Advanced med-surg hematology

The nurse's brief review of a client's electronic health record indicates that the client regularly undergoes therapeutic phlebotomy. Which of the following rationales for this procedure is most plausible? A. The client may chronically produce excess red blood cells B. The client may frequently experience a low relative plasma volume C. The client may have impaired cell function D. The client may previously have undergone bone marrow biopsy

Ans: A Persistently elevated hematocrit is an indication for therapeutic phlebotomy. It is not used to address excess or deficient plasma volume and is not related to stem cell function. Bone marrow biopsy is not an indication for therapeutic phlebotomy

The results of a client's most recent blood work and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This client should undergo testing for which of the following potential causes? SATA A. Hepatitis B. Acute kidney injury C. HIV D. Malignant melanoma E. Cholecystitis

Ans: A,C Viral illnesses have the potential to cause ITP. Acute kidney injury, malignancies, and gallbladder inflammation are not typical causes of ITP.

A client is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications? A. Folic acid B. Vitamin B12 C. Lactulose D. Magnesium sulfate

Ans: B Pernicious anemia is characterized by vitamin B12 deficiency. Magnesium sulfate, lactulose, and folic acid do not address the pathology of this type of anemia.

The clinical nurse educator is presenting health promotion education to a client who will be treated for non-hodgkin lymphoma on an outpatient basis. The nurse should recommend what of the following actions? A. Avoiding direct sunlight exposure in excess of 15 minutes daily B. Avoiding grapefruit juice and grapefruits C. Avoiding highly crowded public areas D. Using an electric shaver rather than a razor

Ans: C The risk of infection is significant for these clients, not only from treatment-related myelosuppression but also from the defective immune response that results from the disease itself. Limiting infection exposure is thus necessary. The need to avoid grapefruit is dependent on the client's medication regimen. Sun exposure and the use of razors are not necessarily contraindicated.

A nurse is admitting a client with immune thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function? SATA A. Antihypertensives B. Penicillins C. Sulfa-containing medications D. Aspirin-based drugs E. NSAIDS

Ans: C, D, E The nurse must be alert for sulfa-containing medications and others that alter platelet function (eg., aspirin-based or other NSAIDS). Antihypertensive drugs and the penicillins do not alter platelet function.

A client with von Willebrand disease has experienced recent changes in bowel function that suggest the need for a screening colonoscopy. What intervention should be performed in anticipation of this procedure? A. The client should not undergo the normal bowel cleansing protocol prior to the procedure. B. The client should receive a unit of fresh-frozen plasma 48 hours before the procedure. C. The client should be admitted to the surgical unit on the day before the procedure. D. The client should be given necessary clotting factors before the procedure.

Ans: D A goal of treating von Willebrand disease is to replace the deficient protein (e.g., vWF or factor VIII) prior to an invasive procedure to prevent subsequent bleeding. Bowel cleansing is not contraindicated and FFP does not reduce the client's risk of bleeding. There may or may not be a need for pre-procedure hospital admission.

A client has been living with a diagnosis of anemia for several years and has experienced recent declines in hemoglobin levels despite active treatment. Which assessment finding would signal complications of anemia? A. Venous ulcers and visual disturbances B. Fever and signs of hyperkalemia C. Epistaxis and gastroesophageal reflux D. Shortness of breath and peripheral edema

Ans: D A significant complication of anemia is heart failure from chronic diminished blood volume and the heart's compensatory effort to increase cardiac output. Client's with anemia should be assessed for signs and symptoms of heart failure, including dyspnea and peripheral edema. None of the other listed signs and symptoms is characteristic of heart failure.

Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult who is otherwise healthy. The client and the care team have collaborated and the client will soon begin induction therapy. The nurse should prepare the client for: A. Daily treatment with targeted therapy medications B. Radiation therapy on a daily basis C. Hematopoietic stem cell transplantation D. An aggressive course of chemotherapy

Ans: D Attempts are made to achieve remission of AML by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks. Induction therapy is not synonymous with radiation, stem cell transplantation, or targeted therapies.

A client is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals a fever and a new onset of fine crackles on lung auscultation. Which action by the nurse would be the most appropriate? A. Apply supplementary oxygen by nasal cannula B. Administer bronchodilators by nebulizer C. Liaise with the respiratory therapist and consider high-flow oxygen D. Inform the health care provider that the client may have an infection

Ans: D Clients with sickle cell disease are highly susceptible to infection, thus any early signs of infection should be reported promptly. There is no evidence of respiratory distress, so oxygen therapy and bronchodilators are not indicated.

A home health nurse is caring for a client with multiple myeloma. What intervention should the nurse prioritize when addressing the client's severe bone pain? A. Implementing distraction techniques B. educating the client about the effective use of hot and cold packs C. Teaching the client to use NSAIDS effectively D. Helping the client manage the opioid analgesic regimen

Ans: D For severe pain resulting from multiple myeloma, opioids are most likely necessary. NSAIDS would likely be ineffective and are associated with significant adverse effects. Hot and cold packs as well as distraction would be insufficient for severe pain, though they may be useful as adjuncts.

The nurse educating a client with anemia is describing the process of red blood cell production. When the client's kidneys sense a low level of oxygen in circulating blood, which physiologic response is initiated? A. Increased stem cell synthesis B. Decreased respiratory rate C. Arterial vasoconstriction D. Increased levels of erythropoietin

Ans: D If the kidney detects low levels of oxygen, as occurs when fewer red blood cells are available to bind oxygen (i.e., anemia), erythropoietin levels increase. The body does not compensate with vasoconstriction, decreased respiration, or increased stem cell activity.

The nurse is caring for a client who has developed scar tissue in many of the areas that normally produce blood cells. What organs can become active in blood cell production by the process of extramedullary hematopoiesis? A. Spleen and kidneys B. Kidneys and pancreas C. Pancreas and liver D. Liver and spleen

Ans: D In adults with disease that causes marrow destruction, fibrosis, or scarring, the liver and spleen can also resume production of blood cells by a process known as extramedullary hematopoiesis. The kidneys and pancreas do not produce blood cells for the body.

A client's wound has begun to heal and the blood clot which formed is no longer necessary. When a blood clot is no longer needed, the fibrinogen and fibrin will be digested by which of the following? A. Plasminogen B. Thrombin C. Prothrombin D. Plasmin

Ans: D The substance plasminogen is required to lyse the fibrin. Plasminogen, which is present in all body fluids, circulates with fibrinogen and is therefore incorporated into the fibrin clot as it forms. When the clot is no longer needed (eg., after an injured blood vessel has healed), the plasminogen is activated to form plasmin. Plasmin digests the fibrinogen and fibrin. Prothrombin is converted to thrombin, which in turn catalyzes the the conversion of fibrinogen to fibrin so a clot can form.

A client comes to the clinic reporting fatigue and the health interview is suggestive of pica. Laboratory findings reveal a low serum iron level and a low ferritin level. With what would the nurse suspect that the client will be diagnosed? A. Iron deficiency anemia B. Pernicious anemia C. Sickle cell disease D. Hemolytic anemia

Ans: A A low serum iron level, a low ferritin level, and symptoms of pica are associated with iron deficiency anemia. TIBC may also be elevated. None of the other anemias are associated with pica.

A nurse is planning the care of a client who has been diagnosed with essential thrombocythemia (ET). Which nursing diagnosis should the nurse prioritize when choosing interventions? A. Risk for ineffective tissue perfusion B. Risk for imbalanced fluid volume C. Risk for ineffective breathing pattern D. Risk for ineffective thermoregulation

Ans: A Clients with ET are at risk for hypercoagulation and consequent ineffective tissue perfusion. Fluid volume, breathing, and thermoregulation are not normally affected.

Following an extensive diagnostic workup, a client has been diagnosed with myelodysplastic syndrome (MDS). Which assessment question most directly addresses the potential etiology of this client's health problem? A. "Were you ever exposed to toxic chemicals in any of the jobs that you held?" B. "When you were younger, did you tend to have recurrent infections of any kind?" C. "Have you ever smoked cigarettes or used other tobacco products?" D. "Would you say that you've had a lot of sun exposure in your lifetime?"

