is prothrombin, and clotting factor V is proaccelerin factor, none of which are associated with hemophilia.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

Which organ systems are usually the first to sustain long-term damage as a result of vasoocclusive crises associated with sickle cell disease? Select all that apply. 1 Liver 2 Heart 3 Lungs 4 Spleen 5 Kidneys 6 Central nervous system

1,4 The spleen and liver are usually the first to be damaged from many episodes of hypoxia and ischemia. All other systems are affected, but are not usually the first to sustain long-term effects.

The nurse is caring for a patient who is in sickle cell crisis. Which nursing action is a priority? 1 Provide pain medications as needed. 2 Apply cool compresses to the patient's forehead. 3 Increase food sources of iron in the patient's diet. 4 Encourage the patient's use of two methods of birth control.

1 Analgesics are needed to treat sickle cell pain. The nurse would provide pain medications as needed. Cool compresses do not help the patient in sickle cell crisis. Warm soaks or compresses can help reduce pain perception. Increasing iron in the diet and discussing birth control are not priorities for the patient in sickle cell crisis.

A registered nurse (RN) from pediatrics has "floated" to the medical-surgical unit. Which patient should be assigned to the float nurse? 1 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells 2 50-year-old with pancytopenia needing assessment of risk factors for aplastic anemia 3 55-year-old with folic acid deficiency anemia caused by alcohol abuse who needs counseling 4 60-year-old with newly diagnosed polycythemia vera who needs teaching about the disease

1 Because sickle cell disease is commonly diagnosed during childhood, the pediatric nurse will be familiar with the disease and with red blood cell transfusion; therefore he or she should be assigned to the patient with sickle cell disease. Aplastic anemia, folic acid deficiency, and polycythemia vera are problems more commonly seen in adult patients who should be cared for by nurses who are more experienced in caring for adults.Test-Taking Tip: Avoid choosing answers that use words such as always, never, must, all, and none. If you are confused about the question, read the choices, label them true or false, and choose the answer that is the odd one out (i.e., the one false one or the one true one). When a question is framed in the negative, such as "When assessing for pain, you should not," the false option is the correct choice.

A 56-year-old patient admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed intravenous cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. An infection develops. What knowledge does the nurse use to determine that the appropriate antibiotic has been prescribed for this patient? 1 Checking the culture and sensitivity test results 2 Evaluating the patient's white blood cell (WBC) count level 3 Evaluating the patient's liver function tests (LFTs) and serum creatinine levels 4 Recognizing that vancomycin is the drug of choice used to treat all infections in patients with AML

1 Checking the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection is the best action to take. Drug therapy is the main defense against infections that develop in patients undergoing therapy for AML. Agents used depend on the patient's sensitivity to various antibiotics for the organism causing the infection. Although LFTs and kidney function tests may be influenced by antibiotics, these tests do not determine the effectiveness of the antibiotic. Although the WBC count is elevated in infection, this test does not influence which antibiotic will be effective in fighting the infection. Vancomycin may not be effective in all infections; culturing of the infection site and determining the organism's sensitivity to a cohort of drugs are needed, which will provide data on drugs that are capable of eradicating the infection in this patient.

The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 38,000/mm 3. What treatment does the nurse anticipate for this patient? 1 Corticosteroids 2 Platelet transfusion 3 Fresh frozen plasma 4 Haemophilus influenza vaccine

1 Corticosteroids are indicated in a patient with ITP with a platelet count under 50,000. Platelet transfusion would be used if the platelet count is under 10,000. Fresh frozen plasma is indicated for thrombotic thrombocytopenic purpura. Unnecessary intramuscular injections should be avoided.

Which statement indicates a failure of blood clotting as a result of hemophilia? 1 Formation of the fibrin mesh is inadequate to stop the bleeding. 2 The production of platelets from the bone marrow is inadequate. 3 Formation of the platelet plug takes place properly to stop the bleeding. 4 Constriction of the blood vessels does not take place to stop the bleeding.

1 In a patient diagnosed with hemophilia, there is a hereditary deficiency of clotting factor, which results in inadequate fibrin mesh formation. There is adequate production of platelets from the bone marrow, but formation of a platelet plug does not take place properly. Constriction of the blood vessels, the first step in the clotting process, is adequate in people with hemophilia.

The nurse is caring for a patient with neutropenia who has a suspected infection. Which intervention does the nurse implement first? 1 Obtain requested cultures 2 Place the patient on Bleeding Precautions 3 Initiate the administration of prescribed antibiotics 4 Hydrate the patient with 1000 mL of IV normal saline

1 Obtaining cultures to identify the infectious agent correctly is the priority for this patient. Hydrating the patient is not the priority. Administering antibiotics is important, but antibiotics should always be started after cultures are obtained. Placing the patient on Bleeding Precautions is unnecessary.

Which laboratory value may be normal for an asymptomatic patient with sickle cell disease (SCD) during non-sickle cell crisis times? 1 Decreased hematocrit 2 Low reticulocyte count 3 Elevated hemoglobin A 4 Low white blood cell (WBC) count

1 Patients with SCD usually have decreased hematocrit levels between 20% and 30% because the life span of the red blood cell is much shorter and many cells are destroyed. Hemoglobin A is normal hemoglobin and is lower than normal in patients with SCD. Patients with SCD usually have elevated reticulocyte and WBC counts.

