NU 306 EXAM 2

A deficit of clotting factor VIII, or an abnormality of clotting factor VIII, is found in A. von Willebrand's disease. B. disseminated intravascular coagulation (DIC). C. hemophilia A. D. idiopathic thrombocytopenic purpura (ITP).

C. hemophilia A.

An abnormal type of hemoglobin, called hemoglobin S, is the cause of A. polycythemia vera. B. aplastic anemia. C. sickle cell anemia. D. pernicious anemia.

C. sickle cell anemia.

which of the following is true regarding the difference between neutrophils and macrophages? 1) neutrophils arrive after monocytes 2) macrophages survive and divide at the site of inflammation 3) neutrophils and macrophages are attracted by the same factors 4) neutrophils activate the adaptive immune system

2) macrophages survive and divide at the site of inflammation

What is a purpose of the inflammatory process? 1) to provide specific responses toward antigens 2) to prevent infection of the injured tissue 3) to lyse cell membranes of microorganisms 4) to create immunity against subsequent tissue injury

2) to prevent infection of the injured tissue

62. What is the earliest clinical manifestation in a client with acute disseminated intravascular coagulation (DIC)? 1. Severe shortness of breath. 2. Bleeding without history or cause. 3. Orthopnea. 4. Hematuria.

2. Bleeding without history or cause.

which of the following is true regarding the inflammatory response? 1) it is the third line of defense 2) it relies on cellular components only 3) it is nonspecefic 4) it occurs at the site of healthy tissue

3) it is nonspecefic

59. When receiving a client from the postanesthesia care unit after a splenectomy, which should the nurse assess next after obtaining vital signs? 1. Nasogastric drainage. 2. Urinary catheter. 3. Dressing. 4. Need for pain medication.

3. Dressing.

52. The nurse is preparing a teaching plan about increased exercise for a female client who is receiving long-term corticosteroid therapy. What type of exercise is most appropriate for this client? 1. Floor exercises. 2. Stretching. 3. Running. 4. Walking.

4. Walking.

Blood formation occurs primarily in the A. plasma. B. bone marrow. C. hemoglobin. D. none of the above

B. bone marrow.

With proper management, patients with sickle cell disease live into their A. teens. B. 20s. C. 30s. D. 50s

D. 50s

91. In providing care to the client with leukemia who has developed thrombocytopenia, the nurse assesses the most common sites for bleeding. Which of the following is not a common site? 1. Biliary system. 2. Gastrointestinal tract. 3. Brain and meninges. 4. Pulmonary system.

1. Biliary system.

When a client is diagnosed with aplastic anemia, the nurse should assess the client for changes in which of the following physiologic functions? 1. Bleeding tendencies. 2. Intake and output. 3. Peripheral sensation. 4. Bowel function

1. Bleeding tendencies.

41. The nurse should instruct the client with a platelet count of 31,000/μL (31 × 10 9 /L) to: 1. Pad sharp surfaces to avoid minor trauma when walking. 2. Assess for spontaneous petechiae in the extremities. 3. Keep the room darkened. 4. Check for blood in the urine.

1. Pad sharp surfaces to avoid minor trauma when walking.

55. Platelets should not be administered under which of the following conditions? 1. The platelet bag is cold. 2. The platelets are 2 days old. 3. The platelet bag is at room temperature. 4. The platelets are 12 hours old.

1. The platelet bag is cold.

92. The nurse's best explanation for why the severely neutropenic client is placed in reverse isolation is that reverse isolation helps prevent the spread of organisms: 1. To the client from sources outside the client's environment. 2. From the client to health care personnel, visitors, and other clients. 3. By using special techniques to dispose of contaminated materials. 4. By using special techniques to handle the client's linens and personal items.

1. To the client from sources outside the client's environment.

34. A client with microcytic anemia is having trouble selecting food from the hospital menu. Which food is best for the nurse to suggest for satisfying the client's nutritional needs? 1. Egg yolks. 2. Brown rice. 3. Vegetables. 4. Tea

2. Brown rice.

When a client with thrombocytopenia has a severe headache, the nurse interprets that this may indicate which of the following? 1. Stress of the disease. 2. Cerebral bleeding. 3. Migraine headache. 4. Sinus congestion

2. Cerebral bleeding.

35. A client with macrocytic anemia has a burn on the foot and reports watching television while lying on a heating pad. Which action should be the nurse's first response? 1. Assess for potential abuse. 2. Check for diminished sensations. 3. Document the findings. 4. Clean and dress the area.