Ans: A MDS is idiopathic in nature due to HSC damage, although 10%-15% of clients will develop MDS following exposure to alkylating agents, radiotherapy, or chemicals (e.g., benzene), and/or have an inherited genetic disorder, such as Fanconi anemia or trisomy 21. Genetic syndromes account for about 50% of cases (e.g., Down syndrome, trisomy 8 syndrome, neurofibromatosis type 1). MDS is not known to be caused by an infection, tobacco use, or sun exposure.

A nurse is writing the care plan of a client who has been diagnosed with myelofibrosis. What nursing diagnoses should the nurse address? SATA A. disturbed body image B. impaired mobility C. imbalanced nutrition: less than body requirements D. Acute confusion E. Risk for infection

Ans: A,B,C,E The profound splenomegaly that accompanies myelofibrosis can impact the client's body image and mobility. As well, nutrition deficits are common and the client is at risk for infection. Cognitive effects are less common.

Through the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what do myeloid stem cells further differentiate? SATA A. Leukocytes B. Natural killer cells C. Cytokines D. Platelets E. Erythrocytes

Ans: A,D,E Myeloid stem cells differentiate into three broad cell types: erythrocytes, leukocytes, and platelets. Natural killer cells and cytokines do not originate as myeloid stem cells.

A nurse is preparing health education for a client who has received a diagnosis of myelodysplastic syndrome (MDS). Which of the following topics should the nurse prioritize? A. Techniques for energy conservation and activity management B. Emergency management of bleeding episodes C. Technique for the administration of bronchodilators by metered-dose inhaler D. Techniques for self-palpation of lymph nodes

Ans: B Because of clients' risk of hemorrhage, clients with MDS should be taught techniques for managing emergent bleeding episodes. Bronchodilators are not indicated for the treatment of MDS and lymphedema is not normally associated with the disease. Energy conservation techniques are likely to be useful, but management of hemorrhage is a priority of the potential consequences.

A client has a diagnosis of multiple myeloma and the nurse is preparing health education in preparation for discharge from the hospital. Which action should the nurse report? A. Daily performance of weight-bearing exercise to prevent muscle atrophy B. Close monitoring of urine output and kidney function C. Daily administration of warfarin, as prescribed D. Safe use of supplementary oxygen in the home setting

Ans: B Renal function must be monitored closely in the client with multiple myeloma. Excessive weight-bearing can cause pathologic fractures. There is no direct indication for anticoagulation for supplemental oxygen.

An adult client's abnormal CBC and physical assessment have prompted the primary care provider to order a diagnostic workup for Hodgkin-lymphoma. The presence of what assessment finding is considered diagnostic of the disease? A. Schwann cells B. Reed-sternberg cells C. Lewy bodies D. Loops of Henle

Ans: B The malignant cell fo Hodgkin lymphoma is the Reed-sternberg cell, a gigantic tumor cell that is morphologically unique and thought to be of immature lymphoid origin. It is the pathologic hallmark and essential diagnostic criterion. Schwann cells exist in the peripheral nervous system and lewy bodies are markers of Parkinson's disease. Loops of Henle exist in nephrons.

A client with myelodysplastic syndrome (MDS) is being treated on a medical unit. Which priority finding should prompt the nurse to contact the client's primary care provider? A. Reports of a frontal lobe headache B. An episode of urinary incontinence C. An oral temp of 37.5 C (99.5 F) D. An oxygen saturation (SPO2) of 91% on room air

Ans: C Because the client with MDS is at a high risk for infection, any early signs of infection must be reported promptly. The nurse should address each of the listed assessment findings, but none is as direct a threat to the client's immediate health as an infection.

A nurse at a long-term care facility is amending the care plan of a resident who has just been diagnosed with essential thrombocytopenia (ET). The nurse should anticipate the administration of which medication? A. Dalteparin B. Allopurinol C. Hydroxyurea D. Hydrochlorothiazide

Ans: C Hydroxyurea is effective in lowering the platelet count for clients with ET. Dalteparin, allopurinol, and hydrochlorothiazide do not have this therapeutic effect.

A client has received news that the client's treatment for Hodgkin lymphoma has been deemed successful and that no further treatment is necessary at this time. The care team should ensure that the client receives regular health assessments in the future due to the risk of which complication? A. Iron deficiency anemia B. Hemophilia C. Secondary malignancy D. Lymphedema

Ans: C Survivors of Hodgkin lymphoma have a high risk of secondary malignancies. There is no consequent risk of anemia, hemophilia, or lymphedema.

After receiving a diagnosis of acute lymphocytic leukemia (ALL), a client is visibly distraught, stating, "I have no idea where to go from here." How should the nurse prepare to meet this client's psychosocial needs? A. Assess the client's previous experience with the health care system B. Reassure the client that treatment will be challenging but successful C. Assess the client's specific needs for education and support D. Identify the client's plan of medical care

Ans: C In order to meet the client's needs, the nurse must first identify the specific nature of these needs. According to the nursing process, assessment must precede interventions. The pain of medical care is important, but not central to the provision of support. The client's previous health care is not a primary consideration, and the nurse cannot assure the client of successful treatment.

A nurse is caring for a client whose diagnosis of multiple myeloma is being treated with bortezomib . The nurse should assess for what adverse effect of this treatment? A. Stomatitis B. Nephropathy C. cognitive changes D. Peripheral neuropathy

Ans: D A significant toxicity associated with the use of bortezomib for multiple myeloma is peripheral neuropathy. Stomatitis, cognitive changes, and nephropathy are not noted to be adverse effects of this medication.

A critical care nurse is caring for a client with immune hemolytic anemia. The client is not responding to conservative treatments, and the client's condition is now becoming life-threatening. The nurse is aware that a treatment option may include which intervention? A. Hepatectomy B. Vitamin K administration C. Platelet transfusion D. Splenectomy

Ans: D A splenectomy may be the course of treatment if autoimmune hemolytic anemia does not respond to conservative treatment. Vitamin K administration is treatment for vitamin K deficiency and does not resolve anemia. Platelet transfusion may be the course of treatment for some bleeding disorders. Hepatectomy would not help the client.

A client is being treated with Polycythemia vera, and the nurse is providing health education. Which practice should the nurse recommend to prevent the complications of this health problem? A. Avoiding natural sources of vitamin K B. Avoiding altitudes of 1500 feet (457 meters) C. Performing active range of motion exercises daily D. Avoiding tight and restrictive clothing on the legs

Ans: D Because of the risk of DVT, clients with polycythemia vera should avoid tight and restrictive clothing. There is no need to avoid foods with vitamin K or to avoid higher altitudes. Activity levels should be maintained, but there is no specific need for range of motion exercises.

A client lives with a diagnosis of sickle cell disease and receives frequent blood transfusions. The nurse should recognize the client's consequent risk of what complication of treatment? A. Hypovolemia B. Vitamin B12 deficiency C. Thrombocytopenia D. Iron overload

Ans: D Clients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to an iron overload. These individuals are not at risk for hypovolemia and there is no consequent risk for low platelet or vitamin B12 levels.

An intensive care nurse is aware of the need to identify patients who may be at risk of developing disseminated intravascular coagulation (DIC). Which of the following ICU patients most likely faces the highest risk of DIC? A) A patient with extensive burns B) A patient who has a diagnosis of acute respiratory distress syndrome C) A patient who suffered multiple trauma in a workplace accident D) A patient who is being treated for septic shock

Ans: D Sepsis is a common cause of DIC. A wide variety of acute illnesses can precipitate DIC, but sepsis is specifically identified as a cause.

A clinic nurse is working with a client who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the client's disease? A. Document the color of the client's palms and face during each visit B. Follow the client's ESR over time. C. Document the client's response to erythropoietin injections D. Follow the trends of the client's hematocrit

Ans: D The course of polycythemia vera can be best ascertained by monitoring the client's hematocrit, which should remain below 45%. Erythropoietin injections would be exacerbate the condition. Skin tone should be observed , but is a subjective assessment finding. The client's ESR is not relevant to the course of the disease.