The nurse is caring for a patient diagnosed with autoimmune idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 6,000/mm 3. What treatment should be administered first? 1 Platelets 2 Rituximab 3 Azathioprine 4 Dexamethasone

1 Platelet transfusion is the priority when a patient has a platelet count lower than 10,000. Rituximab, dexamethasone, and azathioprine are medications used for treatment of ITP but would not be first treatment administered with a platelet count of 6,000.

Which assessment findings are consistent with a diagnosis of leukemia? Select all that apply. 1 Pallor 2 Weight gain 3 Brown urine 4 Hypertension 5 Frequent colds 6 Multiple bruises

1,3,5,6 The patient with leukemia may present with manifestations of pallor, frequent colds, and multiple bruises. Anemia is the cause of pallor, excessive but immature white blood cells cause frequent colds, and thrombocytopenia leads to bruising or bleeding. Weight loss, not weight gain, occurs from the increased metabolism of leukemic cells. Hematuria, which may present as red-tinged urine, not brown, is an assessment finding in leukemia. Hypertension is not an assessment finding consistent with a diagnosis of leukemia.

A 35-year-old female complains of bruises on her legs, arms, and thighs and has heavy menstrual bleeding. While taking the medical history of patient, the nurse finds that the patient had a history of frequent nose and gum bleeding. A complete blood count revealed the platelet count to be 10,000 mm 3. What should be the immediate intervention given to the patient? 1 Transfusing platelets 2 Providing low dosage of chemotherapy 3 Providing intravascular immunoglobulin and intravascular anti-rho 4 Providing corticosteroid therapy for inhibiting antiplatelet antibodies

1 Severe bruises on the skin indicate internal bleeding. Nosebleeds, gum bleeding, and heavy menstrual bleeding are indicators of external bleeding. When the platelet count is less than 10,000 mm 3, immediate treatment should involve platelet transfusion to avoid further serious complications. A low dosage of chemotherapy is a part of aggressive therapy. Intravascular immunoglobulin and intravascular anti-rho are given to prevent further destruction of antibody-coated platelets. Corticosteroids are used to suppress the immune system.

Which patient is at highest risk for development of idiopathic thrombocytopenic purpura? 1 A 30-year-old female with Hashimoto's thyroiditis 2 A 55-year-old female diagnosed with celiac disease 3 A 45-year-old male diagnosed with Sjögren's syndrome 4 An 18-year-old male newly diagnosed with diabetes type 1

1 The 30-year-old female with Hashimoto's thyroiditis is most at risk for developing idiopathic thrombocytopenic purpura (ITP) because she is female between the ages of 20 and 50 with a current autoimmune disorder. The 55-year-old female is diagnosed with an autoimmune disorder but is not within the age range in which ITP is normally diagnosed. The 45-year-old male is within the age range in which ITP is diagnosed; however, males are less likely than females to develop ITP. The 18-year-old is not female and not within the age range.Test-Taking Tip: Key words or phrases in the question stem such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; however, every rule has its exceptions, so answer with care.

The nurse is assessing a newly admitted patient with thrombocytopenia. Which factor needs immediate intervention? 1 Nosebleed 2 Reports of pain 3 Increased temperature 4 Decreased urine output

1 The patient with thrombocytopenia has a high risk for bleeding. The nosebleed should be attended to immediately. The patient's report of pain, decreased urine output, and increased temperature are not the highest priority.

Which nursing intervention is effective in helping promote peripheral perfusion in a patient who has sickle cell disease? 1 Remove constrictive clothing 2 Elevate the head of the bed at least 30 degrees 3 Place pillows under the knees to elevate the legs 4 Keep the room temperature at or just below 72° F

1 To help prevent damage to peripheral tissues, the nurse should remove constrictive clothing from the patient sickle cell crisis. The head of the bed should be no higher than 30 degrees and the legs should not be elevated, especially with pillows under the knees. The room should be kept warm at a temperature of 72° F or higher.

The nurse is providing teaching for a patient who follows a lacto-ovo vegetarian diet. Which statement by the nurse is most appropriate regarding a sufficient intake of vitamin B 12? 1 "Egg yolks contain a high amount of vitamin B 12." 2 "You should seriously consider eating meat again." 3 "Avoid dairy products as they inhibit the absorption of vitamin B 12." 4 "Try to eat fish, especially salmon, twice weekly because it is high in vitamin B 12."

1 Vitamin B 12 is found in animal protein, eggs, and dairy products. Telling the patient to change his or her beliefs about consuming meat is dictatorial and not supportive. Dairy products contain vitamin B 12; therefore absorption is not inhibited. Salmon contains omega-3 fatty acids, which may prevent heart disease, but not vitamin B 12 deficiency.

Which signs are neurologic manifestations of acute leukemia? Select all that apply. 1 Fever 2 Fatigue 3 Headache 4 Hematuria 5 Ecchymoses

1,2,3 Fever, fatigue, and headache are neurologic manifestations of acute leukemia. Hematuria is a renal manifestation of acute leukemia. Ecchymoses is an integumentary manifestation of acute leukemia.

