Quiz 3: Hem. 1 & 2

The home health nurse is obtaining a history for a patient who has deep vein thrombosis and is taking warfarin 2mg/day. Which statement by the patient is the BEST indicator that additional teaching about warfarin may be needed? 1. "I have started to eat more healthy foods like green salads and fruit." 2. "The doctor said that it is important to avoid becoming constipated." 3. "Warfarin makes me feel a little nauseated unless I take it with food." 4. "I will need to have some blood testing done once or twice a week."

1. "I have started to eat more healthy foods like green salads and fruit." Patients taking warfarin are advised to avoid making sudden dietary changes because changing the oral intake of foods high in Vitamin K (e.g., green leafy vegetables and some fruits) will have an impact on the effectiveness of the medication. The other statements suggest that further teaching may be indicated, but more assessment for teaching needs is required first.

A client is receiving epoetin (Epogen) for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary? 1. "I realize it is important to take this medication because it will cure my anemia." 2. "I know many ways to protect myself from injury because I am at risk for seizures." 3. "I recognize that I may still need blood transfusions if my blood values are very low." 4. "I understand that I will still have to take supplemental iron therapy with this medication."

1. "I realize it is important to take this medication because it will cure my anemia." Epoetin (Epogen) will increase a sense of well-being, but it will not cure the underlying medical problem. This misconception needs to be corrected

After the nurse receives the change-of-shift report, which patient should be assessed FIRST? 1. A 20-year-old patient with possible acute myelogenous leukemia who has just arrived on the medical unit 2. A 38-year-old patient with aplastic anemia who needs teaching about decreasing infection risk before discharge 3. A 40-year-old patient with lymphedema who requests help in putting on compression stockings before getting out of bed 4. A 60-year-old patient with non-Hodgkin lymphoma who is refusing the prescribed chemotherapy regimen

1. A 20-year-old patient with possible acute myelogenous leukemia who has just arrived on the medical unit The newly admitted patient should be assessed first because the baseline assessment and plan of care need to be completed. The other patients also need assessments or interventions but do not need immediate nursing care.

A group of patients is assigned to an RN-LPN/LVN team. The LPN/LVN should be assigned to provide patient care and administer medications to which patient? 1. A 36-year-old patient with chronic kidney failure who will need a subcutaneous injection of epoetin alfa 2. A 39-year-old patient with hemophilia B who has been admitted to receive a blood transfusion 3. A 50-year-old patient with newly diagnosed polycythemia vera who will require phlebotomy 4. A 55-year-old patient with a history of stem cell transplantation who has a bone marrow aspiration scheduled

1. A 36-year-old patient with chronic kidney failure who will need a subcutaneous injection of epoetin alfa LPNs/LVNs should be assigned to care for stable patients. Subcutaneous administration of epoetin is within the LPN/LVN scope of practice. Blood transfusions should be administered by RNs because evaluation for and management of transfusion reactions require RN-level education and scope of practice. The other patients will require teaching about phlebotomy and bone marrow aspiration that should be implemented by the RN.

A client is diagnosed with Hodgkin disease. Which lymph nodes does the nurse expect to be affected FIRST? 1. Cervical 2. Axillary 3. Inguinal 4. Mediastinal

1. Cervical Painless enlargement of the cervical lymph nodes often is the first sign of Hodgkin disease, a malignant lymphoma of unkown etiology 1 is incorrect because axillary node enlargement occurs after cervical lymph node enlargement 3 is incorrect because inguinal node enlargement occurs later 4 is incorrect because mediastinal node involvement follows after the disease progresses

These activities are included in the car plan for a 78-year-old patient admitted to the hospital with anemia caused by possible gastrointestinal bleeding. Which activity can the nurse delegate to an experienced unlicensed assistive personnel (UAP)? 1. Obtaining stool specimens for fecal occult blood test (FOBT) 2. Having the patient sign a colonoscopy consent form 3. Giving the prescribed polyethylene glycol electrolyte solution 4. Checking for allergies to contrast dye or shellfish

1. Obtaining stool specimens for fecal occult blood test (FOBT) An experienced UAP will have been taught how to obtain a stool specimen for the fecal occult blood test because this is a common screening test for hospitalized patients. Having the patient sign an informed consent form should be done by the health care provider who will be performing the colonoscopy. Administering medications and checking for allergies are within the scope of practice of licensed nursing staff.

The nurse is making a room assignment for a newly arrived patient whose laboratory test results indicate pancytopenia. Which patient will be the BEST roommate for the new patient? 1. Patient with digoxin toxicity 2. Patient with viral pneumonia 3. Patient with shingles 4. Patient with cellulitis

1. Patient with digoxin toxicity Patients with pancytopenia are at higher risk for infection. The patient with digoxin toxicity presents the least risk of infecting the new patient. Viral pneumonia, shingles, and cellulitis are infectious processes.

A client has a low hemoglobin level, which is attributed to nutritional deficiency, and the nurse provides dietary teaching. Which food choices by the client indicate that the nurse's instructions are effective? (Select all that apply) 1. Raisins 2. Squash 3. Carrots 4. Spinach 5. Apricots

1. Raisins & 4. Spinach Both are high in iron 2 is incorrect because although squash contains some iron, it is not the best source 3 is incorrect because although carrots contain some iron, they are not the best source 5 is incorrect because although apricots contain some iron, they are not the best source

A patient with acute myelogenous leukemia is receiving induction-phase chemotherapy. Which assessment finding requires the MOST rapid action? 1. Serum potassium level 7.8 mEq/L (7.8 mmol/L) 2. Urine output less than intake by 400 mL 3. Inflammation and redness of the oral mucosa 4. Ecchymoses present on the anterior trunk

1. Serum potassium level 7.8 mEq/L (7.8 mmol/L) Fatal hyperkalemia may be caused by tumor lysis syndrome, a potentially serious consequence of chemotherapy in acute leukemia. The other symptoms also indicate a need for further assessment or interventions but are not as critical as the elevated potassium level, which requires immediate treatment.

A female client has a low hemoglobin level, which is attributed to an iron deficiency. Which foods should the nurse recommend that the client increase in the diet? (Select all that apply) 1. Spinach 2. Broccoli 3. Beef liver 4. Baked beans 5. Chicken breast

1. Spinach, 3. Beef liver, & 4. Baked beans 1. One cup of cooked spinach contains 6.4 mg of iron, which is necessary to produce red blood cells 2. One cup of cooked broccoli contains 1.2 mg of iron; this is not the best source of iron 3. Three ounces of beef liver contains 5.2 mg of iron; this is an excellent source of iron 4. One cup of baked beans contains 8.2 mg of iron 5. One half chicken breast contains 0.6 mg of iron

When administering a blood transfusion to a patient, which action can the nurse delegate to the unlicensed assistive personnel (UAP)? 1. Take the patient's vital signs before the transfusion is started 2. Assure that the blood is infused within no more than 4 hours 3. Ask the patient at frequent intervals about presences of chills or dyspnea 4. Assist with double-checking the patient's identification and blood bag number

1. Take the patient's vital signs before the transfusion is started UAP education and role includes obtaining vital signs, which will be reported to the RN prior to the initiation of the transfusion. Monitoring for transfusion reactions, adjusting transfusion rate, and assuring that the blood type and number are correct require critical thinking and should be done by the RN.

The nurse is caring for a patient who takes warfarin daily for a diagnosis of atrial fibrillation. Which information about the patient is MOST important to report to the health care provider (HCP)? 1. The international normalized ratio (INR) is 5.2 2. Bruising is noted at sites where blood has been drawn 3. The patient reports eating a green salad for lunch every day 4. The patient has questions about whether a different anticoagulation can be used.

