Hematology

The health care provider orders an ultrasound of the spleen for a patient who has been in a car accident. Which action should the nurse take before this procedure? a. Check for any iodine allergy. b. Insert a large-bore IV catheter. c. Place the patient on NPO status. d. Assist the patient to a flat position.

d. Assist the patient to a flat position

All of these patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first? a. 19-year-old with no previous health problems who has a nontender lump in the axilla b. 46-year-old with sickle cell anemia who says that my eyes always look sort of yellow c. 21-year-old with hemophilia who wants to learn how to self-administer factor VII replacement d. 50-year-old with early-stage chronic lymphocytic leukemia who has complaints of chronic fatigue

a. 19-year-old with no previous health problems who has a nontender lump in the axilla

518 The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor? a. Age younger than 50 years b. History of colorectal polyps c. Family history of colorectal cancer d. Chronic inflammatory bowel disease

a. Age younger than 50 years

While examining the lymph nodes during physical assessment, the nurse would be most concerned about a. a 2-cm nontender supraclavicular node. b. a 1-cm mobile and nontender axillary node. c. an inability to palpate any superficial lymph nodes. d. firm inguinal nodes in a patient with an infected foot.

a. a 2-cm nontender supraclavicular node

The nurse who is reviewing laboratory data for an 86-year-old patient will be most concerned about a. a white blood cell (WBC) count of 3500/mL. b. a hematocrit of 37%. c. a platelet count of 400,000/mL. d. a hemoglobin of 11.8 g/dL.

a. a white blood cell (WBC) count of 3500/mL

Clients with anemia will typically have which of the following symptoms? a. dyspnea and fatigue b. anorexia c. depression d. diarrhea alternating with constipation

a. dyspnea and fatigue

A patient with type A hemophilia has been admitted to the hospital with severe pain and swelling in the right knee. During the initial care of the patient, the nurse should a. immobilize the knee. b. apply heat to the joint. c. assist the patient with light weight bearing. d. perform passive range of motion to the knee.

a. immobilize the knee

After receiving change-of-shift report for the following four patients with neutropenia, which patient should the nurse assess first? a. 66-year-old who has white pharyngeal lesions b. 35-year-old who has a fever of 100.8 F (38.2 C) c. 56-year-old who has frequent explosive diarrhea d. 23-year old who is complaining of severe fatigue

b. 35-year-old who has a fever of 100.8 F

Which of the following assessment data obtained by the nurse when caring for a patient with thrombocytopenia should be immediately communicated to the health care provider? a The platelet count is 52,000/l. b. The patient is difficult to arouse. c. There are large bruises on the back. d. There are purpura on the oral mucosa.

b. The patient is difficult to arouse

When caring for a patient with a chronic iron deficiency anemia, the nurse will assess for a. yellow-tinged sclerae. b. shiny, smooth tongue. c. numbness of the extremities. d. gum bleeding and tenderness.

b. shiny, smooth tongue

The patient is 15 minutes into receiving a blood transfusion and his temperature has gone up by 2 degrees. The first intervention by the nurse is to: a. administer Tylenol b. check a CBC c. stop the transfusion d. call the physician

c. stop the transfusion

When reviewing the complete blood count (CBC) for a patient admitted with abdominal pain, which information will be most important for the nurse to communicate to the health care provider? a. Monocytes 4% b. Hemoglobin 11.6 g/dL c. Platelet count 145,000/L d. White blood cells (WBCs) 13,500/L

d. White blood cells (WBCs) 13,500/L

A patient who complains of fatigue and paresthesias in the extremities is found to be anemic. The nurse knows that the patient most likely has: a. iron-deficiency anemia b. hemolytic anemia c. folate deficiency anemia d. pernicious anemia

d. pernicious anemia

When evaluating the red cell indices of a patient, the nurse knows that a low mean corpuscular volume (MCV) indicates a. hypochromic red blood cells (RBCs). b. inadequate numbers of RBCs. c. low hemoglobin in the RBCs. d. small size of the RBCs

d. small size of the RBCs

Which newly admitted patient should the nurse assign as a roommate for a patient who has aplastic anemia? a. A patient with severe heart failure b. A patient who has viral pneumonia c. A patient who has right leg cellulitis d. A patient with multiple abdominal drains

a. A patient who has viral pneumonia

The nurse is creating a plan of care for the client with multiple myeloma and includes which prority intervention in the plan? a. Encouraging fluids b. Providing frequent oral care c. Coughing and deep breathing d. Monitoring the red blood cell count

a. Encouraging fluids rationale: Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubles. Options 2, 3, and 4 may be components of the plan of care but are not the priority in this client.

