Chapter 28. Hematologic and Lymphatic Disorders

52. The nurse suspects a patient is experiencing manifestations of Hodgkins disease. Which are characteristics of this health disorder? (Select all that apply.) a. Visual changes occur. b. It is the most curable of all lymphomas. c. Skeletal pain is a common symptom. d. It is distinguished by the presence of Reed-Sternberg cells. e. Painless swelling of cervical, axillary, or inguinal nodes occurs. f. It is distinguished by the presence of Philadelphia chromosome.

B, D, E B. It is the most curable of all lymphomas D. It is distinguished by the presence of Reed-Sternberg cells E. Painless swelling of cervical, axillary, or inguinal nodes occurs

13. The nurse is teaching a patient with sickle cell anemia how to prevent crises. Which foods should the nurse teach the patient to avoid? a. Citrus fruits b. Alcoholic beverages c. Chocolates and colas d. Whole grain products

B. Alcoholic beverages

1. The nurse is caring for a patient with anemia. Which blood component is deficient in this patient? a. Plasma b. Platelets c. Red blood cells (RBCs) d. White blood cells (WBCs)

C. Red blood cells (RBCs)

47. The nurse suspects a patient has polycythemia. Which hematocrit value is causing the nurse to have this concern? a. 38% b. 45% c. 47% d. 55%

D. 55% Hematocrit level greater than 55% is characteristic of polycythemia. Normal hematocrit - 38-47% females and 40-54% for males

7. A patient with thrombocytopenia is having pain. If each of the following medications is ordered, which should the nurse choose to administer? a. Morphine SQ b. Meperidine (Demerol) IM c. Oxycodone with aspirin (Percodan) PO d. Acetaminophen with codeine (Tylenol No. 3) PO

D. Acetaminophen with codeine (Tylenol No. 3) PO This is oral, making it the best choice. Aspirin increases risk for bleeding.

29. The nurse is emptying the bedside commode of a patient with chronic leukemia and notes that the stool is very dark. Which assumption should guide the nurses action? a. The patient may be bleeding. b. The patient may be dehydrated. c. The patient is most likely on iron supplements. d. The patient ate something that turned the stool a dark color.

A. The patient may be bleeding

38. A patient with terminal lymphoma says to the nurse, Im tired of being so fatigued all the time. Cant you just give me a big shot of morphine and help me end this suffering? Which response by the nurse is most appropriate? a. You sound frustrated. It must be difficult to feel so tired all the time. b. Are you sure that is what you want me to do? Maybe you should think about it first. c. That is really not appropriate to ask. Would you like a shot just to take away the pain? d. You have orders for morphine 10 to 15 mg. I dont think thats enough to end your suffering.

A. You sound frustrated. It must be difficult to fell so tired all the time.

8. The nurse is caring for a patient with thrombocytopenia. Which activity should be avoided? a. Ambulation b. Intramuscular injections c. Visits from family members d. Eating fresh fruits and vegetables

B. Intramuscular injections

45. A patient with anemia and a nursing diagnosis of activity intolerance due to tissue hypoxia and dyspnea is attempting to increase activity tolerance. What percentage of increase in pulse and respiratory rate should the nurse use to determine if the activity is too strenuous for the patient? a. 5% b. 10% c. 20% d. 30%

C. 20% (30% could cause the patient to develop cardiac or respiratory problems).

39. A patient is being prepared for splenectomy. What is the purpose of the order for a vitamin K injection? a. It corrects a dietary deficiency. b. It helps correct underlying anemia. c. It corrects clotting factor deficiencies. d. It replaces vitamin K lost during night sweats.

C. It corrects clotting factor deficiencies.

30. A patient receiving chemotherapy for chronic myelocytic leukemia has irritated mucous membranes. Which mouth care intervention should the nurse include in the plan of care? a. Brush teeth twice a day with a firm toothbrush. b. Use waxed floss between meals and at bedtime. c. Use sponge Toothettes to clean teeth after meals. d. Swab teeth and mucous membranes four times daily with lemon-glycerin swabs.

