Test 2 Practice questions: Heme and Immune
The nurse is providing teaching to a client diagnosed with chronic myeloid leukemia (CML). Which statement will the nurse include in the teaching on the pathophysiology of the disease?
"Uncontrolled growth of blood cells causes the marrow to expand to organs."
The nurse provides patient education related to the management of iron deficiency anemia. Which statement made by the patient signifies understanding of the education provided?
I should take iron pill with orange juice because it enhances irons absorption
Which statement indicates the client understands teaching about induction therapy for leukemia?
I will be in the hospital for several weeks
The nurse is caring for a client with an exacerbation of sickle cell disease (SCD). Which finding indicates to the nurse that the client is experiencing a liver complication from this condition?
abdominal pain
A 20-year-old man has been admitted to the emergency department with a femoral fracture as a result of a motorcycle accident. When the nurse is taking the patient's history, he states, "I had leukemia when I was little kid but they managed to cure it." The nurse should suspect that this patient likely had what type of leukemia?
acute lymphoid leukemia
how to prevent sickle cell crisis
avoid dehydration because it can lead to sickle cell crisis
Kaposi sarcoma (KS) is diagnosed through
biopsy
A client is being tested for acute myeloid leukemia (AML). The nurse knows that which diagnostic test will be used as the hallmark for the diagnosis?
bone marrow analysis
The nurse cares for a client with acute myeloid leukemia with severe bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain?
bone marrow expands
The nurse is assessing a client with leukemia. How would the nurse assess for enlargement and tenderness over the liver and spleen?
by palpating the abdomen
A nurse cares for a client with early Hodgkin lymphoma. While assessing the client, the nurse will most likely find painless enlargement of which lymph node?
cervical
A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of?
chronic diarrhea
A nurse working with clients diagnosed with sickle cell disease notices that sickle cell crisis cases increase in the winter months. What is the primary pathophysiological reason for this?
cold temperatures slow the blood flow
Idopathic Thrombocytopenia Purpura (ITP), when should the nurse report possible small vessel clotting when which of the following is assessed?
cyanotic nail beds
A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for?
diarrheal stools
Acute myeloid leukemia (AML) results from a defect in the hematopoietic stem cell that differentiates into which of the following myeloid cells?
erythrocytes granulocytes monocytes PLT's
A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action?
evaluate PLT count
A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?
hemoglobin S
An client has pernicious anemia and has been receiving treatment for several years. What is the client lacking that results in pernicious anemia?
intrinsic factor
While assessing a client, the nurse discovers the client has a history of restless leg syndrome. Which hematological condition does the nurse associate with this condition?
iron deficiency anemia
A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess?
leukocyte count less than 100,000
A client with sickle cell anemia has a
low Hct
During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding?
low ferritin level concentration
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal?
maintain adequate nutrition
The most common cause of iron-deficiency anemia in premenopausal women includes which of the following?
menorrhagia
The nurse provides care for an older adult client, diagnosed with anemia, who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine the cause of the client's blood loss, which is the priority nursing action?
observe clients stool for blood
The client reports night sweats and fatigue and suspects he may have HIV. The nurse should take what actions?
perform physical assessment determine when symptoms began obtain sexual history
The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia?
smooth tongue
A client with sickle cell disease is treated for a thrombotic event. Which organs or body systems does the nurse recognize as being at greatest risk for thrombosis in a client with sickle cell disease?
spleen lungs CNS
A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?
A hemolytic allergic reaction caused by an antigen reaction
Which is usually the most important consideration in the decision to initiate antiretroviral therapy?
CD4 + counts
A client with suspected human immunodeficiency virus (HIV) has had two positive enzyme-linked immunosorbent assay (ELISA) tests. What diagnostic test would be run next?
Western Blot
A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?
AIDS dementia complex (ADC)
The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation?
Allopurinol
A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms?
B12
The nurse is explaining the potential signs and symptoms of a transfusion reaction to a patient who is receiving a first blood transfusion for the first time. How will the nurse ensure safe blood product administration?
Check ABO compatibility by comparing the blood product label to the patient's medical record. Use two patient identifiers, such as the patient's date of birth and name, to verify the blood product. Administer the blood product slowly for the first 15 minutes.
A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine?
Disconnect the blood tubing, flush with normal saline, and administer morphine
A patient has requested to be tested for an HIV infection. What test might be performed on this patient?