1. The international normalized ratio (INR) is 5.2 An INR of 2 to 3 is the goal for patients who are taking warfarin for atrial fibrillation; the INR of 5.2 will require that the medication dose be adjusted. Because bleeding times are prolonged when patients receive anticoagulants, bruising is a common adverse effect. Green leafy vegetables contain Vitamin K and have an impact on the effectiveness of warfarin, but if patients eat these vegetables consistently, then warfarin dosing will also be consistent. The HCP may need to discuss use of the newer oral anticoagulants (which do not require blood testing) with the patient, but the highest concern is the very prolonged INR.

When the nurse is assessing a patient with chronic kidney disease who is receiving epoetin alfa (erythropoietin) injections, which finding MOST indicates a need to talk with the health care provider (HCP) before giving the medication? 1. Hemoglobin level is 8.9 g/dL (89 g/L) 2. Blood pressure is 198/92 mmHg 3. The patient does not like subcutaneous injections 4. The patient has a history of myocardial infarction

2. Blood pressure is 198/92 Epoetin alfa can cause hypertension, and blood pressure should be controlled before administering the medication. Because patients with chronic kidney disease have chronic anemia, a hemoglobin level of 8.9 g/dL (89 g/L) is not unusual. Although the nurse could ask the HCP about IV administration of the medication, subcutaneous administration requires a lower dose of the medication and is preferred. Epoetin alfa can cause angina or myocardial infarction, but the risk is highest when hemoglobin levels are greater than 11 g/dL (110 g/L).

A 32-year-old patient with sickle cell anemia is admitted to the hospital during a sickle cell crisis. Blood pressure is 104/62 mmHg, oxygen saturation is 92%, and the patient reports pain at a level 8 (on a scale of 0-10). Which action prescribed by the health care provider will the nurse implement FIRST? 1. Administer morphine sulfate 4 to 8 mg IV 2. Give oxygen at 4 L/min per nasal cannula 3. Start an infusion of normal saline at 200 mL/hr 4. Apply warm packs to painful joints

2. Give oxygen at 4 L/min per nasal cannula National guidelines for sickle cell crisis indicate that oxygen should be administered if the oxygen saturation is less than 95%. Hypoxia and deoxygenation of the blood cells are the most common cause of sickling, so administration of oxygen is the priority intervention here. Pain control (including administration of morphine and application of warm packs to joints) and hydration are also important interventions for this patient and should be accomplished rapidly.

A nurse is caring for a client with a diagnosis of polycythemia vera. The client asks, "Why do I have an increased tendency to develop blood clots?" Which affect of the polycythemia vera should the nurse explain increases the risk of these thromboses? 1. Elevated blood pressure 2. Increased blood viscosity 3. Fragility of the blood cells 4. Immaturity of red blood cells

2. Increased blood viscosity Polycythemia vera results in pathologically high concentrations of erythrocytes in the blood; increased viscosity promotes thrombus formation 1 is incorrect because hypertension is usually related to the narrowing or sclerosing of arteries, not to an increased number of blood cells. 3 is incorrect because the fragility of blood cells does not affect the viscosity of the blood 4 is incorrect because erythrocyte immaturity is not related to increased viscosity

A patient who has sickle cell disease is admitted with vaso-occlusive crisis and reports severe abdominal and flank pain. Which of the analgesic medications on the pain treatment protocol will be BEST for the nurse to administer initially? 1. Ibuprofen 800 mg PO 2. Morphine sulfate 4 mg IV 3. Hydromorphone liquid 5 mg PO 4. Fentanyl 25 mcg/hr transdermal patch

2. Morphine sulfate 4 mg IV Guidelines for the management of vaso-occulsive crisis suggest the rapid use of parenteral opioids for patients who have moderate to severe pain. The other medications may also be appropriate for the patient as the crisis resolves but are not the best choice for rapid treatment of severe pain.

A patient who has been receiving cyclosporine following an organ transplantation is experiencing these symptoms. Which one is of MOST concern? 1. Bleeding of the gums while brusing the teeth 2. Nontender lump in the right groin 3. Occasional nausea after taking the medication 4. Numbness and tingling of the foot

2. Nontender lump in the right groin A nontender lump in this area (or near any lymph node) may indicate that the patient has developed lymphoma, a possible adverse effect of immunosuppressive therapy. The patient should receive further evaluation immediately. The other symptoms may also indiacte side effects of cyclosporine (gingival hyperplasia, nausea, paresthesia) but do not indicate the need for immediate action.

A patient in a long-term care facility who has anemia reports chronic fatigue and dizziness with minimal activity. Which nursing activity will the nurse delegate to the unlicensed assistive personnel (UAP)? 1. Evaluating the patient's response to normal activities of daily living 2. Obtaining the patient's blood pressure and pulse with position changes 3. Determining which self-care activities the patient can do independently 4. Assisting the patient in choosing a diet that will improve strength

2. Obtaining the patient's blood pressure and pulse with position changes UAP education covers routine nursing skills such as assessment of vital signs. Evaluation, baseline assessment of patient abilities, and nutrition planning are activities appropriate to RN practice.

What group of clients should the nurse anticipate to have the highest incidence of non-Hodgkin lymphomas? 1. Children 2. Older adults 3. Young adults 4. Middle-aged persons

2. Older adults The incidence increases with age; the median age when diagnosed is 67 years old 1, 3, and 4 are incorrect because younger individuals have a lower incidence of non-Hodgkin lymphomas

Which of these patients who have just arrived at the emergency department should the nurse assess FIRST? 1. Patient who reports several dark, tarry stools and a history of peptic ulcer disease 2. Patient with hemophilia A who is experiencing thigh swelling after a fall 3. Patient who has pernicious anemia and reports parasthesia of the hands and feet 4. Patient with thalassemia major who needs a scheduled blood transfusion

2. Patient with hemophilia A who is experiencing thigh swelling after a fall Thigh swelling after an injury in a patient with hemophilia likely indicates acute bleeding, which can compromise blood flow and nerve function in the leg and should be treated immediately with the administration of factor replacement. The other patients also need assessment, treatment, or both, but the data does not indicate any immediate threat to life or function

A nurse is teaching a client with Hodgkin disease about responses to whole-body radiation. Which clinical indicator increase should the nurse include? 1. Blood viscosity 2. Susceptibility to infection 3. Red blood cell production 4. Tendency for pathologic fractures

2. Susceptibility to infection Radiation exposure may lead to depression of the bone marrow, with subsequent insufficient WBCs to combat infection 1 is incorrect because there is no increase in the number of cells; therefore, viscosity is not increased 3 is incorrect because RBC production is decreased by radiation 4 is incorrect because pathologic fractures may occur in response to the disease, not treatment

The nurse in the outpatient clinic is assessing a 22-year-old patient who needs a physical exam before starting a new job. The patient reports a history of a splenectomy several years previously after an accident but has otherwise been healthy. Which information obtained during the assessment will be of MOST immediate concern to the nurse? 1. The patient engages in unprotected sex 2. The oral temperature is 100*F (37.8*C) 3. The blood pressure is 148/76 mmHg 4. The patient admits to daily marijuana use

2. The oral temperature is 100*F (37.8*C) Because the spleen has an important role in the phagocytosis of microorganisms, the patient is at higher risk for severe infection after a splenectomy. Antibiotic administration is usually indicated for any symptoms of infection. The other information also indicates the need for more assessment and intervention, but prevention and treatment of infection are the highest priorities for this patient.