513 The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply a. Facial edema in the morning b. Weight loss of 20 lb (9kg) in 1 month c. Serum calcium level of 12 mg/dL (3.0 mmol/L) d. Serum sodium level of 136 mg/dL (136 mmol/L) e. Serum potassium level of 136 mg/dL (3.4 mmol/L) f. Numbness and tingling of the lower extremities

a. Facial edema in the morning c. Serum calcium level of 12 mg/dL (3.0 mmol/L) f. Numbness and tingling of the lower extremities

After the nurse has finished teaching a patient about taking oral ferrous sulfate, which patient statement indicates that additional instruction is needed? a. I will call the doctor if my stools start to turn black. b. I will take a stool softener if I feel constipated occasionally. c. I should take the iron with orange juice about an hour before eating. d. I should increase my fluid and fiber intake while I am taking the iron tablets.

a. I will call the doctor if my stools start to turn black

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? a. Increased calcium levels b. Increased white blood cells c. Decreased blood urea nitrogen level d. Decreased number of plasma cells in the bone marrow

a. Increased calcium levels rationale: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.

Which nursing action will be included in the plan of care for a patient admitted with multiple myeloma? a. Monitor fluid intake and output. b. Administer calcium supplements. c. Assess lymph nodes for enlargement. d. Limit weight-bearing and ambulation.

a. Monitor fluid intake and output

A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take? a. Notify the patients physician. b. Avoid unnecessary venipunctures. c. Apply sterile dressings to the sites. d. Give prescribed proton-pump inhibitors.

a. Notify the patients physician

Which menu choice indicates that the patient understands the nurses teaching about best dietary choices for iron-deficiency anemia? a. Omelet and whole wheat toast b. Cantaloupe and cottage cheese c. Strawberry and banana fruit plate d. Cornmeal muffin and orange juice

a. Omelet and whole wheat toast

516 The nurse is conduction a history and monitoring laboratory values on a client with multiple myeloma. What assessment findings should the nurse expect to note? Select all that apply a. Pathological fracture b. Urinalysis positive for nitrites c. Hemoglobin level of 15.5 g/dL (155 mmol/L) d. Calcium level of 8.6 mg/dL (2.15 mmol/L e. Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L)

a. Pathological fracture b. Urinalysis positive for nitrites e. Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L)

523 A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the health care provider will request which prescriptions? Select all that apply a. Radiation b. Chemotherapy c. Increased fluid intakes d. Decreased oral sodium intake e. Serum sodium level determination f. Medication that is antagonistic to antidiuretic hormone

a. Radiation b. Chemotherapy e. Serum sodium level determination f. Medication that is antagonistic to antidiuretic hormone

The home health care nurse is caring for a client with cancer who is complaining of acute pain. The most appropriate determination of the the client's pain should include which assessment? a. The client's pain rating b. Nonverbal cues from the client c. The nurse's impression of the client's pain d. Pain relief after appropriate nursing intervention

a. The client's pain rating rationale: The client's self-report is a critical component of pain assessment. The nurse should ask the client to describe the pain and listen carefully to the words the client uses to describe the pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. The nurse's impression of the client's pain is not appropriate in determining the client's level of pain. Assessing pain relief is an important measure, but this option is not related to the subject of the question.

