Chapter 20: Hematologic Disorders. Mix of PrepU/ATI/RegisteredRN MCQs

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called A. blast cells. B. megaloblasts. C. monocytes. D. mast cells.

B Megaloblasts are abnormally large erythrocytes. Blast cells are primitive WBCs. Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.

The physician orders a patient with suspected iron-deficiency anemia a blood smear test to assess the quality of the red blood cells. How would the red blood cells appear if the patient had iron- deficiency anemia? A. Hyperchromic and macrocytic B. Hypochromic and microcytic C. Hyperchromic and macrocytic D. Hypochromic and macrocytic

B The RBCs would appear pale (hypochromic) and small (microcytic).

A nurse is administering a unit of packed red blood cells (RBCs) to a client who is postoperative. The client reports itching and has hives 30 min after the infusion begins. Which of the following actions should the nurse take first? A. maintain the IV access with 0.9% sodium chloride. B. stop the infusion of blood C. send the blood container and tubing to the blood bank D. obtain a urine sample

B The nurse should apply urgent vs. non-urgent priority-setting framework. The nurse should stop the infusion of the blood because the client has manifestations of an allergic reaction.

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? The client with enlarged lymph nodes in the neck. The client with painful lymph nodes in the groin. The client with a painful sore throat. The client with painful lymph nodes under the arm.

A Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.

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

A Platelet pheresis is used to remove platelets from the blood in patients with extreme thrombocytosis or essential thrombocythemia (temporary measure)or in a single-donor platelet transfusion.

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

A Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow.

A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for? A. Diarrheal stools B. Laryngeal edema C. Hair loss D. Adventitious lung sounds

A Side effects of radiation therapy are limited to the area being irradiated. Clients who have abdominal radiation therapy may experience diarrhea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal edema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.

A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess? A. A leukocyte count >100,000/mm3 B. Increased number of blast cells C. An enlarged liver D. Lymphadenopathy

A The diagnostic marker of leukemia is the high leukocyte count. Normal WBC count: 5000-10000

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions? A. Avoid contact with family/friends who are sick. B. Encourage frequent handwashing. C. Plan for frequent periods of rest. D. Use a disposable razor when shaving.

D People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Encourage behaviors that will lower the risk for bleeding. Avoiding contact with people who are sick reduces the risk of acquiring an infection. Handwashing reduces the risk of acquiring an infection. Anemia can cause fatigue and shortness of breath with even mild exertion.

When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature? A. Reduced plasma volume in response to a reduced production of cellular elements B. Compensatory polycythemia stimulated by thrombocytopenia C. Increased blood viscosity, resulting from an overproduction of white cells D. Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

D The term leukemia means "white blood," which is used to describe the neoplastic proliferation of one hematopoietic cell type (granulocytes, monocytes, lymphocytes, and sometimes, erythrocytes and megakaryocytes).

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? - Hypermagnesemia - Hypernatremia - Hyperkalemia - Hypercalcemia

Hypercalcemia Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.

A nurse is reviewing a client's repeat lab results 4 hours after administering fresh frozen plasma (FFP). Which of the following lab results should the nurse review? A. Prothrombin time B. WBC count C. Platelet count D. Hematocrit

A FPP is a plamsa rich in clotting factors. FFP is administered to treat acute clotting disorders. The desired effect is a decrease in prothrombin time and it should be evaluated after FFP administration.

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia? A. Erythrocytes that are microcytic and hypochromic B. Clustering of platelets with sickled red blood cells C. An increased number of erythrocytes D. Erythrocytes that are macrocytic and hyperchromic

A For iron-deficiency anemia, a blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal).

A nurse is caring for an older client who has been admitted to the unit with iron-deficiency anemia. What would the nurse suspect? Blood loss from the gastrointestinal or genitourinary tract Excessive consumption of coffee or tea Decrease in the total body iron stores with age Elimination of iron by the body

A If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tract is suspected. This is because iron deficiency anemia is unusual in older adults as the body does not eliminate excessive iron, causing total body iron stores to increase with age.

