Hematology

The home health nurse is obtaining a history for a patient who has deep vein thrombosis and is taking warfarin 2 mg/day. Which statement by the patient is the best indicator that additional teaching about warfarin may be needed?

"I have started to eat more healthy foods like green salads and fruit."

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?

"I take ibuprofen every day because of my history of osteoarthritis."

After the nurse receives the change-of-shift report, which patient should be assessed first?

A 20-year-old patient with possible acute myelogenous leukemia who has just arrived on the medical unit

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?

A 36-year-old patient with chronic kidney failure who will need a subcutaneous injection of epoetin alfa

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)?

A 52-year-old patient with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy

After the nurse receives a change-of-shift report, which patient should be seen first?

A 69-year-old patient with chemotherapy-induced neutropenia who has an oral temperature of 100.1°F (37.8°C)

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?

Blood pressure is 198/92 mm Hg.

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?

Cleaning the skin over the area daily with a mild soap

A 32-year-old patient with sickle cell anemia is admitted to the hospital during a sickle cell crisis. Blood pressure is 104/62 mm Hg, oxygen saturation is 92%, and the patient reports pain at a level 8 (on a scale of 0 to 10). Which action prescribed by the health care provider will the nurse implement first?

Give oxygen at 4 L/min per nasal cannula.

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.

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?

Infusing 5% dextrose in 0.45% saline at 125 mL/hr

A patient with an absolute neutrophil count of 300/μL (0.3 × 109/L) 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?

LPN/LVN with 2 years of experience on the oncology unit

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?Rationale:

Morphine sulfate 4 mg IV

A patient who has been receiving cyclosporine following an organ transplantation is experiencing these symptoms. Which one is of most concern?

Nontender lump in the right groin

These activities are included in the care 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)?

Obtaining stool specimens for fecal occult blood test (FOBT)

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)?

Obtaining the patient's blood pressure and pulse with position changes

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?

Patient with digoxin toxicity

Which of these patients who have just arrived at the emergency department should the nurse assess first?

Patient with hemophilia A who is experiencing thigh swelling after a fall

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?

Priming the transfusion set using 5% dextrose in lactated Ringer's solution

A patient with acute myelogenous leukemia is receiving induction-phase chemotherapy. Which assessment finding requires the most rapid action?

Serum potassium level 7.8 mEq/L (7.8 mmol/L)

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 blanket." Which action should the nurse take first?

Stop the transfusion.

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)?

The international normalized ratio (INR) is 5.2.

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?

The oral temperature is 100°F (37.8°C).

The nurse obtains the following data about a patient admitted with multiple myeloma. Which information requires the most rapid action by the nurse?

The patient reports new-onset leg numbness.

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?

The patient takes an antacid with the iron to avoid nausea.

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?

The patient's chemotherapy has resulted in neutropenia

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?

The patient's oxygen saturation is 87%.

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 white blood cell count is 39,000 mm3 (39.0 × 109/L).

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?

Transfuse factor VII concentrate.

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