ELISA for specific antibodies
The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?
Erythrocytes that are microcytic and hypochromic
What is the priority nursing diagnosis for a client experiencing anemia?
Fatigue related to decreased cellular oxygenation. A low red blood cell (RBC) count decreases oxygen availability to the tissues, and fatigue, shortness of breath, and weakness may be noted.
A patient with a diagnosis of AIDS has experienced a recent acceleration in the progression of the disease, and the nurse has documented the patient's memory lapses and increasingly slow, uncoordinated movements. The nurse is justified in suspecting that this patient may be exhibiting the signs and symptoms of what complication of AIDS?
HIV encephalopathy
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 severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client?
Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit
A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy?
It will remove the major site of red blood cell (RBC) destruction
During a routine checkup, a nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the most common AIDS-related cancer?
Kaposi's sarcoma
While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate?
Kaposi's sarcoma
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
A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and her condition is now becoming life-threatening. The nurse is aware that a treatment option in this case may include what?
Splenectomy
A patient with sickle cell disease comes to the emergency department and reports severe pain in the back, right hip, and right arm. What intervention is important for the nurse to provide?
Start an intravenous line with dextrose 5% in 0.25 normal saline
The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse?
The client has converted from HIV infection to AIDS.
The physician orders a transfusion with packed red blood cells (RBCs) for a client hospitalized with severe iron deficiency anemia. When blood is administered, what is the most important action the nurse can take to prevent a transfusion reaction?
Verify the client's identity according to hospital policy
A nurse is completing an integumentary assessment of a client with anemia. Which of the following findings should the nurse expect?
spoon-shaped nails
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept?
staging of the disease
A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis?
stool specimen for ova and parasites
An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200-900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client?
supplement diet with vitamin b12
The nurse knows to follow the CDC's guidelines for Standard Precautions while caring for patients regardless of known or unknown infectious status. The nurse is aware that barrier protection is not necessary for which body fluid?
sweat
The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency?
vitamin b12
The nurse recognizes this as the most common hematologic condition associated with aging.
Anemia. Anemia is the most common hematologic condition affecting elderly patients; with each successive decade of life, the incidence of anemia increases. Anemia frequently results from iron deficiency (in the case of blood loss) or from a nutritional deficiency, particularly folate or vitamin B12 deficiency or protein--calorie malnutrition; it may also result from inflammation or chronic disease.
When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following?
Antibodies to HIV are not present in his blood.
A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor?
Decreased level of erythropoietin
A client comes to the walk-in clinic reporting weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses and notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?
Aplastic Anemia
A patient with thrombocytopenia due to chemotherapy develops a nose bleed (epistaxis). What is the nurse's expected response?
Apply pressure to the nares and position the patient in a high Fowler's position, leaning slightly forward. Sitting upright decreases the risk of aspiration of blood and pressure is applied for a minimum of 5 minutes. Ice may also be applied to the nares. The patient's mouth should be open so that blood can drain rather than be swallowed, which may cause vomiting.
A nurse cares for a client with anemia requiring nutritional supplementation. Which nursing intervention best promotes client adherence with the prescribed therapy?
Assist the client to incorporate the therapeutic regimen into daily activities.
A nurse is caring for a patient who is 73 years old with a platelet count of 5,000/mm3 resulting from myelodysplastic syndrome. At 10 PM, the patient complains of a headache. What should be the nurse's immediate action to take?
Notify the health care provider. Platelet counts ≤10,000/mm³ are associated with serious episodes of spontaneous bleeding, including intracranial hemorrhage; thus complaints of headaches or change in the level of consciousness necessitate immediate notification of the health care provider.
A patient with a diagnosis of immune thrombocytopenic purpura (ITP) is currently receiving IVIG for the treatment of her health condition. The nurse who is providing this patient's care is aware that ITP is a consequence of:
Platelet destruction and impaired platelet production resulting from an autoimmune process
A client with human immunodeficiency virus (HIV) develops a nonproductive cough, shortness of breath, a fever of 101°F and an O2 saturation of 92%. What infection caused by Pneumocystis jiroveci does the nurse know could occur with this client?
Pneumocystis pneumonia
A hospital nurse has experienced percutaneous exposure to an HIV-positive client's blood because of a needlestick injury. The nurse has informed the supervisor and identified the client. What action should the nurse take next?
Report to ED