520 The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment finding indicates that the colostomy is beginning to function? a. The passage of flatus b. Absent bowel sounds c. The client's ability to tolerate food d. Bloody drainage from the colostomy

a. The passage of flatus

The nurse is caring for a patient with immune thrombocytopenic purpura (ITP) who has an order for a platelet transfusion. Which patient information indicates that the nurse should consult with the health care provider before administering platelets? a. The platelet count is 42,000/mL. b. Blood pressure (BP) is 94/56 mm Hg. c. Blood is oozing from the venipuncture site. d. Petechiae are present on the chest and back.

a. The platelet count is 42,000/mL

When doing discharge teaching for a patient who has had an emergency splenectomy following an automobile accident, the nurse will teach the patient about the increased risk for a. infection. b. lymphedema. c. chronic anemia. d. prolonged bleeding.

a. infection

Interventions for a hemophilliac patient who is experiencing an episode of bleeding into a joint may include (select all that apply) a. monitoring of vital signs b. checking for infection c. rest the joint d. administering aspirin for pain e. administering replacement factor

a. monitoring of vital signs c. resting the joint e. administering replacement factor

If a patient is experiencing bruising and bleeding, it may be caused by a deficiency of : a. platelets b. red blood cells c. white blood cells d. neutrophils

a. platelets

While obtaining a health history from a patient with numerous petechiae on the skin, the nurse asks the patient specifically about the patients use of a. salicylates. b. contraceptives. c. antiseizure drugs. d. antihypertensives.

a. saliclates

The patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about (select all that apply)? a. Strict hand washing b. Daily nasal swabs for culture c. Encourage eating all foods to increase nutrients d. Monitor temperature every hour e. Daily skin care and oral hygiene

a. strict hand washing e. daily skin care and oral hygiene

The nurse is caring for a client who is postoperative following a pelvic exenteration and the health care provider changes the client's diet from NPO (nothing by mouth) status to clear liquids. The nurse should check which priority item before administering the diet? a. Bowel sounds b. Ability to ambulate c. Incision appearance d. Urine specific gravity

a.Bowel sounds rationale: The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. The most important assessment is to assess bowel sounds before feeding the client. Options b, c, and d are unrelated to the data in the question

Which nursing intervention will be included in the care plan for a patient with immune thrombocytopenic purpura (ITP)? a. Assign the patient to a private room. b. Avoid intramuscular (IM) injections. c. Use rinses rather than a toothbrush for oral care. d. Restrict activity to passive and active range of motion.

b. Avoid intramuscular (IM) injections

519 The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is most appropriate? a. Clamp the surgical darin b. Change the dressing as prescribed c. Notify the health care provider (HCP) d. Remove and replace the perineal packing

b. Change the dressing as prescribed

Which action will be included in the care plan for a hospitalized patient who is neutropenic? a. Avoid any IM or subcutaneous injections. b. Check the oral temperature every 4 hours. c. Omit all fruits or vegetables from the diet. d. Place a No Visitors sign on the patient door.

b. Check the oral temperature every 4 hours

A patients complete blood count shows a hemoglobin of 20 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding? a. Has there been any recent weight loss? b. Do you have any history of lung disease? c. What is your intake of fruits and vegetables? d. Have you noticed any dark or bloody stools?

b. Do you have any history of lung disease?

529 The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? a. Placing cool compresses on the affected arm b. Elevating the affected arm on a pillow above heart level c. Avoiding arm exercises in the immediate postoperative period d. Maintaining an intravenous site below the antecubital area on the affected side

b. Elevating the affected arm on a pillow above heart level

A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT). Which action will the nurse include in the plan of care? a. Use low-molecular-weight heparin (LMWH) only. b. Flush all intermittent IV lines using normal saline. c. Administer the warfarin (Coumadin) at the scheduled time. d. Teach the patient about the purpose of platelet transfusions.

b. Flush all intermittent IV lines using normal saline

521 The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common sign or symptom of this type of cancer? a. Dysuria b. Hematuria c. Urgency on urination d. Frequency of urination

b. Hemaruria

A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature 102 F (38.9 C), and severe back pain. Which of these physician orders will the nurse implement first? a. Administer morphine sulfate 4 mg IV. b. Infuse normal saline 500 mL over 30 minutes. c. Draw blood for complete blood count and coagulation studies. d. Give acetaminophen (Tylenol) 650 mg for temperature 102 F or higher.

