Nursing Assessment and Care of Patients with Hematologic and Lymphatic Disorders > Level- 4: Confident NUPN1510

The nurse is caring for a client who is in disseminated intravascular coagulation (DIC). Which clinical manifestations will the nurse expect to find? Select all that apply. 1. Petechiae 2. Painful joints 3. Dyspnea 4. Abnormal bleeding 5. Fever

1, 2, 3, 4

The nurse is caring for a client with thrombocytopenia. Which bleeding precautions will the nurse implement? Select all that apply. 1. Avoid intramuscular (IM) injections 2. Encourage use of slippers when out of the bed 3. Keep the area free of clutter 4. Instruct the client to blow nose only when necessary 5. Encourage the client to floss teeth frequently

1, 2, 3, 4

The nurse is caring for a client with Hodgkin lymphoma (HL). Which clinical manifestations can the nurse expect to find? Select all that apply. 1. Painless swollen lymph node 2. Generalized pruritus 3. High fever 4. Malaise 5. Cough

1, 2, 4, 5

The nurse is caring for a client with a hematologic disorder. Which clinical manifestations can the nurse expect to find? Select all that apply. 1. Petechiae 2. Increase in energy 3. Weakness 4. Dyspnea 5. Weight gain

1, 3, 4

The nurse is preparing to administer intravenous dextran to a client who weighs 62 kg. The prescribed dose is 20 mL/kg per day. How many milliliters will the nurse administer? Enter the numeral only. 1,240

1,240 Correct Feedback Multiply 62 kg by 20 mL to equal 1240 mL.

The nurse is caring for a client with leukemia. Which interventions will the nurse implement? Select all that apply. 1. Use lemon-glycerin swabs for mouth care daily. 2. Allow periods of rest between activities. 3. Encourage increased fluid intake. 4. Monitor client for signs of infection. 5. Ensure a dietitian is consulted for planning meals.

2, 3, 4, 5

The nurse is preparing to administer red blood cells (RBCs) to a client with anemia. Which interventions should the nurse implement? Select all that apply. 1. Use D5 ½ normal saline (NS) for transfusion 2. Transfuse each unit over 2 hr, and no more than 4 units 3. Use tubing that contains a filter 4. Monitor the client for the first 5 min of the transfusion administration 5. Use two nurses to verify the blood is being transfused to the right client

2, 3, 5

Below are the steps the nurse will take as interventions for a client who is experiencing hemolytic reaction following a blood transfusion. Place the steps in order from start to finish. 1 Infuse normal saline with new tubing. 2 Stay with the client and ask a nurse to notify the health-care provider (HCP). 3 Stop the transfusion. 4 Administer high volumes of fluid as ordered.

3,2,1,4 Correct Feedback The nurse will immediately stop the transfusion. The nurse will stay with the client and request another nurse to notify the HCP. The nurse will infuse normal saline with new tubing to keep the vein open, and administer high volumes of fluid as ordered to decrease shock and hypotension.

The nurse is caring for a client with multiple myeloma. Which clinical manifestations can the nurse expect to find? 1. Joint swelling 2. Headache 3. Vomiting 4. Weight gain

Option 1: Joint swelling and pain is a common symptom.

The nurse is reviewing lab results for a female client with anemia. Which lab result will concern the nurse the most? 1. Red blood cell (RBC) count of 3.1 million/mm3 2. White blood cell count of 6.2/mm3 3. Platelets 180,000/mm3 4. Hemoglobin 12.5 g/100mL

Option 1: RBC is low because the client is anemic.

The nurse is caring for a client with a platelet level of 10,000/mm3. Which intervention will the nurse implement? 1. Initiate bleeding precautions 2. Inform the family that they cannot visit 3. Place the client in protective isolation 4. Administer 1 unit of platelets

Option 1: This client is at high risk for bleeding and should be placed on bleeding precautions.

The nurse is caring for a group of clients. Which client is at highest risk for developing leukemia? 1. An individual with Down syndrome 2. A client with iron deficiency anemia 3. An individual who drinks alcohol 4. A client with hemophilia

Option 1: This client is at high risk for leukemia.

