NSG320 Topic 6 Chapter 31 NCLEX

Arrange the steps involved in the pathophysiology of leukemia in chronologic order. A. Reduction in RBC, WBC, and platelet count B. Occurrence of anemia, pallor, and infection C. Replacement of bone marrow with blast cells D. Proliferation of immature white blood cells

1. D. Proliferation of immature white blood cells 2. C. Replacement of bone marrow with blast cells 3. B. Occurrence of anemia, pallor, and infection 4. A. Reduction in RBC, WBC, and platelet count In leukemia, immature white blood cells such as malignant and blast cells proliferate. Blast cells replace bone marrow resulting in bone marrow failure, which causes a decrease in RBC, WBC, and platelet count. Anemia and pallor occur due to reduction in RBC count. The decrease in WBC count leads to immunosuppression resulting in infection. Text Reference - p. 667

The nurse is caring for a hemophilic patient with a bleeding knee after a fall. All the following interventions are appropriate in providing care for the patient. In which order should the nurse perform these interventions? A. Administer specific coagulation factor. B. Rest the knee and pack in ice. C. Administer prescribed analgesic. D. Encourage mobilization as soon as bleeding ceases.

1. Rest the knee and pack in ice. 2. Administer specific coagulation factor. 3. Administer prescribed analgesic. 4. Encourage mobilization as soon as bleeding ceases. Acute nursing intervention for a hemophilic patient with a bleeding knee is to stop the topical bleeding by resting the knee and packing it in ice. The patient is administered specific coagulation factor to raise the level of deficient coagulation factor. Analgesics that do not contain aspirin or aspirin compounds are administered to reduce severe pain. The patient should be encouraged to mobilize the joint through range-of-motion exercises and physiotherapy as soon as bleeding ceases; however, weight bearing is avoided until all swelling has resolved and muscle strength has returned. Text Reference - p. 657

The primary health care provider assesses a leukemia patient and anticipates that the leukemic cells may infiltrate the patient's organs. Which diagnostic studies does the primary health care provider prescribe for the patient? Select all that apply. A. Lumbar puncture B. Morphologic study C. Histochemical study D. Cytogenetic method E. Computed tomography

A, B. Lumbar puncture and computed tomography are used to detect leukemic cells outside of the blood and bone marrow. Therefore, the primary health care provider prescribes lumbar puncture and computed tomography for the patient. Morphologic study, histochemical study and cytogenetic method are used to identify leukemic cell type. Test-Taking Tip: Try putting questions and answers in your own words to test your understanding. Text Reference - p. 666

The oncology nurse is administering a chemotherapeutic agent to a patient with relapsed Hodgkin's lymphoma. Which medication administered will have the best outcome for this patient? A. Fludarabine B. Mitoxantrone C. Cyclophosphamide D. Brentuximab vedotin

D. Brentuximab vedotin is the recommended drug used to treat relapsed or refractory Hodgkin's lymphoma disease by releasing an agent that disrupts the microtubule network. Fludarabine, mitoxantrone, and cyclophosphamide are used as combination chemotherapy to treat non-Hodgkin's lymphoma. Text Reference - p. 670

A 63-year-old patient with recurrent illness is diagnosed with leukemia. The nurse understands that the patient should be informed about vaccinations to prevent infections. Which instructions provided by the nurse are correct related to vaccinations? Select all that apply. A. Influenza vaccine should be taken annually. B. Gonococcal vaccine should be taken annually. C. Tetanus toxoid should be taken annually. D. Revaccination with the pneumococcal vaccine is recommended five years after the initial dose for immunocompromised patients. E. Pneumococcal vaccine should be taken at the time of diagnosis

A,D,E. Leukemia patients are at greater risk of developing infections and should be immunized against life-threatening infections. Influenza vaccine should be administered every year to protect against influenza. Pneumococcal vaccine should be given upon diagnosis and, according to the CDC, revaccination is recommended five years after the initial dose for immunocompromised patients. Because gonococcal infection is not life threatening and spreads through sexual contact, the patient should only be educated about safe sex practices and not vaccinated. Leukemia patients are not at any greater risk of developing tetanus than the general population unless there is exposure. Therefore, they should receive tetanus toxoid vaccine just once every 5 to10 years. Text Reference - p. 669

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. Monitor temperature every hour. D. Daily skin care and oral hygiene E. Encourage eating all foods to increase nutrients. F. Private room with a high-efficiency particulate air (HEPA) filter

A,D,F. Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora, other people, and uncooked meats, seafood, eggs, unwashed fruits and vegetables, and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4° F or more, but temperature is not monitored every hour.

Which condition is depicted in the figure? A. Acute hemarthrosis B. Severe ecchymoses C. Heparin-induced thrombocytopenia (HIT) D. Acute idiopathic thrombocytopenic purpura

A. Acute hemarthrosis is characterized by bleeding into the joint spaces, as is seen in hemophilia. Bleeding in the joints causes local inflammation. The image shows inflammation of the knee joint and is therefore acute hemarthrosis. Severe ecchymoses causes accumulation of waste blood due to hematomas. Therefore, the image for severe ecchymoses will show red coloration on the body. Heparin-induced thrombocytopenia (HIT) will show skin necrosis. Acute idiopathic thrombocytopenic purpura will show purplish petechiae. Text Reference - p. 656

A leukemia patient complains of nausea, vomiting, and lethargy. The diagnostic findings indicate meningitis. Which condition is most likely to be present in the patient? A. Acute lymphocytic leukemia B. Acute myelogenous leukemia C. Chronic lymphocytic leukemia D. Chronic myelogenous leukemia

A. Acute lymphocytic leukemia (ALL) is characterized by the uncontrolled proliferation of immature small lymphocytes in the bone marrow. ALL is commonly associated with central nervous system (CNS) manifestations such as meningitis and increased intracranial pressure, which lead to nausea, vomiting and lethargy. Acute myelogenous leukemia is characterized by the proliferation of myeloblasts and is not associated with CNS manifestations. Chronic lymphocytic leukemia is associated with the accumulation of small, mature-appearing lymphocytes in the bone marrow and does not involve CNS. Chronic myelogenous leukemia is characterized by the proliferation of mature neoplastic granulocytes in the bone marrow and is not associated with CNS manifestations. Text Reference - p. 665

Which type of leukemia is characterized by the proliferation of immature small lymphocytes in the bone marrow? A. Acute lymphocytic leukemia B. Acute myelogenous leukemia C. Chronic lymphocytic leukemia D. Chronic myelogenous leukemia

A. Acute lymphocytic leukemia is characterized by the presence of an excessive number of immature small lymphocytes in the bone marrow. Acute myelogenous leukemia is characterized by an increase in the number of myeloblasts. Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes. Chronic myelogenous leukemia occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow. Text Reference - p. 664

Which leukemia is most commonly seen in children? A. Acute lymphocytic leukemia B. Acute myelogenous leukemia C. Chronic lymphocytic leukemia D. Chronic myelogenous leukemia

A. Acute lymphocytic leukemia is most commonly seen in children. Acute myelogenous leukemia, chronic lymphocytic leukemia, and chronic myelogenous leukemia are commonly seen in older adults. Text Reference - p. 664

A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? A. Prevent patient infection. B. Avoid abnormal bleeding. C. Give pneumococcal vaccine. D. Provide companionship while isolated.