What are the risk factors for the development of leukemia? Select all that apply. 1 Down syndrome 2 Ionizing radiation 3 Prematurity at birth 4 Chemical exposure 5 Bone marrow hypoplasia 6 Multiple blood transfusions

1,2,4,5 Reduced production of blood cells in the bone marrow is one of the risk factors for developing leukemia. Exposure to chemicals through medical need or by environmental events can also contribute. Certain genetic factors contribute to the development of leukemia; Down syndrome is one such condition. Radiation therapy for cancer or other exposure to radiation, perhaps through the environment, also contributes. There is no indication that multiple blood transfusions are connected to patients who have leukemia. Although some genetic factors may influence the incidence of leukemia, prematurity at birth is not one of them.

The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). What manifestations of this diagnosis should the patient be assessed for? Select all that apply. 1 Petechiae 2 Ecchymosis 3 Hypotension 4 Abdominal pain 5 Mucosal bleeding

1,2,5 Petechiae, ecchymosis, and mucosal bleeding are manifestations of idiopathic thrombocytopenic purpura (ITP). Hypotension and abdominal pain are not common findings in ITP.Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.

A patient has aplastic anemia. The nurse regularly assesses which diagnostic test results? Select all that apply. 1 Platelets 2 D-dimer assay 3 White blood cells 4 Prothrombin time 5 Hemoglobin/hematocrit 6 B-type natriuretic peptide

1,3,5 Aplastic anemia is a disease of the bone marrow that results in pancytopenia, deficiency of red blood cells (RBCs), white blood cells, and platelets. Hemoglobin and hematocrit results are related to the amount of hemoglobin present in RBCs and the percentage of RBCs found in 1 cubic mL of blood. Prothrombin is synthesized by the liver; prolonged prothrombin time is associated with hepatic disease and ingestion of warfarin. D-dimer assay assesses for deep vein thrombosis, pulmonary embolism, or disseminated intravascular coagulation. The B-type natriuretic peptide assesses for heart failure.

The nurse is educating a group of young women who have sickle cell disease (SCD). Which comment from a class member requires correction? 1 "The pneumonia vaccine is protection that I need." 2 "Getting an annual 'flu shot' would be dangerous for me." 3 "I must take my penicillin pills as prescribed, all the time." 4 "Frequent handwashing is an important habit for me to develop."

2 A patient with SCD should receive annual influenza and pneumonia vaccinations; this helps prevent the development of these infections, which could cause a sickle cell crisis. Handwashing is a very important habit for the patient with SCD to develop because it reduces the risk for infection. Prophylactic penicillin is given to patients with SCD orally twice a day to prevent the development of infection.

Which type of leukemia most commonly has its onset during adulthood? 1 Acute lymphocytic leukemia (ALL) 2 Acute myelogenous leukemia (AML) 3 Chronic lymphocytic leukemia (CLL) 4 Chronic myelogenous leukemia (CML)

2 AML is the most common form of adult-onset leukemia. ALL is the most common in children. CLL is the most common chronic form of adult leukemia. CML is a rarer form of adult leukemia.

The nurse assesses the patient with which hematologic problem first? 1 32-year-old with pernicious anemia who needs a vitamin B 12 injection 2 81-year-old with thrombocytopenia and an increase in abdominal girth 3 67-year-old with acute myelocytic leukemia with petechiae on both legs 4 40-year-old with iron deficiency anemia who needs a Z-track iron injection

2 An increase in abdominal girth in a patient with thrombocytopenia indicates possible hemorrhage; this warrants further assessment immediately. The 32-year-old with pernicious anemia, the 40-year-old with iron deficiency anemia, and the 67-year-old with acute myelocytic leukemia do not indicate any acute complications, so the nurse can assess them after assessing the patient with thrombocytopenia.Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action.

The provider has recommended chemotherapy for a patient diagnosed with chronic lymphocytic leukemia (CLL). What does the nurse tell the patient about this treatment? 1 "Chemotherapy is used to cure CLL." 2 "Chemotherapy may produce remission of CLL." 3 "Chemotherapy will slow the progression of CLL." 4 "Chemotherapy prevents the development of acute lymphocytic leukemia (ALL)."

2 Chemotherapy may be used to treat CLL depending on the patient's symptoms, disease stage, and disease activity. It can cause remission, but does not cure the disease. It does not prevent the development of ALL or slow the progression of CLL.

A patient diagnosed with idiopathic thrombocytopenic purpura has received teaching about the diagnosis. What statement by the patient indicates a need for further teaching? 1 "My body is destroying my own platelets." 2 "I should not have major issues with clotting." 3 "My body makes a normal amount of platelets." 4 "I may have developed this after a viral infection."

2 Clotting is impaired in patients with idiopathic thrombocytopenic purpura (ITP). The body does make a normal amount of platelets; however, the body produces antibodies that destroy them. It is likely that the ITP developed from a viral infection.

A patient diagnosed with septic shock should be assessed for which complication? 1 Hemophilia A 2 Disseminated intravascular coagulation 3 Idiopathic thrombocytopenic purpura (ITP) 4 Thrombotic thrombocytopenic purpura (TTP)

2 Disseminated intravascular coagulation often occurs with septic shock. Hemophilia A, ITP, and TTP are not associated with septic shock.Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.