After a car accident a patient with a medical alert bracelet indicating hemophilia A is admitted to the emergency department. Which action prescribed by the health care provider will the nurse implement FIRST? 1. Transport to the radiology department for cervical spine radiography 2. Transfuse factor VII concentrate 3. Type and cross-match for 4 units of packed red blood cells (PRBCs) 4. Infuse normal saline at 250 mL/hr

2. Transfuse factor VII concentrate When a hemophiliac patient is at high risk for bleeding, the priority intervention is to maximize the avaliability of clotting factors. The other prescribed actions also should be implemented rapidly but do not have as high a priority as administering clotting factors.

A 67-year-old patient who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. Which statement made by the patient when the nurse is obtaining the admission history is of MOST concern? 1. "I've noticed that I bruise more easily since the chemotherapy started." 2. "My bowel movements are soft and dark brown." 3. "I take ibuprofen everyday because of my history of osteoarthritis." 4. "My appetite has decreased since the chemotherapy started."

3. "I take ibuprofen everyday because of my history of osteoarthritis." Because nonsteroidal anti-inflammatory drugs (NSAIDs) will decrease platelet aggregation, patients with thrombocytopenia should not use ibuprofen routinely. Patient teaching about this should be included in the care plan. Bruising is consistent with the patient's admission problem of thrombocytopenia. Soft, dark brown stools indicate that there is no frank or occult blood in the bowel movements. Although the patient's decreased appetite requires further assessment by the nurse, this is a common complication of chemotherapy.

A 22-year-old patient with stage I Hodgkin disease is admitted to the oncology unit for radiation therapy. During the initial assessment, the patient tells the nurse, "Sometimes I'm afraid of dying." Which response is MOST appropriate at this time? 1. "Many individuals with this diagnosis have some fears." 2. "Perhaps you should ask the doctor about medication." 3. "Tell me a little bit more about your fear of dying." 4. "Most people with stage I Hodgkin disease survive."

3. "Tell me a little bit more about your fear of dying." More assessment about what the patient means is needed before any interventions can be planned or implemented. All of the other statements indicate an assumption that the patient is afraid of dying of Hodgkin disease, which may not be the case.

The charge nurse is making the daily assignments on the medical-surgical unit. Which patient is BEST assigned to a float RN who has come from the postanesthesia care unit (PACU)? 1. A 30-year-old patient with thalassemia major who has an order for subcutaneous infusion of deferoxamine 2. A 43-year-old patient with multiple myeloma who requires discharge teaching 3. A 52-year-old patient with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy 4. A 65-year-old patient with pernicious anemia who has just been admitted to the unit

3. A 52-year-old patient with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy A nurse who works in the postanesthesia care unit will be familiar with the monitoring needed for a patient who has just returned from a procedure such as a colonoscopy, which requires moderate sedation or monitored anesthesia care (conscious sedation). Care of the other patients requires staff with more experience with various types of hematologic disorders and would be better to assign to nursing personnel who regularly work on the medical-surgical unit.

A client is started on a continuous infusion of heparin. Which finding does the nurse use to conclude that the intervention is therapeutic? 1. INR is between 2 and 3 2. PT is 2 1/2 times the control value 3. APTT is 2 times the control value 4. ACT is in the range of 70 and 120

3. APTT is 2 times the control value Activated partial thromboplastin time should be 1.5 to 2.5 the control for heparin therapy 1 and 2 are incorrect because INR and PT are used to evaluate therapeutic levels of warfarin (Coumadin) 4 is incorrect because the ACT increases to a range of 150 to 200 when heparin reaches therapeutic levels

A client has a bone marrow aspiration performed. After the procedure, what is the FIRST nursing action? 1. Position the client on the affected side 2. Cleanse the site with an antiseptic solution 3. Briefly apply pressure over the aspiration site 4. Begin frequent monitoring of the client's vital signs

3. Briefly apply pressure over the aspiration site Brief pressure generally is enough to prevent bleeding 1 is incorrect because no special positioning is required 2 is incorrect because the site is cleansed before aspiration 4 is incorrect because frequent monitoring is unnecessary

A client is admitted with a higher than expected red blood cell count. What physiological alteration does the nurse expect will result from this clinical finding? 1. Increased serum pH 2. Decreased hematocrit 3. Increased blood viscosity 4. Decreased immune response

3. Increased blood viscosity Viscosity, a measure of a fluid's internal resistance to flow, is increased as the number of red cells suspended in plasma increases 1 is incorrect because the number of cells does not affect the blood pH 2 is incorrect because the hematocrit would be higher 4 is incorrect because RBCs do not affect immunity

A patient with sickle cell disease is admitted with splenic sequestration. The blood pressure is 86/40 mmHg, and heart rate is 124 beats/min. Which of these actions will the nurse take FIRST? 1. Complete a head-to-toe assessment 2. Draw blood for type and cross-match 3. Infuse normal saline at 250 mL/hr 4. Ask the patient about vaccination history

3. Infuse normal saline at 250 mL/hr Because the patient is severely hypotensive, correction of hypovolemia caused by the splenic sequestration is the most urgent action. The other actions are appropriate because a complete assessment will be needed to plan care, a transfusion is likely to be needed, and a vaccination history is pertinent for patients with sickle cell disease. However, infusion of saline is the priority need.

A patient with graft-versus-host disease after bone marrow transplantation is being cared for on the medical unit. Which nursing activity is BEST assigned to a travel RN? 1. Administering oral cyclosporine 2. Assessing the patient for signs of infection 3. Infusing 5% dextrose in 0.45% saline at 125 mL/hr 4. Educating the patient about ways to prevent infection

3. Infusing 5% dextrose in 0.45% saline at 125 mL/hr The infusion of IV fluids is a common intervention that can be implemented by RNs who do not have experience in caring for patients who are severely immunosuppressed. Administering cyclosporine, assessing for subtle indications of infection, and patient teaching are more complex tasks that should be done by RN staff members who have experience caring for immunosuppressed patients.

A client with upper gastrointestinal (GI) bleeding develops mild anemia. What should the nurse expect to be prescribed for this patient? 1. Epogen 2. Dextran 3. Iron salts 4. Vitamin B12

3. Iron salts Iron is needed in the formation of hemoglobin 1 is incorrect because the client's anemia is caused by GI bleeding, not impaired RBC production. 2 is incorrect because Dextran is a plasma volume expander; it does not affect erythrocyte production 4 is incorrect because Vitamin B12 is a water-soluble vitamin that must be used as a supplement when an individual has pernicious anemia

A patient with an absolute neutrophil count of 300/microliter is admitted to the oncology unit. Which staff member should the charge nurse assign to provide care for this patient, under the supervision of an experienced oncology RN? 1. LPN/LVN who has floated from the same-day surgery unit 2. RN from a staffing agency who is being oriented to the oncology unit 3. LPN/LVN with 2 years experience on the oncology unit 4. RN who recently transferred to the oncology unit from the emergency department

3. LPN/LVN with 2 years experience on the oncology unit Because many aspects of nursing care need to be modified to prevent infection when a patient has a low absolute neutrophil count, care should be provided by the staff member with the most experience with neutropenic patients. The other staff members have the education required to care for this patient but are not as clinically experienced. When LPN/LVN staff members are given acute care patient assignments, they must work under the supervision of an RN. The LPN/LVN in this case would report to the RN assigned to the patient.