A. After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done, but should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.

A patient diagnosed with leukemia is given the initial treatment. During a follow-up visit, the primary health care provider identifies that there are no symptoms, and the peripheral blood smear is normal, but there is evidence of disease in the bone marrow. In which stage of disease control does the nurse anticipate the patient to be? A. Partial remission B. Complete remission C. Molecular remission D. Minimal residual disease

A. After the diagnosis of leukemia, the first stage of therapy, which is the induction therapy, is given to achieve remission. In partial remission, there will be a lack of symptoms, and the peripheral blood smear will appear to be normal; however, evidence of disease in the bone marrow can be observed. In complete remission, there will be a lack of symptoms and no evidence of disease in the bone marrow. In molecular remission, all molecular studies are negative for residual leukemia. In minimal residual disease, tumor cells are not detected by morphologic examination but can be identified by molecular testing. Text Reference - p. 666

The physical assessment of a patient reveals ecchymoses and subcutaneous hematomas. The patient's medical record indicates hemophilia A. The patient is prescribed desmopressin acetate. What would be the expected therapeutic outcome in this patient? A. Increase in factor VIII B. Increase platelet count C. Increase in hemoglobin D. Increase in neutrophil count

A. Ecchymoses and subcutaneous hematomas are the clinical manifestations of bleeding in a patient with hemophilia A. Desmopressin acetate is used to stimulate an increase in factor VIII in patients with hemophilia. An increase in platelet count is a therapeutic outcome related to corticosteroids and immunosuppressants, which are used in the treatment of thrombocytopenia. An increase in hemoglobin is seen in the patients who are receiving erythropoietin therapy for anemia. Granulocyte colony-stimulating factors such as filgrastim and pegfilgrastim are used in the treatment of neutropenia. These drugs stimulate the production of neutrophils, thereby increasing the neutrophil count. Text Reference - p. 656

The nurse is assessing a female patient who has hemophilia. What would the nurse infer about the patient's family? A. The father has hemophilia and the mother is a carrier of hemophilia. B. The father has hemophilia and the mother is unaffected by hemophilia. C. The father is unaffected by hemophilia and the mother has hemophilia. D. The father is unaffected by hemophilia and the mother is a carrier of hemophilia.

A. Hemophilia is an X-linked recessive genetic disorder caused by a defective or deficient coagulation factor. For a female to be hemophilic, both the X chromosomes should carry hemophilia, because it is a recessive disorder. The daughter can have hemophilia if her father has hemophilia and the mother is a carrier for hemophilia. If the father or mother is unaffected by hemophilia the daughter will not have hemophilia, because it is an X-linked recessive disorder. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 655

The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient? A. Multiple myeloma B. Thrombocytopenia C. Megaloblastic anemia D. Myelodysplastic syndrome

A. Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.

A patient with leukemia, who is on induction therapy, shows absence of any symptoms of the disease. The peripheral blood smear of the patient is normal, but the bone marrow shows evidence of the disease. Which term is used to refer to the patient's condition? A. Partial remission B. Complete remission C. Molecular remission D. Minimal residual disease

A. Partial remission is a condition in which there is a lack of symptoms of the disease and a normal peripheral blood smear, but evidence of the disease in the bone marrow. Complete remission refers to the condition in which the bone marrow and the peripheral blood appear normal. Molecular remission is the condition in which all molecular studies are negative for residual leukemia. Minimal residual disease refers to the tumor cells that cannot be detected by morphologic examination, but can be detected by molecular testing. Text Reference - p. 666

The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? A. Elevated D-dimers B. Elevated fibrinogen C. Reduced prothrombin time (PT) D. Reduced fibrin degradation products (FDPs)

A. The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.

A patient is scheduled for a Schilling test. The nurse explains that the purpose of the test is to measure: A. B12 absorption B. The size of the spleen C. Gastric secretion levels D. Severity of thrombocytopenia

A. The Schilling test measures B12 absorption. It is usually prescribed as the definitive test for pernicious anemia when other signs of the disease are present. A Schilling test does not measure the size of the spleen, gastric secretion levels, or thrombocytopenia severity. Text Reference - p. 640

The nurse receives a physician's order to transfuse fresh frozen plasma to a patient suffering from an acute blood loss. Which procedure is most appropriate for infusing this blood product? A. Infuse the fresh frozen plasma as rapidly as the patient will tolerate. B. Hang the fresh frozen plasma as a piggyback to the primary IV solution. C. Infuse the fresh frozen plasma as a piggyback to a primary solution of normal saline. D. Hang the fresh frozen plasma as a piggyback to a new bag of primary IV solution without KCl.

A. The fresh frozen plasma should be administered as rapidly as possible and should be used within 24 hours of thawing to avoid a decrease in Factors V and VIII. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion.

Before beginning a transfusion of RBCs, which action by the nurse would be of highest priority to avoid an error during this procedure? A. Check the identifying information on the unit of blood against the patient's ID bracelet. B. Select new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. C. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction. D. Add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow.

A. The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer's because it will cause RBC hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started, as this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.

The surgical patient has a new prescription to be transfused with two units of packed red blood cells (PRBCs). The nurse should take which action to ensure patient safety? A. Have a second registered nurse check the identifying information on the unit of blood against the identification bracelet and blood-bank identification bracelet. B. Select a new primary intravenous (IV) tubing to use for the administration and piggyback with 500 mL of normal saline. C. Add the blood transfusion as a secondary line to the existing IV and infuse over 60 minutes or less. D. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of transfusion reaction.