2. Check for diminished sensations.

64. A client with disseminated intravascular coagulation develops clinical manifestations of microvascular thrombosis. The nurse should assess the client for: 1. Hemoptysis. 2. Focal ischemia. 3. Petechiae. 4. Hematuria.

2. Focal ischemia.

70. A client with neutropenia has an absolute neutrophil count (ANC) of 900 (0.9 × 10 9 /L). What is the client's risk of infection? 1. Normal risk. 2. Moderate risk. 3. High risk. 4. Extremely high risk.

2. Moderate risk.

45. The nurse should instruct the client with a platelet count of less than 150,000/μL (150 × 10 9 /L) to avoid which of the following activities? 1. Ambulation. 2. Valsalva's maneuver. 3. Visiting with children. 4. Semi-Fowler's position.

2. Valsalva's maneuver.

The nurse is teaching a client with polycythemia vera about potential complications from this disease. Which manifestations should the nurse include in the client's teaching plan? Select all that apply. 1. Hearing loss. 2. Visual disturbance. 3. Headache. 4. Orthopnea. 5. Gout. 6. Weight loss.

2. Visual disturbance. 3. Headache. 4. Orthopnea. 5. Gout.

A 20-year-old male shoots his hand with a nail gun while replacing roofing shingles. Which of the following cell types would be the first to aid in killing bacteria to prevent infection in his hand? 1.Eosinophils 2.Neutrophils 3.Leukotrienes 4.Monocytes

2.Neutrophils

A health care provider prescribes 0.5 mg of protamine sulfate for a client who is showing signs of bleeding after receiving a 100-unit dose of heparin. The nurse should expect the effects of the protamine sulfate to be noted in which of the following time frames? 1. 5 minutes. 2. 10 minutes. 3. 20 minutes. 4. 30 minutes.

3. 20 minutes.

63. Which of the following is contraindicated for a client diagnosed with disseminated intravascular coagulation (DIC)? 1. Treating the underlying cause. 2. Administering heparin. 3. Administering warfarin sodium (Coumadin). 4. Replacing depleted blood products.

3. Administering warfarin sodium (Coumadin).

60. The client's family asks why the client who had a splenectomy has a nasogastric (NG) tube. An NG tube is used to: 1. Move the stomach away from where the spleen was removed. 2. Irrigate the operative site. 3. Decrease abdominal distention. 4. Assess for the gastric pH as peristalsis returns.

3. Decrease abdominal distention.

58. A client is scheduled for an elective splenectomy. Immediately before the client goes to surgery, the nurse should determine that the client has: 1. Voided completely. 2. Signed the consent. 3. Vital signs recorded. 4. Name band on wrist.

3. Vital signs recorded.

84. The nurse is assessing a client with chronic myeloid leukemia (CML). The nurse should assess the client for: 1. Lymphadenopathy. 2. Hyperplasia of the gum. 3. Bone pain from expansion of marrow. 4. Shortness of breath.

4. Shortness of breath.

49. The client with idiopathic thrombocytopenic purpura (ITP) asks the nurse why it is necessary to take steroids. Which is the nurse's best response? 1. Steroids destroy the antibodies and prolong the life of platelets. 2. Steroids neutralize the antigens and prolong the life of platelets. 3. Steroids increase phagocytosis and increase the life of platelets. 4. Steroids alter the spleen's recognition of platelets and increase the life of platelets.

4. Steroids alter the spleen's recognition of platelets and increase the life of platelets.

Anemia is diagnosed in females when hematocrit is less than A. 37% B. 50% C. 75% D. 93%

A. 37%

In which stage of Hodgkin's lymphoma are the lymphoma cells found in one lymph node group, or in only one part of a tissue or organ? A. Stage I B. Stage II C. Stage III D. Stage IV

A. Stage I

The most plentiful type of blood cell in the human body is A. erythrocytes. B. leukocytes. C. thrombocytes. D. stem cells.

A. erythrocytes.

Cyanocobalamin (vitamin B12) deficiency is found in A. pernicious anemia. B. aplastic anemia. C. hemolytic anemia. D. sickle cell anemia.