The nurse is providing orientation for a new RN who is preparing to administer packed red blood cells (PRBCs) to a patient who had blood loss during surgery. Which action by the new RN requires that the nurse intervene IMMEDIATELY? 1. Waiting 20 minutes after obtaining the PRBCs before starting the infusion 2. Starting an IV line for the transfusion using a 22-gauge catheter 3. Priming the transfusion set using 5% dextrose in lactated Ringer's solution 4. Telling the patient that the PRBCs may cause a serious transfusion reaction

3. Priming the transfusion set using 5% dextrose in lactated Ringer's solution Normal saline, an isotonic solution, should be used when priming the IV line to avoid causing hemolysis of red blood cells (RBCs). Ideally, blood products should be infused as soon as possible after they are obtained; however, a 20-minute delay would not be unsafe. Large-bore IV catheters are preferable for blood administration; if a smaller catheter must be used, normal saline may be used to dilute the RBCs. Although the new RN should avoid increasing patient anxiety by indicating that a serious transfusion reaction may occur, this action is not as high a concern as using an inappropriate fluid for priming the IV tubing.

A transfusion of packed red blood cells (PRBCs) has been infusing for 5 minutes when the patient becomes flushed and tachypneic and says, "I'm having chills. Please get me a blank." Which action should the nurse take FIRST? 1. Obtain a warm blanket for the patient 2. Check the patient's oral temperature 3. Stop the transfusion 4. Administer oxygen

3. Stop the transfusion The patient's symptoms indicate that a transfusion reaction may be occurring, so the first action should be to stop the transfusion. Chills are an indication of a febrile reaction, so warming the patient may not be appropriate. Checking the patient's tempterature and administering oxygen are also appropriate actions if a transfusion reaction is suspected; however, stopping the transfusion is the priority.

A patient is admitted to the intensive care unit with disseminated intravascular coagulation (DIC) associated with a gram-negative infection. Which assessment information has the MOST immediate implications for the patient's care? 1. There is no palpable radial or pedal pulse 2. The patient reports chest pain 3. The patient's oxygen saturation is 87% 4. There is mottling of the hands and feet

3. The patient's oxygen saturation is 87% Because the decrease in oxygen saturation will have the greatest immediate effect on all body systems, improvement in oxygenation should be the priority goal of care. The other data also indicate the need for rapid intervention, but improvement of oxygenation is the most urgent need.

A patient with chemotherapy-related neutropenia is receiving filgrastim injections. Which finding by the nurse is MOST important to report to the health care provider? 1. The patient says, "My bones are aching." 2. The patient's platelet count is 110,000 mm^3 3. The patient's white blood cell count is 39,000 mm^3 4. The patient reports that the medication stings when it is injected

3. The patient's white blood cell count is 39,000 mm^3 Leukocytosis is an adverse effect of filgrastim and indicates a need to stop the medication or decrease dosage. Bone pain is a common adverse effect as the bone marrow starts to produce more neutrophils; the patient should receive analgesics, but the medication will be continued. Stinging with injection may occur; the nurse should administer the medication more slowly. The patient's platelet count is low and should be reported, but the level of 110,000 mm^3 does not increase risk for spontaneous bleeding.

A transfusion of packed red blood cells is ordered for a client with anemia. List the following actions in the order in which they should be performed by the nurse. 1. Don a pair of clean gloves 2. Run the transfusion slowly. 3. Determine the client's vital signs 4. Ensure that the client signed a consent for the transfusion 5. Compare the number on the blood product and laboratory record

4, 3, 5, 1, 2 4. Ensure that the client signed a consent for the transfusion (A client must sign a consent for the transfusion before the procedure; clients have the right to refuse) 3. Determine the client's vital signs (Vital signs should be obtained immediately before the transfusion to serve as a baseline for comparison if a reaction is suspected) 5. Compare the number on the blood product and laboratory record (Two nurses must verify that the numbers, ABO type, and Rh type on the blood label and laboratory record match before hanging the transfusion to minimize the risk of transfusion reactions) 1. Don a pair of clean gloves (Clean gloves must be worn before inserting the spike of the blood administration set) 2. Run the transfusion slowly (The transfusion is run slowly for the first 12 to 20 minutes, but only after other steps have been completed)

After the nurse receives a change-of-shift report, which patient should be seen FIRST? 1. A 26-year-old patient with thalassemia who has a hemoglobin level of 8 g/dL (80 g/L) and orders for a blood transfusion 2. A 44-year-old patient admitted 3 days previously for sickle cell crisis who is scheduled for a computed tomographic (CT) scan 3. A 50-year-old patient with stage IV non-Hodgkin lymphoma who is crying and saying, "I'm not ready to die" 4. A 69-year-old patient with chemotherapy-induced neutropenia who has an oral temperature of 100.1*F (37.8*C)

4. A 69-year-old patient with chemotherapy-induced neutropenia who has an oral temperature of 100.1*F (37.8*C) Any temperature elevation in a neutropenic patient may indicate the presence of a life-threatening infection, so actions such as drawing blood for culture and administering antibiotics should be initiated quickly. The other patients need to be assessed as soon as possible but are not critically ill.

A patient with Hodgkin lymphoma who is receiving radiation therapy to the groin area has skin redness and tenderness in the area being irradiated. Which nursing activity should the nurse delegate to the unlicensed assistive personnel (UAP) caring for the patient? 1. Checking the skin for signs of redness or peeling 2. Assisting the patient in choosing appropriate clothing 3. Explaining good skin care to the patient and family 4. Cleaning the skin over the area daily with a mild soap

4. Cleaning the skin over the area daily with a mild soap Skin care is included in UAP education and job description. Assessment and patient teaching are more complex tasks that should be delegated to RNs. Because the patient's clothes need to be carefully chosen to prevent irritation or damage to the skin, the RN should assist the patient with this.

A client is receiving Coumadin (warfarin). The nurse explains the need for careful regulation of dietary intake of Vitamin K. What physiologic process does vitamin K promote that makes this instruction essential? 1. Platelet aggregation 2. Ionization of blood calcium 3. Fibrinogen formation by the liver 4. Prothrombin formation by the liver

4. Prothrombin formation by the liver Vitamin K promotes the liver's synthesis of prothrombin, an important blood clotting factor, and will reverse the effects of warfarin (Coumadin). 1 and 3 are incorrect because these are not promoted by Vitamin K 2 is incorrect because Vitamin K does not affect calcium ionization

The nurse obtains the following data about a patient admitted with multiple myeloma. Which information requires the MOST rapid action by the nurse? 1. The patient reports chronic bone pain 2. The blood uric acid level is very elevated 3. The 24-hour urine test shows Bence Jones proteins 4. The patient reports new-onset leg numbness

4. The patient reports new-onset leg numbness The leg numbness may indicate spinal cord compression, which should be evaluated and treated immediately by the health care provider to prevent further loss of function. Chronic bone pain, hyperuricemia, and the presence of Bence Jones proteins in the urine all are typical of multiple myeloma and do require assessment or treatment; however, the loss of motor or sensory function is an emergency.

A patient with iron deficiency anemia who is taking oral iron supplements is evaluated by the nurse in the outpatient clinic. Which finding by the nurse is of MOST concern? 1. The patient reports that stools are black 2. The patient complains of occasional constipation 3. The patient takes a multivitamin tablet every day 4. The patient takes an antacid with the iron to avoid nausea

4. The patient takes an antacid with the iron to avoid nausea Concurrent use of antacids with iron supplements will decrease absorption of the iron and decrease the efficacy in resolving the patient's anemia. Black stools are expected when taking oral iron. The patient's occasional constipation may indicate a need for information about prevention of constipation while taking iron. Use of a multivitamin tablet is safe when taking iron supplements (although the patient may need to avoid taking combined vitamin and mineral supplements).

