Exam #1

An adolescent diagnosed with thalassemia major (Cooley's anemia) is at risk for which condition?

Chronic hypoxia and iron overload

A patient with sickle cell disease is admitted with splenic sequestration. The blood pressure is 86/40 mm Hg, and heart rate is 124 beats/min. Which of these actions will the nurse take first?

Infuse normal saline at 250 mL/hr

The nurse is caring for a patient who is receiving warfarin (Coumadin) and notes bruising and petechiae on the patient's extremities. The nurse will request an order for which laboratory test? A. Internalized normalized ratio (INR) B. Platelet level C. Partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT) D. Vitamin K level

Ans: A

The nurse is caring for a patient with chronic myeloid leukemia (CML) who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission? A. Chronic B. Transformation C. Accelerated D. Blast crisis

Ans: A

The term that describes the percentage of individuals known to carry the gene for a trait and who actually manifest the condition is A. Penetrance B. Pedigree C. Genotype D. Variable expression

Ans: A

When caring for a young adult patient who has abnormalities in the cytochrome P450 (CYP450) gene, which action will the nurse include in the patient's plan of care? A. Teach that some medications may not work effectively B. Teach about genetic risk for cystic fibrosis in any children C. Encourage scheduling screening mammograms starting at age 30 D. Encourage the patient to watch for early symptoms of heart disease

Ans: A The CYP450 gene affects the metabolism of many medications, and they may not work as effectively or may have unexpected toxic effects. The CYP 450 gene does not affect risk for breast cancer, cystic fibrosis, or coronary artery disease

1. A patient who has cancer is about to begin chemotherapy. The patient asks the nurse why two chemotherapeutic agents are being used instead of just one. Which response by the nurse is correct? A. "The drugs may be given in less toxic doses if two drugs are used B. "Two agents used together can have synergistic effects." C. "Use of two drugs will increase tumoricidal activity in the GO phase of the cell." D. "Using two agents will shorten the length of time chemotherapy is needed"

Ans: B

A patient has been receiving intravenous heparin. When laboratory tests are drawn, the nurse has difficulty stopping bleeding at the puncture site. The patient has bloody stools and is reporting abdominal pain. The nurse notes elevated partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT). Which action will the nurse perform? A. Ask for an order for oral warfarin (Coumadin) B. Obtain an order for protamine sulfate C. Request an order for vitamin K D. Suggest that the patient receive subcutaneous heparin

Ans: B

A patient who has been anti-coagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote? A. Vitamin E B. Vitamin K C. Protamine sulfate D. Potassium chloride

Ans: B

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

Ans: B

A patient understands that her diagnosis of ovarian cancer syndrome is an autosomal-dominant inherited condition. What is the chance that her daughter will inherit the gene mutation for this disease? A. 80% B. 10% C. 25% D. 50%

Ans: C

A patient who had a total hip replacement had an intraoperative hemorrrhage 14 hours ago. Which laboratory test result would the nurse expect? A. Hematocrit of 46% B. Hemaglobin of 13.8g/dl C. Elevated reticulocyte count D. Decreased white blood cell (WBC) count

Ans: C

The nurse is teaching a patient who will take oral cyclophosphamide (Cytoxan). Which statement by the patient indicates understanding of the teaching? A. "I should follow a diet high in organ meats and beans while taking this drug." B. "I should brush my teeth and gums vigorously twice daily." C. "I should report any low-grade temperature elevation immediately." D. "I should take the drug at bedtime ti minimize side effects."

Ans: C

A patient diagnosed with grade IV of graft-versus-host disease would most probably exhibit ________. (Select all that apply) A. Serum bilirubin levels of 2-3mg/dl B. Jaundice C. Skin blistering and desquamation D. Severe abdominal pain E. Maculopapular rash on less than 25% of body surface

B,C,D

A nurse is caring for a client who has cervical cancer and is scheduled for brachytherapy. Which of the following actions should the nurse take? A. Permit visitors to stay with the client 30 min at a time B. Place the client on bed rest C. Insert an indwelling urinary catheter D. Administer fiber laxatives E. Dispose soiled linens in hamper outside client's room

A,B,C

A patient is receiving interferon alpha (Roferon-A) subcutaneously. The patient experiences chills, fatigue, and malaise, and the nurse assesses a temperature of 102 F. The nurse will notify the provider of the temperature and will anticipate which order? A. Administer acetaminophen (Tylenol) B. Change to intravenous (IV) interferon alpha C. Give diphenhydramine (Benadryl) D. Obtain a serum blood urea nitrogen (BUN) and creatinine level

Ans: A

A patient with acute myelogenous leukemia is receiving induction-phase chemotherapy. Which assessment finding requires the most rapid action? A. Serum potassium level of 7.8 mEq/L B. Urine output less than intake by 400 ml C. Inflammation and redness of the oral mucosa D. Ecchymoses present on the anterior trunk

Ans: A

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?

The patient's hits blood cell count is 39,000 mm3(39.0 x 109/L)

Which of the following statements best reflects autosomal-recessive inherited conditions?

Transmission usually occurs horizontally in families

A patient with a documented history of glucose-6-phosphate dehydrogenase deficiency has presented to the emergency department with signs and symptoms including pallor, jaundice, and malaise. Which of the nurse's assessment questions relates most directly to this patient's Hematologic disorder?

What medications have you taken recently?

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?

White blood cell count of 16,000/mm3

A patient comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has?

hemolytic anemia

Which of the following is the hallmark of polycythemia Vera?

splenomegaly