A patient who is pregnant with a girl has a family history of hemophilia. The patient knows she is a carrier and is worried that her daughter will be a carrier and/or be hemophilic. What can the nurse tell her? 1 "There's a 30% chance she will be a carrier but is unlikely to be hemophilic." 2 "There's a 50% chance she will be a carrier but is unlikely to be hemophilic." 3 "There's a 50% chance she will be a carrier, and if so, she is likely to be hemophilic." 4 "There's a 30% chance she will be a carrier, and if so, she is likely to be hemophilic."

2 Hemophilia is an X-linked recessive trait. Women who are carriers have a 50% chance, not 30%, of passing the hemophilia gene to their daughters, who are unlikely to be hemophilic. Women are rarely hemophilic; hemophilia is more common among men.Test-Taking Tip: You have at least a 25% chance of selecting the correct response to a multiple choice item. If you are uncertain about a question, eliminate the choices you believe are wrong, and then call on your knowledge, skills, and abilities to choose from the remaining responses.

A patient who has undergone stem cell transplantation develops graft-versus-host disease (GVHD) and is prescribed cyclosporine. The nurse teaches the patient that this drug is given for which purpose? 1 To facilitate engraftment of donor cells 2 To inhibit immune activity of donor T-cells 3 To prevent host cells from attacking donor cells 4 To wipe out remaining host cells by myeloablation

2 In GVHD, donor T-cells attack the host's cells, tissues, and organs. Cyclosporine is given to suppress this. It does not facilitate engraftment of donor cells. In GVHD, host cells do not attack donor cells. Myeloablation is performed as part of pretransplant conditioning.

What is the focus of management of thrombotic thrombocytopenic purpura (TTP)? Select all that apply. 1 Prevention of infection 2 Destruction of antibodies 3 Increase of platelet production 4 Prevention of platelet clumping 5 Stopping the autoimmune process

4,5 It is important to prevent platelet clumping and stop the autoimmune process. Destruction of antibodies is not indicated. Increasing platelet production will increase the clumping. Prevention of infection is indicated when a patient has had a splenectomy for treatment, not for management of TTP.

An African American patient taking a thiazide diuretic develops hemolytic anemia. The nurse notifies the provider and anticipates an order to test this patient for which type of anemia? 1 Iron deficiency 2 G6PD deficiency 3 Immunohemolytic 4 Sickle cell disease

2 Patients with G6PD deficiency do not have symptoms until they develop a severe infection or are exposed to certain drugs, such as a thiazide—a diuretic that causes red blood cells (RBCs) with reduced G6PD to break more easily. Immunohemolytic anemia results from increased RBC destruction following viral illness, trauma, and exposure to some drugs. Iron deficiency anemia and sickle cell disease are not characterized by hemolysis of RBCs.

What is the priority for the nurse in caring for a patient with sickle cell anemia who is in crisis? 1 Improving nutrition 2 Restoring tissue perfusion 3 Correcting decreased cardiac output 4 Restoring normal hemoglobin and hematocrit

2 Patients with sickle cell anemia who have decreased oxygen conditions develop crisis, causing reduction in oxygen supply and furthering development of sickled cells and organ damage. The nurse must encourage oral fluids and administer parenteral fluids to restore tissue perfusion. During a sickle cell crisis, restoring tissue perfusion is most important. Usually sickled cells go back to normal shape when the precipitating condition is removed, and the blood oxygen level is normalized, which allows tissue perfusion to resume. Improving nutrition, correcting decreased cardiac output, and restoring normal hemoglobin and hematocrit are not priorities during a sickle cell crisis.

A patient with a large, painless lymph node has a biopsy that reveals Reed-Sternberg cells. Which form of cancer does this finding indicate? 1 Multiple myeloma 2 Hodgkin's lymphoma 3 Non-Hodgkin's lymphoma 4 Acute myelogenous leukemia

2 Reed-Sternberg cells are indicative of Hodgkin's lymphoma. Acute myelogenous leukemia is characterized by atypical blood cells. A diagnosis of multiple myeloma begins with a positive finding of a serum monoclonal protein in the blood. Non-Hodgkin's lymphoma includes all lymphoid cancers that do not have the Reed-Sternberg cell.

The nurse is reinforcing information about genetic counseling to a patient with sickle cell disease (SCD) who has a healthy spouse. What information does the nurse include? 1 "Sickle cell disease will be inherited by your children." 2 "The sickle cell trait will be inherited by your children." 3 "Your children will have the disease, but your grandchildren will not." 4 "Your children will not have the disease, but your grandchildren could."

2 The children of the patient with sickle cell disease will inherit the sickle cell trait, but not inherit the disease. If both parents have the sickle cell trait; their children could get the disease. The only way grandchildren will have the disease is if both parents have the sickle cell trait. If one parent has the sickle cell trait, and one parent does not have the trait, then the grandchildren will only inherit the sickle cell trait.

Which factor is a possible cause of sickle cell crisis in a patient with sickle cell disease? 1 Priapism 2 Dysuria with cloudy urine 3 Drinking 3000 mL of fluid yesterday 4 Taking a 50-mile car trip with the family 2 days ago

2 The patient is reporting dysuria and cloudy urine, which are signs of a urinary tract infection; infections may initiate a sickle cell crisis. Fluids are the appropriate treatment for a sickle cell crisis; therefore this is not a likely cause. Air travel, due to changes in altitude and oxygen diffusion, may cause a sickle cell crisis rather than a car trip. Priapism (prolonged penile erection) may result from a crisis due to excessive vascular engorgement; however, it does not initiate sickle cell crisis.