A client with Hodgkin lymphoma is receiving information from the oncology nurse. The client asks the nurse why it is necessary to stop drinking and smoking and stay out of the sun. Which response by the nurse would be best? A. "Avoiding these factors can reduce the risk of Reed-Sternberg cells developing." B. "These behaviors can reduce the effectiveness of your chemotherapy." C. "Engaging in these activities increases your risk of hemorrhage." D. "It's important to reduce other factors that increase the risk of second cancers."

Ans: D The nurse should encourage clients to reduce other factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and exposure to environmental carcinogens and excessive sunlight. the presence of Reed-Sternberg cells is the pathological Hallmark and essential diagnostic criterion for Hodgkin lymphoma, so avoiding these behaviors will not reduce the risk of Reed-Sternberg cells developing. There is no evidence that these behaviors will reduce the effectiveness of chemotherapy or increase the risk of hemorrhage, which is not a typical complication of Hodgkin lymphoma.

A client has been diagnosed with a lymphoid stem cell defect. This client has the potential for a problem involving which of the following? A. Plasma cells B. Neutrophils C. Red blood cells D. Platelets

Ans: A A defect in a myeloid stem cell can cause problems with erythrocyte, leukocyte, and platelet production. In contrast, a defect in the lymphoid stem cell can cause problems with T or B lymphocytes, plasma cells ( a more differentiated form of B lymphocytes), or natural killer cells.

The nurse caring for a client receiving a transfusion notes that 15 minutes after the infusion of PRBCs has begun, the client is having difficulty breathing and reports severe chest tightness. What is the most appropriate initial action for the nurse to take? A. Notify the client's health care provider B. Stop the transfusion immediately C. Remove the client's IV access D. Assess the client's chest sounds and vital signs

Ans. B Vascular collapse, bronchospasm, laryngeal edema, shock, fever, chills, and JVD are severe reactions. The nurse should discontinue the transfusion immediately, monitor the client's v/s, and notify the HCP. The blood container and tubing should be sent to the blood bank. A blood and urine specimen may be needed if a transfusion reaction or bacterial infection is suspected. The client's IV access should not be removed.

A client has come to the OB/GYN clinic due to heavy menstrual flow. Because of the clients consequent increase in red cell production, the nurse should recommend the client increase which daily intake of what substance? A. Vitamin E B. Vitamin D C. iron D. Magnesium

Ans. C To replace blood loss, the rate of red cell production increases. Iron is incorporated into hemoglobin. Vitamin E and D and magnesium do not need to be increased when RBC production is increased.

The nurse is planning the care of a client with a nutritional deficit and a diagnosis of megaloblastic anemia. The nurse should recognize that this client's health problem is due to which issue with the red blood cells? A. Production of inadequate quantities of RBCs B. Premature release of immature RBCs C. Injury to the RBC's in circulation D. Abnormalities in the structure and function of RBCs

Ans. D Vitamin B12 and folate deficiencies are characterized b the production of abnormally large erythrocytes called megaloblasts. Because these cells are abnormal, many are sequestered (trapped) while still in the bone marrow, and their rate of release is decreased. Some of these cells actually die in the marrow before they can be released into the circulation. This results in megaloblastic anemia. This pathologic process does not involve inadequate production, premature release or injury to existing RBCs.

A nurse at a blood donation clinic has completed the collection of blood from a client. The client reports feeling "light-headed" and appears pale. Which action by the nurse is most appropriate? A. Help the client to sit, with head lowered below knees B. Administer supplementary oxygen by nasal prongs C. Obtain a full set of vital signs D. Inform a health care provider of other primary care provider

Ans: A A donor who appears pale or complains of faintness should immediately lie down or sit with the head lowered below the knees. The client should be observed for another 30 minutes. There is no immediate need for an HCP's care. Supplementary oxygen may be beneficial, but may take too much time to facilitate before a syncopal episode. Repositioning must precede assessment of vital signs.

A client's most recent blood work reveals low levels of albumin. This assessment finding should suggest the possibility of what nursing diagnosis? A. Risk for imbalanced fluid volume related to low albumin B. Risk for infection related to low albumin C. Ineffective tissue perfusion related to low albumin D. Impaired skin integrity related to low albumin

Ans: A Albumin is particularly important for the maintenance of fluid balance within the vascular system. Deficiencies nearly always manifest as fluid imbalances. Tissue oxygenation and skin integrity are not normally affected. Low albumin does not constitute a risk for infection.

A nurse is caring for a client who has a diagnosis of acute myelocytic leukemia (AML). Assessment of which factor most directly addresses the most common cause of death among clients with leukemia? A. Infection status B. Nutritional status C. Electrolyte levels D. Liver function

Ans: A Because of the lack of mature and normal granulocytes that help fight infection, clients with leukemia are prone to infection. In client's with AML, death typically occurs from infection or bleeding. Symptoms of AML include weight loss, fever, night sweats, and fatigue, which would guide the nurse to monitor the client's nutrition and electrolytes. Gastrointestinal problems (nausea and vomiting) and electrolyte imbalances (hyperkalemia and hypocalcemia) may result from chemotherapy use. The liver is responsible for metabolism and metabolic detoxification, so monitoring liver function is important for the client who is receiving chemotherapy. These problems may contribute to and/or result in death but ar not the most common cause.

A client is receiving treatment for a new diagnosis of chronic lymphocytic leukemia (CLL). Based on known risk factors, age, ethnicity, and accompanying clinical conditions, which client is most likely to have this disease? A. 82-year-old vietnam war veteran with widely disseminated shingles B. 62-year-old client of Asian decent with a left hip fracture C. 69-year-old Gulf war veteran with DVT D. 85-year-old client of Native American/ First Nation descent with chest pain

Ans: A CLL is a common malignancy of older adults with an average age of 71 at diagnosis and the most prevalent leukemia in the Western world. It is rarely seen in clients of Native American/First Nation descent and has an infrequent incidence in clients of Asian descent. Veterans of the Vietnam War who were exposed to the herbicide Agent Orange are at risk for CLL. The time period of exposure was from 1962-1975 so veterans from the Gulf War in 1991 were not exposed. Infections are common with advanced CLL. None of the other conditions are related to infection, so they are not the best choice. Viral infections such as herpes zoster (shingles)can be widely disseminated with CLL.

A client with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to prescribe for this client? A. PRBCs B. Vitamin K C. Oral anticoagulants D. Heparin infusion

Ans: A Clients with liver dysfunction may have life-threatening hemorrhage from peptic ulcers or esophageal varices. In these cases, replacement with fresh- frozen plasma, PRBCs and platelets is usually required. Vitamin K may be prescribed once the bleeding is stopped, but that is not what is needed to stop the bleeding of the varices. Anticoagulants would exacerbate the client's bleeding.

A client with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, "I have low platelets, so why not give me a transfusion of exactly what I'm missing?" How should the nurse best respond? A. "Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body." B. "A platelet transfusion often further blunts your body's own production of platelets." C. "Finding a matching donor for a platelet transfusion is exceedingly difficult." D. "A very small percentage of the platelets in a transfusion are actually functional."

Ans: A Despite extremely low platelet counts, platelet transfusions are usually avoided. Transfusions tend to be ineffective not because the platelets are nonfunctional but because the client's antiplatelet antibodies bind with the transfused platelets, causing them to be destroyed. Matching the client's blood type is not usually necessary for a platelet transfusion. Platelet transfusions do not exacerbate low platelet production.

An oncology nurse is caring for a client with multiple myeloma who is experiencing bone destruction. When reviewing the client's most recent blood tests, the nurse should anticipate which imbalance? A. Hypercalcemia B. Hyperproteinemia C. Elevated serum viscosity D. Elevated red blood count

Ans: A Hypercalcemia may result when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin but would not result from bone destruction. The RBC count will decrease, not increase, resulting in anemia due to the abnormal protein produced from the malignant cells. Hyperproteinemia is defined as high protein in the blood and is commonly seen in clients with dehydration but would not result from bone destruction.

A client with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the client? A. Chew with care and avoid inadvertently biting the tongue B. Use the oral anesthetic 1 hour prior to mealtime C. Brush teeth before and after eating D. Swallow slowly and deliberately

Ans: A If oral anesthetics are used, the client must be warned to chew with extreme care to avoid inadvertently biting the tongue or buccal mucosa. An oral anesthetic would be metabolized by the time the client eats if it is used 1 hour prior to meals. There is no specific need to warn the client about brushing teeth or swallowing slowly because an oral anesthetic has been used.

