PassPoint - Immune and Hematologic Disorders

The nurse is teaching the client with a platelet disorder about signs of bleeding. What statement from the client indicates the client has understood the teaching?

"Ecchymoses are large, purple skin bruises."

A client with iron-deficiency anemia is prescribed liquid iron supplements. The nurse evaluates the client's understanding of how to take this drug. Which statement indicates the client has adequate knowledge?

"I'll dilute the medication and drink it with a straw."

A client with allergic rhinitis asks the nurse what to do to decrease rhinorrhea. Which instruction would be appropriate for the nurse to give the client?

"Keep a diary of when your symptoms occur. This can help you identify what precipitates your attacks."

A client is about to undergo bone marrow aspiration of the sternum. What should the nurse tell the client?

"You will feel a pulling type of discomfort for a few seconds."

A parent asks the nurse if a child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which principle?

Children with iron deficiency anemia are more susceptible to infection than are other children.

A mother asks the nurse if her child's iron-deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following?

Children with iron-deficiency anemia are more susceptible to infection than are other children.

Which laboratory test result does the nurse anticipate for a client diagnosed with a bite from a pit viper?

INR (international normalized ratio) of 2.3

A nurse preparing to discharge a child with leukemia observes a family member who has a cold sharing a meal with the child. How should the nurse approach the situation?

Offer a face mask to the person with the cold and use this as an opportunity for further teaching.

The nurse is teaching a female client about taking folic acid supplements for folic acid deficiency anemia. What information should be included in the teaching plan?

Oral contraceptive use, pregnancy, and lactation increase daily requirements.

The nurse is developing the plan of care for a client newly diagnosed with aplastic anemia. Which is a realistic goal for this client?

Perform activities of daily living without excessive fatigue or dyspnea.

The nurse is planning care for a client who has an allergy to latex. What intervention would be the priority for the nurse to include in the plan of care?

Place latex-free, powder-free gloves at client's bedside.

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?

Risk for injury

The nurse is developing a teaching plan for women about human immunodeficiency virus (HIV) transmission. What should the nurse instruct the group about reducing the risk for transmission?

Use latex condoms with sexual intercourse.

Which step must be done first when administering a blood transfusion?

Verify the physician's order.

A client with granulocytopenia has many visitors. What is the most important thing the nurse should tell the visitors to do to prevent infection?

Wash their hands.

The nurse is developing a plan of care for a client who has joint stiffness because of rheumatoid arthritis. Which measure will be the most effective in relieving stiffness?

a warm shower before performing activities of daily living

Which laboratory test should the nurse monitor while the client is receiving heparin therapy?

activated partial thromboplastin time (APTT)

The nurse is administering an intravenous (IV) infusion of packed red blood cells and normal saline solution to a client who is in hemorrhagic shock. Which is a priority for the nurse to assess for this client?

anaphylactic reaction

A sexually active client asks the nurse about using pre-exposure prophylaxis (PrEP) for HIV. The nurse should tell the client the drug, a combination of 300 mg tenofovir disoproxil fumarate and 200 mg emtricitabine (TDF/FTC) can be used for which group of people who are at risk for becoming infected with human immunodeficiency virus (HIV)?

anyone who is in an ongoing sexual relationship with an HIV-infected partner

A client with thrombocytopenia has just had a bone marrow aspirate performed to monitor for treatment effectiveness. Which nursing intervention takes priority?

applying pressure to the puncture site for a full 10 minutes

A client with a pleural effusion has a diagnostic thoracentesis. The nurse notifies the healthcare provider immediately upon discovering what assessment finding?

asymmetrical chest expansion

The nurse is assessing a client who has aplastic anemia. Which finding indicates the client has physiologic changes as a result of the disease?

bleeding tendencies

A client with rheumatoid arthritis is receiving antiinflammatory drugs and physical therapy. What is the expected outcome of these actions?

manage joint pain and fatigue to perform activities of daily living.