A client has been diagnosed with polycythemia vera. What is the best instruction for the nurse to give to this client? A. Drink alcohol to decrease blood viscosity B. Take a daily multivitamin with iron supplement C. Bath in tepid or cool water to control itching D. Maintain adequate blood pressure control

D The client with polycythemia vera needs to control blood pressure, because of the increased risk for thrombosis or hemorrhage. Iron supplements can stimulate red blood cell production. Ingestion of alcohol may cause bleeding. Bathing in cool or tepid water may control itching, but this is not as high a priority as preventing thrombosis or hemorrhage.

Which statement indicates the client understands teaching about induction therapy for leukemia? "I will be in the hospital for several weeks." "I will start slowly with medication treatment." "I will need to come every week for treatment." "I know I can never be cured."

A Induction therapy involves high doses of several medications and the client is usually admitted to the hospital for several weeks. The treatment is started quickly and the goal is to cure or put the disease into remission.

Which client is most at risk for developing disseminated intravascular coagulation (DIC)? A client admitted with suspected cocaine overdose A client with a stage IV pressure ulcer A client with heart failure and renal failure A client with an amniotic fluid embolism

D The client with the amniotic fluid embolism (Complication of pregnancy) is at greatest risk for developing DIC. Other risk factors for developing DIC include trauma, cancer, shock, and sepsis.

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? - Apply prolonged pressure to needle sites or other sources of external bleeding. - Monitor temperature at least once per shift. - Eliminate direct contact with others who are infectious. - Implement neutropenic precautions.

Apply prolonged pressure to needle sites or other sources of external bleeding. For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.

A nurse is transfusing a unit of B-positive fresh frozen plasma to a client whose blood type is O-negative. Which of the following actions should the nurse take? A. Continue to monitor for manifestations of a transfusion reaction. B. Remove the unit of plasma immediately and start an IV infusion of a normal saline solution. C. Continue the transfusion and repeat the type and crossmatch. D. Prepare to administer a dose of diphenhydramine IV.

B A client who receives FFP that is not compatible (as in this case) can experience a hemolytic transfusion reaction. The nurse should stop the transfusion STAT and infuse 0.9% sodium chloride solution with new tubing.

Which of the following is the most common hematologic condition affecting elderly patients A. Leukopenia B. Anemia C. Thrombocytopenia D. Bandemia

B Anemia is the most common hematologic condition affecting elderly patients: with each successive decade of life, the incidence of anemia increases.

A nurse assesses a client who has been diagnosed with DIC. Which indicators are consistent with this diagnosis? Select three that apply. A. Cyanosis in the extremities B. Capillary fill time <3 seconds C. Dyspnea and hypoxia D. Increased breath sounds E. Increased blood urea nitrogen (BUN) and creatinine F. Polyuria

A, C, E At early phase of DIC, clotting occurs systemically, leading to ischemia of tissues (cyanosis and increased capillary fill time). Due to blockage of vessels of the lungs, dyspnea nad hypoxia occur. Also, DIC affects sensitive organs such as brain, heart, lungs, and the kidney. Decreased blood flow to the kidney results in increased BUN and Cr, indicating reduced renal function.

Which of the following is the only curative treatment for chronic myeloid leukemia (CML)? - Idarubicin - Cytarabine - Allogeneic stem cell transplant - Imatinib

Allogeneic stem cell transplant Allogeneic stem cell transplantation remains the only curative treatment for CML.

The nurse is providing palliative care for a 69-year-old patient who has a diagnosis of multiple myeloma. The patient states that she enjoyed good health for most of her life and rarely had to visit her family health care provider until she experienced the first signs and symptoms of her current illness. Which of the following complaints most likely prompted the patient to initially seek care? A. Fatigue and activity intolerance B. Bone pain C. Lymphadenopathy D. Recurrent infections

B As many as 90% of patients with multiple myeloma develop bone lesions. Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. For elderly patient presenting with bone pain, multiple myeloma should always be included in differential Dx.

A nurse is reviewing lab values for an adult client who has sickle cell anemia and a history of receiving blood transfusions. For which of the following complications should the nurse monitor? A. Hypokalemia B. Lead poisoning C. Hypercalcemia D. Iron toxicity

D

A nurse is developing a care plan for a client with disseminated intravascular coagulation (DIC). Which nursing intervention should the nurse include? Administer aspirin daily as ordered. Provide mouth care every 4 hours with lemon-glycerin swabs. Administer meperidine (Demerol) I.M. as needed for pain. Place a pressure-reducing mattress on the client's bed.