A. pernicious anemia.

Multiple myeloma is a cancer of the A. plasma cells. B. neutrophils. C. thromboplastin. D. all of the above

A. plasma cells.

The liquid protein component of blood is the A. plasma. B. red blood cells. C. leukocytes. D. stem cells

A. plasma.

Thalassemia patients who are effectively treated can survive into their A. teens. B. 30s. C. 50s. D. 70s

B. 30s.

Another name for red blood cells is A. stem cells. B. erythrocytes. C. leukocytes. D. thrombocytes

B. erythrocytes.

The most common anemia worldwide is A. pernicious anemia. B. iron deficiency anemia. C. aplastic anemia. D. sickle cell anemia.

B. iron deficiency anemia.

Which leukemia affects mainly adults? A. Acute myeloid leukemia B. Chronic lymphoid leukemia C. Chronic myeloid leukemia D. All of the above

D. All of the above

Which of the following statements about polycythemia vera is true? A. Polycythemia vera is disease in which too few blood cells are produced. B. It is a common disease. C. Polycythemia vera occurs most frequently in women. D. It is a rare disease.

D. It is a rare disease.

Clinical manifestations of Hodgkin's disease include A. weight loss. B. pruritus. C. swollen, painless lymph nodes. D. all of the above

D. all of the above

Coagulation is controlled by A. thrombocytes. B. hematopoiesis. C. clotting factors. D. both A and C, above

D. both A and C, above

The immune system destroys its own platelets in A. thrombotic thrombocytopenic purpura (TTP). B. disseminated intravascular coagulation (DIC). C. hemophilia A. D. idiopathic thrombocytopenic purpura (ITP)

D. idiopathic thrombocytopenic purpura (ITP)

if a person has innate resistance to a disease, the person has ________ immunity? 1) natural 2) active 3) active acquired 4) passive

Natural

The mast cell, a major activator of inflammation, initiates the inflammatory response thorugh the process of: 1) cytokinesis 2) endocytosis 3) degranulation 4) hemolysis

degranulation

. A client is to receive epoetin injections. What laboratory value should the nurse assess before giving the injection? 1. Hematocrit. 2. Partial thromboplastin time. 3. Hemoglobin concentration. 4. Prothrombin time.

1. Hematocrit.

40. The nurse is to administer subcutaneous heparin to an older adult. What facts should the nurse keep in mind when administering this dose? Select all that apply. 1. It should be administered in the anterior area of the iliac crest. 2. The onset is immediate. 3. Use a 27G, 5/8″ (1.6-cm) needle. 4. Cephalosporin potentiates the effects of heparin. 5. Double check the dose with another nurse.

1. It should be administered in the anterior area of the iliac crest. 3. Use a 27G, 5/8″ (1.6-cm) needle. 4. Cephalosporin potentiates the effects of heparin. 5. Double check the dose with another nurse

71. Which factor in addition to the degree of neutropenia should the nurse assess in determining the client's risk of infection? 1. Length of time neutropenia has existed. 2. Health status before neutropenia. 3. Body build and weight. 4. Resistance to infection in childhood.

1. Length of time neutropenia has existed.

69. The nurse is developing a care plan for a client with leukemia. The plan should include which of the following? Select all that apply. 1. Monitor temperature and report elevation. 2. Recognize signs and symptoms of infection. 3. Avoid crowds. 4. Maintain integrity of skin and mucous membranes. 5. Take a baby aspirin each day.

1. Monitor temperature and report elevation. 2. Recognize signs and symptoms of infection. 3. Avoid crowds. 4. Maintain integrity of skin and mucous membranes.

66. A young adult is diagnosed with infectious mononucleosis. The white blood cell (WBC) count is 19,000/μL (19 × 10 9 /L). The client has a streptococcal throat infection, enlarged spleen, and aching muscles. Which of the following instructions should the nurse include in discharge planning with the client? Select all that apply. 1. Stay on bed rest until the temperature is normal. 2. Gargle with warm saline while the throat is irritated. 3. Increase intake of fluids until the infection subsides. 4. Wear a mask if others are present. 5. Avoid contact sports while the spleen is enlarged.

1. Stay on bed rest until the temperature is normal. 2. Gargle with warm saline while the throat is irritated. 3. Increase intake of fluids until the infection subsides.5. Avoid contact sports while the spleen is enlarged.