A. The patient's identifying information (name, date of birth, medical record number) on the identification bracelet should match exactly the information on the blood-bank tag that has been placed on the unit of blood. If any information does not match, the transfusion should not be hung because of possible error and risk to the patient. Blood tubing, not primary tubing, is needed for blood transfusion and should not be administered as a secondary infusion. The nurse should remain with the patient for 15 minutes following initiation of transfusion. Text Reference - p. 676

A nurse is assessing a patient with nonhemolytic anemia. What integumentary finding is indicative of anemia? A. Pallor B. Pruritus C. Jaundice D. Hyperpigmentation

A. A common integumentary change observed in anemia is pallor. Pruritus is seen in conditions associated with an increase in serum bile salts. Jaundice is seen in hemolytic anemia due to increased serum bilirubin. Hyperpigmentation is usually not associated with anemia. Text Reference - p. 633

Which disease originates from B-cell blasts present in the lymph nodes? A. Burkitt's lymphoma B. Hodgkin's lymphoma C. Diffuse large B-cell lymphoma D. Non-Hodgkin's lymphoma (NHL)

A. Burkitt's lymphoma is a highly aggressive disease that originates from B-cell blasts in lymph nodes. Hodgkin's lymphoma originates from proliferation of Reed-Sternberg cells. Diffuse large B-cell lymphoma originates at lymph nodes of the neck and abdomen. Non-Hodgkin's lymphoma (NHL) originates outside the lymph nodes. Text Reference - p. 671

A patient is diagnosed with acute disseminated intravascular coagulation (DIC). In addition to reduced plasminogen levels, the nurse expects that which other laboratory levels will be decreased? Select all that apply. A. Fibrin split products (FSPs) B. Antithrombin III (AT III) levels C. Fibrinogen and platelet levels D. Protein C and protein S levels E. D-dimers (cross-linked fibrin fragments)

B,C,D. The laboratory report of a patient with acute disseminated intravascular coagulation (DIC) disorder may show reduced plasminogen levels due to imbalance in the coagulation system. The other results that are indicative of acute DIC include reduced antithrombin III (AT III) levels, reduced fibrinogen and platelet levels, and reduced protein C and protein S levels. Elevated fibrin split products (FSPs) and elevated D-dimers (cross-linked fibrin fragments) are also indicative of acute DIC disorder. Text Reference - p. 659

The nurse identifies that which therapies are reserved for patients with a life-threatening hemorrhage? Select all that apply. A. Heparin B. Platelets C. Cryoprecipitates D. Fresh frozen plasma E. Antithrombin III (ATnativ)

B,C,D. Therapies with blood products such as platelets, cryoprecipitates, and fresh frozen plasma are reserved for patients with life-threatening hemorrhage. Heparin is used in the treatment of disseminated intravascular coagulation (DIC) only when the benefits of using it outweigh the risks. Antithrombin III (ATnativ) is used in the treatment of a patient with fulminant DIC. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 659

A 57-year-old patient has been diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what? A. Leukapheresis B. Attaining remission C. One chemotherapy agent D. Waiting with active supportive care

B. Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the WBC count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia (CLL), waiting may be done to attain remission, but not with AML.

A patient diagnosed with factor VIII deficiency has joint bleeding. Which nursing interventions would be beneficial for the patient? Select all that apply. A. Administer aspirin. B. Pack the joint in ice. C. Provide analgesics such as acetaminophen. D. Encourage the patient to do weight bearing activity to increase muscle strength. E. Encourage the patient to do range-of-motion exercises when bleeding is stopped.

B,C,E. Factor VIII deficiency leads to hemophilia, which is a severe bleeding disorder. When joint bleeding occurs, the joint should be packed in ice to reduce bleeding. Analgesics such as acetaminophen should be provided to reduce pain. When bleeding is stopped, the patient should be encouraged to perform range-of-motion exercises to increase mobilization. Aspirin should be avoided, because it may increase bleeding. Weight bearing activity should be performed when the swelling has decreased and muscle strength has returned. Text Reference - p. 657

The lab report of a patient shows a platelet count of 40,000/µL. Which patient symptom indicates to the nurse that a health care provider should be notified? Select all that apply. A. Pruritus B. Headache C. Elation of mood D. Difficulty in talking E. Black, tarry stools

B,D,E. Because the patient has a low platelet count, there is an increased risk of bleeding. The primary health care provider should be notified if any symptoms of internal bleeding appear. A headache could be caused by intracranial bleeding. The patient may experience difficulty in talking due to intracranial bleeding. Passing black, tarry stools indicates gastrointestinal bleeding. Pruritus and elation are usually not seen in thrombocytopenia, and do not indicate bleeding. Text Reference - p. 651

The nurse provided patient teaching regarding daily activities of a patient who has thrombocytopenia. Which activity of the patient indicates an understanding of the teaching? A. Brushing using a stiff-bristle toothbrush B. Shaving using an electric razor C. Flossing using thick-tape floss D. Wearing flip flops to go walking

B. A patient with thrombocytopenia has a decreased number of platelets and, therefore, prolonged bleeding will be observed even for minor injuries. Shaving using an electric razor blade decreases the risk of cuts and wounds resulting in decreased bleeding. Therefore, this activity of the patient indicates understanding of the nurse's teaching. Walking with flip flops can cause the patient to trip, causing the risk for cuts or wounds and increased bleeding. Flossing using a thick tape floss is not safe and can cause an increased risk for bleeding. Brushing using a stiff-bristle toothbrush causes injury to the gums and is not safe; therefore the nurse needs to perform more patient teaching. Test-Taking Tip: A patient with thrombocytopenia has decreased number of platelets and therefore activities that expose the patient at a risk of bleeding should be avoided. Use this concept to answer the question correctly. Text Reference - p. 654

What would a nurse consider the highest priority in the nursing care of a patient with thrombocytopenia? A. Maintaining a quiet environment B. Protecting the patient from injury C. Administering pain medication as needed D. Encouraging the patient to ambulate as much as can be tolerated

B. A patient with thrombocytopenia has a very low platelet count and an impaired clotting mechanism. Any injury, even a minor one, could cause spontaneous hemorrhage, internally or externally. Quiet, pain medication, and ambulation are not priority aspects of nursing care in regard to thrombocytopenia. Text Reference - p. 654

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? A. A 59-year-old man whose alcoholism has precipitated folic acid deficiency B. A 23-year-old African American man who has a diagnosis of sickle cell disease C. A 30-year-old woman with a history of "heavy periods" accompanied by anemia D. A 3-year-old child whose impaired growth and development is attributable to thalassemi

B. A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? A. A 59-year-old man whose alcoholism has precipitated folic acid deficiency B. A 23-year-old African American man who has a diagnosis of sickle cell disease C. A 30-year-old woman with a history of "heavy periods" accompanied by anemia D. A 3-year-old child whose impaired growth and development is attributable to thalassemia