What laboratory reports should be used to assess a patient diagnosed with idiopathic thrombocytopenic purpura who is symptomatic? Select all that apply. 1 Potassium 2 Hematocrit 3 Hemoglobin 4 Magnesium 5 White blood cell count

2,3 Hemoglobin and hematocrit may be low in a patient with symptomatic idiopathic thrombocytopenic purpura. Potassium and magnesium are not related to the diagnosis of ITP. White blood cell count is not indicated.

A patient diagnosed with thrombotic thrombocytopenic purpura should be assessed for which complications? Select all that apply. 1 Septicemia 2 Renal failure 3 Myocardial infarction 4 Right-sided heart failure 5 Cerebrovascular accident

2,3,5 Renal failure, myocardial infarction, and cerebrovascular accidents occur from tissue ischemia resulting from platelet aggregation and clotting. Septicemia and right-sided heart failure are not complications of thrombotic thrombocytopenic purpura.

What should be assessed when ruling out intracranial bleeding in a patient diagnosed with idiopathic thrombocytopenic purpura (ITP)? Select all that apply. 1 Petechiae 2 Mental status 3 Platelet count 4 Neurologic function 5 Splenic enlargement

2,4 Mental status and neurologic function should be assessed to rule out intracranial bleeding in a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). Petechiae is a normal finding in patients with ITP. Platelet count will not indicate this complication. Splenic enlargement will not indicate this complication.

Where are the level defects that cause coagulation disorders? Select all that apply. 1 Bladder 2 Platelet 3 Kidneys 4 Vascular 5 Clotting factor

2,4,5 Coagulation disorders have defects at the platelet, vascular, and clotting factor level. Defects in the bladder and kidneys are not associated with the coagulation disorder defect.

What findings are consistent with a diagnosis of idiopathic thrombocytopenic purpura (ITP)? Select all that apply. 1 Low fibrin levels 2 Low platelet count 3 Decrease in factor IX 4 Antiplatelet antibodies 5 High megakaryocyte count

2,4,5 Low platelet count, antiplatelet antibodies, and high megakaryocyte count indicate a diagnosis of idiopathic thrombocytopenic purpura. Decreased clotting factor IX and low fibrin levels are not associated with ITP.

What laboratory reports should be assessed for complications secondary to thrombotic thrombocytopenic purpura? Select all that apply. 1 AST/ALT 2 Creatinine 3 Platelet count 4 White blood cells 5 Blood urea nitrogen (BUN)

2,5 The blood urea nitrogen should be checked along with creatinine for renal failure, which is a complication of thrombotic thrombocytopenic purpura. AST and ALT are not indicated because a patient does not experience liver function issues as a complication of TTP. Platelet counts are indicative of TTP but not complications of TTP. A white blood cell count will not indicate a complication of TTP.

The nurse is teaching a patient about pharmacologic and nonpharmacologic pain management during a sickle cell crisis. Which method does the nurse encourage? 1 Avoid taking opiate analgesics 2 Request acetaminophen for pain 3 Use a warm compress on swollen joints 4 Keep the room cool for maximum comfort

3 A warm compress on swollen joints will promote comfort through relaxation and vasodilation. The pain of sickle cell crisis is severe due to vasoocclusive crisis and lack of tissue perfusion; intravenous opiates are typically required for 48 hours. A warm, rather than cool, room will promote comfort. Acetaminophen may be used for fever in crisis, but is not typically strong enough to relieve the pain of tissue ischemia.

Which laboratory parameter helps to differentiate between classic hemophilia and Christmas disease? 1 Platelet count 2 Prothrombin time 3 Coagulation factor 4 Partial prothromboplastin time

3 Lack of factor VII causes hemophilia A and lack of factor XI causes hemophilia B; thus the coagulation factor can be used to differentiate between classic hemophilia and Christmas disease. The difference in the platelet count indicates thrombocytopenia. Platelet count would not be beneficial in the differentiation of hemophilia and Christmas disease. Prothrombin time is tested in a patient who has symptoms of bleeding disorders. Partial prothromboplastin time indicates a deficiency of one or more of the coagulation factors in the patient's plasma but would not differentiate between hemophilia and Christmas disease.

The patient with which condition is at increased risk for developing cancer later in life? 1 Sickle cell disease 2 Pernicious anemia 3 Myelodysplastic syndrome 4 Polycythemia secondary to chronic obstructive pulmonary disease

3 Myelodysplastic syndromes (MDS) are a group of precancerous disorders resulting from abnormal bone marrow cells; 30% of individuals with MDS develop leukemia. Pernicious anemia results from a deficiency of intrinsic factor needed to absorb vitamin B 12. Sickle cell disease is an inherited disorder and is not a predisposition to cancer. Chronic obstructive pulmonary disease is typically related to respiratory issues.