The nurse is transferring a patient with newly-diagnosed chronic myeloid leukemia to a long-term care facility. Which information is MOST important to communicate to the nurse at the long-term care facility before transferring the patient? 1. Philadelphia chromosome is present in the patient's blood smear 2. Glucose level is elevated as a result of prednisone therapy 3. There has been a 20-lb (9.1 kg) weight loss over the last year 4. The patient's chemotherapy has resulted in neutropenia

4. The patient's chemotherapy has resulted in neutropenia. A patient with neutropenia is at increased risk for infection, and the nurse who will be receiving the patient needs to know about the neutropenia to make decisions about the patient's room assignment and to plan care. The other information also will impact planning for patient care, but the charge nurse needs the information about neutropenia before the patient is transferred.

The nurse is reviewing the complete blood count for a patient who has been admitted for knee arthroscopy. Which value is MOST important to report to the health care provider before surgery? 1. Hematocrit of 33% 2. Hemoglobin level of 10.9 g/DL 3. Platelet count of 426,000/mm^3 4. White blood cell count of 16,000/mm^3

4. White blood cell count of 16,000/mm^3 Centers for Disease Control and Prevention guidelines for the prevention of surgical site infections indicate that surgery should be postponed when there is evidence of a preexisting infection such as an elevation in white blood cell count. The other values are slightly abnormal but would not be likely to cause postoperative problems for knee arthroscopy.

During an employee health physical assessment, the patient reports noticing a large lymph node about a month ago. The patient states, "It doesn't hurt so I just ignored it." What questions would the nurse ask to find out if the patient has any of the constitutional symptoms of lymphoma? (Select all that apply) a. "Have you had any unplanned weight loss?" b. "Have you had any headaches?" c. "Have you seen blood in your urine or stool?" d. "Have you noticed heavy night sweats?" e. "Have you had a fever (>101.5*F or >38.6*C)?" f. "Have you had any problems with balance?"

a. "Have you had any unplanned weight loss?" d. "Have you noticed heavy night sweats?" e. "Have you had a fever (>101.5*F or >38.6*C)?"

In assessing the patient's hematologic status, which questions would the nurse include? (Select all that apply) a. "Have you had unusual or increased fatigue?" b. "Have you ever had any radiation therapy?" c. "Have you ever donated blood or plasma?" d. "Do you have a personal or family history of blood disorders?" e. "What drugs have you used in the past 3 days?" f. "Have you ever had a job that exposed you to chemicals?"

a. "Have you had unusual or increased fatigue?" b. "Have you ever had any radiation therapy?" d. "Do you have a personal or family history of blood disorders?" f. "Have you ever had a job that exposed you to chemicals?"

A patient with sickle cell crisis is admitted to the hospital. Which questions does the nurse ask the patient to elicit information about the cause of the current crisis? (Select all that apply) a. "Have you recently traveled on an airplane?" b. "Have you ever had radiation therapy?" c. "In the past 24 hours, has any activity made you short of breath?" d. "Have you recently consumed alcohol or used recreational drugs?" e. "Have you had any symptoms of infection, such as fever?" f. "Lately have you increased strenuous physical activities?"

a. "Have you recently traveled on an airplane?" c. "In the past 24 hours, has any activity made you short of breath?" d. "Have you recently consumed alcohol or used recreational drugs?" e. "Have you had any symptoms of infection, such as fever?" f. "Lately have you increased strenuous physical activities?"

The new registered nurse is giving a blood transfusion to a patient. Which statement by the new nurse indicates the need for action by the supervising nurse? a. "I will complete the red blood cell transfusion within 6 hours" b. "I will check the patient verification with another nurse" c. "I will use normal saline solution to begin the blood transfusion" d. "I will remain with the patient for the first 15 to 30 minutes of the infusion"

a. "I will complete the red blood cell transfusion within 6 hours"

A patient has been taught how to care for his central venous catheter at home. Which statement by the patient indicates that further instruction is necessary? a. "I will flush the catheter with heparin once a day and after infusions" b. "I will change the Luer-Lok cap on each catheter every week" c. "I will look for and report any signs of infection" d. "I will wash my hands before working with the catheter"

a. "I will flush the catheter with heparin once a day and after infusions"

The nurse has instructed a patient at risk for bleeding about techniques to manage bleeding. Which statements by the patient indicated that teaching has been successful? (Select all that apply) a. "I will take a stool softener to prevent straining during a bowel movement" b. "I won't take aspirin or aspirin-containing products" c. "I won't participate in any contact sports" d. "I will report a headache that is not responsive to acetaminophen" e. "I will avoid bending over at the waist" f. "If I am injured, I will apply a warm compress for at least 10 minutes"

a. "I will take a stool softener to prevent straining during a bowel movement" b. "I won't take aspirin or aspirin-containing products" c. "I won't participate in any contact sports" d. "I will report a headache that is not responsive to acetaminophen" e. "I will avoid bending over at the waist"

Which lab values would the nurse expect to see for a patient with sickle cell disease? (Select all that apply) a. 80% hemoglobin S b. 90% red blood cell sickling c. Increased hematocrit d. Increased reticulocyte count e. Decreased total bilirubin f. Elevated total white blood cell count

a. 80% hemoglobin S b. 90% red blood cell sickling d. Increased reticulocyte count f. Elevated total white blood cell count

A patient has polycythemia vera. Which action by the unlicensed assistive personnel requires intervention by the supervising nurse? a. Assisting the patient to floss his teeth b. Using an electric shaver on the patient c. Helping the patient with a soft-bristled toothbrush d. Assisting the patient to don support hose

a. Assisting the patient to floss his teeth

The nurse is assessing a patient who is newly diagnosed with anemia. Which assessment findings are typical of this disorder? (Select all that apply) a. Dyspnea on exertion b. Systolic hypertension c. Intolerance to heat d. Concave appearance of nails e. Pallor of the ears f. Headache

a. Dyspnea on exertion d. Concave appearance of nails e. Pallor of the ears f. Headache

The nurse is interviewing a patient who has iron deficiency anemia. Which symptom is the patient MOST LIKELY to report? a. Fatigue b. Night sweats c. Calf pain d. Blood in urine

a. Fatigue

What equipment would the nurse need to perform a hematologic assessment? (Select all that apply) a. Gloves b. Otoscope c. Stethoscope d. Blood pressure cuff e. Penlight f. Cotton-tip applicator

a. Gloves c. Stethoscope d. Blood pressure cuff e. Penlight

Which medication increases the risk for the patient to develop infection? a. Glucocorticoids b. Nonsteroidal anti-inflammatory agents c. Iron solutions d. Anticoagulants

a. Glucocorticoids

The nurse hears in report that the patient is diagnosed with autoimmune thrombocytopenic purpura. Which instruction is the nurse MOST LIKELY to give to unlicensed assistive personnel? a. Handle the patient very gently to minimize bruising b. Wear a mask when caring for the patient to prevent infection c. Encourage the patient to drink fluids to prevent dehydration d. Assist the patient to stand to prevent falls related to weakness

a. Handle the patient very gently to minimize bruising

The nurse is caring for a patient with acute leukemia. Which signs/symptoms is the nurse MOST LIKELY to observe during the assessment? (Select all that apply) a. Hematuria b. Orthostatic hypotension c. Bone pain d. Joint swelling e. Fatigue f. Weight gain

a. Hematuria b. Orthostatic hypotension c. Bone pain d. Joint swelling e. Fatigue