48. The nurse should assess a client with thrombocytopenia who has developed a hemorrhage for which of the following? 1. Tachycardia. 2. Bradycardia. 3. Decreased PaCO2 . 4. Narrowed pulse pressure

1. Tachycardia.

51. When teaching the client older than age 50 who is receiving long-term prednisone therapy, the nurse should recommend which of the following? 1. Take the prednisone with food. 2. Take over-the-counter drugs as needed. 3. Exercise three to four times a week. 4. Eat foods that are low in potassium.

1. Take the prednisone with food.

73. The nurse should teach the client with neutropenia and the family to avoid which of the following? 1. Using suppositories or enemas. 2. Using a high-efficiency particulate air (HEPA) filter mask. 3. Performing perianal care after every bowel movement. 4. Performing oral care after every meal.

1. Using suppositories or enemas.

90. The nurse is evaluating the client's learning about combination chemotherapy. Which of the following statements by the client about reasons for using combination chemotherapy indicates the need for further explanation? 1. "Combination chemotherapy is used to interrupt cell growth cycle at different points." 2. "Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously." 3. "Combination chemotherapy is used to decrease resistance." 4. "Combination chemotherapy is used to minimize the toxicity from using high doses of a single agent

2. "Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously."

44. The nurse evaluates that the client correctly understands how to report signs and symptoms of bleeding when the client makes which of the following statements? 1. "Petechiae are large, red skin bruises." 2. "Ecchymoses are large, purple skin bruises." 3. "Purpura is an open cut on the skin." 4. "Abrasions are small pinpoint red dots on the skin."

2. "Ecchymoses are large, purple skin bruises."

47. A client's bone marrow report reveals normal stem cells and precursors of platelets (megakaryocytes) in the presence of decreased circulating platelets. The nurse recognizes a knowledge deficit when the client makes which of the following statements? 1. "I need to stop flossing and throw away my hard toothbrush." 2. "I am glad that my report turned out normal." 3. "Now I know why I have all these bruises." 4. "I shouldn't jump off that last step anymore."

2. "I am glad that my report turned out normal."

53. The nurse is teaching a female client with a history of acquired thrombocytopenia about how to prevent and control hemorrhage. Which statement indicates that the client needs further instruction? 1. "I can apply direct pressure over small cuts for at least 5 to 10 minutes to stop a venous bleed." 2. "I can count the number of tissues saturated to detect blood loss during a nosebleed." 3. "I can take hormones to decrease blood loss during menses." 4. "I can count the number of sanitary napkins to detect excess blood loss during menses."

2. "I can count the number of tissues saturated to detect blood loss during a nosebleed."

A client is afraid of receiving vitamin B12 injections because of potential toxic reactions. Which is the nurse's best response to relieve these fears? 1. "Vitamin B12 will cause ringing in the ears before a toxic level is reached." 2. "Vitamin B12 may cause a very mild rash initially." 3. "Vitamin B12 cause mild nausea but nothing toxic." 4. "Vitamin B12 is generally free of toxicity because it is water soluble."

2. "Vitamin B12 may cause a very mild rash initially."

54. A client has been on long-term prednisone therapy. The nurse should instruct the client to consume a diet high in which of the following? Select all that apply. 1. Carbohydrate. 2. Protein. 3. Trans fat. 4. Potassium. 5. Calcium. 6. Vitamin D.

2. Protein.4. Potassium. 5. Calcium. 6. Vitamin D.

50. A client is to be discharged on prednisone. Which of the following statements indicates that the client understands important concepts about the medication therapy? 1. "I need to take the medicine in divided doses at morning and bedtime." 2. "I am to take 40 mg of prednisone for 2 months and then stop." 3. "I need to wear or carry identification that I am taking prednisone." 4. "Prednisone will give me extra protection from colds and flu.

3. "I need to wear or carry identification that I am taking prednisone."

68. A client who had an exploratory laparotomy 3 days ago has a white blood cell (WBC) differential with a shift to the left. The nurse instructs unlicensed personnel to report which clinical manifestation? 1. Swelling around the incision. 2. Redness around the incision. 3. Elevated temperature. 4. Purulent wound drainage.

3. Elevated temperature.

56. The nurse is preparing to administer platelets. The nurse should: 1. Check the ABO compatibility. 2. Administer the platelets slowly. 3. Gently rotate the bag. 4. Use a whole blood tubing set.