A client with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the client's plan? A. Protective isolation and vigilant use of standard precautions B. Provision of a high-calorie, low texture diet and appropriate oral hygiene. C. Including the family in planning the client's activities of daily living D. Monitoring and treating the client's pain.

Ans: A Induction therapy causes neutropenia and a severe risk of infection. This risk must be addressed directly in order to ensure the client's survival. For this reason, infection control would be prioritized over nutritional interventions, family care, and pain, even though each of these are important aspects of nursing care.

An older adult client is exhibiting many of the characteristic signs and symptoms of iron deficiency. In addition to a complete blood count, what diagnostic assessment should the nurse anticipate? A. Stool for occult blood B. Bone marrow biopsy C. Lumbar puncture D. Urinalysis

Ans: A Iron deficiency in the adult generally indicates blood loss (e.g., from bleeding in the GI tract or heavy menstrual flow). Bleeding in the GI tract can be preliminary identified by testing stool for the presence of blood. A bone marrow biopsy would not be undertaken for the sole purpose of investigating an iron deficiency. Lumbar puncture and urinalysis would not be clinically relevant.

An oncology nurse is providing health education for a client who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia? A. The different leukemias all involve unregulated proliferation of white blood cells. B. The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function C. The different leukemias all result in a decrease in the production of white blood cells. D. The different leukemias all involve the development of cancer in the lymphatic system

Ans: A Leukemia commonly involves unregulated proliferation of white blood cells. Decreased production of red blood cells is associated with anemias. Decreased production of white blood cells is associated with leukopenia. The leukemias are not characterized by their involvement with the lymphatic system.

A 60-year-old client with chronic myeloid leukemia (CML) will be treated in the home setting, and the nurse is preparing appropriate health education. Which topic should the nurse emphasize? A. The importance of adhering to the prescribed drug regimen B. The need to ensure that vaccinations are up to date C. The importance of daily physical activity D. The need to avoid shellfish and raw foods

Ans: A Nurses need to understand that the effectiveness of the drugs use to treat CML is based on the ability of the client to adhere to the medication regimen as prescribed. Adherence is often incomplete, thus this must be a focus of health education. Vaccinations normally would not be given during treatment, and daily physical activity may not be possible for this client. Dietary restrictions are not normally necessary.

A client suffers with a leg wound which causes major blood loss. As a result of the bleeding, the process of primary hemostasis is activated. What will occur during this process? A. Severed blood vessels constrict B. Thromboplastin is released C. Prothrombin is converted to thrombin D. Fibrin is lysed

Ans: A Primary hemostasis involves the severed vessel constricting and platelets collecting at the injury site. Secondary hemostasis occurs when thromboplastin is released, prothrombin converts to thrombin, and fibrin is lysed.

A client's absolute neutrophil count (ANC)is 440 but the nurse's assessment reveals no apparent signs or symptoms of infection. What action should the nurse prioritize when providing care for this client? A. Meticulous hand hygiene B. Timely administration of antibiotics C. Provision of a nutrient-dense diet D. Maintaining a sterile care environment

Ans: A Providing care for a client with neutropenia requires that the nurse adhere closely to standard precautions and infection control procedures. Hand hygiene is central to such efforts. Prophylactic antibiotics are rarely used and it is not possible to provide a sterile environment for care. Nutrition is highly beneficial, but hand hygiene is the central aspect of care.

A client is receiving a blood transfusion and reports a new onset of slight dyspnea. The nurse's rapid assessment reveals bilateral lung crackles and elevated BP. What is the nurse's most appropriate action? A. Slow the infusion rate and monitor the client closely. B. Discontinue the transfusion and begin resuscitation. C. Pause the transfusion and administer a 250 mL bolus of normal saline D. Discontinue the transfusion and administer a betablocker as prescribed.

Ans: A The client is showing early signs of hypervolemia; the nurse should slow the infusion rate and assess the client more closely for any signs of exacerbation. At this stage, discontinuing the infusion is not necessary. A bolus would worsen the client's fluid overload.

A client is scheduled to undergo a bone marrow aspiration. When preparing the client for the procedure, which action would the nurse do first? A. Ensure informed consent has been obtained B. CLeanse the skin with an antiseptic C. Administer a local anesthetic D. Cover the area with a sterile drape

Ans: A The first step in the procedure is ensuring that informed consent has been obtained by the HCP, nurse practitioner, or HCP assistant performing the procedure performing the procedure and includes the reason the procedure is being performed, alternatives, and risks of the procedure. Risks include infection, bleeding, and pain. After the informed consent is obtained, the client is assisted to either a prone or lateral decubitus position. The skin is cleansed using aseptic technique and either a chlorhexidine-based solution or povidone-iodine. A sterile drape is applied, and the skin is numbed using local anesthesia.

A nurse is caring for a client with Hodgkin Lymphoma at the oncology clinic. The nurse should identify what main goal of care? A. Cure of the disease B. Enhancing quality of life C. Controlling symptoms D. Palliation

Ans: A The goal in the treatment of Hodgkin lymphoma is cure. Palliation is thus not normally necessary. Quality of life and symptom control are vital, but the overarching goal is the cure of the disease.

A client is being treated for the effects of a longstanding vitamin B12 deficiency. Which aspect of the client's health history would most likely predispose the client to this deficiency? A. The client has irregular menstrual periods B. The client is vegan C. The client donated blood 60 days ago D.The client frequently smokes marijuana

Ans: B Because vitamin B12 is found only in foods of animal origin, vegans may ingest little B12. Irregular menstrual periods, marijuana use, and blood donation would not precipitate a vitamin B12 deficiency

The nurse is preparing to administer a unit of platelets to an adult client. When administering this blood product, which of the following actions should the nurse perform? A. Administer the platelets as rapidly as the client can tolerate B. Establish IV access as soon as the platelets arrive from the blood bank C. Ensure that the client has a patent central venous catheter D. Aspirate 10-15 mL of blood from the client's IV immediately following the transfusion

Ans: A The nurse should infuse each unit of platelets as fast as client can tolerate to diminish platelet clumping during administration. IV access should be established prior to obtaining the platelets from the blood bank. A central line is appropriate for administration, but peripheral IV access (22-gauge or larger) is sufficient. There is no need to aspirate after the transfusion.

An oncology nurse recognizes a patients risk for fluid imbalance while the patient is undergoing treatment for leukemia. What relevant assessments should the nurse include in the patients plan of care? Select all that apply. A) Monitoring the patients electrolyte levels B) Monitoring the patients hepatic function C) Measuring the patients weight on a daily basis D) Measuring and recording the patients intake and output E) Auscultating the patients lungs frequently

Ans: A,C,D,E Assessments that relate to fluid balance include monitoring the client's electrolytes, auscultating the client's chest for adventitious lung sounds, weighing the client daily, and closely monitoring intake and output. Liver function is not directly relevant to the client's fluid status in most cases.

A 20-year-old client with no medical history arrives at a walk-in/urgent care clinic reporting swelling on the left side of the neck. On palpation, the lymph nodes on the neck are painless, firm but no had. What is the next appropriate intervention for this client? A. Recommend immediate and urgent transfer to the nearest trauma center. B. Perform diagnostic studies to rule out any infectious origin at a hospital. C. Refer the client to a primary health care provider for a nonurgent appointment. D. Complete a computed tomography scan because the client has Hodgkin Lymphoma

Ans: B Although a high suspicion of Hodgkin Lymphoma is present, diagnosis is premature prior to ruling out any infectious origin with diagnostic testing. This testing is by excisional node biopsy and usually done at a surgical center or hospital. Transfer is not an urgent matter unless the swelling is impacting the airway. Hodgkin lymphoma usually begins as an enlargement of one or more lymph nodes on one side of the neck. The individual nodes are painless and firm but not hard. It is also more common in males with 2 peaks in age groups. The first peak is between 15 and 34 and the second is after 60 years of age. Because these findings are consistent with hodgkin lymphoma , a hospital admission, not a nonurgent appointment, is appropriate. Chest x-ray , CT scan, and PET scan are all involved in staging of Hodgkin Lymphoma.

