Ch 28 Green

2. 1

The nurse is assisting in the development of a care plan for a patient with pernicious anemia. Which of the following would be the most common nursing diagnosis with this medical condition? 1. Activity intolerance related to tissue hypoxia 2. Ineffective airway clearance related to dyspnea. 3. Chronic pain related to bone marrow dysfunction 4. Risk for infection related to reduction in white blood cells (WBCs)

11. 2

The nurse is assisting the patient with multiple myeloma in arranging a meal plan to lower the risk of complications from hypercalcemia. Which of the following would be the most important component of the patient's intake? 1. The patient should increase intake of fresh fruits. 2. The patient should increase intake of fluids. 3. The patient should decrease intake of red meat. 4. The patient should avoid alcoholic beverages.

4. 4

The nurse is caring for a patient in sickle cell crisis. What is the rationale for providing warm compresses and blankets for this patient? 1. Sickle cell crisis pain can be exacerbated with shivering. 2. Heat relaxes the muscles and distracts the patient from the pain. 3. Heat promotes proper formation of red blood cells (RBCs) and prevents sickling. 4. Heat increases circulation by preventing vasoconstriction.

16. 4

The nurse is caring for a patient receiving treatment for a hemolytic anemia due to a reaction from a mismatched blood transfusion. The nurse understands that hemolytic anemia is a definition of what type of anemia? 1. Malformed RBCs 2. An abundance of immature RBCs 3. A deficiency in vitamin B12 4. Destruction of RBCs

22. 1

The nurse is caring for a patient who has CLL when the patient suddenly develops petechiae, nausea, and severe back pain. The nurse recognizes this life-threatening event as which of the following? 1. DIC 2. Sickle cell crisis 3. Thrombocytopenia 4. Pancytopenia

3. 1,2,5

The nurse is caring for a patient who has been recently diagnosed with aplastic anemia. Which of the following are indicators of this disease process? (Select all that apply.) 1. Bone marrow that is pale, fatty, and fibrous 2. A CBC with all low values 3. Presence of Reed-Sternberg cells 4. Decreased serum iron levels 5. Increased total iron-binding capacity (TIBC)

25. 4

The nurse is caring for a patient who must undergo a splenectomy for treatment for idiopathic thrombocytopenic purpura (ITP).Which of the following statements best describes the rationale for the splenectomy? 1. The spleen becomes engorged and ischemic during an ITP crisis. 2. The spleen causes an overabundance of immature platelets. 3. The spleen is at risk for infection due to the critical loss of WBCs. 4. The spleen is the primary site for platelet destruction.

1. 2,34

The nurse is caring for a patient with a folic acid deficiency. What foods should the nurse encourage the patient to improve this deficiency? (Select all that apply.) 1. Almond milk and toasted white bread 2. Split pea soup with whole grain crackers 3. Garden salad with green leafy vegetables 4. Cereals made with fortified grain and wheat germ 5. Yogurt and aged cheeses with crackers

4. 3,4,5

The nurse is caring for a patient with a platelet count of <20,000/mm3. Which of the following precautions should the nurse take in providing care for this patient? (Select all that apply.) 1. Immediately report any fever to the HCP. 2. Administer NSAIDs for pain control. 3. Monitor for black tarry stools. 4. Avoid blood draws when possible. 5. Use soft toothbrush to clean the teeth.

21. 1

The nurse is caring for a patient with chronic episodes of hypoxia secondary to chronic obstructive pulmonary disease. The nurse will monitor the patient's laboratory results for increased RBCs due to the low oxygen levels. Which of the following blood disorders will the nurse expect to find? 1. Aplastic anemia 2. DIC 3. Chronic lymphatic leukemia (CLL) 4. PV

17. 1

The nurse is caring for a patient with iron deficiency anemia, which of the following would be the most appropriate nursing intervention for this patient? 1. Instruct the patient to notify the HCP of nausea or constipation. 2. Take the iron supplement at the same time every day with meals. 3. Stop taking the iron supplement when symptoms are resolved. 4. Take advantage of energy spurts and cluster activities at that time.

13. 3

The nurse is caring for a patient with stage IV Hodgkin disease. Where should the nurse expect to find enlarged lymph nodes during the assessment? 1. Two or more areas on the same side of the diaphragm 2. Localized in the cervical neck area only 3. Generalized throughout the body within multiple organs 4. Two areas of lymph nodes above and below the diaphragm

7. 2

The nurse is caring for a patient with thrombocytopenia. Which of the following products would the nurse anticipate being prescribed? 1. Albumin 2. Cryoprecipitate 3. Lactated Ringer's 4. Packed RBCs

30. 1

The nurse is caring for the patient who is 1 day status postsplenectomy. The patient complains of pain with breathing especially with inspiration. What would be the most appropriate nursing intervention for this patient? 1. Medicate with opioids for pain and assist the patient to deep breathe, cough, and ambulate. 2. Contact the surgeon to obtain orders for a nebulizer treatment from respiratory therapy. 3. Provide the patient with a heating pad alternated with a cold pack for incisional pain. 4. Contact the surgeon to request a chest x-ray and a laboratory draw for CBC with differential.