C. Use sponge Toothettes to clean teeth after meals

46. A patient has a platelet count of 20,000/mm3. What action should the nurse take? a. Assist out of bed to a chair b. Draw another blood sample c. Measure a rectal temperature d. Place on bleeding precautions

D. Place on bleeding precautions

21. The nurse is assessing a patient with a bleeding disorder and finds large purplish areas in the skin and oral mucosa. Which term should the nurse use to document this finding? a. Purpura b. Bleeding c. Petechiae d. Hemorrhage

A. Purpura Purpura is the correct term for hemorrhage into the skin, mucous membranes, and organs

35. The nurse is preparing teaching for a patient with Hodgkins disease. Which beverage should the nurse instruct this patient to avoid? a. Wine b. Coffee c. Ginger ale d. Orange juice

A. Wine Alcohol can induce pain in patients with Hodgkins disease

42. The nurse is collaborating on discharge teaching needed for a patient recovering from a splenectomy. What follow-up care is most important for the nurse to emphasize with this patient? a. Monthly coagulation studies b. Yearly influenza vaccination c. Oral analgesics for pain control d. Routine transfusion of packed RBCs to prevent anemia

B. Yearly influenza vaccination

54. A patient is planning to have an allogeneic bone marrow transplant. What will the patient most likely have completed before this transplant occurs? (Select all that apply.) a. Electrophoresis b. Peritoneal dialysis c. Total body irradiation d. High-dose chemotherapy e. Massive blood transfusions

C, D C. Total body irradiation D. High-dose chemotherapy

48. The nurse is preparing teaching materials for a patient with PV. How many liters of fluid should the nurse instruct the patient to consume each day? a. 1 b. 2 c. 3 d. 4

C. 3 Patients should drink 3 liters of water daily to reduce blood viscosity

53. During a home visit, the nurse becomes concerned that a child is developing idiopathic thrombocytopenic purpura (ITP). Which health problems could have precipitated the development of this disorder in the child? (Select all that apply.) a. HIV b. Rubella c. Hepatitis C d. Chickenpox e. Cystic fibrosis

A, B, C, D A. HIV B. Rubella C. Hepatitis C D. Chickenpox

50. The nurse is providing education to an individual with sickle cell anemia. Which activities should the nurse instruct the patient to avoid? (Select all that apply.) a. Scuba diving b. Contact sports c. Sexual activity d. Long-distance driving e. Skiing in the mountains f. Standing for long periods

A, E A. Scuba diving E. Skiing in the mountains Decreased oxygenation

4. The nurse is assisting in the development of a care plan for a patient with anemia. Which nursing diagnosis is most common in a patient with anemia? a. Activity Intolerance related to tissue hypoxia b. Ineffective Airway Clearance related to dyspnea c. Chronic Pain related to bone marrow dysfunction d. Risk for Infection related to reduction in circulating WBCs

A. Activity intolerance related to tissue hypoxia

18. The nurse is caring for a patient with a bleeding disorder. Which medication order should the nurse question? a. Aspirin b. Morphine c. Digoxin (Lanoxin) d. Thyroid hormone (Synthroid)

A. Aspirin

41. A patient who has had a splenectomy complains of malaise. The nurse checks the patients temperature and finds it is 102F (39C). Which action by the nurse should take priority? a. Notify the physician. b. Encourage fluids to reduce fever and prevent dehydration. c. Administer acetaminophen to reduce fever and relieve discomfort. d. Explain to the patient that low-grade fevers are common after splenectomy because the spleen is part of the immune system.

A. Notify the physician Fever in the post-splenectomy period signals overwhelming post-splenectomy infection. This can be deadly if not recognized and treated quickly, so notifying the physician is essential

31. A patient with multiple myeloma is being cared for at home. Which nursing diagnosis should guide the nurse when teaching the family how to provide care for the patient? a. Risk for Injury related to compromised bone integrity b. Ineffective Tissue Perfusion related to vascular occlusion c. Risk for Deficient Fluid Volume related to bleeding disorder d. Ineffective Airway Clearance related to cervical lymphadenopathy

A. Risk for injury related to compromised bone integrity Multiple myeloma causes destruction of the bone and widespread osteoporosis

49. The daughter of a male patient with hemophilia is concerned about transmitting the genetic disorder to any future children. What percentage of chance of transmitting the gene to future children should the nurse instruct the daughter? a. 10% b. 25% c. 50% d. 100%

C. 50%

11. The nurse is reviewing the current patient census on a care area. Which individual is most likely to present with signs or symptoms of sickle cell anemia? a. A 1-month-old boy who is Hispanic b. A 5-year-old girl of Hispanic origin c. A 1-year-old boy who is African American d. A 3-month-old girl who is African American

C. A 1-year-old boy who is African American Symptoms are not present until after 6 months of age. African or eastern mediterranean origins are common for sickle cell anemia.