D A client with DIC is at risk for Impaired skin integrity secondary to bleeding or ischemia. The nurse should place the client on a pressure-reducing mattress and perform skin care every 2 hours. The nurse should avoid administering any medication that decreases platelet function, such as aspirin.

A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy? A. It will increase red blood cell (RBC) production to compensate for blood loss. B. It will increase production of platelets by the bone marrow. C. It will reduce the destruction of platelets by macrophages. D. It will remove the major site of red blood cell (RBC) destruction.

D For clients with autoimmune hemolytic anemia, if corticosteroids do not produce remission, a splenectomy (i.e., removal of the spleen) may be performed because it removes the major site of RBC destruction.

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

D In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia.

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for? A. Bleeding B. Diarrhea C. Abdominal pain D. The onset of a bacterial infection

D Lymphopenia (a lymphocyte count less than 1,500/mm3) can result from ionizing radiation, long-term use of corticosteroids, uremia, infections (particularly viral infections), some neoplasms (e.g., breast and lung cancers, advanced Hodgkin disease), and some protein-losing enteropathies (in which the lymphocytes within the intestines are lost) When lymphopenia is mild, it is often without sequelae; when severe, it can result in bacterial infections (due to low B lymphocytes) or in opportunistic infections (due to low T lymphocytes).

A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? - Medicate the client to relieve pain. - Place a cooling blanket on the client. - Evaluate the client for potential infection. - Administer an antitussive.

Evaluate the client for potential infection. The client with leukemia has a lack of mature and normal granulocytes to fight infection. For this reason, the client is susceptible to infection. The primary nursing intervention is to evaluate for potential infection if the client has a cough and increased fatigue. Administering an antitussive would not be appropriate before determining the cause of the cough. A cooling blanket would not be needed if the client does not have a fever. Medicating the client to relieve pain would come after the assessment phase.

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? - Multiple myeloma - Leukemia - Hemolytic anemia - Polycythemia vera

Multiple myeloma The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

Which nursing intervention is most appropriate for a client with multiple myeloma? - Restricting fluid intake - Preventing bone injury - Monitoring respiratory status - Balancing rest and activity

Preventing bone injury When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict his fluid intake.

A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: - hypoxemia. - pathologic bone fractures. - chronic liver failure. - acute heart failure.

pathologic bone fractures. Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.

A patient's complete blood count (CBC) results are back. Which result demonstrates polycythemia? A. RBC 10 million B. WBC 15,000 C. Platelets 600,000 D. RBC 2.5 million

A

A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and her condition is now becoming life-threatening. The nurse is aware that a treatment option in this case may include what? A. Splenectomy B. Vitamin K administration C. Platelet transfusion D. Hepatectomy

A A splenectomy may be the course of treatment if autoimmune hemolytic anemia does not respond to conservative treatment. Vitamin K administration is treatment for vitamin K deficiency. Platelet transfusion may be the course of treatment for some bleeding disorders. Hepatectomy is not a relevant intervention.

A 20-year-old patient has been admitted to the emergency department with a femoral fracture as a result of a motorcycle accident. When the nurse is taking the patient's history, the patient states, "I had leukemia when I was little kid but they managed to cure it." The nurse should suspect that this patient likely had what type of leukemia? A. Acute lymphoid leukemia (ALL) B. Chronic lymphoid leukemia (CLL) C. Acute myeloid leukemia (AML) D. Chronic myeloid leukemia (CML)

A ALL is most common in young children, with boys affected more often than girls; the peak incidence is 4 years of age. After 15 years of age, ALL is relatively uncommon. CLL, AML, and CML are all more common in adults and older adults than in children.

Select the patient below who is at MOST risk for pernicious anemia: A. A 75 year old male who recently had surgery on the ileum. B. A 25 year old female who reports craving ice and clay. C. A 66 year old male whose peripheral blood smear showed hypochromic red blood cells. D. All the patients above are at risk for pernicious anemia.

A Patients who've had GI surgery (the ileum is part of the GI system), have endocrine disorders (like Addison's Disease, Diabetes Type 1 etc.), or GI disease are at risk for pernicious anemia. This reason is because as the person ages GI secretions decrease along with intrinsic factor and with GI surgery the parietal cells can be damaged (which are responsible for secreting intrinsic factor). So, the patient in option A is at most risk. Options B and C are risk factors for IRON-DEFICIENCY anemia (not pernicious anemia).