A client is being treated in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. What was the etiology of this client's adverse reaction? A. Antibodies to donor leukocytes remained in the blood B. The donor blood was incompatible with that of the client C. The client had a sensitivity reaction to a plasma protein in the blood D. The blood was infused too quickly and overwhelmed the client's circulatory system.

Ans: B An acute hemolytic reaction occurs when the donor blood is incompatible with that of the recipient. In the case of a febrile non hemolytic reaction, antibodies to donor leukocytes remain in the unit of blood or blood component. An allergic reaction is a sensitivity reaction to a plasma protein within the blood component. Hypervolemia does not cause an acute hemolytic reaction

A client is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). Which assessment finding is certain to be present if the client has CLL? A. Increased number of blast cells B. Increased lymphocyte levels C. Intractable bone pain D. Thrombocytopenia with no evidence of bleeding

Ans: B An increased lymphocyte count (lymphocytosis) is always present in clients with CLL. Each of the other listed symptoms may or may not be present, and none is definitive for CLL

A client's electronic health record notes that the client has previously undergone treatment for secondary polycythemia. The nurse should assess for which factor? A. Recent blood donation B. Evidence of lung disease C. A history of venous thromboembolism D. Impaired renal function

Ans: B Any reduction in oxygenation, such as lung disease, can cause secondary polycythemia. Blood donation does not precipitate this problem and impaired renal function typically causes anemia, not polycythemia. A history of venous thromboembolism is not a likely contributor.

A client with a new diagnosis of leukemia is about to start treatment and expresses fear and anxiety with the prognosis. Which action is the nurse's most appropriate? A. Communicate to the health care provider the need to provide more information to the client and family. B. Assess how much information is desired from the client in terms of illness, treatment, and complications. C. Offer to call pastoral services and review hospice and/or palliative care so the client can have a client, dignified death D. Encourage the client to call their family and discuss immediate role restructuring in both their family and professional life

Ans: B As with any client exhibiting anxiety and fear about a prognosis, listening should come first in order to assess how much information the client wants to have regarding the illness, treatment and potential complications. This is an outgoing assessment, since needs and interest in information changes throughout the course of treatment. Managing a client's care is a team effort, so involving the primary care provider and family is important, but not the nurse's priority action. Offering pastoral services and role restructuring has its place in treatment but should be discussed after an assessment of the client's needs. A discussion about palliative care and hospice is not options are exhausted, or the client is diagnosed as terminal, should palliative and/or hospice care be considered.

A client on the medical unit is receiving a unit of PRBCs. Difficult IV access has necessitated a slow infusion rate, and the nurse notes that the infusion began 4 hours ago. Which action by the nurse is the most appropriate? A. Apply an icepack to the blood that remains to be infused B. Discontinue the remainder of the PRBC transfusion, and inform the HCP C. Discontinue the bag of PRBCs, cool for 30 minutes, and then administer D. Administer the remaining PRBCs by the IV direct (IV Push) route

Ans: B Because of the risk of increased bacterial proliferation in the PRBCs and subsequent infection in the client, a PRBC transfusion should not exceed 4 hours. Remaining blood should not be transfused, even if it is cooled. BLood is not administered by the IV direct route

A client is scheduled for a splenectomy. During discharge education, which teaching point should the nurse prioritize? A. Adhering to prescribed immunosuppressant therapy B. Reporting any signs or symptoms of infection promptly C. Ensuring adequate folate, iron and vitamin B12 intake D. Limiting activity postoperatively to prevent hemorrhage

Ans: B Clients face an increased risk for infection following splenectomy; therefore, long-term use of antibiotic therapy is indicated. After splenectomy, the client is instructed to seek prompt medical attention if even relatively minor symptoms of infection occur. Often, clients with high platelet counts have even higher counts after splenectomy, which can predispose them to serious thrombotic or hemorrhagic problems. However, this increase is usually transient and therefore often does not warrant additional treatment. Dietary modifications are not normally necessary, and immunosuppressants would be strongly contraindicated

A nurse is providing discharge education to a client who has recently been diagnosed with a bleeding disorder. Which topic should the nurse prioritize when teaching this client? A. Avoiding buses, subways, and other crowded, public sites B. Avoiding activities that carry a risk for injury C. Keeping immunizations current D. Avoiding foods high in vitamin K

Ans: B Clients with bleeding disorders need to understand the importance of avoiding activities that increase the risk of bleeding, such as contact sports. Immunizations involve injections and may be contraindicated for some clients. Clients with bleeding disorders do not need to normally avoid crowds. Foods high in vitamin K may be beneficial not detrimental.

A client diagnosed with acute myeloid leukemia has just been admitted to the oncology unit. When writing this client's care plan, which potential complication should the nurse address? A. Pancreatitis B. Hemorrhage C. Arteritis D. Liver dysfunction

Ans: B Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency. The low platelet count can cause ecchymoses and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000. The most common bleeding sources include GI, pulmonary, vaginal, and intracranial. Pancreatitis, arteritis, and liver dysfunction are generally not complications of leukemia.

The nurse is providing care for a 73-year-old client who has a hematologic disorder. Which change in hematologic function is age-related? A. Bone-marrow in older adults produces a smaller proportion of healthy, functional blood cells B. Older adults are less able to increase blood cell production when demand suddenly increases C. Stem cells in older adults eventually lose their ability to differentiate D. The ratio of plasma to erythrocytes and lymphocytes increase with age

Ans: B Due to a variety of factors, when an older person needs more blood cells, the bone marrow may not be able to increase production of these cells adequately. Stem cell activity continues throughout the lifespan, although at a somewhat decreased rate. The proportion of functional cells does not greatly decrease, and the relative volume of plasma does not change significantly.

A client 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 client's hematologic disorder? A. "When did you last have a blood transfusion?" B. "What medications have you taken recently?" C. "Have you been under significant stress lately?" D. "Have you suffered any recent injuries?"

Ans: B Exacerbations of glucose-6-phosphate dehydrogenase deficiency are nearly always precipitated by medications. Blood transfusions, stress, and injury are less common triggers.

A client has sustained a cut to the hand, immediately initiating the process of hemostasis. Following vasoconstriction, which event in the process of hemostasis will take place? A. Fibrin will be activated at the bleeding site B. Platelets will aggregate at the injury site C. Thromboplastin will form a clot D. Prothrombin will be converted to thrombin

Ans: B Following vasoconstriction, circulating platelets aggregate at the site and adhere to the vessel and to one another, forming an unstable hemostatic plug. events involved in the clotting cascade take place subsequent to this initial platelet action.

A nurse has participated in organizing a blood donation drive at a local community center. Which client would most likely be disallowed from donating blood? A. A client who is 81 years of age B. A client whose blood pressure is 78/49 mm Hg C. A client who donated blood 4 months ago D. A client who has type 1 diabetes

Ans: B For potential blood donors, systolic arterial blood pressure should be 80-180 mm Hg, and the diastolic pressure should be 50-100 mm Hg. There is no absolute upper age limit. Donation 4 months ago does not preclude safe repeat donation (donors are only required to wait at least 8 weeks between donations), and diabetes is not a contraindication.

A client's health history reveals daily consumption of 2 to 3 bottles of wine. The nurse would consider increased risk for which hematologic disorder when planning assessments and interventions for this client? A. Leukemia B. Anemia C. Thrombocytopenia D. Lymphoma

Ans: B Heavy alcohol use is associated with numerous health problems, including anemia. Leukemia and lymphoma are not associated with alcohol use; red blood cell levels are typically affected more than platelet levels (i.e., thrombocytopenia)

A nurse is caring for a client with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this client, the nurse should assign the highest priority to which nursing diagnosis? A. Activity intolerance B. Risk for infection C. Acute confusion D. Risk for spiritual distress

Ans: B Induction therapy places the client at risk for infection, thus this is the priority nursing diagnosis. During the time of induction therapy, the client is very ill, with bacterial, fungal, and occasional viral infections; bleeding and severe mucositis, which causes diarrhea; and marked decline in the ability to maintain adequate nutrition. Supportive care consists of administering blood products and promptly treating infections. Immobility, confusion, and spiritual distress are possible, but infection is the client's most acute physiological threat.