A patient recently diagnosed with polycythemia vera (PV) has a serum hemoglobin of 20 g/dL, elevated leukocytes and platelets, a purplish flushed appearance, and reports intense itching. A family member asks the nurse if the patient will get better. How does the nurse respond? 1 "This is a temporary and easily treatable condition." 2 "Most people with this disease will die within 2 years." 3 "With aggressive management, people can live for over 10 years." 4 "Because these symptoms are severe, this episode will probably be fatal."

3 PV is a type of cancer of the red blood cells. With aggressive treatment, patients can live for 10 to 15 years. Without treatment, most patients die within 2 years. PV is not a temporary condition and requires aggressive treatment. Because these symptoms are severe, this episode will probably be fatal is not a true statement.

A patient who is donating stem cells via apheresis reports tingling in the fingers and toes and muscle cramping. Which action by the nurse is correct? 1 Slow the rate of the stem cell pheresis collection 2 Request an order for an anticoagulant medication 3 Contact the provider to request a calcium supplement 4 Monitor the patient closely for symptoms of hypotension

3 Patients undergoing apheresis may experience hypocalcemia caused by anticoagulants, characterized by numbness, tingling, muscle cramps, and chest pain. This can be treated with oral calcium supplements. While hypotension may develop, this patient is not showing signs of hypotension. Administering anticoagulants would increase the hypocalcemia, making these symptoms worse. It is not necessary to slow the pheresis.

A 32-year-old patient recovering from a sickle cell crisis is to be discharged. The nurse says, "You and all patients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the health care provider will request? 1 Cefaclor 2 Gentamicin 3 Penicillin V 4 Vancomycin

3 Prophylactic therapy with twice-daily oral penicillin reduces the incidence of pneumonia and other streptococcal infections and is the correct drug to use. It is a standard protocol for long-term prophylactic use in patients with sickle cell disease (SCD). Cefaclor and vancomycin are antibiotics more specific for short-term use and would be inappropriate for this patient. Gentamicin is a drug that can cause liver and kidney damage with long-term use.

A nurse is caring for a patient who has weakness, pallor, fatigue, reduced exercise tolerance, and fissures at the corners of the mouth. The nurse recognizes these symptoms are associated with which condition? 1 Aplastic anemia 2 Folic acid deficiency 3 Iron deficiency anemia 4 Vitamin B12 deficiency (pernicious) anemia

3 Weakness, pallor, fatigue, reduced exercise tolerance, and fissures at the corners of the mouth are symptoms of iron deficiency anemia. In patients with aplastic anemia, a complete blood count (CBC) shows severe macrocytic anemia, leukopenia, and thrombocytopenia. Patients with folic acid deficiency and vitamin B12 deficiency anemia may exhibit pallor and jaundice, glossitis, fatigue, and weight loss.

While performing an admission assessment on a 55-year-old woman, the nurse notes a serum hemoglobin level that indicates anemia. What does the nurse ask this patient about first? 1 If she consumes red meat regularly 2 If she is still having menstrual periods 3 Whether she takes a vitamin supplement 4 Whether she has noticed blood in her stools

4 Any adult with iron deficiency should be evaluated for abnormal bleeding, especially from the gastrointestinal tract, so the nurse should ask about blood in her stools. Dietary intake of iron should be assessed, but this is a less common cause of iron deficiency anemia. Blood loss from periods is not as likely in an older woman. A vitamin B 12 deficiency results in pernicious anemia, so asking whether she takes a vitamin supplement is important, but still does not address how she got anemia.

A patient has a glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse teaches the patient to avoid which substance? 1 Vitamin K 2 Yellow food dye 3 Iron-containing vitamins 4 Trimethoprim-sulfamethoxazole

4 Cells with reduced amounts of G6PD tend to hemolyze during exposure to some drugs (e.g., sulfonamides, aspirin, quinine derivatives, rasburicase, chloramphenicol, dapsone, high doses of vitamin C, and thiazide diuretics) and exposure to benzene and other toxins. Vitamin K (which antagonizes warfarin), yellow food dye, and iron are not implicated in promoting hemolysis in the individual with G6PD deficiency.

A patient with sickle cell anemia is admitted for treatment of a vasoocclusive crisis. In addition to administering oxygen, which intervention will help reduce hypoxia in this patient? 1 Giving iron supplements 2 Providing analgesic medication 3 Encouraging strenuous exercise 4 Administering intravenous (IV) fluids

4 Dehydration can cause increased sickling of HbS cells and can also make occlusion worse, causing more tissue ischemia. Patients should be taught to consume 3 to 4 L of fluid daily as a maintenance measure, and hospitalized patients should be given IV fluids. Patients should engage in mild, low-impact exercise. Iron supplements will not improve hypoxia since iron deficiency is not the underlying problem. Analgesics are given for pain, but do not directly affect oxygenation.

A patient with leukemia has a blood pressure of 170/95 mm Hg along with a bounding pulse. The nurse suspects that these findings are most likely related to which hematologic changes in this patient? 1 Decreased platelets 2 Immature reticulocytes 3 Excessive red blood cells 4 Elevated white blood cells

4 Excessive amounts of white blood cell (WBC) blast cells can increase blood viscosity, causing increased blood pressure and bounding pulse. These symptoms are not caused by decreased platelets, which would cause excessive bleeding. Excessive red blood cells occur with polycythemia, usually present in patients with chronic hypoxia. Immature reticulocytes do not cause these symptoms.