A nurse is planning care for a client who has pernicious anemia. Which of the following interventions should the nurse include in the plan? A. Administer ferrous sulfate supplementaion B. Increase dietary intake of folic acid C. Initiate weekly injections of Vit B12 D. Initiate a blood transfusion

C Pernicious anemia is caused by a lack of intrinsic factor needed to absorb Vit B12 from GI track.

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client? A. Pernicious anemia B. Aplastic anemia C. Iron-deficiency anemia D. Agranulocytosis

B Clients with a plastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client's blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. The blood cell count shows insufficient numbers of blood cells. A bone marrow aspiration confirms that the production of stem cells is suppressed. This scenario does not describe a client with pernicious anemia, iron-deficiency anemia, or agranulocytosis.

The nurse is caring for a pt diagnosed with ALL receiving initial treatment. The pt has been complaining of a dry cough. She also has diminished breath sounds upon auscultation. Which of the following should the nurse monitor as priority with regards to potential complications in this pt? A. hemoglobin B. Absolute Neutrophil Count C. hematocrit D. urine

B Dry cough and diminished breath sound may suggest infection in the respiratory system. Infections are common complications of ALL and should be monitored and prioritized.

An elderly client is hospitalized for induction of chemotherapy to treat leukemia. The client reports fatigue to the nurse. What nursing intervention would best address the client's fatigue? A. Talk to the family about not visiting so the client can obtain rest. B. Assist the client to sit in a chair for meals. C. Provide sedentary activities only, such as watching television. D. Have the client maintain complete bedrest.

B Fatigue is a common symptom with clients who have leukemia. Despite the fatigue, clients still need to maintain some physical activity. An example of physical activity is having the client sit in a chair for meals. The nurse does not want to encourage complete bedrest or sedentary activities, such as watching television, due to possible deconditioning. The nurse has not discussed with the client about limiting family visits. The client may want some family to visit.

While assessing a client, the nurse will recognize what as the most obvious sign of anemia? A. Flow murmurs B. Pallor C. Tachycardia D. Jaundice

B On physical examination, pallor is the most common and obvious sign of anemia. Other findings may include tachycardia and flow murmurs. Patients with hemolytic anemia may exhibit jaundice and splenomegaly.

The nurse practitioner suspects that a patient has multiple myeloma based on his major presenting symptom and the analysis of his laboratory results. Select the classic symptom for this disease. - Severe thrombocytopenia - Bone pain in the back of the ribs - Gradual muscle paralysis - Debilitating fatigue

Bone pain in the back of the ribs Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; patients may report that they have less pain on awakening but the pain intensity increases during the day.

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

C Complications of AML include bleeding due to lack of functional platelet production. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3.

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

C During the pre-transfusion assessment, the nurse should carefully inspect for any signs of cardiac failure, such as jugular venous distention.

A client with multiple myeloma presents to the emergency department and reports excessive thirst and constipation. Family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? A. Serum sodium level of 133 mEq/L B. Platelet count 300,000/mm3 C. Serum calcium level 13.8 mg/dl D. Hemoglobin of 9.8 g/dl

C Excessive thirst, constipation, dehydration, confusion, and altered mental state are possible signs of hypercalcemia. Hypercalcemia is common in multiple myeloma because of the increased bone destruction. A platelet count of 300,000/mm3 is normal and wouldn't cause the client's symptoms. A sodium level of 133 mEq/L is slightly decreased but wouldn't cause confusion and excessive thirst. A hemoglobin of 9.8 g/dl level is slightly low but isn't likely responsible for the client's symptoms.

A nurse cares for a client with early Hodgkin lymphoma. While assessing the client, the nurse will most likely find painless enlargement of which lymph node? A. Popliteal B. Axillary C. Inguinal D. Cervical

D Non painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.

You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching? A. "Pernicious anemia is caused by not consuming enough Vitamin B12." B. "Pernicious anemia causes the red blood cells to appear very large and oval." C. "Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12." D. "A red, smooth tongue can be a sign of pernicious anemia.

A This statement is wrong because pernicious anemia is caused by the patient lacking intrinsic factor which helps with the absorption of vitamin B12. The patient can consume supplements or foods with vitamin B12, but they will not absorb B12 because they lack intrinsic factor. All the other statements are correct about pernicious anemia.