B. A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss. Text Reference - p. 646

After an upper endoscopy with biopsy, a patient has been diagnosed with Helicobacter pylori gastric lymphoma. About what treatment will the nurse educate the patient? A. Phototherapy B. Antibiotic therapy C. Radiation therapy D. Topical chemotherapy

B. Antibiotic or antiviral therapy treats Helicobacter pylori gastric lymphoma by eradicating the microbes. Phototherapy is used to treat a diffuse state of cutaneous T-lymphoma. Radiation therapy is used to treat non-Hodgkin's lymphoma. Topical chemotherapy treats peripheral T- cell lymphoma. Text Reference - p. 672

Before hanging a unit of packed red blood cells, the nurse would arrange for another nurse to monitor his or her assignment for how many minutes while the nurse administers the transfusion? A. 10 minutes B. 15 minutes C. 20 minutes D. 25 minutes

B. As part of standard procedure, the nurse remains with the patient for the first 15 minutes after hanging a blood transfusion. Patients who are likely to have a transfusion reaction more often will exhibit signs within the first 15 minutes that the blood is infusing. Ten minutes is not enough time to evaluate for adverse reactions; unless the patient is having an adverse reaction it is not necessary to remain at the bedside for longer than 15 minutes. Text Reference - p. 677

Before starting a transfusion of packed red blood cells for an older anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion? A. 5 B. 15 C. 30 D. 60

B. As part of standard procedure, the nurse remains with the patient for the first 15 minutes after starting a blood transfusion. Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing. Monitoring during the transfusion will be every 30 to 60 minutes.

A 57-year-old patient has been diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what? A. Leukapheresis B. Attaining remission C. One chemotherapy agent D. Waiting with active supportive care

B. Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the white blood cell (WBC) count and risk of leukemia cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia (CLL), but not those with AML, waiting may be done to attain remission. Text Reference - p. 668

The blood bank notifies the nurse that the two units of blood ordered for an anemic patient are ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? A. Immediately pick up both units of blood from the blood bank. B. Infuse the blood slowly for the first 15 minutes of the transfusion. C. Regulate the flow rate so that each unit takes at least 4 hours to transfuse. D. Set up the Y-tubing of the blood set with dextrose in water as the flush solution.

B. Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging a unit of blood. Only one unit of blood can be picked up at a time, must be infused within 4 hours, and cannot be hung with dextrose.

An 82-year-old patient has a prescription to receive a transfusion of two units of packed red blood cells. The nurse would ask which health team member to assist in checking the unit before administration? A. The unlicensed assistive personnel (UAP) B. Another registered nurse (RN) C. The physician's assistant D. The unit secretary

B. Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. If there is not another nurse available, a health care provider could check the blood with the nurse. The unit secretary and UAP are not licensed to perform this duty. Text Reference - p. 676

What nursing intervention should be the priority in the care of a 30-year-old woman who has a diagnosis of immune thrombocytopenic purpura (ITP)? A. Administration of packed red blood cells B. Administration of oral or IV corticosteroids C. Administration of clotting factors VIII and IX D. Maintenance of reverse isolation and application of standard precautions

B. Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients.

A patient has a hemoglobin level of 11 g/dL. The nurse determines that the patient has what level of severity of anemia? A. Aplastic anemia B. Mild anemia C. Severe anemia D. Moderate anemia

B. In mild anemia, hemoglobin is in the range of 10-12 g/dL. Aplastic anemia refers to a type of anemia caused by a decrease in red blood cell precursors. It does not refer to the severity of anemia. In severe anemia, it is less than 6 g/dL. In moderate anemia, the hemoglobin it is in the range of 6-10 g/dL. Hemoglobin above 12 g/dL is considered normal (no anemia). Text Reference - p. 633

A patient with a diagnosis of hemophilia had a fall down an escalator earlier in the day and is now experiencing bleeding in her left knee joint. What should be the emergency nurse's immediate response to this? A. Immediate transfusion of platelets B. Resting the patient's knee to prevent hemarthroses C. Assistance with intracapsular injection of corticosteroids D. Range-of-motion exercises to prevent thrombus formation

B. In patients with hemophilia, joint bleeding requires resting of the joint in order to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.

A 36-year-old mother of two children has anemia related to inadequate intake of essential nutrients. Which intervention would be appropriate for the nurse to include in the plan of care for this woman? A. Plan for 30 minutes of rest before and after every meal. B. Encourage foods high in protein, iron, vitamin C, and folate. C. Instruct the patient to select soft, bland, and nonacidic foods. D. Give the patient a list of medications that inhibit iron absorption.

B. Increased intake of protein, iron, folate, and vitamin C provides nutrients needed for maximum iron absorption and hemoglobin production. The other interventions do not address the patient's identified problem of inadequate intake of essential nutrients. Selection of foods that are soft, bland, and nonacidic is appropriate if the patient has oral mucosal irritation. Scheduled rest is an appropriate intervention if the patient has fatigue related to anemia. Providing information about medications that may inhibit iron absorption (e.g., antacids, tetracycline, soft drinks, tea, coffee, calcium, phosphorus, and magnesium salts) is important but does not address the patient's problem of inadequate intake of essential nutrients.

The oncology nurse is administering chemotherapy to a group of patients with non- Hodgkin's lymphoma. Which patient will have the best outcome with indolent therapy? A. A patient with Burkitt's lymphoma B. A patient with follicular lymphoma C. A patient with mantle cell lymphoma D. A patient with peripheral T cell lymphoma

B. Indolent therapy or low-grade therapy is used to treat patients with follicular lymphoma. Burkitt's lymphoma, mantle cell lymphoma, and peripheral lymphoma are treated with aggressive therapy. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 673

A nursing student is caring for a patient with thrombocytopenia under the supervision of a registered nurse. Which action of the student nurse indicates an understanding of proper care for a patient with thrombocytopenia? A. Giving an intramuscular injection B. Applying ice on the injection site C. Avoiding direct pressure on the injection site D. Using a large-gauge needle for subcutaneous injection

B. Intramuscular injection should be avoided in a patient with thrombocytopenia because hematomas may develop on the injected site due to improper clotting of blood. Ice packs should be applied after injection to provide comfort. Applying direct pressure on the injected site will reduce the risk of hematoma, so direct pressure should not be avoided. Using a large-gauge needle for subcutaneous injection will cause bleeding. Text Reference - p. 654

The nurse cares for a patient with iron-deficiency anemia. Which nursing diagnostic statement associated with the condition is the highest priority? A. Deficient fluid volume B. Impaired gas exchange C. Impaired breathing pattern D. Decreased cardiac output