b. Infuse normal saline 500 mL over 30 minutes

When caring for a client with an internal radiation implant, the nurse should observe which principles? Select all that apply a. Limiting the time with the client to 1 hour per shift b. Keeping pregnant women out of the client's room c. Placing the client in a private room with a private bath d. Wearing a lead shield when providing direct client care e. Removing the dosimeter film badge when entering the client's room. f. Allowing individuals younger than 16 years old in the room as long as they are 6 feet away from the client

b. Keeping pregnant women out of the client's room c. Placing the client in a private room with a private bath d. Wearing a lead shield when providing direct client care rationale: The time that the nurse spends in the room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The client must be placed in a private room with a private radiation. The dosimeter film badge must be worn when in the client's room. children younger than 16 years of age and pregnant women are not allowed in the client's room.

Which nursing action should the nurse delegate to nursing assistive personnel (NAP) when administering a transfusion of packed red blood cells (PRBCs) to a patient with blood loss? a. Verify the patient identification (ID) according to hospital policy. b. Obtain the temperature, blood pressure, and pulse before the transfusion. c. Double-check the product numbers on the PRBCs with the patient ID band. d. Monitor the patient for shortness of breath or chest pain during the transfusion.

b. Obtain the temperature, blood pressure, and pulse before the transfusion

528 A client is diagnosed as having a bowel tumor. The nurse should monitor the client for which complications of this type of tumor? Select all that apply. a. Flatulence b. Peritonitis c. Hemorrhage d. Fistula formation e. Bowel perforation f. Lactose intolerance

b. Peritonitis c. Hemorrhage d. Fistula formation e. Bowel perforation

A patient is admitted to the hospital with idiopathic aplastic anemia. Which of these collaborative problems will the nurse include when developing the care plan? a. Potential complication: seizures b. Potential complication: infection c. Potential complication: neurogenic shock d. Potential complication: pulmonary edema

b. Potential complication: infection

515 The nurse is instructing a client to perform a testicular self-examination (TSE). The nurse should provide the client with which information about the procedure? a. To examine the testicles while lying down b. That the best time for the examination is after a shower c. To gently feel the testicle with 1 finger to feel for a growth d. That TSEs should be done at least every 6 months

b. That the best time for the examination is after a shower

During the admission assessment of a patient with hemolytic anemia, the nurse notes jaundice of the sclerae. The nurse will plan to check the laboratory results for a. the Schilling test. b. the bilirubin level. c. the stool occult blood test. d. the gastric analysis testing.

b. The bilirubin level

514 A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition? a. Rupture of the bladder b. The development of a vesicovaginal fistula c. Extreme stress caused by the diagnosis of cancer d. Altered perineal sensationas a side effect of radiation therapy

b. The development of a vesicovaginal fistula

A patient who has a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action will the nurse take to decrease the risk for TRALI for this patient? a. Infuse the PRBCs slowly over 4 hours. b. Transfuse only leukocyte-reduced PRBCs. c. Administer the scheduled oral diuretic before the transfusion. d. Give the PRN dose of antihistamine before starting the transfusion.

b. Trans fuse only leukocyte-reduced PRBCs

A patient with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the a. platelet count. b. bleeding time. c. thrombin time. d. prothrombin time.

b. bleeding time

A confused patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse should contact the patients family member to sign a consent form before the a. ABO blood typing. b. bone marrow biopsy. c. abdominal ultrasound. d. complete blood count (CBC).

b. bone marrow biopsy

A routine complete blood count indicates that a patient may have myelodysplastic syndrome. At this time, the nurse will plan to teach the patient about a. packed red blood cells (PRBCs) transfusion. b. bone marrow biopsy. c. filgrastim (Neupogen) administration. d. erythropoietin (Epogen) administration.