An older patient is receiving a blood transfusion. Which signs/symptoms suggest that the patient is experiencing transfusion-associated circulatory overload? a. Hypertension, bounding pulse, and distended neck veins b. Fever, chills, and tachycardia c. Urticaria, itching, and bronchospasm d. Headache, chest pain, and hemoglobinuria

a. Hypertension, bounding pulse, and distended neck veins

Which factors are associated with an increased risk for non-Hodgkin's lymphoma? (Select all that apply) a. Immunosuppressive disorders b. Chronic infection from Helicobacter pylori c. Epstein-Barr viral infection d. Chronic alcoholism e. Pesticides and insecticides f. Smoking cigars or cigarettes

a. Immunosuppressive disorders b. Chronic infection from Helicobacter pylori c. Epstein-Barr viral infection e. Pesticides and insecticides

The nurse is caring for a patient in sickle cell crisis. What are the PRIORITY interventions for this patient? (Select all that apply) a. Managing pain b. Managing nutrition c. Ensuring hydration d. Administering platelets e. Assessing oxygen saturation f. Monitoring for signs/symptoms of infection

a. Managing pain c. Ensuring hydration e. Assessing oxygen saturation f. Monitoring for signs/symptoms of infection

Which patient is MOST LIKELY to have severe manifestations of sickle cell disease even when triggering conditions are mild? a. Mother and father both have hemoglobin S gene alleles b. Mother has hemoglobin S gene alleles and father has hemoglobin A gene alleles c. Mother has sickle cell trait and father has hemoglobin A gene alleles d. Mother and father both have hemoglobin A gene alleles

a. Mother and father both have hemoglobin S gene alleles

The experienced nurse is supervising a new graduate nurse during administration of a blood product. In which circumstance would the experienced nurse intervene? a. New graduate nurse prepares to use blood administration tubing to infuse stem cells b. New graduate nurse obtains Y-tubing with a blood filter to administer packed red blood cells c. New graduate nurse uses a special shorter tubing with a smaller filter to deliver platelets d. New graduate nurse rapidly delivers fresh frozen plasma through regular straight filtered tubing

a. New graduate nurse prepares to use blood administration tubing to infuse stem cells

A patient is receiving a red blood cell transfusion through a double-lumen peripherally insterted central catheter. The patient has two other peripheral IVs: one is capped and the other has D5/.45 NS running at a rate of 50 mL/hr. What can be given concurrently through the line that is selected for the red cell transfusion? a. Normal saline b. Infusion of platelets c. Dextrose in water d. Morphine 2 mg IV push

a. Normal saline

While reviewing the patient's medication list, the nurse notes that the patient is receiving parenteral enoxaparin. Which outcome statement reflects the goal of the enoxaparin therapy? a. Patient shows no signs/symptoms of a blood clot b. Patient reports a decrease in fatigue and dizziness c. Patient shows no signs/symptoms of infection d. Patient reports no shortness of breath on exertion

a. Patient shows no signs/symptoms of a blood clot

The nurse is caring for a patient who just had a bone marrow aspiration. Which outcome statement reflects the PRIORITY goal of care after the procedure? a. Patient will not experience excessive bleeding b. Patient's pain level will be 3/10 or less c. Patient will not show signs/symptoms of infection d. Patient will verbalize understanding of procedure results

a. Patient will not experience excessive bleeding

The nurse is performing a hematologic assessment. Which finding would be considered a normal change in an older adult? a. Progressive loss of body hair b. Loss of nails and cuticles c. Irregular pattern of ecchymosis d. Cyanosis of the lips and earlobes

a. Progressive loss of body hair

In caring for a patient with acute leukemia, what is the PRIORITY collaborative problem? a. Protecting the patient from infection b. Minimizing the side effects of chemotherapy c. Controlling the patient's pain d. Assisting the patient to cope with fatigue

a. Protecting the patient from infection

A deficiency in any of the anticlotting factors, such as protein C, protein S, and antithrombin III increases the patient's risk for which disorder(s)? (Select all that apply) a. Pulmonary embolism b. Myocardial infarction c. Iron deficient anemia d. Pernicious anemia e. Stroke f. Hemolytic anemia

a. Pulmonary embolism b. Myocardial infarction e. Stroke

Which disorder poses the GREATEST risk of infection for the patient? a. Sickle cell crisis b. Vitamin B12 deficiency anemia c. Polycythemia vera d. Thrombocytopenia

a. Sickle cell crisis

What is the FIRST priority intervention when the nurse recognizes that a patient is having a transfusion reaction? a. Stop the transfusion b. Notify the Rapid Response Team c. Flush the IV tubing with normal saline d. Apply oxygen via face mask

a. Stop the transfusion

The home care nurse is visiting a patient who had a stem cell transplant. Which observation by the nurse requires IMMEDIATE action? a. The patient's grandson is visiting after receiving the measles, mumps, and rubella vaccine b. The patient bumps his toe on a chair and applies pressure to the toe for 10 minutes c. The patient with a platelet count of 48,000/mm^3 follows platelet precautions d. The patient avoids going outdoors if conditions are icy or slippery

a. The patient's grandson is visiting after receiving the meals, mumps, and rubella vaccine

The student nurse is caring for a patient in sickle cell crisis. Which action by the student nurse warrants intervention by the supervising nurse? a. Turning down the thermostat to a cooler temperature b. Using distraction and relaxation techniques c. Positioning patient's painful areas with support d. Using therapeutic touch and aroma therapy

a. Turning down the thermostat to a cooler temperature

Which person is MOST LIKELY to benefit from a referral for genetic counseling? a. Young woman who has an older brother who has hemophilia A b. Young woman whose sister is being treated for iron deficiency anemia c. Young man whose mother had a thromboembolic event after taking thalidomide d. Young man whose older brother is being treated for Hodgkin's lymphoma

a. Young woman who has an older brother who has hemophilia A

A patient admitted for sickle cell crisis is being discharged home. Which statement by the patient indicates the need for further post-discharge instruction? a. "I will walk rather than jog every morning" b. "I will visit my friends in Denver" c. "I will avoid the sauna at the gym" d. "I will not drink alcoholic beverages"

b. "I will visit my friends in Denver"

A patient has the signs/symptoms of hereditary hemochromatosis. The health care provider asks the nurse to immediately report RELEVANT laboratory results, so the diagnosis can be confirmed. Which laboratory result is the health care provider waiting for? a. Complete blood count b. Blood ferritin level c. Platelet count d. Peripheral blood smear

b. Blood ferritin level

The patient is admitted for a chronic liver disorder and will be receiving vitamin K to address one of the problems associated with the disorder. Which clinical manifestation is the nurse MOST LIKELY to observe before vitamin K therapy is initiated? a. Sore throat and a smooth tongue b. Bruising and bleeding at venipuncture sites c. Fever and increased white blood cell count d. Calf swelling due to deep vein thrombosis

b. Bruising and bleeding at venipuncture sites

Based on knowledge of albumin's role in maintaining osmotic pressure of the blood, which sign/symptom would the nurse look for if the patient has low albumin levels? a. Fever b. Edema c. Bruising d. Pain

b. Edema

For a patient who has a dysfunction of the bone marrow, which sign/symptom is the nurse MOST LIKELY to observe? a. Long bone pain b. Fatigue c. Loss of appetite d. Weight gain