B. Iron is necessary for hemoglobin synthesis. Hemoglobin is responsible for oxygen transport in the body. With iron-deficiency anemia a subnormal hemoglobin level cannot carry enough oxygen to the tissues. This results in impaired tissue oxygenation caused by impaired gas exchange. Deficient fluid volume and decreased cardiac output are not directly associated with iron-deficiency anemia. An impaired breathing pattern may develop as a result of impaired gas exchange. Text Reference - p. 639

Which side effect does the nurse observe in a patient who is on ferrous gluconate? A. Hypotension B. Constipation C. Clay-colored stool D. Abdominal swelling

B. Iron supplements such as ferrous gluconate reduce peristalsis and result in constipation. Ferrous gluconate does not reduce blood pressure and does not result in hypotension. Ferrous gluconate can cause gastrointestinal bleeding and black, tarry stools. Ferrous gluconate does not cause fluid accumulation in the peritoneal cavity or abdominal swelling. Text Reference - p. 638

A leukemia patient asks the nurse, "What is the reason for the red- to purple-colored spots on my skin?" What should the nurse's response be? A. "These spots are due to low platelet count." B. "These spots are due to low neutrophil count." C. "These spots are due to low erythrocyte count." D. "These spots are due to low lymphocyte count."

B. Leukemia is associated with bone marrow failure and a low platelet count. A low platelet count results in bleeding, which causes red- to purple-colored spots on the skin. A low neutrophil count is not associated with red- to purple-colored spots on the skin. A low erythrocyte count results in anemia, which causes weakness and pallor. A low lymphocyte count results in immunosuppression, leading to infection and fever. Test-Taking Tip: Remember the various conditions associated with changes that occur in the different blood cells in the body. Text Reference - p. 666

A patient who has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient? A. Start IV fluids. B. Maintain oxygenation. C. Maintain distal warmth. D. Check peripheral pulses.

B. Maintaining oxygenation is a priority as sickling episodes are frequently triggered by low oxygen tension in the blood which is commonly caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity will also be used, but oxygenation is the priority.

Which finding supports the nurse's conclusion that a patient has pernicious anemia? A. Bleeding of the gums B. Smooth, beefy-red tongue C. Spoon-shaped concave nails D. Fissures in corners of the mouth

B. Pernicious anemia is characterized by the presence of a smooth, beefy-red tongue, and abdominal pain. Platelet function is reduced in the patient with leukemia; therefore, bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron deficiency anemia. Text Reference - p. 640

What will caring for a patient with a diagnosis of polycythemia vera likely require the nurse to do? A. Encourage deep breathing and coughing. B. Assist with or perform phlebotomy at the bedside. C. Teach the patient how to maintain a low-activity lifestyle. D. Perform thorough and regularly scheduled neurologic assessments.

B. Primary polycythemia vera often requires phlebotomy in order to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation. Deep breathing and coughing exercises do not directly address the etiology or common sequelae of polycythemia, and neurologic manifestations are not typical.

The nurse notes a physician's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? A. 11:45 AM B. 12:00 noon C. 12:30 PM D. 3:30 PM

B. The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank.

When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What should the nurse place highest priority on initiating interventions to reduce? A. Thirst B. Fatigue C. Headache D. Abdominal pain

B. The patient with a low hemoglobin and hematocrit is anemic and would be most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Thirst, headache, and abdominal pain are not related to anemia.

A 22-year-old female patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? A. Brentuximab vedotin (Adcetris) B. Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine C. Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine D. BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone

B. The patient with stage favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.

A 22-year-old female patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? A. Brentuximab vedotin B. Two to four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) C. Four to six cycles of ABVD D. Bleomycin, etoposide, dosorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP)

B. The patient with stage-favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of ABVD. Brentuximab vedotin is a newer agent that will be used to treat patients who have relapsed or refractory disease. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Text Reference - p. 671

A 50-year-old man with an acute peptic ulcer and major blood loss requires an immediate transfusion with packed red blood cells. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Confirm the IV solution is 0.9% saline. B. Obtain the vital signs before the transfusion is initiated. C. Monitor the patient for shortness of breath and back pain. D. Double check the patient identity and verify the blood product.

B. The registered nurse (RN) may delegate tasks such as taking vital signs to unlicensed assistive personnel (UAP). Assessments (e.g., monitoring for signs of a blood transfusion reaction [shortness of breath and back pain]) are within the scope of practice of the RN and may not be delegated to UAP. The RN must also assume responsibility for ensuring the correct IV fluid is used with blood products. Verification of the patient's identity and the blood product data must be completed by a licensed nurse.

The patient has a prescription for cobalamin (vitamin B12) 1,000 mg by mouth (PO). On hand, the nurse has 250-mg tablets available. How many tablets should the nurse give? A. Two tablets B. Four tablets C. Six tablets D. Eight tablets

B. Using ratio and proportion, multiply 250 by x and multiply 1000 × 1 to yield 250x = 1000. Divide 1000 by 250 to yield four tablets. Text Reference - p. 641

A patient presents with cough, dyspnea, and dysphasia. The laboratory reports show mediastinal node involvement. Which chemotherapy regimens will the oncology nurse administer in the treatment of this patient? Select all that apply. A. FND (Fludarabine, novantronel, dexamethasone) B. FMC (Fludarbine, mitoxantrone, cyclophosphamide) C. ABVD (Adreomycin, bleomycin, vinblastine, and dacarbazine) D. R-CVP (Rituximab, cyclophosphamide, vincristine, and prednisone) E. BEACOPP (Bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin, procarbazine, and prednisone)

C,E. Cough, dyspnea, and dysphasia occur as a result of mediastinal node involvement in Hodgkin's lymphoma. The standard chemotherapy is ABVD (adreomycin, bleomycin, vinblastine, and dacarbazine) for the treatment of early stage Hodgkin's disease and BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin, procarbazine, and prednisone) is given in six to eight cycles of chemotherapy. FND, FMC, and R-CVP are used to treat non-Hodgkin's lymphoma. Test-Taking Tip: Emphasize on the diagnostic finding given in the question stem to answer correctly. Text Reference - p. 673

The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse check on first? A. A 60-year-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL B. A 50-year-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer C. A 40-year-old patient with a temperature of 100.8o F (38.2o C) and a neutrophil count of 256/µL D. A 30-year-old patient with a pulse of 112 beats/minute and a white blood cell count of 14,000/µL

C. A low-grade fever greater than 100.4° F (38° C) in a patient with a neutrophil count below 500/µL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately

A nurse is evaluating the actions of a patient with thrombocytopenia after teaching the precautions to be taken at home. Which actions made by the patient indicates the need for correction? A. Drinking 14 glasses of water daily B. Shaving once a day using electric razor C. Using alcohol based mouthwashes twice a day D. Brushing using a soft-bristle toothbrush twice a day

C. A patient with thrombocytopenia should not use alcohol-based mouthwashes because alcohol-based mouthwashes will dry the mouth and increase bleeding. Patients with thrombocytopenia should drink plenty of fluids to prevent constipation. Patients with thrombocytopenia should shave using an electric razor, not blades, to prevent the risk for injury. Patients with thrombocytopenia should use a soft-bristle toothbrush to prevent gum injury. Text Reference - p. 654

Which diagnostic study is helpful in determining the clinical stage of Hodgkin's lymphoma? A. Barium enema B. Upper endoscopy C. Radiologic evaluation D. Magnetic resonance imaging (MRI)

C. A radiologic evaluation is helpful to define all sites and determine the clinical stage of Hodgkin's lymphoma. Barium enemas and upper endoscopies are used to diagnose any suspected gastrointestinal involvement in non-Hodgkin's lymphoma. MRI scans are used to rule out central nervous system or bone marrow infiltration. Text Reference - p. 670

While taking undiluted liquid iron that was prescribed, a patient asks the nurse why it must be drunk through a straw. How should the nurse respond? A. It increases iron absorption. B. It reduces iron absorption. C. It prevents staining of the teeth. D. It reduces allergic reactions.

C. An undiluted iron preparation causes staining of the teeth if consumed without using a straw. Such preparations should therefore be taken using a straw. Compared to drinking undiluted liquid iron without a straw, consuming it with a straw does not boost iron absorption, reduce iron absorption, or reduce allergic reactions. Text Reference - p. 638

The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? A. Unit secretary B. A physician's assistant C. Another registered nurse D. An unlicensed assistive personnel

C. Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. The unit secretary, physician's assistant, or unlicensed assistive personnel should not be asked.

The nurse instructs an African American man who has sickle cell disease about symptom management and prevention of sickle cell crisis. The nurse determines further teaching is necessary if the patient makes which statement? A. "When I take a vacation, I should not go to the mountains." B. "I should avoid contact with anyone who has a respiratory infection." C. "When my vision is blurred, I will close my eyes and rest for an hour." D. "I may experience severe pain during a crisis and need narcotic analgesics."

C. Blurred vision should be reported immediately and may indicate a detached retina or retinopathy. Hypoxia (at high altitudes) and infection are common causes of a sickle cell crisis. Severe pain may occur during a sickle cell crisis, and narcotic analgesics are indicated for pain management.

The registered nurse teaches a group of student nurses about the etiology and pathophysiology of disseminated intravascular coagulation (DIC). Which statement made by a student nurse indicates the need for further teaching? A. "It is stimulated by a disease process or disorder." B. "Bleeding occurs as a result of depletion of platelets." C. "It results from the surplus production of clotting factors." D. "DIC results from abnormally initiated and accelerated clotting."

C. Disseminated intravascular coagulation (DIC) is a disorder that results from depletion of coagulation or clotting factors. Therefore this statement by the student nurse requires correction. The disorder causes bleeding manifestations or hemorrhage due to depletion of platelets. DIC is a disorder that results from abnormally initiated and accelerated clotting due to stimulation by a disease process or disorder. Therefore, these statements by the student nurse do not require correction. Text Reference - p. 657

The nurse knows that hemolytic anemia can be caused by which extrinsic factors? A. Trauma or splenic sequestration crisis B. Abnormal hemoglobin or enzyme deficiency C. Macroangiopathic or microangiopathic factors D. Chronic diseases or medications and chemicals

C. Macroangiopathic or microangiopathic extrinsic factors lead to acquired hemolytic anemias. Trauma or splenic sequestration crisis can lead to anemia from acute blood loss. Abnormal hemoglobin or enzyme deficiency are intrinsic factors that lead to hereditary hemolytic anemias. Chronic diseases or medications and chemicals can decrease the number of RBC precursors which reduce RBC production.

When preparing to administer a prescribed blood transfusion, which intravenous (IV) solution does the nurse use when priming the blood tubing? A. Lactated Ringer's B. 5% Dextrose in water C. 0.9% Sodium chloride D. 0.45% Sodium chloride

C. The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It also is used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Dextrose and lactated Ringer's solutions cannot be used with blood, because they will cause red blood cell (RBC) hemolysis. Text Reference - p. 677

When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? A. Lactated Ringer's B. 5% dextrose in water C. 0.9% sodium chloride D. 0.45% sodium chloride

C. The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Dextrose and lactated Ringer's solutions cannot be used with blood as they will cause RBC hemolysis.

The primary health care provider gives initial emergency treatment with leukapheresis and hydroxyurea to a patient with leukemia. Which laboratory parameter in the patient's report likely led to this decision by the primary health care provider? A. Hemoglobin of 9 g/dL B. Platelet count of 90,000/µL C. WBC count of 120,000 cells/µL D. Lactate dehydrogenase 300 U/L

C. The initial emergent treatment with leukapheresis and hydroxyurea is indicated if the patient has a high WBC count of 100,000 cells/µL or more. The normal range of hemoglobin is 13.2 to 17.3 g/dL in males and 11.7 to 15.5 g/dL in females. Therefore, a hemoglobin value of 9 g/dL is indicative of severe anemia and a blood transfusion would be beneficial to this patient. The normal range of platelets is 150,000 to 400,000/µL. Therefore, the platelet count of 90,000/µL is indicative of thrombocytopenia. Patients with leukemia may have thrombocytopenia due to bone marrow depression. Thrombocytopenia is treated using colony stimulating factors and platelet transfusions. The normal lactate dehydrogenase level is 140 to 280 mcg/dL. This will be elevated due to tissue damage that occurs from cancer cell destruction. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 666

Which is a major complication of thrombocytopenia? A. Fatigue B. Weakness C. Hemorrhage D. Abdominal pain

C. The major complication of thrombocytopenia is hemorrhage. This occurs due to a decreased number of platelets in blood, which results in excessive bleeding. Fatigue, weakness, and abdominal pain are minor complications of thrombocytopenia. Text Reference - p. 651

Which system of the body is most commonly affected by leukemia? A. Digestive System B. Immune system C. Central nervous system D. Musculoskeletal System