What statement by a patient diagnosed with hemophilia indicates a need for further teaching? 1 "I am using an electric shaver now." 2 "I will avoid bending over at the waist." 3 "I was taking a stool softener every day." 4 "I have been flossing my teeth once a day."

4 Flossing is contraindicated in patients with bleeding disorders. Patients with bleeding disorders should avoid bending over at the waist, use electric shavers, and take a stool softener to prevent straining during bowel movements.

What medication is used to prevent the destruction of antibody-coated platelets in a patient with idiopathic thrombocytopenic purpura? 1 Rituximab 2 Corticosteroids 3 Platelet transfusion 4 Intravenous (IV) immunoglobulin

4 IV immunoglobulin can help prevent the destruction of antibody-coated platelets. Rituximab, corticosteroids, and platelet transfusions are treatments for idiopathic thrombocytopenic purpura; however, they do not destroy antibody-coated platelets.

The nurse is discussing allogeneic stem cell transplantation with someone who is considering stem cell donation to a sibling with leukemia. What information does the nurse include about this procedure? 1 "Pheresis collection is painless and has no side effects for the donor." 2 "The recipient receives hematopoietic growth factor prior to stem cell harvest." 3 "Bone marrow donation is the most commonly used method and can be painful." 4 "One to five pheresis procedures are necessary to harvest a sufficient number of cells."

4 In allogeneic stem cell transplantation, the donor will undergo one to five pheresis procedures in order to collect enough cells for transplant. Bone marrow transplant is no longer widely used as a method for harvesting stem cells. Pheresis is relatively painless, but donors can develop symptoms associated with low calcium levels or may become dehydrated. Hematopoietic growth factor is given to the donor prior to harvest, not the recipient.

Which disorder causes antiplatelet antibody formation even when platelet production is normal? 1 Hemophilia 2 Heparin-induced thrombocytopenia 3 Thrombotic thrombocytopenic purpura 4 Autoimmune thrombocytopenic purpura

4 In autoimmune thrombocytopenic purpura, a patient's antibodies are produced against their own platelets, which lead to the formation of antiplatelet antibodies. This leads to a decrease in circulating platelets and results in clotting impairment. Hemophilia is a genetic disorder caused by clotting factor deficiencies. Heparin-induced thrombocytopenia is an unexplained drop in platelet count after the treatment of heparin. Thrombotic thrombocytopenic purpura indicates that the platelets have formed a clump in the capillaries.

The nurse is teaching a patient about induction therapy for acute leukemia. Which patient statement indicates a need for additional education? 1 "I will need to avoid people with a cold or flu." 2 "I will probably lose my hair during this therapy." 3 "The goal of this therapy is to put me in remission." 4 "After this therapy, I will not need to have any more."

4 Induction therapy is not a cure for leukemia, it is a treatment; therefore the patient needs more education to understand this. Because of infection risk, patients with leukemia should avoid people with a cold or flu. Induction therapy will most likely cause the patient with leukemia to lose his or her hair. The goal of induction therapy is to force leukemia into remission.

A 56-year-old patient admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed intravenous cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this therapy? 1 Nausea 2 Stomatitis 3 Liver toxicity 4 Bone marrow suppression

4 Intravenous cytosine arabinoside and daunorubicin are a commonly prescribed course of aggressive chemotherapy, and bone marrow suppression is a major side effect. The patient is even more at risk for infection than before treatment began. Liver toxicity, nausea, and stomatitis are not the major problem with this therapy.

A patient with leukemia is being discharged from the hospital. After hearing the nurse's instructions to keep regularly scheduled follow-up provider appointments, the patient says, "I don't have transportation." How does the nurse respond? 1 "You can take the bus." 2 "I might be able to take you." 3 "A pharmaceutical company might be able to help." 4 "The local American Cancer Society may be able to help."

4 Many local units of the American Cancer Society offer free transportation to patients with cancer, including those with leukemia. Suggesting a pharmaceutical company is not the best answer; drug companies typically do not provide this type of service. Although the nurse offering to take the patient is compassionate, it is not appropriate for the nurse to offer the patient transportation. Telling the patient to take the bus is dismissive and does not take into consideration the patient's situation (e.g., the patient may live nowhere near a bus route).

Which assessment finding is consistent with polycythemia vera (PV)? 1 Pallor 2 Bleeding 3 Oxygen toxicity 4 Increased hematocrit

4 PV is a disease with a sustained increase in hemoglobin levels to = 18 g/dL, a red blood cell (RBC) count of 6 million/mm 3, or a hematocrit = 55%. PV is a cancer of the RBCs that has three major hallmarks—massive production of RBCs, excessive leukocyte production, and excessive production of platelets. The patient's facial skin and mucous membranes have a dark, flushed appearance because the blood in these tissues is poorly oxygenated. Even though the number of RBCs is greatly increased, their oxygen-carrying capacity is impaired, and patients have poor oxygenation. In PV, bleeding does not occur. Instead, the blood is so thick that it moves more slowly and places increased demands on the heart, resulting in hypertension. In some areas, blood flow may be so slow that stasis occurs.