A client must receive a blood transfusion of packed red blood cells (RBCs) for severe anemia. What I.V. fluid should the nurse use to prime the tubing before hanging this blood product?

normal saline solution as this is considered an isotonic solution

A client with toxic shock has been receiving ceftriaxone sodium, 1 g every 12 hours. In addition to culture and sensitivity studies, which other laboratory finding does the nurse monitor?

serum creatinine

A client is newly diagnosed with pernicious anemia. The nurse is teaching the client to increase vitamin B12 intake. Which is the most effective way for this client to increase vitamin B12 intake?

taking vitamin B12 injections or nasal spray replacement

A nurse applies standard precautions when caring for a client with human immunodeficiency virus (HIV). The nurse takes what action when applying standard precautions?

wearing gloves for providing mouth care

The nurse is teaching the parents of a child with sickle cell disease. What information should the nurse give the family on how to prevent sickle cell crisis?

Drink at least 8 cups (about 2 L) of fluids per day.

The nurse is preparing a client with sickle cell anemia for discharge. What information should the nurse include in the teaching plan? Select all that apply.

Drink plenty of fluids when outside in hot weather. Avoid being in high altitudes where less oxygen is available. Know that pregnancy with sickle cell disease increases the risk of a crisis.

A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching?

"I can eat whatever I want as long as it's low in fat."

The nurse is teaching the client who is undergoing induction therapy for leukemia. The nurse realizes the client needs additional instruction when the client makes which statement?

"I cannot wait to get home to my cat!"

A client with rheumatoid arthritis reports gastrointestinal irritation after taking piroxicam. To prevent gastrointestinal upset, the nurse should provide which instruction?

"Take piroxicam with food or an antacid."

A client with mild dementia related to end-stage acquired immunodeficiency syndrome is preparing for discharge. The client has decided against further curative treatment and wishes to return home. Before discharge, the client develops ocular cytomegalovirus (CMV). The physician recommends treatment with a ganciclovir-impregnated implant, which requires a surgical procedure. The client's partner feels the implant won't help the client and asks the nurse if the implant will cure CMV. Which answer from the nurse best answers the partner's question reflecting client advocacy?

"The implant won't cure the virus, but it may help preserve your partner's vision. Not being able to see you or the surroundings may worsen your partner's dementia and make caring for your partner at home more difficult."

A client with a new diagnosis of human immunodeficiency virus (HIV) tells the nurse, "I did not think drinks, dinner, and great sex would lead to a life-threatening disease." Which of the following is a therapeutic response by the nurse?

"This sounds distressing for you. What questions do you have?"

A young adult has been bitten by a human, and the skin on the forearm is broken. The client's last tetanus shot was about 8 years ago. What should the nurse tell the client about the anticipated treatment plan?

"You'll need an injection of tetanus toxoid."

A nurse is to give a client heparin 8000 units subcutaneously. The available vial is 10,000 units/mL. How many milliliters should the nurse draw up into the syringe? Record your answer using one decimal place.

0.8

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving

A-positive blood to an A-negative client.

The nurse is developing a teaching plan for the client with aplastic anemia. Which instruction is most important to include in the plan?

Avoid exposure to others with acute infections.

A client with macrocytic anemia has a burn on the foot and reports watching television while lying on a heating pad. Which action should the nurse take first?

Check for diminished sensations.

After one week in the hospital for chemotherapy treatment related to lymphocytic leukemia, a client develops abdominal pain, fever, and foul-smelling diarrhea. What priority recommendation does the nurse make to the healthcare provider?

Collect stool sample for Clostridium difficile.

The client with hepatitis A is experiencing fatigue, weakness, and a general feeling of malaise. The client tires rapidly during morning care. What is the most appropriate goal for this client?

Gradually increase activity tolerance.

A client diagnosed with osteoarthritis tells the nurse, "My friend takes steroid pills for their rheumatoid arthritis. Should I be taking steroids, too?" What should the nurse tell the client?

Intra-articular corticosteroid injections are used to treat osteoarthritis.

A client with a suspected diagnosis of Hodgkin disease is to have a lymph node biopsy. What should the nurse make sure that personnel involved with the procedure do?

Maintain sterile technique.

A client is diagnosed with human immunodeficiency virus (HIV). What information does the nurse provide to best protect the client from advancing to the acquired immunodeficiency syndrome (AIDS) phase of this infection?

Strictly adhere to antiviral medication therapy.

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

Pallor, tachycardia, and a sore tongue

The nurse is assisting with a bone marrow aspiration and biopsy. Place the tasks in the order in which the nurse should perform them, from highest priority to least priority. All options must be used.

Verify the client has signed an informed consent. Position the client in a side-lying position. Clean the skin with an antiseptic solution. Apply ice to the biopsy site.