C. The most common system of the body affected by leukemia is the central nervous system. The immature white blood cells infiltrate sites outside the bone marrow and affect them. The liver, a part of the digestive system, the joints, parts of the musculoskeletal system, and the spleen, a part of the immune system, are also sometimes affected by leukemia, but they are not commonly involved. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on the identified priorities for action. Text Reference - p. 666

A patient with neutropenia is placed in protective (reverse) isolation. The nurse explains to visitors that the primary purpose of the isolation is to help prevent the spread of organisms: A. By using special techniques to destroy discharge from the patient's body B. By using special techniques to handle the patient's linen and personal items C. By preventing spread to the patient from sources outside the patient's environment D. By preventing spread from the patient to healthcare personnel, visitors, and other patients

C. The primary purpose of protective, or reverse, isolation is to reduce transmission of organisms to the patient from sources outside the patient's environment. The use of special techniques to destroy discharge or handle the patient's linen and personal items and preventing the spread from the patient to others are not the purpose of protective isolation. Text Reference - p. 632

The nurse reviews a patient's medical record and identifies what which finding that increases the patient's risk of subacute disseminated intravascular coagulation (DIC) disorder? A. Toxins from snakebite B. Malignancy due to tumor lysis syndrome C. A retained dead fetus D. Transfusion of mismatched blood

C. The types of disseminated intravascular coagulation (DIC) disorders include acute, chronic, and subacute types. The risk factors that predispose a patient to subacute DIC disorder include obstetric conditions such as a retained dead fetus. Toxins from snakebites, malignancy due to tumor lysis syndrome, and hemolytic processes such as transfusion of mismatched blood may predispose a patient to acute disseminated intravascular coagulation (DIC) disorder. Test-Taking Tip: The risk factors that predispose a patient to different types of disseminated intravascular coagulation (DIC) disorders are given. Recall the risk factors that may precipitate subacute DIC. Text Reference - p. 658

After the diagnosis of disseminated intravascular coagulation (DIC), what is the first priority of collaborative care? A. Administer heparin. B. Administer whole blood. C. Treat the causative problem. D. Administer fresh frozen plasma.

C. Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.

After the diagnosis of disseminated intravascular coagulation (DIC), what is the first priority of collaborative care? A. Administer heparin B. Administer whole blood C. Treat the causative problem D. Administer fresh frozen plasma

C. Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. Text Reference - p. 659

Which instructions should the nurse give to a patient who is positive for human immunodeficiency virus and in whom acquired immunodeficiency syndrome is newly diagnosed? A. "You should wear gloves when you prepare meals." B. "You need to restrict visitors to your immediate family." C. "It's important for you to avoid eating any uncooked meat." D. "Make sure to wash your dishes in a diluted bleach solution."

C. Uncooked meat is a potential source of toxoplasmosis cysts, and although they do not cause disease in healthy people they are a major source of encephalitis in patients with acquired immunodeficiency syndrome. Wearing gloves while preparing meals, restricting visitors, and washing dishes and utensils in diluted bleach solution are unnecessary because human immunodeficiency virus is not spread through any of these means. Text Reference - p. 663

Which type of thrombocytopenia may be observed in a patient who has a viral infection? A. Hereditary thrombocytopenia B. Heparin-induced thrombocytopenia (HIT) C. Immune thrombocytopenic purpura (ITP) D. Thrombotic thrombocytopenic purpura (TTP)

C. Viral infections compromise the immune system and contribute to the development of immune thrombocytopenic purpura (ITP). Hereditary thrombocytopenia is observed in the patient with inherited thrombocytopenia. Heparin-induced thrombocytopenia (HIT) is observed in the patient who is on long-term heparin therapy. Thrombotic thrombocytopenic purpura (TTP) is observed in a patient with hemolytic anemia. Text Reference - p. 651

An older patient relates that he or she has increased fatigue and a headache. The nurse identifies pale skin and glossitis on assessment. In response to these findings, which teaching will be helpful to the patient if he or she has microcytic, hypochromic anemia? A. Take enteric-coated iron with each meal. B. Take cobalamin with green leafy vegetables. C. Take the iron with orange juice one hour before meals. D. Decrease the intake of the antiseizure medications to improve.

C. With microcytic, hypochromic anemia, there may be an iron, B6, or copper deficiency, thalassemia, or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals as it is absorbed best in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider. Text Reference - p. 637

An older patient relates that she has increased fatigue and a headache. The nurse identifies pale skin and glossitis on assessment. In response to these findings, which teaching will be helpful to the patient if she has microcytic, hypochromic anemia? A. Take enteric-coated iron with each meal. B. Take cobalamin with green leafy vegetables. C. Take the iron with orange juice one hour before meals. D. Decrease the intake of the antiseizure medications to improve.

C. With microcytic, hypochromic anemia, there may be an iron, B6, or copper deficiency, thalassemia, or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals as it is best absorbed in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help RBC maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider.

A 64-year-old man with leukemia admitted for severe hypovolemia after prolonged diarrhea has a platelet count of 43,000/µL. It is most important for the nurse to take which action? A. Administer prescribed enoxaparin (Lovenox). B. Insert two 18-gauge IV catheters. C. Monitor the patient?s temperature every 2 hours. D. Check stools for presence of frank or occult blood.

D. A platelet count

Which disease process has chromosomal translocations as its contributing factor? A. Leukemia B. Multiple myeloma C. Hodgkin's lymphoma D. Non-Hodgkin's lymphoma

D. Chromosomal translocations (a condition in which the chromosomes break and the broken fragments join other chromosomes) are a cause of Non-Hodgkin's lymphoma. Multiple myeloma occurs because of environmental factors such as exposure to radiation, toxic metals, and herbicides. Hodgkin's lymphoma is caused by a proliferation of Reed-Sternberg cells in the lymph nodes. Leukemia develops due to exposure to chemical agents, chemotherapeutic agents, and radiation. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. Text Reference - p. 671

Which statement made by the registered nurse while training a student nurse on the different stages of chemotherapy indicates effective training? A. "The patient becomes critically ill during consolidation therapy." B. "Consolidation therapy is an aggressive treatment to destroy leukemic cells." C. "Induction therapy is used to eliminate the leukemic cells that are clinically nonevident." D. "Maintenance therapy involves treatment with lower doses of drugs for a prolonged period."