b. Fatigue

A patient with lymphoma requires a hematopoietic stem cell transplant, and a donor is being sought. Which type of transplant is likely to yield the BEST results? a. Partially HLA-matched unrelated donor b. HLA-identical twin sibling c. HLA-matched first-degree relative d. HLA-matched stem cells from an umbilical cord of a related donor

b. HLA-identical twin sibling

Which electrolyte imbalance can occur related to a blood transfusion? a. Hyponatremia b. Hyperkalemia c. Hypocalcemia d. High blood glucose

b. Hyperkalemia

Which drug disrupts platelet action? a. Vitamin K b. Ibuprofen c. Penicillin V d. Morphine

b. Ibuprofen

A patient reports fatigue, bone pain, and frequent bacterial infections. Further investigation reveals anemia and hypercalcemia, and x-ray findings show bone thinning with areas of bone loss that resemble Swiss cheese. The signs/symptoms and diagnostic findings are consistent with which disorder? a. Acute leukemia b. Multiple myeloma c. Non-Hodgkin's lymphoma d. Sickle cell anemia

b. Multiple myeloma

The home health nurse notices that new medications were prescribed for a patient during a recent hospitalization. In addition, the patient reports taking daily low-dose aspirin, but aspirin is not on the medication reconciliation list. Because of the aspirin, the nurse is MOST LIKELY to call the prescribing health care provider for clarification of which type of medication? a. Vitamin supplement b. Platelet inhibitor c. Antihypertensive d. Erythrocyte stimulating agent

b. Platelet inhibitor

The nurse is helping a patient prepare for induction therapy for acute leukemia. What information will the nurse give to the patient? a. A donor is needed for hematopoietic stem cell transplantation b. Prolonged hospitalization is common to protect against infection c. The therapy may last from months to years to maintain remission d. Success of the therapy results in remission and the intent is to cure

b. Prolonged hospitalization is common to protect against infection

The patient reports a history of splenectomy. Based on this information, what is the nurse MOST LIKELY to assess for? a. Signs of bleeding b. Signs of infection c. Digestive problems d. Jaundice of the skin

b. Signs of infection

A patient is at high risk for the development of venoocclusive disease. What assessments does the nurse perform for EARLY detection of this disorder? (Select all that apply) a. Joint pain b. Weight gain c. Hepatomegaly d. Fluid retention e. Raynaud's-like response f. Increase in abdominal girth

b. Weight gain c. Hepatomegaly d. Fluid retention f. Increase in abdominal girth

Which blood product is MOST LIKELY to have stricter monitoring policies requiring that a physician be present on the unit during administration? a. Packed red blood cell transfusion b. White blood cell transfusion c. Fresh frozen plasma transfusion d. Platelet transfusion

b. White blood cell transfusion

Which outcome statement indicates successful engraftment of transplanted cells in the patient's bone marrow? a. There is no evidence of graft-versus-host disease b. White blood cell, red blood cell, and platelet counts are rising c. Laboratory results indicate probable regressive chimerism d. Laboratory results show decreasing percentage of donor cells

b. White blood cell, red blood cell, and platelet counts are rising

A patient scheduled for surgery tells the nurse that he is fearful of the possibility of needing a blood transfusion. What is the nurse's BEST response? a. "Have you spoken with your health care provider about a family member donating blood for your transfusion?" b. "With today's technology, typing and receiving blood is a very safe procedure, and there is no need to worry." c. "Autologous transfusion, where you donate your own blood for later transfusion, may be an option for you." d. "Have you had previous unpleasant experiences with blood transfusions during past surgeries?"

c. "Autologous transfusion, where you donate your own blood for later transfusion, may be an option for you."

The nurse has taught the patient about dietary modifications for his Vitamin B12 deficiency anemia. Which statement by the patient indicates that additional teaching is needed? a. "Dairy products are a good source of Vitamin B12" b. "Dried beans taste okay if they are prepared correctly" c. "Leafy green vegetables interfere with my therapy" d. "I like nuts, and I will gladly include them in my diet"

c. "Leafy green vegetables interfere with my therapy"

The nurse is caring for a patient with thrombocytopenia. Which order does the nurse question? a. Test all urine and stool for occult blood b. Avoid IM injections c. Administer enemas d. Apply ice to areas of trauma

c. Administer enemas

Based on knowledge of physiologic triggers for red blood cell (RBC) production, the nurse would anticipate which chronic health condition to be associated with an increase in RBC production? a. Diabetes mellitus b. Osteoarthritis c. Chronic obstructive pulmonary disease d. Chronic kidney disease

c. Chronic obstructive pulmonary disease

The new registered nurse is identifying a patient for blood transfusion. Which action by the new nurse warrants intervention by the supervising nurse? a. Checks the health care provider's order before the blood transfusion b. Compares the identification name band and number to the blood component tag c. Cross-checks the patient's room number as a form of identification d. Compares blood bag label and requisition slip to ensure compatibility of ABO and Rh

c. Cross-checks the patient's room number as a form of identification

Which types of medications are used as pre-medication to prevent a reaction for patients receiving a stem cell transfusion? a. Vitamin K and a diuretic b. Aspirin and hydroxyurea c. Diphenhydramine and acetaminophen d. Hydrocortison and an antihypertensive

c. Diphenhydramine and acetaminophen

The nurse notes that the patient's platelet count is 400,000/mm^3. What action is the nurse MOST LIKELY to take? a. Immediately inform the health care provider because of possible spontaneous bleeding b. Instruct unlicensed assistive personnel to handle patient gently to minimize bruising c. Document the result because it is within the normal range and continue to monitor d. Initiate protective isolation and monitor for signs/symptoms of systemic infection

c. Document the result because it is within the normal range and continue to monitor

A patient with acute leukemia has been receiving an erythropoiesis-stimulating agent (ESA). The nurse sees that the hemoglobin level is 10.5 mg/dL. Why does the nurse call the health care provider to have the ESA discontinued? a. The hemoglobin level is below normal limits, and this increases the risk for side effects b. The ESA therapy is not effective, and an alternate medication should be ordered c. ESAs can cause hypertension and increase the risk for myocardial infarction d. The hemoglobin level of 10.5 mg/dL is the cutoff point recommended by the manufacturer

c. ESAs can cause hypertension and increase the risk for myocardial infarction

Which hematologic disorder is MOST LIKELY to cause the patient to have joint problems? a. Thrombocytopenia b. Aplastic anemia c. Hemophilia D. Warm antibody anemia

c. Hemophilia

Which laboratory result would indicate that the prescription for epoetin alfa is having the desired therapeutic effect? a. Increase in platelet count b. Increase in white blood cell count c. Increase in red blood cell count d. Increase in iron level

c. Increase in red blood cell count

Which abnormal vital sign is the nurse MOST LIKELY to see in a patient who has polycythemia vera? a. Elevated temperature b. Decreased respiratory rate c. Increased blood pressure d. Rapid thready pulse

c. Increased blood pressure

The home health nurse is visiting a patient who was recently treated for leukemia. The patient says he feels fine and has been carefully following all discharge instructions. The patient's temperature is 1*F (0.5* C) above baseline. What should the nurse do? a. Tell the patient to recheck the temperature in 4 hours b. Administer two 325mg tablets of acetaminophen c. Initiate standard infection control and call the health care provider d. Document the temperature and other vital signs in the record

c. Initiate standard infection control and call the health care provider

The nurse notes that a 45-year-old woman has a low hemoglobin level. The nurse would perform a dietary assessment to identify a possible deficiency in which nutrient? a. Calcium b. Vitamin K c. Iron d. Vitamin D

c. Iron

The nurse is performing the IMMEDIATE post-procedure care for a bone marrow donor. What is the PRIORITY assessment that the nurse will perform? a. Monitoring for activity intolerance b. Monitoring for infection c. Monitoring for fluid loss d. Monitoring platelet count

c. Monitoring for fluid loss

The unlicensed assistive personnel (UAP) is assisting in the care of a patient in sickle cell crisis. Which action by the UAP requires intervention by the supervising nurse? a. Elevating the head of the bead to 25 degrees b. Helping to remove any restrictive clothing c. Obtaining the blood pressure with an external cuff d. Offering the patient a caffeine-free beverage

c. Obtaining the blood pressure with an external cuff

The nurse routinely checks mental status on all patiens; however, which patient has the GREATEST need for frequent neurologic assessment and checks of cognitive function? a. Elderly patient with chronic dementia has iron deficiency anemia due to poor diet b. Younger female patient has low hemoglobin and hematocrit related to heavy menses c. Older male with alcoholism sustains head injury during an episode of intoxication d. Young male has fever and elevated white blood cell count related to an upper respiratory infection

c. Older male with alcoholism sustains head injury during an episode of intoxication