28. A patient is being tested for possible leukemia. With which diagnostic test should the nurse anticipate assisting? a. Liver biopsy b. Thoracentesis c. Bone marrow biopsy d. Arterial blood gas analysis

C. Bone marrow biopsy

34. A patient with Hodgkins disease has cervical lymph node enlargement. Which symptom should the nurse attend to first? a. Pain b. Fever c. Stridor d. Fatigue

C. Stridor Stridor indicates airway involvement due to enlarged lymph nodes. Airway is always a priority, as airway compromise is life-threatening

40. The nurse is providing care for a patient who has had a splenectomy. Which nursing action has the highest priority? a. Assess pain every shift. b. Provide a diet rich in fruits and vegetables. c. Teach the patient to cough and deep breathe every hour. d. Encourage the patient to look at the incision during dressing changes.

C. Teach the patient to cough and deep breathe every hour This will mobilize secretions and help prevent respiratory infection - patients are at risk for serious infection following a splenectomy.

27. The nurse is identifying approaches to reduce the risk of infection in a patient with leukemia. Why is it important for the nurse to institute infection control measures for this patient? a. Infection can precipitate hemorrhage in the patient with leukemia. b. The drugs needed to fight infection have life-threatening side effects. c. Infection in the patient with leukemia can lead to permanent neurological damage. d. Leukemia seriously impairs the leukocytes and the bodys ability to fight infection.

D. Leukemia seriously impairs the leukocytes and the bodys ability to fight infection

6. The nurse is preparing to give an injection of iron (Imferon) to a patient with anemia. What is the rationale for using the Z-track method for injection? a. Prevent pain at the site b. Prevent tissue damage at the site c. Promote absorption of the medication d. Prevent discoloration of tissue at the site

D. Prevent discoloration of tissue at the site.

56. A patient is diagnosed with a folic acid deficiency. On what dietary changes should the nurse instruct this patient? (Select all that apply.) a. Snack on peanuts. b. Eat breads fortified with folic acid. c. Add green leafy vegetables to meals. d. Increase the intake of milk each day. e. Prepare soups with dried peas and beans.

A, B, C, E A. Snack on peanuts B. Eat breads fortified with folic acid C. Add green leafy vegetables to meals E. Prepare soups with dried peas and beans

57. The nurse is caring for a patient scheduled for tests to confirm the diagnosis of lymphoma. For which diagnostic tests should the nurse prepare the patient? (Select all that apply.) a. CT scan b. Cerebral angiogram c. Lymph node biopsy d. Lymphangiography e. Complete blood count

A, C, D, E A. CT scan C. Lymph node biopsy D. Lymphangiography E. Complete blood count

55. During a home visit, the nurse becomes concerned that a patient recovering from a splenectomy is at risk for infection. What did the nurse observe to come to this conclusion? (Select all that apply.) a. Received a manicure and pedicure b. Washed hands before preparing lunch c. Poured a cup of tea after petting the cat d. Had a hot tub installed on the back patio e. Planting tomato plants in an outside garden

A, C, D, E A. Received a manicure or pedicure C. Poured a cup of tea after petting the cat D. Had a hot tub installed on the back patio E. Planting tomato plants in an outside garden

51. The nurse is collecting information about sickle cell disease for an upcoming seminar. What should the nurse include as common triggers for a sickle cell crisis? (Select all that apply.) a. Anesthesia b. Chemotherapy c. Severe infection d. Strenuous exercise e. Use of nasal oxygen f. Blood loss during surgery

A, C, D, F A. Anesthesia C. Severe infection D. Strenuous exercise F. Blood loss during surgery

32. A patient with multiple myeloma is at risk for hypercalcemia. Which nursing intervention is most important for the patient with hypercalcemia? a. Encourage fluids. b. Offer citrus juices and fruits. c. Place the patient on a low-sodium diet. d. Discourage intake of alcoholic beverages.