A night nurse is reviewing the next day's medication administration record (MAR) of a hospital client who has hemophilia. The nurse notes that the MAR specifies both oral and subcutaneous options for the administration of a PRN antiemetic. What is the nurse's best action? A. Ensure that the day nurse knows not to give the antiemetic B. Contact the prescriber to have the subcutaneous option discontinued. C. Reassess the client's need for antiemetics D. Remove the subcutaneous route from the client's MAR

Ans: B Injections must be avoided in client's with hemophilia. Consequently, the nurse should ensure that the prescriber makes the necessary change. The nurse cannot independently make a change to a client's MAR in most cases. Facilitating the necessary change is preferable to deferring to the day nurse.

A nurse practitioner is assessing a client who has a fever, malaise, and a WBC that is elevated. What principle should guide the nurse's management of the client's care? A. There is a need for the client to be assessed for lymphoma. B. Infection is the most likely cause of the client's change in health status. C. The client is exhibiting signs and symptoms of leukemia D. The client should undergo diagnostic testing for multiple myeloma.

Ans: B Leukocytosis is most often the result of infection. It is only considered pathologic (and suggestive of leukemia) if it is persistent and extreme. Multiple myeloma and lymphoma are not likely the causes of this constellation of symptoms.

The nurse is describing normal erythrocyte physiology to a client who has a diagnosis of anemia. The nurse should explain that erythrocytes consist primarily of which substance? A. Plasminogen B. Hemoglobin C. Hematocrit D. Fibrin

Ans: B Mature erythrocytes consist primarily of hemoglobin, which contains iron and makes up 95% of the cell mass. Erythrocytes are not made of fibrin or plasminogen. Hematocrit is a measure of erythrocyte volume in whole blood.

The nurse is describing the role of plasminogen in the clotting cascade. Where in the body is plasminogen present? A. Myocardial muscle tissue B. All body fluids C. Cerebral tissue D. Venous and arterial vessel walls

Ans: B Plasminogen, which is present in all body fluids, circulates with fibrinogen. Plasminogen is found in body fluids not tissue.

A client who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this client's needs for physical activity? A. Teach the client about the risks of immobility and the benefits of exercise B. Assist the client to a chair during awake times, as tolerated C. Collaborate with the physical therapist to arrange for stair exercises D. Teach the client to perform deep breathing and coughing exercises

Ans: B Sitting up in a chair is preferable to bed rest , even if a client is experiencing severe fatigue. A client who has debilitating fatigue would not likely be able to perform stair exercises. Teaching about mobility may be necessary, but education must be followed by interventions that actually involve mobility. Deep breathing and coughing reduce the risk of respiratory complications but are not substitutes for physical mobility in preventing deconditioning.

A client is receiving the first of two prescribed units of PRBCs. Shortly after the initiation of the transfusion, the client reports chills and experiences a sharp increase in temperature. What is the nurse's priority action? A. Position the client in high fowler's position B. Discontinue the transfusion C. Auscultate the client's lungs D. Obtain a blood specimen from the client

Ans: B Stopping the transfusion is the first step in any suspected transfusion reaction. This must precede other assessments and interventions, including repositioning, chest auscultation, and collecting specimens.

A client with sickle cell disease is taking narcotic analgesics for pain control. Which intervention by the nurse would decrease the risk for narcotic substance abuse? A. Encourage the client to rely on complementary and alternative therapies B. Encourage the client to seek care from a single provider for pain C. Teach the client to accept chronic pain as an inevitable aspect of the disease D. Limit the reporting of emergency department visits to the primary HCP

Ans: B The client should be encouraged to use a single primary provider to address health care concerns. Emergency department visits should be reported to the primary provider to achieve optimal management of disease. It would be inappropriate to teach the client to simply accept the pain. Complementary therapies are usually insufficient to fully address pain in sickle cell disease.

A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. In addition to informing the client's primary care provider, the nurse should perform what action? A. Initiate measures to prevent venous thrombosis (VTE) B. Check the client's most platelet level C. Place the client on protective isolation D. Ambulate the client to promote circulatory function

Ans: B The client's signs are suggestive of thrombocytopenia, thus the nurse should check the client's most recent platelet level. VTE is not a risk and this does not constitute a need for isolation. Ambulation and activity may be contraindicated due to the risk of bleeding

A client with acute kidney injury has decreased erythropoietin production. Upon analysis of the client's complete blood count, the nurse will expect which of the following results? A. An increased hemoglobin and decreased hematocrit B. A decreased hemoglobin and hematocrit C. A decreased MCV and red cell distribution width (RDW) D. An increased MCV and red cell distribution width

Ans: B The decreased production of erythropoietin will result in a decreased hemoglobin and hematocrit. The client will have normal MCV and RDW because the erythrocytes are normal in appearance.

A group of nurses are learning about the high incidence and prevalence of anemia among different populations. Which individual is most likely to have anemia? A. A 50-year-old black woman who is going through menopause B. An 81-year-old woman who has chronic heart failure C. A 48-year-old man who travels extensively and has a high-stress job D. A 13-year-old girl who has just experienced menarche

Ans: B The incidence and prevalence of anemia are exceptionally high among older adults, and the risk of anemia is compounded by the presence of heart disease. None of the other listed individuals exhibits high-risk factors for anemia, through exceptionally heavy menstrual flow can result in anemia.

A client is undergoing a hip replacement has autologous blood on a standby if a transfusion is needed. What is the primary advantage of autologous transfusions? A. Safe transfusion for clients with a history of transfusion reactions B. Prevention of viral infections from another person's blood C. Avoidance of complications in clients with alloantibodies D. Prevention of alloimmunization

Ans: B The primary advantage of autologous transfusions is the prevention of viral infections from another person's blood. Other secondary advantages include safe transfusion for clients with a history of transfusion reactions, prevention of alloimmunization, and avoidance of complications in clients with alloantibodies.

A client newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the client asks the nurse to explain the condition. The nurse explains to this client that this condition occurs due to which factor? A. An attack on the platelets by antibodies B. Decreased production of platelets C. Impaired communication between platelets D. An autoimmune process causing platelet malfunction

Ans: B Thrombocytopenia can result from a decreased platelet production, increased platelet destruction, or increased consumption of platelets. Impaired platelet communication, antibodies, and autoimmune processes are not typical pathologies.

A client's blood work reveals a platelet level of 17,000. When inspecting the client's integumentary system, what finding would be most consistent with this platelet level? A. Dermatitis B. Petechiae C. urticaria D. Alopecia

Ans: B When the platelet count drops to less than 20,000, petechiae can appear. Low platelet levels do not normally result in dermatitis, urticaria (hives), or alopecia (hair loss).

The nurse is assessing a new client with reports of acute fatigue and a sore tongue that is visibly smooth and beefy red. This client is demonstrating signs and symptoms associated with what form of hematologic disorder? A. Sickle cell disease B. Hemophilia C. Megaloblastic anemia D. thrombocytopenia

Ans: C A red, smooth, sore tongue is a symptom associated with megaloblastic anemia. Sickle cell disease, hemophilia, and thrombocytopenia do not have symptoms involving the tongue.

A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the client's previous medication regimen may have contributed to the development of this disorder? A. Calcium carbonate B. Vitamin B12 C. Aspirin D. Vitamin D

Ans: C Aspirin may induce a platelet disorder. Even small amounts of aspirin reduce normal platelet aggregation, and the prolonged bleeding time lasts for several days after aspirin ingestion. Calcium, vitamin D, and vitamin B12 do not have the potential to induce a platelet defect.

Which of the following circumstances would most clearly warrant autologous blood donation? A. The client has type-O blood B. The client has sickle cell disease of thalassemia C. The client has elective surgery pending D. The client has hepatitis C

Ans: C Autologous blood donation is useful for many elective surgeries where the potential need for transfusion is high. Type-O blood, hepatitis, sickle cell disease, and thalassemia are not clear indications for autologous donation.