Which disease process causes an accelerated destruction of red blood cells? 1. Renal failure 2. Sickle cell anemia 3. Lung cancer 4. Crohn disease

Option 2: Sickle cell anemia and malaria cause an accelerated destruction of red blood cells.

A client asks the nurse to explain sickle cell anemia. Which response by the nurse is accurate? 1. "This is a type of anemia in which the bone marrow becomes fatty and cannot produce blood cells." 2. "Sickle cell anemia is a result of not including foods high in iron in your diet." 3. "This is an inherited anemia in which hemoglobin is not synthesized normally." 4. "It is an inherited anemia that causes blood cells to take on a crescent shape and clump."

Option 4: This is an accurate description of sickle cell anemia.

The nurse is reviewing lab values for a client experiencing disseminated intravascular coagulation (DIC). Which of these conditions will the nurse expect to find? 1. Increased platelets 2. Increased hemoglobin 3. Prolonged prothrombin time (PT) 4. Increased red blood cell (RBCs)

Option 3: This is an expected finding.

The nurse is caring for a client with suspected lymphoma. For which diagnostic tool will the nurse prepare the client next? 1. Computed tomography 2. Magnetic resonance imaging 3. Lymphangiography 4. Electroencephalogram

Option 3: This is used to determine lymphoma or blockage.

The nurse is reinforcing teaching for a client with hemophilia A. Which statement made by the client indicates a need for further teaching? 1. "I wish there was a cure for hemophilia." 2. "I need to inform my dentist that I have hemophilia." 3. "I will need to take factor VIII to help clot my blood." 4. "I am signed up to play football this year."

Option 4: Contact sports should be avoided.

The nurse is reinforcing teaching for a client who underwent a splenectomy. Which statement made by the client indicates a need for further teaching? 1. "I am at higher risk for infection." 2. "I will be able to live a normal life." 3. "I should have yearly vaccinations." 4. "I am at high risk for bleeding now."

Option 4: The client is not at risk for bleeding.

The nurse is caring for a client with multiple myeloma who reports loss of bladder function. Which action will the nurse take? 1. Insert an indwelling urinary catheter 2. Position the client on their left side while in bed 3. Instruct the client to perform Kegel exercises 4. Notify the health-care provider

Option 4: This can be indicative of spinal cord compression and should be reported.

The nurse is caring for a group of clients. Which client is at highest risk for developing Hodgkin lymphoma (HL)? 1. A 10-year-old girl 2. A 40-year- old woman 3. A 13-year-old boy 4. A 30-year-old man

Option 4: This client is within the ages 15-40 and is male, which place him at higher risk.

The nurse is caring for a client with leukemia who is undergoing chemotherapy and is neutropenic. Which intervention will the nurse implement? 1. Encourage the family to bring flowers for the client 2. Instruct the client to eat fresh fruits and vegetables 3. Administer aspirin when the client complains of fever 4. Ensure all staff and visitors wash hands before visiting

Option 4: This is a correct intervention and will prevent infection.

The nurse is caring for a client with polycythemia vera (PV). Which clinical manifestation can the nurse expect to find? 1. Sore, beefy red tongue 2. Hypotension 3. Tinnitus 4. Abdominal pain

Option 3: This is a common finding in clients with PV.

The nurse is caring for a client with aplastic anemia who begins bleeding from injection sites. Which action should the nurse take first? 1. Administer 2 units of platelets 2. Notify the health-care provider (HCP) 3. Document the finding as normal 4. Check a hemoglobin and hematocrit level

Option 2: The HCP should be notified to determine whether further orders are required.

The nurse is caring for a client who underwent a bone marrow biopsy. Which intervention will the nurse implement following the procedure? 1. Take the client's vital signs every 8 hr. 2. Monitor the site for bleeding and infection. 3. Position the client in supine position. 4. Prepare the client for a chest x-ray.

Option 2: The nurse will monitor the site for signs of bleeding or infection.