A. Encourage fluids Fluids dilute calcium and flush the kidneys to reduce risk of kidney stones

15. The nurse is caring for a patient with PV. Which laboratory study should the nurse monitor to help evaluate the effectiveness of treatment for this patient? a. Hematocrit b. Total protein c. Blood urea nitrogen (BUN) d. WBC differential

A. Hematocrit Hematocrit reflects the RBC count and monitors the thickness of the blood, the main concern in PV

3. A patient with iron-deficiency anemia has been taking oral iron supplements. Which test should the nurse review to determine the effectiveness of this intervention? a. Hemoglobin and hematocrit b. WBC and platelet counts c. Electrolytes, blood urea nitrogen (BUN), and creatinine d. Thrombin clotting time (TCT) and prothrombin time (PT)

A. Hemoglobin and hematocrit

2. A patient is diagnosed with anemia and asks the nurse what nutrients are important for RBC formation. The nurse bases an answer on the understanding that which nutrients are essential for production of healthy red cells? a. Iron, folic acid, and vitamin B12 b. Vitamin C, Vitamin D, and selenium c. Vitamin A, calcium, and phophorus d. Aluminum, vitamin E, and beta carotene

A. Iron, folic acid, and vitamin B12

23. A nurse is assisting with data collection on a newly admitted patient with a history of hemophilia. Which assessment finding indicates that the patient has experienced some severe episodes of bleeding in the past? a. Joint deformities b. Distended abdomen c. Ecchymoses on the extremities d. Elevated WBC count

A. Joint deformities Ecchymosis indicates new, rather than past bleeding.

22. A comatose patient is admitted to the emergency department after an automobile accident. The nurse notes a Medic-Alert identification bracelet that states the patient has hemophilia. What should the nurse do first? a. Notify the physician of the bracelet. b. Tape the bracelet to the patients arm. c. Call the phone number on the bracelet. d. Remove the bracelet, and give it to the patients family member.

A. Notify the physician of the bracelet

17. The nurse is caring for a patient with a bleeding disorder. Which manifestation might first alert the nurse to the possibility of disseminated intravascular coagulation? a. Petechiae b. Absence of pulses in extremities c. Weakness or paralysis on one side d. Increasing blood pressure and pulse

A. Petechiae Petechiae (tiny colored non-raised patches) indicate bleeding into the skin, a symptom of the reduced clotting factor that occurs in DIC.

43. The nurse is preparing to provide care to a patient recovering from surgery. What nursing action is the best way to prevent infection in a postoperative patient? a. Practice good hand washing. b. Encourage 2 L of fluid daily. c. Change wound dressings daily. d. Assess vital signs every 4 hours.

A. Practice good hand washing

20. The nurse is reviewing the care plan for a patient with disseminated intravascular coagulation. Which nursing intervention is most likely to cause an acute complication in this patient? a. Placing the patient on strict bedrest b. Providing a diet that is high in fat and sodium c. Administering intramuscular meperidine (Demerol) for pain d. Allowing a family member with a respiratory infection to visit

C. Administering intramuscular meperidine (Demerol) for pain This can cause bleeding in the muscle

10. A patient is admitted in sickle cell crisis with symptoms of dyspnea and leg pain. The patients significant other asks, I dont really understand why he is hurting so badly. Which response by the nurse is best? a. The pain is due to a disturbance in cellular metabolism. b. The bone marrow is expanding with the sickled cells and that causes pain. c. Clumping of abnormal red blood cells blocks the flow of blood through the capillaries. d. Bleeding in the joints occurs because red blood cells are being rapidly destroyed by the bone marrow.

C. Clumping of abnormal red blood cells blocks the flow of blood through the capillaries.

19. The nurse is caring for a patient with a clotting disorder. Which blood product should the nurse anticipate being prescribed? a. Albumin b. Normal saline c. Cryoprecipitates d. Packed WBCs

C. Cryoprecipitates Cryoprecipitates replace missing clotting factors.

26. A 54-year-old patient is admitted to the hospital in the final stage of chronic lymphocytic leukemia (CLL). Which manifestations of CLL should the nurse expect to find while collecting admission data? a. Nausea and vomiting b. Hypotension and alopecia c. Fever and abnormal bleeding d. Cervical lymphadenopathy and chest pain

C. Fever and abnormal bleeding During the acute phase of CLL, the patient may exhibit high fevers from infection and ecchymosis or petechiae from thrombocytopenia

25. A patient with hemophilia A is bleeding. Which treatment should the nurse anticipate being prescribed for this patient? a. IV infusion of factor IX b. IM injection of factor IX c. IV infusion of factor VIII d. IM injection of factor VIII

C. IV infusion of factor VIII Hemophilia A is treated with VIII

5. The nurse is providing dietary teaching to an individual with iron-deficiency anemia. Which patient statement indicates that teaching has been effective? a. I know I need to eat more green vegetables and dairy products. b. Berries and natural cereals are good for me because of my low iron levels. c. Im going to drink orange juice for breakfast and increase red meats in my diet. d. Yellow vegetables and green tea will be important to help build up my blood levels.