An emergency department nurse is triaging a 77-year-old client who presents with uncharacteristic fatigue as well as back and rib pain. The client denies any recent injuries. The nurse should recognize the need for this client to be assessed for which health problem? A. Hodgkin disease B. Non-hodgkin lymphoma C. multiple myeloma D. Acute thrombocythemia

Ans: C Back pain, which is often a presenting symptom in multiple myeloma, should be closely investigated in older clients. The lymphomas and bleeding disorders do not typically present with the primary symptom of back pain or rib pain.

A client with a hematological disorder asks the nurse how the body forms blood cells. The nurse understands that this process takes place primarily in which location? A. Spleen B. Kidneys C. Bone marrow D. Liver

Ans: C Bone marrow is the primary site for hematopoiesis. The liver and spleen may be involved during embryonic development or when bone marrow is destroyed. The kidneys release erythropoietin, which stimulates the marrow to increase production of RBCs. However, blood cells are not primarily formed in the spleen, kidneys or liver.

A client has been scheduled for a bone marrow aspiration and admits to the nurse being worried about the pain involved with the procedure. Which statement by the nurse when providing client education would be most accurate? A. "You'll be given painkillers before the test, so there won't likely be any pain." B. "You'll feel some pain when the needle enters your skin, but none during the aspiration." C. " Most people feel some brief, sharp pain when the marrow is aspirated." D. "I'll be there with you, and I'll try to help you keep your mind off the pain."

Ans: C Client's typically feel a pressure sensation as the needle advances into position. The actual aspiration always causes a sharp, brief pain, resulting from the suction exerted as the marrow is aspirated into the syringe; the client should be warned about this. Stating, " I'll try to help you keep your mind off the pain" may increase the client's fears of pain, because this does not help the client know what to expect. Although a local anesthetic agent is administered to the skin, subcutaneous tissue, and periosteum of the bone, it is not possible to anesthetize the bone itself, and the client will most likely experience sharp, brief pain during the actual aspiration. Painkillers are not necessarily given before the test and would not likely block the pain from aspiration.

Fresh-frozen plasma has been prescribed for a hospital client. Prior to administration of this blood product, the nurse should prioritize which client education? A. Infection risks associated with Fresh frozen plasma B. Physiologic functions of plasma C. Signs and symptoms of a transfusion reaction D. Strategies for managing transfusion-associated anxiety

Ans: C Clients should be educated about signs and symptoms of transfusion reactions prior to administration of any blood product. In most cases, this is priority over education relating to infection. Anxiety may be an issue for some clients, but transfusion reactions are life-threatening and should be addressed first. Teaching about the functions of plasma and is not likely a high priority.

A nurse is planning the care of a client who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the client's care plan, the nurse has identified a diagnosis of Risk for Injury, which should be attributed to which factor? A. Labyrinthitis B. Left ventricular hypertrophy C. Decreased bone density D. Hypercoagulation

Ans: C Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis (decreased bone density) and osteolytic lesions. Labyrinthitis is uncharacteristic, and clients do not normally experience hypercoagulation or cardiac hypertrophy as a result of multiple myeloma.

A nurse is providing care to a client with multiple myeloma with reports of nausea, diarrhea, alopecia, and red urine. The client's recent interventions include ECG, multigated acquisition scan (MUGA), and a central line venous access placed on the right chest wall. Which medication is the client most likely receiving? A. Dexamethasone B. Lenalidomide C. Doxorubicin D. Etoposide

Ans: C Doxorubicin is a chemotherapeutic drug and typically part of a combination regimen. Side effects of this medication include nausea, vomiting, alopecia and orange or red urine. Red urine is not listed as a side effect on any other of the medications listed. Doxorubicin can have a cardiotoxic effect (cardiomyopathy and arrhythmias), so ECG and MUGA scans (evaluate pumping function of the ventricles) are done before and periodically throughout treatment. This drug is a vesicant (causes blistering) and can result in tissue necrosis if the medication leaks into the tissues surrounding a vein due to an infiltrate. A central line is placed to avoid that complication. Etoposide and lenalidomide are both chemotherapy drugs without the typical adverse effect of cardiotoxicity Etoposide is an irritant with a low vesicant potential. Dexamethasone is a steroid that does not have the side effect of alopecia nor requires central venous access.

A woman who is in her third trimester of pregnancy has been experiencing an exacerbation of iron-deficiency anemia in recent weeks. When providing the client with nutritional guidelines and meal suggestions, what foods would be most likely to increase the woman's iron stores? A. Salmon accompanied by whole milk B. Mixed vegetables and brown rice C. Beef liver accompanied by orange juice D. Yogurt, almonds, and whole grain oats

Ans: C Food sources high in iron include organ meats, other meats, beans (e.g., black and pinto), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron. All of the listed foods are nutritious, but liver and orange juice are most likely to be of benefit to iron stores.

A nurse is caring for a client who is being treated for leukemia in the hospital. The client was able to maintain nutritional status for the first few weeks following the diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement what intervention? A. Arrange for total parenteral nutrition (TPN) B. Facilitate placement of a percutaneous endoscopic gastrostomy (PEG) tube C. Provide the client with several small, soft-textured meals each day D. Assign responsibility for the client's nutrition to the client's family and friends

Ans: C For clients with experiencing difficulties with oral intake, the provision of small, easily chewed meals may be beneficial. This option would be trialed before resorting to tube feeding or TPN. The family should be encouraged to participate in care, but should not be assigned full responsibility

A young man with a diagnosis of hemophilia A has been brought to ED after suffering a workplace accident resulting in bleeding. Rapid assessment has revealed the source of the client's bleeding and established that his vital signs are stable. What should be the nurse's next action? A. Position the client in a prone position to minimize bleeding B. Establish IV access for the administration of vitamin K C. Prepare for the administration of factor VIII D. Administer a normal saline bolus to increase circulatory volume.

Ans: C Injuries to clients with hemophilia necessitate prompt administration of clotting factors. Vitamin K is not a treatment modality and a prone position will not be appropriate for all types and locations of wounds. A normal saline bolus is not indicated.

The nurse on the pediatric unit is caring for a 10-year-old child with a diagnosis of hemophilia. The nurse should assess carefully for indication of what nursing diagnosis? A. Hypothermia B. Diarrhea C. Ineffective coping D. Imbalanced nutrition; less than body requirements

Ans: C Most clients with hemophilia are diagnosed as children. They often require assistance in coping with the condition because it is chronic, places restrictions on their lives, and is an inherited disorder that can be passed to future generations. Children with hemophilia are not at risk of hypothermia, diarrhea, or imbalanced nutrition.

The nurse's review of a client's most recent blood work reveals a significant increase in the number of band cells. The nurse's subsequent assessment should focus on which of the following? A. Respiratory function B. Evidence of decreased tissue perfusion C. Signs and symptoms of infection D. Recent changes in activity tolerance

Ans: C Ordinarily, band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil production increases, such as infection. This finding is not suggestive of problems with oxygenation and subsequent activity intolerance.

A client's low hemoglobin level has necessitated transfusion of PRBCs. Prior to administration, which action should the nurse perform? A. Have the client identify the blood type in writing B. Ensure that the client has granted verbal consent for transfusion C. Assess the client's vital signs to establish baselines D. Facilitate insertion of a central venous catheter

Ans: C Prior to a transfusion, the nurse must take the client's temperature, pulse, respiration, and blood pressure to establish a baseline. Written consent is required, and the client's blood type is determined by type and cross match, not by the client's self-declaration. Peripheral venous access is sufficient for blood transfusion.

A nurse is providing education to a client with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education? A. Take the iron with dairy products to enhance absorption B. Increase the intake of vitamin E to enhance absorption C. Iron will cause the stools to darken in color D. Limit foods high in fiber due to the risk for diarrhea

Ans: C The nurse will inform the client that iron will cause the stools to become dark in color. Iron should be taken on an empty stomach, as its absorption is affected by food, especially dairy products. Clients should be instructed to increase their intake of vitamin C to enhance iron absorption. Foods high in fiber should be consumed to minimize problems with constipation, a common side effect associated with iron therapy.