b. bone marrow biopsy

A patient with non-Hodgkins lymphoma develops a platelet count of 18,000/l during chemotherapy. An appropriate nursing intervention for the patient based on this finding is to a. provide oral hygiene every 2 hours. b. check all stools for occult blood. c. check the temperature every 4 hours. d. encourage fluids to 3000 mL/day.

b. check all stools for occult blood

A patient is admitted to the hospital with a sickle cell crisis. While caring for the patient during the crisis, it is important for the nurse to a. limit the patients intake of oral and IV fluids. b. evaluate the effectiveness of opioid analgesics. c. encourage the patient to ambulate as much as tolerated. d. teach the patient about high-protein, high-calorie foods.

b. evaluate the effectiveness of opioid analgesics

A patient who is receiving methotrexate develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of a. iron. b. folic acid. c. cobalamin (vitamin B12). d. ascorbic acid (vitamin C).

b. folic acid

522 The nurse is assessing a client who has a new unreterostomy. Which statement by the client indicates the need form more education about urinary stoma care? a. "I change my pouch every week." b. "I change the appliance in the morning." c. "I empty the urinary collection bag when it is two-thirds full." d. "When I'm in the shower I direct the flow of water away from my stoma."

c. "I empty the urinary collection bag when it is two-thrids full."

526 As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? a. "I should avoid blowing my nose." b. "I may need a platelet transfusion if my platelet count is too low." c. "I'm going to take aspirin for my headache as soon as I get home" d. "I will count the number of pads and tampons I use when menstrating"

c. "i'm going to take aspirin for my headache as soon as I get home"

When prioritizing care for a patient having a vaso-occlusive sickle cell crisis, What is your best first intervention? a. Providing hydration b. Administering pain medication c. Applying oxygen d. Monitoring lab values

c. Applying oxygen

When planning discharge teaching for the patient who was admitted with a sickle cell crisis, which instruction will the nurse include? a. Limit fluids to 2 to 3 quarts a day. b. Take a daily multivitamin with iron. c. Avoid exposure to crowds as much as possible. d. Drink only one or two caffeinated beverages daily.

c. Avoid exposure to crowds as much as possible

The complete blood count (CBC) and differential indicate that a patient is neutropenic. Which action should the nurse include in the plan of care? a. Avoid intramuscular injections. b. Encourage increased oral fluids. c. Check temperature every 4 hours. d. Increase intake of iron-rich foods.

c. Check temperature every 4 hours.

517 A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action? a. Measure abdominal girth b. Irrigate the nasogastric tube c. Continue to monitor drainage d. Notify the health care provider (HCP)

c. Continue to monitor drainage

A 4 year old with Sickle cell anemia, is admitted with a vasocclusive sickle cell crisis. Which intervention should be given priority? a. Administer an iron supplement b. Seeing that the child ingests a protein rich diet c. Maintaining an intravenous fluid line d. Encouraging coughing and deep breathing exercises hourly

c. Maintaining an intravenous fluid line

While caring for a patient with thrombocytopenia, the nurse: a. Takes frequent temperatures to assess for fever b. Maintains the patient on strict bed rest to prevent injury c. Monitors the patient for headaches, vertigo, or confusion d. Removes oral crusting and scabs with firm friction every 2 hours

c. Monitors the patient for headaches, vertigo, or confusion

524 The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency? a. Cyanosis b. Arm edema c. Periorbital edema d. Mental status changes

c. Periorbital edema

the nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? a. Restrict all visitors b. Restrict fluid intake c. Teach the client and family about the need for hand hygiene d. Insert an indwelling urinary catheter to prevent skin breakdown

c. Teach the client and family about the need for hand hygiene rationale: In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff. Not all visitors are restricted, but the client is protected from persons with known infections. Fluids should be encouraged. Invasive measures such as indwelling urinary catheter should be avoided to prevent infections.