A patient admitted to the hospital for vasoocclusive crisis with sickle cell disease (SCD) describes moderate to severe pain that is treated with intravenous opioid analgesics. The nurse notes that the provider has ordered routine administration of intravenous hydromorphone rather than a PRN schedule. Which action by the nurse is correct? 1 Contact the provider to verify that the order is correct 2 Explore possible drug-seeking behaviors of the patient 3 Suggest that the patient be evaluated for narcotic addiction 4 Administer the medication and monitor the patient's response

4 Patients with SCD have severe pain; pain management is an important aspect of care. Giving intravenous medications on a routine basis is recommended for the first few days of treatment for a vasoocclusive crisis. It is not necessary to contact the provider to verify the order. Opioid addiction in patients with SCD occurs about 2% to 5% of the time, so unless the patient exhibits specific behaviors associated with addiction, it is not necessary to explore this with the patient or have the patient evaluated for addiction.

A patient with leukemia who is undergoing chemotherapy reports increasing fatigue. A family member tells the nurse that the patient has difficulty eating and asks what the patient should eat to help improve energy. What does the nurse recommend for this patient? 1 Vitamin and mineral supplements 2 Calorie-dense foods such as ice cream 3 Red meats and green, leafy vegetables 4 High-carbohydrate and high-protein foo

4 Patients with fatigue need nutritional counseling to recommend a diet high in carbohydrates and proteins, with smaller, more frequent feedings. Calorie-dense foods can help with weight gain, but choices should have more nutritional value. Red meats and vegetables are not recommended. Vitamins and minerals may be recommended, but not to improve energy levels.

The complete blood count results for a patient with acute myelogenous leukemia shows a platelet count of 40,000/mm 3. Which activity would the nurse instruct the patient to perform? 1 Brush teeth vigorously twice daily. 2 Apply warm soaks to areas of trauma. 3 Wear soft-soled shoes to cushion the feet. 4 Report any abdominal distention immediately.

4 Patients with platelet counts of 40,000/mm 3 are at extreme risk for bleeding. Abdominal distention may represent internal hemorrhage and should be reported immediately. Patients should be instructed to brush teeth carefully, not vigorously, with a sponge or soft-bristled toothbrush; apply ice, not heat, to areas of trauma; and wear hard-soled, not soft-soled, shoes to protect their feet from injury.

A young adult African-American patient receiving intravenous antibiotics for a urinary tract infection reports severe fatigue and pain in all extremities. The nurse assesses a heart rate of 110 beats/min, auscultates an S 3 heart sound, and notes an oxygen saturation of 86%. The patient has no previous history of disease. Which laboratory test will most likely help diagnose sickle cell disease in this patient? 1 Urinalysis 2 Blood culture 3 Complete blood count 4 Hemoglobin electrophoresis

4 Patients with sickle cell trait may never have symptoms until an acute illness is present, since less than 40% of red blood cells are abnormal. Blood culture, complete blood count, and urinalysis may be performed to assist in a complete diagnosis, but hemoglobin electrophoresis will detect underlying sickle cell trait.

Which intervention most effectively protects a patient with thrombocytopenia? 1 Taking rectal temperatures 2 Avoiding the use of dentures 3 Using warm compresses on trauma sites 4 Encouraging the use of an electric shaver

4 The patient with thrombocytopenia should be advised to use an electric shaver instead of a razor. Any small cuts or nicks can cause problems because of the prolonged clotting time. Dentures may be used by patients with thrombocytopenia as long as they fit properly and do not rub. To prevent rectal trauma, rectal thermometers should not be used. Oral or tympanic temperatures should be taken. Ice (not heat) should be applied to areas of trauma.

A patient has pallor; jaundice; a smooth, beefy-red tongue; has been experiencing difficulty with balance and reports tingling of the hands and feet. The patient's lab work indicates macrocytic anemia. The nurse notifies the provider of these findings and anticipates an order for which medication? 1 Steroids 2 Folic acid 3 Iron dextran 4 Vitamin B 12

4 This patient exhibits symptoms of vitamin B12 deficiency anemia, characterized by the symptoms described, and should receive vitamin B 12. Symptoms of folic acid deficiency anemia are similar, but folic acid deficiency anemia does not cause neurologic symptoms. Unless the underlying deficiency of B 12 is addressed, giving iron will not be effective, since B 12 is necessary for synthesizing red blood cells. Steroids are typically given for immunodeficiency anemia.

What disorder is classified by less than 150,000 platelets per microliter? 1 Leukemia 2 Hemophilia 3 Leukocytopenia 4 Thrombocytopenia

4 Thrombocytopenia is characterized by a platelet count of less than 150,000 platelets per microliter. Leukemia, hemophilia, and leukocytopenia are not diagnosed based on platelet counts of less than 150,000.Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

The nurse is to administer packed red blood cells to a patient. How does the nurse ensure proper patient identification? 1 Asks the patient's name 2 Checks the patient's armband 3 Verifies the patient's room number 4 Reviews all information with another registered nurse

4 With another registered nurse, verify the patient by name and number, check blood compatibility, and note expiration time. Human error is the most common cause of ABO incompatibility reactions, even for experienced nurses. Asking the patient's name and checking the patient's armband are not adequate for identifying the patient before transfusion therapy. Using the room number to verify patient identification is never appropriate.