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?

hypercalcemia

The nurse examines laboratory findings for a client. What result should the nurse investigate further?

platelet count of 115,000/mm3 (115 x109/L)

The nurse should assess a client for which complications associated with disseminated intravascular coagulation (DIC)?

pulmonary embolism

A client with acquired immunodeficiency syndrome is receiving zidovudine. Which laboratory value indicates an adverse reaction to zidovudine?

red blood cell (RBC) count of 1.8 million/μl (1.8 million x 10 to the 12th/L)

A client has been taking a decongestant for allergic rhinitis. Which finding suggests that the decongestant demonstrates maximum therapeutic effective?

reduced sneezing

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to

sit upright, leaning slightly forward.

A client has moved into the acquired immunodeficiency syndrome (AIDS) phase of the human immunodeficiency virus (HIV) positive infection. The nurse advises the client to avoid what outdoor recreational activity?

swimming in rivers or lakes

The nurse is preparing the client with neutropenia for discharge to home. What should the nurse teach the client to avoid?

using suppositories or enemas

The daily white blood cell (WBC) count in a client with aplastic anemia drops overnight from 3,900 to 2,900/µl (3.9 to 2.9 X 109/L). Which is the appropriate nursing intervention?

Call the primary care provider, and request that the client be placed in reverse isolation.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the health care provider (HCP) immediately?

urine output of 20 ml/hour

The nurse is evaluating the laboratory results of a client who was recently admitted to the hospital. Which result indicates the presence of inflammation?

leukocytosis

The nurse reviews the laboratory results for a client with type 2 diabetes who is scheduled for surgery in about one month. What result should the nurse notify the healthcare provider about as most relevant to the preoperative plan of care?

low hematocrit (HCT) and hemoglobin (Hb) levels

The teaching plan for a client with rheumatoid arthritis includes rest promotion. What position of the involved joints should the nurse tell the client to avoid when at rest?

maintaining the joints in a flexed position

Which dietary strategy best meets the needs of a client with acquired immunodeficiency syndrome (AIDS)?

Instruct the client to cook foods thoroughly and adhere to safe food-handling practices.

A female client with human immunodeficiency virus (HIV) receives family-planning counseling. Which statement made by the client about safer sex practices for persons with HIV is accurate?

"A latex condom provides the best protection against HIV transmission during sexual intercourse."

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

"I will receive parenteral vitamin B12 therapy for the rest of my life."

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?

"My finger joints are oddly shaped."

Which nursing instructions help parents of a child with hemophilia provide a safe home environment for their child? Select all that apply.

"Pad the corners of coffee tables when your child is a toddler." "Establish a written emergency plan including what to do in specific situations and the names and phone numbers of emergency contacts." "Be sure your child wears a helmet when riding a bike." "Talk with your child about home safety and problem-solve hypothetical situations about your child's health."

A client with chronic progressive multiple sclerosis is learning to use a walker. What instruction will best ensure the client's safety?

"Place the walker directly in front of you and step into it as you move it forward."

A client with AIDS develops a fever, severe headache, and stiff neck and begins to vomit. Family members state they have noticed that the client does not seem to be as alert and oriented as before. What is the nurse's priority intervention?

protecting the client's airway

A nurse is caring for a client with human immunodeficiency virus (HIV). To determine the effectiveness of treatment the nurse expects the physician to order:

quantification of T-lymphocytes.

A pregnant client who developed deep vein thrombosis (DVT) in her right leg is receiving heparin I.V. on the medical floor. Physical therapy is ordered to maintain her mobility and prevent additional DVT. A nursing assistant working on the medical unit helps the client with bathing, range-of-motion exercises, and personal care. Which collaborative multidisciplinary considerations should the care plan address?

The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include reporting evidence of bleeding or easy bruising.

A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used

to provide long-term access to central veins.

Allopurinol is prescribed for a client who has chronic gout. Which comment indicates that the client understands how to take the allopurinol?

"I should drink plenty of fluids when taking allopurinol."

A client with rheumatoid arthritis has been on aspirin therapy for an extended time. Which assessment is the most important for the nurse to obtain?

hearing

The nurse is teaching a client about possible side effects when taking a diuretic. Which is an early indication that the client's serum potassium level is below normal?

muscle cramps in the legs