A nurse is planning the care of a client with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. Which nursing diagnosis should the nurse prioritize in the client's plan of care? A. Risk for disuse syndrome related to ineffective peripheral circulation B. Functional urinary incontinence related to urethral occlusion C. Ineffective tissue perfusion related to thrombosis D. Ineffective thermoregulation related to hypothalamic dysfunction

Ans: C There are multiple potential complications of sickle cell disease and sickle cell crisis. Central among these, however, is the risk of thrombosis and consequent lack of tissue perfusion. Sickle cell crisis are not normally accompanied by impaired thermoregulation or genitourinary complications. Risk for disuse syndrome is not associated with the effects of acute vaso-occlusive crisis.

A nurse in a long-term care facility is admitting a new resident who has a bleeding disorder. When planning this resident's care, the nurse should include which action? A. Housing the resident in a private room B. Implementing a passive ROM program C. Implementing of a plan for fall prevention D. Providing the client with a high-fiber diet

Ans: C To prevent bleeding episodes, the nurse should ensure that an older adult with a bleeding disorder does not suffer a fall. Activity limitation is not necessarily required, however. A private room is not necessary and there is no reason to increase fiber intake.

A client with a history of atrial fibrillation has contacted the clinic reporting an accidental overdose on prescribed warfarin. The nurse should recognize the possible need for which antidote? A. Intravenous immunoglobulins (IVIG) B. Factor IX C. Vitamin K D. Factor VIII

Ans: C Vitamin K is given as an antidote for warfarin toxicity. IVIG is a form of immunosuppressive therapy given to treat immune thrombocytopenic purpura and to counteract hemolytic transfusion reaction and neutralizing antibodies (inhibitors) that develop in response to factor replacement therapy in clients with hemophilia. IVIG is not used as an antidote for warfarin toxicity. Factors VIII and IX are clotting factors that are deficient in clients with hemophilia due to a genetic defect; these clients may receive recombinant forms of these factors to treat their condition.

An adult client has been diagnosed with iron-deficiency anemia. What nursing diagnosis is most likely to apply to this client's health status? A. Risk for deficient fluid volume related to impaired erythropoiesis B. Risk for infection related to tissue hypoxia C. Acute pain related to uncontrolled hemolysis D. Fatigue related to decreased oxygen-carrying capacity

Ans: D Fatigue is the major assessment finding common to all forms of anemia. Anemia does not normally result in acute pain of fluid deficit. The client may have an increased risk of infection due to impaired immune function, but fatigue is more likely.

A 35-year-old client is admitted to the hospital reporting severe headaches, vomiting, and testicular pain. The client's blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this client suspects which diagnosis? A. Acute myeloid leukemia B. Chronic myeloid leukemia C. Myelodysplastic syndromes D. Acute lymphocytic leukemia

Ans: D In acute lymphocytic leukemia, manifestations of leukemic cell infiltration into other organs are more common that with other forms of leukemia, and include pain from an enlarged liver or spleen, as well as bone pain. The CNS is frequently a site for leukemic cells; thus, clients may exhibit headache and vomiting because of meningeal involvement. Other extranodal sites include the testes and breasts. All the listed types of leukemia, depending on severity and stage, can have the same blood work results. The difference is the client's signs and symptoms, which are closely associated with ALL. A large number of clients when first diagnosed with any type of leukemia are asymptomatic or have nonspecific symptoms. It is discovered on routine lab work.

A client comes into the clinic reporting fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. Which condition should the nurse most suspect the client has? A. A hypoproliferative anemia B. A leukemia C. Thrombocytopenia D. A hemolytic anemia

Ans: D In hemolytic anemias, premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma; the released hemoglobin is converted in large part to bilirubin, and therefore the bilirubin concentration rises. The increased erythrocyte destruction leads to tissue hypoxia, which in turn stimulates erythropoietin production. This increased production is reflected in an increased reticulocyte count as the bone marrow responds to the loss of erythrocytes. Hypoproliferative anemias, leukemia, and thrombocytopenia lack this pathology and presentation.

When teaching a client with sickle cell disease about strategies to prevent crises, what measures should the nurse recommend? A. Using prophylactic antibiotics and performing meticulous hygiene B. Maximizing physical activity and taking OTC iron supplements C. Limiting psychosocial stress and eating a high-protein diet D. Avoiding cold temperatures and ensuring sufficient hydration

Ans: D Keeping warm and providing adequate hydration can be effective in diminishing the occurrence and severity of attacks. Hygiene, antibiotics, and high protein intake do not prevent crises. Maximizing activity may exacerbate pain and be unrealistic.

A nurse is planning the care of a client who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurse's choice of interventions? A. Gabapentin (Neurontin) is effective because of the neuropathic nature of the client's pain. B. Opioids partially inhibit the client's synthesis of clotting factors C. Opioids may cause vasodilation and exacerbate bleeding D. NSAIDS are contraindicated due to the risk for bleeding

Ans: D NSAIDS may be contraindicated in clients with hemophilia due to the associated risk of bleeding. Opioids do not have a similar effect and they do not inhibit platelet synthesis. The pain associated with hemophilia is not neuropathic.

A 25-year-old client comes to the ED with excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged prothrombin time (PT), but a vitamin K deficiency is ruled out. When assessing the client, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the client's signs and symptoms? A. Lymphoma B. Leukemia C. Hemophilia D. Hepatic dysfunction

Ans: D Prolongation of the PT, unless it is caused by vitamin K deficiency, may indicate severe hepatic dysfunction. Liver dysfunction can lead to decreased amount of factors needed for coagulation and hemostasis. The majority of hemophiliacs are diagnosed as children. The scenario does not describe signs and symptoms of lymphoma or leukemia.

A client's diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin. When assessing the therapeutic response to this medication, which action by the nurse is the most appropriate? A. Assess for signs of myelosuppression B. Review the client's platelet level C. Assess the client's capillary refill time D. Review the client's INR

Ans: D The INR and Aptt serve as useful tools for evaluating a client's clotting ability and monitoring the therapeutic effectiveness of anticoagulant medications. The client's platelet level is not normally used as a short-term indicator of anticoagulation effectiveness. Assessing the client for signs and symptoms of myelosuppression and assessing capillary refill time do not address the effectiveness of anticoagulants.

Two units of PRBCs have been prescribed for a client who has experienced a GI bleed. The client is highly reluctant to receive a transfusion, stating, "I'm terrified of getting AIDS from a blood transfusion." How can the nurse best address the client's concerns? A. "All donated blood is treated with antiretroviral medications before it is used." B. "That did happen in some high-profile cases in the 20th century, but it is no longer a possibility." C. " HIV was eradicated from the blood supply in the early 2000s." D. "Donated blood is screened for HIV, and the risk of contraction is very low."

Ans: D The client can be reassured about the very low possibility of contracting HIV from the transfusion. However, it is not an absolute impossibility. Antiretroviral medications are not introduced into donated blood. The blood supply is constantly dynamic, due to the brief life of donated blood.

An interdisciplinary team has been commissioned to create policies and procedures aimed at preventing acute hemolytic transfusion reactions. What action has the greatest potential to reduce the risk of this transfusion reaction? A) Ensure that blood components are never infused at a rate greater than 125 mL/hr. B) Administer prophylactic antihistamines prior to all blood transfusions. C) Establish baseline vital signs for all patients receiving transfusions. D) Be vigilant in identifying the patient and the blood component.

Ans: D The most common causes of acute hemolytic reaction are errors in blood component labeling and client identification that result in the administration of an ABO- compatible transfusion. Actions to address these causes are necessary in all health care settings. Prophylactic antihistamines are not normally given, and would not prevent acute hemolytic reactions. Similarly, baseline vital signs and slow administration will not prevent this reaction

A nurse is caring for a client who is undergoing preliminary testing for a hematologic disorder. What sign and symptom of a hematological disorder is most common? A. Sudden change in LOC B. recurrent infections C. Anaphylaxis D. Severe fatigue

Ans: D The most common indicator of a hematologic disease is extreme fatigue. This is more common than changes in LOC, infections, or anaphylaxis.

A nurse is educating a client about the role of B lymphocytes. The nurse's description will include which of the following physiologic processes? A. Stem cell differentiation B. Cytokine production C. Phagocytosis D. Antibody production

Ans: D B lymphocytes are capable of differentiating into plasma cells. Plasma cells, in turn, produce antibodies. Cytokines are produced by natural killer cells. Stem cell differentiation greatly precedes B lymphocyte production.