A patient with a diagnosis of immune thrombocytopenic purpura (ITP) is currently receiving IVIG for the treatment of her health condition. The nurse who is providing this patient's care is aware that ITP is a consequence of: A. Impaired liver function and the sequestering of platelets by hepatocytes B. Platelet destruction and impaired platelet production resulting from an autoimmune process C. Hemolysis of platelets in individuals who lack immunity to the Epstein-Barr virus D. Inappropriate platelet aggregation on the walls of the great vessels

B Although the precise cause of ITP remains unknown, the platelet count is decreased by a combination of autoantibody-mediated platelet destruction and impaired platelet production secondary to autoantibody effects on the megakaryocyte. Viruses, impaired liver function, and inappropriate platelet aggregation are not dimensions of the etiology of ITP.

A nurse is caring for a client who has hemophilia. The client reports pain and swelling in a joint following an injury. Which of the following actions should the nurse take? A. Obtain blood samples to test platlet function. B. Prepare for replacement of the missing clotting factor. C. Administer aspirin for the client's pain. D. Place the bleeding joint in the dependent position.

B Hemophilia is a hereditary bleeding disorder in which blood clots slowly and abnormal bleeding occurs. It is caused by a deficiency in certain clotting factor, most commonly factor VIII (hemophilia A). Aggressive factor replacement is initiated to prevent hemarthrosis (bleeding into a joint). Not A- coag test are used for diagnosis of bleeding disorder, not as a treatment Not D- The affected joint should be elevated to allow blood to drain away from the joint.

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms? A. Folate B. Thiamine C. B12 D. Iron

C The hematologic effects of vitamin B12 deficiency are accompanied by effects on other organ systems, particularly the gastrointestinal tract and nervous system. Patients with pernicious anemia may become confused; more often, they have paresthesias in the extremities (particularly numbness and tingling in the feet and lower legs). They may have difficulty maintaining their balance because of damage to the spinal cord, and they also lose position sense (proprioception).

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? A. Vitamin C B. Folate C. Vitamin B12 D. Vitamin A

C The medication metformin (Glucophage) increases the client's risk for developing B12 deficiency because the medication inhibits the absorption of B12.

Mrs. Jones is being treated for sepsis. On the second day caring for her, she experiences epistaxis and persistent bleeding from a venipuncture site. The nurse suspects DIC. Which of the following lab results supports the nurse's suspicion? A.) increased fibrinogen, decreased PTT, decreased platelets B.) decreased fibrinogen, increased PTT, increased platelets C.) decreased fibrinogen, increased PTT, decreased platelets D.) increased fibrinogen, increased PTT, increased platelets

C With DIC, the body uses up the clotting factors and becomes more prone to bleeding. This would be reflected as decreased fibrinogen and platelets and increased PTT (clotting time).

A nurse is assessing a client for manifestations of aplastic anemia. Which of the following findings should the nurse expect? A. Plethoric appearance of facial skin B. Glossitis and weight loss C. Jandice with an enlarged liver D. Petechiae and ecchymosis

D Petechiae and ecchymosis are signs of aplastic anemia; all three major blood components are reduced or absent in aplastic anemia because the bone marrow does not make enough new blood cells.

The client is diagnosed with polycythemia vera. The nurse prepares the client for which procedure? A. Apheresis B. Blood transfusion C. Platelet infusion D. Phlebotomy

D Polycythemia vera is a condition in which the blood contains a large amount of red blood cells, increasing the viscosity of the blood. Phlebotomy is a preferred treatment to rid the circulation of excess red blood cells. Apheresis is a process in which platelets and leukocytes are removed from the blood. Blood and platelet infusions can exacerbate this condition.

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

A As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? Assess the client's hemoglobin and platelets. Assess the client's skin. Assess the client's pulse and blood pressure. Check the client's history.

A Clients with AML may develop pallor from anemia and a tendency to bleed because of a low platelet count. Assessing the client's hemoglobin and platelets will help to determine whether this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.

A home care nurse is caring for a client with multiple myeloma. Which nursing interventions are appropriate for this client? Select all that apply. A. Assist with ambulation because exercise can worsen loss of calcium from the bone. B. Monitor renal function C. Delay position changes and bathing if the client is experiencing pain. D. Limit fluid intake. E. Instruct the client to avoid activities that may cause injury.