C. Im going to drink orange juice for breakfast and increase red meats in my diet

9. A patient with aplastic anemia is to receive an injection of erythropoietin (Epogen). The patient asks what the injection is intended to do. Which should the nurse respond to the patient? a. It will inhibit the protein that is attacking your blood cells. b. It works like a blood transfusion to give you extra red blood cells. c. It will stimulate your body to produce more of its own red blood cells. d. It will increase your energy while your body is recovering from the anemia.

C. It will stimulate your body to produce more of its own red blood cells.

24. A patient walks into the urgent care clinic, stating that he has hemophilia and that he is bleeding. The triage nurse does a quick assessment and sees no signs of active bleeding. Several patients are already in the waiting area. Which action by the nurse is most appropriate? a. Palpate the suspected area for tenderness and edema. b. Ask the patient to sit in the waiting room until his name is called. c. Place the patient in an examination room and tell the physician that the patient may be bleeding. d. Send the patient for routine x-rays according to clinic protocol to look for a source of bleeding, and then place him in an examination room.

C. Place the patient in an examination room and tell the physician that the patient may be bleeding

37. A patient with lymphoma wants to attend a family members wedding but is extremely fatigued. The nurse develops a plan for Activity Intolerance related to symptoms of lymphoma. How will the nurse know if the plan has been effective? a. The patient is able to sleep 8 hours at night. b. The patient can list three ways to combat fatigue. c. The patient attends the family members wedding. d. The patient verbalizes understanding of the importance of gradually increasing activity.

C. The patient attends the family members wedding The pts goal is to attend the wedding, so attendance tells the nurse the patient had enough energy to go.

14. A patient is admitted to the hospital with hypertension and vertigo related to polycythemia vera (PV). For which treatment should the nurse prepare the patient? a. Myelogram b. Splenectomy c. Therapeutic phlebotomy d. Injection of colony-stimulating factors

C. Therapeutic phlebotomy Phlebotomy reduces the RBCs and viscosity of the blood and the patient usually feels more comfortable quickly.

33. The nurse is determining the effectiveness of treatment prescribed for a patient with anemia. Which question should the nurse use to make this evaluation? a. Is your appetite improving? b. Are you sleeping all night? c. Are you requiring many analgesics? d. Are you keeping up with your work schedule?

D. Are you keeping up with your work schedule?

44. The nurse is reviewing laboratory results for a patient with a blood disorder. Reduced fibrinogen and platelet levels, increased thrombin time, and reduced factor assays are laboratory results associated with which hematological disorders? a. Aplastic anemia b. Sickle cell anemia c. PV d. Disseminated intravascular coagulation

D. Disseminated intravascular coagulation

16. The nurse is planning discharge teaching for a patient with polycythemia. Which nursing intervention should the nurse consider to help prevent complications in this patient? a. Monitor intake and output. b. Avoid use of injections for pain. c. Maintain bedrest during treatment. d. Encourage 3 L of water intake daily.

D. Encourage 3 L of water intake daily

36. The nurse is assessing a patient with stage III Hodgkins disease. Where should the nurse expect to find enlarged lymph nodes? a. In the neck only b. Above the diaphragm only c. Below the diaphragm only d. Generalized throughout the body

D. Generalized throughout the body Stage III Hodgkins disease is characterized by nodes on both sides of the diaphragm, with or without organ involvement

12. The nurse is caring for a patient in sickle cell crisis. What is the rationale for providing warm compresses and blankets for this patient? a. Sickle cell crisis causes shivering and discomfort. b. Heat helps prevent the cells from becoming sickled. c. Heat speeds production of new healthy RBCs. d. Heat prevents vasoconstriction and impaired circulation.

D. Heat prevents vasoconstriction and impaired cirulation