The nurse is caring for a client who underwent a splenectomy. This procedure places the client at risk for which of these illnesses? 1. Cancer 2. Meningitis 3. Asthma 4. Anemia

Option 2: This client is at high risk for bacterial infections such as pneumonia and meningitis.

The nurse is caring for a group of clients. Which client will the nurse see first? 1. A client with non-Hodgkin lymphoma (NHL) reporting malaise 2. A client with hemophilia having a nosebleed 3. A client with anemia on the third hour of a blood transfusion 4. A client with leukemia waiting for discharge

Option 2: This client may continue to bleed and should be seen first.

The nurse reads that a client has stage III Hodgkin lymphoma (HL). Which statement accurately describes stage III HL? 1. The most serious form and least curable; located in both lymph nodes and other organs 2. Disease affects nodes on both sides of the diaphragm. 3. Disease is limited to a single lymph node, site, or single organ. 4. Occurs when two or more nodes are involved on the same side of the diaphragm

Option 2: This describes stage III.

The nurse is teaching a client who has iron deficiency anemia about nutrition. Which statement made by the client indicates an understanding of the teaching? 1. "I need to limit the amount of meat I eat." 2. "For dinner, I am eating legumes and chicken." 3. "I have to avoid eating green leafy vegetables." 4. "I love fish, but I'm low in iron and can't eat it."

Option 2: This indicates an understanding of the teaching.

The nurse is caring for a client admitted with sickle cell crisis. Which assessment will the nurse expect to find? 1. Decreased respiratory rate 2. Severe pain in the joints 3. Increased oxygen saturation 4. Elevated hemoglobin

Option 2: This is a common finding in clients in sickle cell crisis.

The nurse is caring for a client with pancytopenia who reports dyspnea upon exertion. Which condition will the nurse assess further? 1. Pain 2. Anemia 3. Neutropenia 4. Thrombocytopenia

Option 2: This is a priority assessment for dyspnea.

The nurse is reviewing lab values for a client with multiple myeloma. Which lab value will concern the nurse the most? 1. Hemoglobin 15.8 g/100mL 2. Calcium 18 mg/dL 3. White blood cell (WBC) 4,800/mm3 4. Platelets 200,000/mm3

Option 2: This is very elevated and should be brought to the health-care provider's attention.

The nurse is assessing a client with anemia. The nurse will expect to document which assessment finding on the client's skin? 1. Jaundice 2. Petechiae 3. Pallor 4. Cyanosis

Option 3: A client with anemia exhibits pallor.

The nurse is caring for a client receiving blood transfusion. The client suddenly develops chest pain, frothy sputum, distended neck veins, and crackles. Which action will the nurse take? 1. Administer a diuretic immediately 2. Stop the transfusion and administer saline 3. Notify the health-care provider (HCP) for orders 4. Call the blood bank and administer a new unit

Option 3: The client is exhibiting symptoms of circulatory overload, and the HCP should be notified.

The nurse is caring for a client in sickle cell crisis. Which intervention will the nurse implement? 1. Apply ice over the painful areas 2. Restrict oral fluids 3. Administer opioid analgesics as ordered 4. Encourage frequent ambulation

Option 3: The client will have pain and should be given opioid analgesics.

How many liters of blood are contained in the human body? 1. 1-3 2. 4-6 3. 7-9 4. 10-12

Option 3: There are 4-6 L of blood.

The nurse is caring for a client undergoing chemotherapy for non-Hodgkin lymphoma (NHL). Which assessment finding will concern the nurse? 1. The client has night sweats. 2. The client has a swollen lymph node. 3. The client has a fever and cough. 4. The client has lost weight.

Option 3: This can be indicative of infection and should be reported.

The nurse is caring for a group of clients with sickle cell anemia. Which client is at high risk for development of sickle cell crisis? 1. A client with fluid volume excess 2. A client with celiac disease 3. A client with pneumonia 4. A client with a sprained ankle

Option 3: This client is at risk for developing sickle cell crisis.