B, C, E Pain can become quite severe. Delay position changes and bathing until analgesic has reached peak concentration level and the client is experiencing maximum pain relief. Safety is paramount because any injury, no matter how slight, can result in a fracture. The nurse assists the client with ambulation because immobility can worsen loss of calcium from the bone. The nurse provides up to 4000 mL of fluid to prevent renal damage from hypercalcemia and precipitation of protein in the renal tubules.

The nurse caring for an older adult with a diagnosis of leukemia would encourage the client to use an electric razor. What is the rationale for this statement by the nurse? Strong tissues and intact clotting mechanisms may prevent hemorrhage. The client is not at risk for infection from microorganisms. Trauma and microabrasions from a non-electric razor may contribute to anemia. The client is at risk for spontaneous and uncontrolled bleeding.

C In a client with leukemia who is at risk for hemorrhage, the nurse handles the client gently when assisting and encourages the client to use electric razors. Trauma and microabrasions from razors may contribute to anemia from bleeding.

A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia? Chronic lymphocytic leukemia Acute myelogenous leukemia Chronic myelogenous leukemia Acute lymphocytic leukemia

A Clients with CLL are typically older than 40 years of age, have increased immature lymphocytes, normal or decreased granulocytes, but erythrocyte and platelet counts may be normal or low. Clients with ALL are younger than 5 years of age; uncommon after 15 years of age.

The nurse is caring for a patient with Hodgkin lymphoma in the hospital and preparing discharge planning education. Knowing that this patient is at risk for the development of a second malignancy, what education would be beneficial to reduce the risk factors? (Select three that apply.) A. Smoking cessation B. Decrease intake of antipyretic medications such as acetaminophen C. Reduce exposure to excessive sunlight D. Decrease fat intake E. Decrease alcohol intake

A,C,E The potential development of a second malignancy should be addressed with the patient when initial treatment decisions are made. However, patients should also be told that Hodgkin lymphoma is often curable. The nurse should encourage patients to reduce other factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and exposure to environmental carcinogens and excessive sunlight.

A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for? A. Aplastic anemia B. Pernicious anemia C. Sickle cell anemia D. Iron deficiency anemia

B A deficiency of vitamin B 12 can occur in several ways. Inadequate dietary intake is rare but can develop in strict vegans (who consume no meat or dairy products). Faulty absorption from the GI tract is a more common cause. This occurs in conditions such as Crohn's disease, or after ileal resection or gastrectomy.

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? A. Dairy products B. Beans, dried fruits, and leafy, green vegetables C. Fruits high in vitamin C, such as oranges and grapefruits D. Berries and orange vegetables

B Food sources high in iron include organ meats (e.g., beef or calf liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy and green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

The nurse is currently planning the care of a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood work, what value would the nurse pay particular attention to? A. Elevated red blood cell (RBC) count B. Hypercalcemia C. Elevated serum viscosity D. Hyperproteinemia

B Hypercalcemia may occur when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin. RBC count will be decreased. Hyperproteinemia would not be present.

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? A. Osteopathic tumors destroy bone causing fractures. B. Osteolytic activating factor weakens bones producing fractures. C. Osteoclasts break down bone cells so pathologic fractures occur. D. Osteosarcomas form producing pathologic fractures.

C In multiple myeloma, the abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This in turn causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a 'punched-out' or 'honeycombed' appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain

The nurse recognizes the clinical assessment of a patient with acute myeloid leukemia (AML) includes observing for signs of infection early. What nursing action will most likely help prevent infection? A. Encourage increased fluid consumption. B. Monitor the client's temperature every shift. C. Practice vigilant handwashing. D. Maintain contact precautions.

C Infection prevention is best handled by vigilant handwashing. Monitoring the client's temperature once a shift is not often enough. The client will take precautions, but precautions are enough to prevent infections. Encouraging increased fluid consumption will not prevent infection.

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? A. Pallor, bradycardia, and reduced pulse pressure B. Sore tongue, dyspnea, and weight gain C. Pallor, tachycardia, and a sore tongue D. Angina pectoris, double vision, and anorexia

C Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina pectoris; weakness; fatigue; and paresthesia of the hands and feet. *Beefy red tongue is due to atrophy (cell death) of papillary cells on the tongue.