D. Maintenance therapy involves treatment with a lower dose of drugs for a prolonged period than what is used in induction therapy. The patient becomes critically ill during induction therapy, because it involves severe bone marrow depression. Induction therapy is an aggressive treatment to destroy leukemic cells and to restore normal hematopoiesis. Consolidation therapy is given to eliminate the leukemic cells that are clinically nonevident. Text Reference - p. 667

Which condition may occur due to infiltration of leukemic cells in a patient's body systems? A. Anemia B. Leukostasis C. Thrombocytopenia D. Meningeal irritation

D. Meningeal irritation may occur due to infiltration of leukemic cells in patient's body systems such as the central nervous system. Bone marrow failure may lead to replacement of bone marrow with blast cells thereby causing anemia. Leukostasis is thickening of the blood potentially blocking circulatory pathways, which is caused by a high leukemic white blood cell count in the peripheral blood. Bone marrow failure may impair the production of platelets leading to thrombocytopenia. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 666

Which statement is true regarding non-Hodgkin's lymphoma? A. Non-Hodgkin's lymphoma is localized to regional nodes. B. Non-Hodgkin's lymphoma involves common B symptoms. C. Non-Hodgkin's lymphoma has rare extranodal involvement. D. Non-Hodgkin's lymphoma originates from natural killer lymphocytes

D. Non-Hodgkin's lymphoma originates from immune cells such as natural killer lymphocytes. Non-Hodgkin's lymphoma is disseminated. Non-Hodgkin's lymphoma is characterized by 40 percent B symptoms and common extra-nodal involvement. Text Reference - p. 669

The nurse is caring for a patient with suspected mediastinal lymphadenopathy. Which diagnostic test will the nurse prepare the patient for to confirm the diagnosis? A. Barium enema B. Upper endoscopy C. Radiologic evaluation D. Positron emission tomography (PET)

D. Positron emission tomography (PET) is used to diagnose and evaluate mediastinal lymphadenopathy. Barium enemas and upper endoscopies are used to diagnose any suspected gastrointestinal involvement in non-Hodgkin's lymphoma. Radiologic evaluation is helpful to determine the clinical stage of Hodgkin's lymphoma. Text Reference - p. 670

A patient who is on heparin therapy manifests signs of heparin overdose. Which medication would be beneficial to the patient in this situation? A. Lepirudin B. Rituximab C. Prednisone D. Protamine sulfate

D. Protamine sulfate reverses the anticoagulant effects of circulating heparin during severe clotting. Lepirudin is given to maintain anticoagulation. Rituximab is given to reduce the immune recognition of platelets. Prednisone is used to suppress the phagocytic response of splenic macrophages. Text Reference - p. 653

A patient is being treated with chemotherapy for the treatment of non-Hodgkin's lymphoma. What combination therapy will the oncology nurse administer that is both an indolent and aggressive therapy? A. FND (Fludarbine, novantronel, dexamethasone) B. FMC (Fludaribine, metoxantrone, cyclophosphamide) C. RICE (Rituximab, ifosfamide, cyclophosphamide, etoposide) D. R-CHOP (Rituximab, cyclophosphamide, doxorubicin hydrochloride)

D. R-CHOP combination is used as both an indolent (low-grade) and aggressive (medium or high-grade) therapy in the treatment of non-Hodgkin's lymphoma. FND and FMC are used in indolent or low grade therapy to treat non-Hodgkin's lymphoma. RICE is used in aggressive therapy to treat non-Hodgkin's lymphoma. Text Reference - p. 673

To prepare for a transfusion of packed red blood cells, the nurse selects which intravenous solution to use for the procedure? A. 3% normal saline B. Lactated Ringer's C. 5% dextrose in water D. 0.9% normal saline

D. The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Lactated Ringer's, 5% dextrose in water, and 3% normal saline are not compatible with blood products. Text Reference - p. 676

A patient has pernicious anemia. Which assessment finding does the nurse recall is a classic sign of this condition? A. Diarrhea B. Indigestion C. Flushed skin D. Red, beefy tongue

D. The decreased absorption of vitamin B12 resulting from a lack of intrinsic factor causes a decrease in hemoglobin, hematocrit, and red blood cells. A smooth, red, enlarged or "beefy" appearance of the tongue may also be seen. Intrinsic factor is produced by the parietal cells of the stomach lining and is required to absorb vitamin B12 from the intestines. Causes of decreased intrinsic factor production include surgical alterations such as gastrectomy and autoimmune disease. Diarrhea, indigestion, and flushed skin appearance are not signs specifically associated with pernicious anemia. Text Reference - p. 640

A patient undergoing regular dialysis has been experiencing fatigue when executing activities of daily living. Which management intervention should the nurse teach the patient and caregiver? A.Assist the patient in walking immediately after meals. B. Ensure all activities are completed in the morning. C. Encourage visitors to visit the patient often. D. Assist in assigning priority to activities.

D. The nurse should teach and assist the patient and caregiver to assign priority to activities to accommodate energy levels and promote tolerance for important activities. The patient should be asked to avoid activity immediately after meals to reduce competition for oxygen supply to vital functions. Activities should be alternated with rest periods throughout the day rather than completed in the morning. The caregiver should limit the number of visitors so that the patient receives adequate rest. Text Reference - p. 635

The patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? A. Skin care that will be needed B. Method of obtaining the treatment C. Gastrointestinal tract effects of treatment D. Treatment type and expected side effects

D. The patient first should be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment. Text Reference - p. 673

The patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? A. Skin care that will be needed B. Method of obtaining the treatment C. Gastrointestinal tract effects of treatment D. Treatment type and expected side effects

D. The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.

A patient with thrombocytopenia has a nosebleed. Which is the priority nursing intervention? A. Call the primary health care provider. B. Tap gently the patient's nose with a tissue. C. Place ice bags over the bridge of the patient's nose. D. Position the patient's head upwards and apply pressure to nostrils

D. The primary nursing intervention for a patient with thrombocytopenia and nosebleed is to prevent excessive blood loss. Positioning the patient's head upwards and applying pressure on the nostrils will reduce the flow of blood and will decrease bleeding. The primary health care provider is called if the bleeding does not stop after 10 minutes. The patient's nose will be tapped gently if the patient has a feeling of discomfort in the nose after reducing the risk of excessive blood loss. If the bleeding continues after positioning the patient's head upward, then ice bags should be placed over the bridge of the patient's nose to decrease bleeding. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 654

A nurse is assessing four patients. Which patient is most likely to have thrombotic thrombocytopenic purpura (TTP)? A. A 12-year-old male child B. A 30-year old male adult C. A 10-year-old female child D. A 35-year old female adult

D. Thrombotic thrombocytopenic purpura (TTP) is seen primarily in adults between 20 and 50 years of age, with a slight female predominance. Therefore, a 35-year old female adult is more likely to have TTP. A 12-year-old male child, a 30-year old male adult, and a 10-year-old female child are less likely to have TTP than a 35-year old female adult is. Text Reference - p. 651