3. Gently rotate the bag.

65. Which of the following is an assessment finding associated with internal bleeding with disseminated intravascular coagulation? 1. Bradycardia. 2. Hypertension. 3. Increasing abdominal girth. 4. Petechiae.

3. Increasing abdominal girth.

36. Which of the following is a late symptom of polycythemia vera? 1. Headache. 2. Dizziness. 3. Pruritus. 4. Shortness of breath.

3. Pruritus.

When beginning IV erythropoietin therapy, the nurse should do which of the following? Select all that apply. 1. Check the hemoglobin levels before administering subsequent doses. 2. Shake the vial thoroughly to mix the concentrated white, milky solution. 3. Keep the multidose vial refrigerated between scheduled twice-a-day doses. 4. Administer the medication through the IV line without other medications. 5. Adjust the initial doses according to the client's changes in blood pressure. 6. Instruct the client to avoid driving and performing hazardous activity during the initial treatment

4. Administer the medication through the IV line without other medications. 5. Adjust the initial doses according to the client's changes in blood pressure. 6. Instruct the client to avoid driving and performing hazardous activity during the initial treatment

46. A client who is taking acetylsalicylic acid (ASA) caplets develops prolonged bleeding from a superficial skin injury on the forearm. The nurse should tell the client to do which of the following first? 1. Place the forearm under a running stream of lukewarm water. 2. Pat the injury with a dry washcloth. 3. Wrap the entire forearm from the wrist to the elbow. 4. Apply an ice pack for 20 minutes.

4. Apply an ice pack for 20 minutes.

83. The goal of nursing care for a client with acute myeloid leukemia (AML) is to prevent: 1. Cardiac arrhythmias. 2. Liver failure. 3. Renal failure. 4. Hemorrhage.

4. Hemorrhage.

75. The nurse should remind the unlicensed personnel that which of the following is the most important goal in the care of the neutropenic client in isolation? 1. Listening to the client's feelings of concern. 2. Completing the client's care in a nonhurried manner. 3. Completing all of the client's care at one time. 4. Instructing the client to dispose of the tissue used after blowing the nose.

4. Instructing the client to dispose of the tissue used after blowing the nose.

42. A client with a history of systemic lupus erythematosus was admitted with a severe viral respiratory tract infection and diffuse petechiae. Based on these data, it is most important that the nurse further evaluate the client's recent: 1. Quality and quantity of food intake. 2. Type and amount of fluid intake. 3. Weakness, fatigue, and ability to get around. 4. Length and amount of menstrual flow.

4. Length and amount of menstrual flow.

57. Which of the following indicates that a client has achieved the goal of correctly demonstrating deep breathing for an upcoming splenectomy? The client: 1. Breathes in through the nose and out through the mouth. 2. Breathes in through the mouth and out through the nose. 3. Uses diaphragmatic breathing in the lying, sitting, and standing positions. 4. Takes a deep breath in through the nose, holds it for 5 seconds, and blows out through pursed lips.

4. Takes a deep breath in through the nose, holds it for 5 seconds, and blows out through pursed lips.

Hemoglobin binds to A. nitrogen. B. oxygen. C. leukocytes. D. plasma

B. oxygen.

A lack of enough erythrocytes, leukocytes, and platelets is referred to as A. leukemia. B. pancytopenia. C. neutropenia. D. anemia.

B. pancytopenia.

There are a number of causes of anemias, but a common clinical manifestation is A. weight gain. B. weakness. C. bradycardia. D. bone pain.

B. weakness.

Which of the following statements is true about disseminated intravascular coagulation (DIC)? A. Bleeding of a person with DIC is quickly halted by his or her clotting factors. B. Few clotting factors are present in the bloodstream of an individual with DIC. C. Clotting factors become abnormally active in DIC. D. To treat DIC, it is merely necessary to treat the bleeding.

C. Clotting factors become abnormally active in DIC.

Hematocrit refers to how much of the blood volume is occupied by A. thrombocytes. B. neutrophils. C. erythrocytes. D. leukocytes

C. erythrocytes.

Blood gets its red color from A. von Willebrand factor. B. DIC. C. hemoglobin. D. pancytopenia

C. hemoglobin.

Another name for white blood cells is A. erythrocytes. B. thrombocytes. C. leukocytes. D. plasmin.

C. leukocytes.