A 22-year-old with acute myelogenous leukemia who is receiving outpatient chemotherapy develops an absolute neutrophil count of 900/l. Which action by the nurse in the outpatient clinic is most appropriate? a. Discuss the need for hospital admission to treat the neutropenia. b. Plan to discontinue the chemotherapy until the neutropenia resolves. c. Teach the patient how to administer filgrastim (Neupogen) injections at home. d. Obtain a high-efficiency particulate air (HEPA) filter for the patient for home use.

c. Teach the patient how to administer filgrastim (Neupogen) injections at home

All of the following patients are waiting to be admitted by the emergency department nurse. Which one requires the most rapid assessment and care by the nurse? a. The patient with hemochromatosis who is complaining of abdominal pain b. The patient with thrombocytopenia who has oozing after having a tooth extracted c. The patient with chemotherapy-induced neutropenia who has a temperature of 100.8 F d. The patient with a history of sickle cell anemia who has had nausea and diarrhea for 24 hours

c. The patient with chemotherapy-induced neutropenia who has a temperature of 100.8 F

A patient with anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patients laboratory findings to include a. normal red blood cell (RBC) indices. b. a hematocrit (Hct) of 38%. c. a hemoglobin (Hb) of 8.6 g/dL (86 g/L). d. an RBC count of 4,500,000/mL.

c. a hemoglobin (Hb) of 8.6 g/dL (86 g/L)

A patient is hospitalized for treatment of severe hemolytic anemia. An appropriate nursing action for the patient is to a. provide a diet high in vitamin K. b. place the patient on protective isolation. c. alternate periods of rest and activity. d. teach the patient how to avoid injury.

c. alternate periods of rest and activity

A 45-year-old patient with acute myelogenous leukemia (AML) is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT). To assist the patient with treatment decisions, the best approach for the nurse to use is to a. emphasize the positive outcomes of a bone marrow transplant. b. discuss the need for adequate insurance to cover post-HSCT care. c. ask the patient whether there are any questions or concerns about HSCT. d. explain that a cure is not possible with any other treatment except HSCT.

c. ask the patient whether there are any questions or concerns about HSCT

The history and physical for a newly admitted patient states that the complete blood count (CBC) shows a shift to the left. The nurse will plan to monitor the patient for a. cool extremities. b. pallor and weakness. c. elevated temperature. d. low oxygen saturation.

c. elevated temperature

527 The community health nurse is instructing a group of young female clients about breast self-examination. The nurse should instruct the clients to perform the examination. The nurse should instruct the clients to perform the examination at which time? a. At the onset of menstruation b. Every month during ovulation c. Weekly at the same time of day d. 1 week after menstruation begins

d. 1 week after menstruation begins

512 During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of the disease? a. Diarrhea b. Hypermenorrhea c. Abdominal bleeding d. Abdominal distention

d. Abdominal distention

Which laboratory test will the nurse use to determine whether the prescribed filgrastim (Neupogen) is effective in the treatment of a patient who is receiving chemotherapy for acute lymphocytic leukemia? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count

d. Absolute neutrophil count

Which laboratory information will the nurse monitor to detect heparin-induced thrombocytopenia (HIT) in a patient who is receiving a continuous heparin infusion? a. Prothrombin time b. Erythrocyte count c. Fibrinogen degradation products d. Activated partial thromboplastin time

d. Activated partial thromboplastin time

A patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, what is the first action that the nurse should take? a. Draw blood for a new crossmatch. b. Send a urine specimen to the laboratory. c. Give the PRN diphenhydramine (Benadryl). d. Administer the PRN acetaminophen (Tylenol).

d. Administer the PRN acetaminophen (Tylenol)

Which of the following nursing actions included in the care plan for a patient with neutropenia is appropriate for the RN to delegate to an LPN/LVN who is assisting with patient care? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of neutropenic precautions c. Developing a discharge teaching plan for the patient and family d. Administering the ordered subcutaneous filgrastim (Neupogen) injection

d. Administering the ordered subcutaneous filgrastim (Neupogen) injection

A patient with hemophilia calls the nurse in the hemophilia clinic to discuss all of these problems. Which problem is most important to communicate to the physician? a. Skin abrasions b. Bleeding gums c. Multiple bruises d. Dark tarry stools

d. Dark tarry stools

525 The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptom of this oncological emergency? a. Headache b. Dysphagia c. Constipation d. Electrocardiographic changes

d. Electrocardiographic changes

A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? a. Fatigue b. Weakness c. Weight gain d. Enlarged lymph nodes

d. Enlarged lymph nodes rationale: Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.