The nurse has just received a handoff report and is planning care for several patients who must receive blood products during the shift. Which patient will require the MOST monitoring for the longest period of time? a. Young woman needs a unit of packed red blood cells for a hemoglobin of 5 mg/dL b. Patient with thrombocytopenia needs pooled platelets for a platelet count of 45,000 c. Older patient with heart failure needs washed red blood cells for chronic bleeding d. Patient with thrombotic thrombocytopenic purpura needs fresh frozen plasma

c. Older patient with heart failure needs washed red blood cells for chronic bleeding

Which patient has the GREATEST risk for developing a febrile transfusion reaction? a. Patient is an older adult, and transfusion was given too rapidly b. Patient received an intraoperative autologous transfusion c. Patient has received multiple blood transfusions for chronic bleeding d. Patient sustained multiple injuries and needed an emergency transfusion

c. Patient has received multiple blood transfusion for chronic bleeding

The patient is diagnosed with hereditary hemochromatosis. Which therapy does the nurse expect will be prescribed for this patient? a. Interferon alfa therapy to control RBC production b. Hydration to decrease "sludging" of blood c. Phlebotomy to reduce overall iron load of the blood d. Administration of folic acid and Vitamin B12 to prevent anemia

c. Phlebotomy to reduce overall iron load of the blood

A patient is diagnosed with iron deficiency anemia. Which assessment finding is the nurse MOST LIKELY to observe in this patient? a. Neck veins are distended and edema is present b. Lower extremities show signs of phlebitis c. Systolic blood pressure is lower than normal d. Palpation of ribs or sternum elicits tenderness

c. Systolic blood pressure is lower than normal

The nurse is interviewing a patient who might be a candidate for fibrinolytic therapy for treatment of myocardial infarction. Why is determining the time of symptom onset essential for decision making? a. Fibrinolytic drugs will not dissolve clots that are older than 6 hours b. Clots that are older than 6 hours are tightly meshed and complete c. Tissue that is anoxic for more than 6 hours is unlikely to benefit d. After 6 hours, the patient is more likely to have excessive bleeding

c. Tissue that is anoxic for more than 6 hours is unlikely to benefit

The nurse would measure abdominal girth to monitor for which complication of hematopoietic stem cell transplantation? a. Failure to engraft b. Graft-versus-host disease c. Venoocclusive disease d. Septic shock

c. Venoocclusive disease

To avoid transfusion reaction, the nurse is carefully monitoring the patient during a blood transfusion. When are hemolytic reactions to blood transfusions MOST LIKELY to occur? a. 1 mL is sufficient b. 5 mL is typical c. Within the first 50 mL d. After 100 mL

c. Within the first 50 mL

A patient is scheduled to undergo diagnostic testing for sickle cell anemia. Which educational brochure is the nurse MOST LIKELY to provide to the patient? a. "What to Expect During a Bone Marrow Biopsy" b. "How Your Doctor Interprets Your Platelet Count" c. "What Is a Philadelphia Chromosome Analysis?" d. "How Is Hemoglobin S Used to Confirm My Diagnosis?"

d. "How Is Hemoglobin S Used to Confirm My Diagnosis?"

Which hematologic disorder is MOST LIKELY to occur if the hormonal function of the kidneys is not working properly? a. Leukemia b. Thrombocytopenia c. Neutropenia d. Anemia

d. Anemia

Which food should a patient with a low white blood cell count be encouraged to eat? a. Fresh blueberries b. Unpasteurized yogurt c. Green leaf lettuce d. Baked chicken

d. Baked chicken

The nurse knows that erythropoietin is a growth factor that is required for stem cell specialization. Which sign/symptom would the nurse observe if erythropoietin is lacking or not performing its role? a. Elevated body temperature b. Bruising and ecchymosis c. Swelling of lymph nodes d. Fatigue and exhaustion

d. Fatigue and exhaustion

Which dinner selection represents the BEST choice of foods to supply the nutrients required for good cell quality and clotting function? a. Fried chicken breast with mashed potatoes b. Mixed fruit and vegetable salad, French bread with butter, and wine c. Small lean beef steak with cheese and hash brown potato casserole d. Grilled salmon with spinach salad and fresh strawberries for dessert

d. Grilled salmon with spinach salad and fresh strawberries for dessert

A patient has a suspected hematologic problem. Which instruction is the nurse MOST LIKELY to give to the unlicensed assistive personnel? a. Record urine output for the shift b. Take the vital signs every 2 hours c. Assess the patient for fatigue after exertion d. Handle the patient gently to avoid bruising

d. Handle the patient gently to avoid bruising

Venous stasis is considered to be an intrinsic factor that can result in activating which physiologic process? a. Increased red blood cell production b. Adjustment of osmotic fluid pressure c. Initiation of anticlotting forces d. Initiation of blood clotting cascade

d. Initiation of blood clotting cascade

Which organ is MOST LIKELY to become enlarged as the result of severe anemia? a. Gallbladder b. Kidneys c. Colon d. Liver

d. Liver

What instructions would the home health nurse give to the home health aide about helping a patient who needs to conserve energy? a. Assist the patient to complete activities and exercises when he gets short of breath b. Let the patient decide whether he has the energy to bathe every day c. Encourage people not to visit to allow the patient to rest and conserve energy d. Offer 4-6 small, easy-to-eat meals rather than serving three large meals

d. Offer 4-6 small, easy-to-eat meals rather than serving three large meals

When assessing the patient with darker skin for pallor and cyanosis, which area would the nurse examine? a. Chest and abdomen b. General appearance of face c. Fingertips and toes d. Oral mucous membranes

d. Oral mucous membranes

An experienced nurse is supervising a new nurse who is assessing a patient with a suspected hematologic problem. The experienced nurse would intervene if the new nurse performed which action? a. Palpated the edge of the liver in the right upper quadrant b. Auscultated the heart for abnormal heart sounds or irregular rhythms c. Used the fingertips to firmly press over the ribs or sternum d. Palpated the left upper quadrant to locate an enlarged spleen

d. Palpated the left upper quadrant to locate an enlarged spleen

During physical assessment the nurse gently palpates the patient's sternum and the patient reports tenderness to touch. Why would the nurse report this finding to the health care provider? a. Hematology problems increase risk for rib fractures b. Pernicious anemia causes fissures in underlying structures c. Elicited tenderness could signal myocardial infarction d. Rib or sternal tenderness may occur with leukemia

d. Rib or sternal tenderness may occur with leukemia