Assessment of the patient's nutritional-metabolic functional health pattern is most useful in determining hematologic problems related to: a. Blood loss b. Low platelets c. Hypercoagulability d. Folic acid deficiency

d. Folic acid deficiency

A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious anemia, the nurse determines that the patient understands the disorder when the patient states, a. I need to start eating more red meat or liver. b. I will stop having a glass of wine with dinner. c. I will need to take a proton pump inhibitor like omeprazole (Prilosec). d. I would rather use the nasal spray than have to get injections of vitamin B12.

d. I would rather use the nasal spray than have to get injections of vitamin B12

While giving care to a client with an internal cervical radiation implant, the nurse finds the implant in the bed. The nurse should take which initial action? a. Call the health care provider (HCP) b. Reinsert the implant into the vagina c. Pick up the implant with gloved hands and flush it down the toilet d. Pick up the implant the long-handled forceps and place it in a lead container

d. Pick up the implant with long-handled forceps and place it in a lead container rationale: In the event that a radiation source becomes dislodged, the nurse would first encourage the client to lie still until the radioactive source has been placed in a safe, closed container. The nurse would use a long-handled forceps to place the source in the lead container that shouldbe in the client's room. The nurse should then call the radiation oncologist and document the event and the actions taken. It is not within the scope of nursing practice to insert a radiation implant.

Which statement by a patient with sickle cell anemia indicates good understanding of the nurses teaching about prevention of sickle cell crisis? a. Home oxygen therapy is frequently used to decrease sickling. b. There are no effective medications that can help prevent sickling. c. Routine continuous dosage narcotics are prescribed to prevent a crisis. d. Risk for a crisis can be lowered by having an annual influenza vaccination.

d. Risk for a crisis can be lowered by having an annual influenza vaccination

A 64-year-old with acute myelogenous leukemia (AML) who has induction therapy prescribed asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. If you do not want to have chemotherapy, there are other options for treatment such as stem cell transplantation. b. The decision about chemotherapy is one that you and the doctor need to make rather than asking what I would do. c. You dont need to make a decision about treatment right now since leukemias in adults tend to progress quite slowly. d. The side effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy.

d. The side effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy

When caring for a patient who is receiving heparin, the nurse will monitor a. prothrombin time (PT). b. fibrin degradation products (FDP). c. international normalized ratio (INR). d. activated partial thromboplastin time (aPTT).

d. activated partial thromboplastin time (aPTT)

In the patient who had an intraoperative hemorrhage 12 hours ago, the nurse would expect to find hematology results indicating a. a hematocrit of 45%. b. a hemoglobin of 13.2 g/dL. c. a decreased white blood cell (WBC) count. d. an elevated reticulocyte count.

d. an elevated reticulocyte count

Fifteen minutes after a transfusion of packed red blood cells is started, a patient complains of back pain and dyspnea. The pulse rate is 124. The nurses first action should be to a. administer oxygen therapy at a high flow rate. b. obtain a urine specimen to send to the laboratory. c. notify the health care provider about the symptoms. d. disconnect the transfusion and infuse normal saline.

d. disconnect the transfusion and infuse normal saline

The health care provider performs a bone marrow aspiration from the left posterior iliac crest on a patient with pancytopenia. Following the procedure, the nurse should a. elevate the head of the bed to 45 degrees. b. apply a sterile Band-Aid at the aspiration site. c. use half-inch sterile gauze to pack the wound. d. have the patient lie on the left side for an hour.

d. have the patient lie on the left side for an hour

During treatment of the patient with an acute exacerbation of polycythemia vera, a critical action by the nurse is to a. place the patient on bed rest. b. administer iron supplements. c. avoid use of aspirin products. d. monitor fluid intake and output.

d. monitor fluid intake and output