23. 2

The nurse is caring for the patient who recently underwent a colectomy due to a bowel perforation and peritonitis. The nurse is preparing to administer the anticoagulant heparin to prevent which of the following blood disorders? 1. PV 2. DIC 3. Pancytopenia 4. Thrombocytopenia

24. 3

The nurse is caring for the patient who underwent emergency treatment for DIC. The patient voices concern over how to explain the tubes and extensive bruising to his family members. Which of the following would be an appropriate nursing intervention for disturbed body image related to physical evidence of aggressive treatment procedures? 1. Cover the ecchymotic areas with bandages and disconnect the IV tubes temporarily. 2. Limit the number of visitors to two at a time for short intervals. 3. Enlist the aid of other members of the health care team to support the family. 4. Place educational materials in the waiting area prior to visitor's arrival.

19. 3

The nurse is caring for the patient with hemoglobin less than 6 g/dL. Which of the following clinical manifestations would the nurse expect the patient to present? 1. Mild palpitations, thirst, and fatigue 2. Tachycardia, fatigue, and exertional dyspnea 3. Orthopnea, blurred vision, and pruritus 4. Petechiae, ecchymosis, and restlessness

14. 1

The nurse is caring for the patient with iron deficiency anemia, who has been taking oral iron supplements. Which of the following laboratory tests would determine the effectiveness of this intervention? 1. Hemoglobin and hematocrit 2. WBC and platelet count 3. Electrolytes, blood urea nitrogen (BUN), and creatinine 4. Activated partial thromboplastin time (APTT) and prothrombin time (PT)

20. 4

The nurse is following the care plan risk for ineffective peripheral perfusion related to sickled cells and infarction. Which of the following would be the most appropriate intervention? 1. Increase the patient's activity daily to achieve previous energy levels. 2. Provide 325 mg aspirin between doses of narcotic pain medications. 3. Apply cold compresses and maintain a cool environment. 4. Avoid restrictive clothing and raising the knee gatch in the bed.

5. 3

The nurse is preparing to provide therapeutic treatment to the patient with an exacerbation of polycythemia vera (PV). Which of the following is the expected treatment for this patient? 1. Alternated heat and cold packs 2. Schedule for a splenectomy 3. Therapeutic phlebotomy 4. Weekly injections of erythropoietin

1. 75

The nurse is providing a blood transfusion and sets the infusion pump to run at 300 mL/hr for 15 minutes. What is the amount of blood that will be transfused at that time (in mL)?

6. 1

The nurse is providing care to a patient with a hematological disorder. Which of the following would be a manifestation of disseminated intravascular coagulation (DIC)? 1. Absent peripheral pulses 2. Hypertension and bounding pulses 3. Presence of scattered petechiae 4. Weakness or one-sided paralysis

8. 3

The nurse is triaging several patients in an urgent care center. One patient states that he has hemophilia and is bleeding, with no apparent signs of bleeding. Which action by the nurse is most appropriate at this time? 1. Palpate the suspected area of bleeding for tenderness and edema. 2. Have the patient take a number and stay in the waiting area. 3. Place the patient in an examination room immediately and notify the physician of a potential bleeding crisis. 4. Send the patient for routine x-rays to locate the source of bleeding and place him in an examination room.

10. 4

The home care nurse is providing teaching to the family of a patient with multiple myeloma. Which nursing diagnosis should guide the nurse for this teaching? 1. Ineffective airway clearance related to swelling of the lymph nodes 2. Ineffective tissue perfusion related to vascular occlusion 3. Risk for deficit fluid volume related to a bleeding disorder 4. Risk for injury related to compromised bone integrity

9. 1

The nurse caring for a patient with chronic leukemia in an acute care setting. The patient asks the nurse to observe the patient's last bowel movement as it is very dark. The nurse immediately contacts the primary health care provider (HCP). What would explain the nurse's action? 1. The patient may have a gastrointestinal bleed. 2. The patient may have overdosed on iron supplements. 3. The patient is most likely severely dehydrated. 4. The patient is ready for discharge to home.

2. 3,4

The nurse is assessing a patient in a family practice clinic. The patient had extensive testing to rule out Hodgkin disease. Which of the following characteristics would indicate Hodgkin disease? (Select all that apply.) 1. The patient complained of blurred vision and excessive thirst. 2. The patient complained of skeletal and generalized pain. 3. The laboratory results show presence of Reed-Sternberg cells. 4. The patient has painless swelling of the cervical and axillary nodes. 5. The patient's laboratory results indicate presence of Philadelphia chromosomes.

28. 3

The nurse is assessing the patient recently diagnosed with chronic myelogenous leukemia (CML). What of the following indicates a positive diagnosis for CML? 1. CBC reveals decrease of platelets and RBCs. 2. Lumbar puncture shows presence of Reed-Sternberg cells. 3. Genetic analysis of bone marrow reveals Philadelphia chromosome. 4. Laboratory results reveal a prolonged PTT and low factor IX.

27. 2

The nurse is assisting in developing a plan of care for the patient with hemophilia who is experiencing severe acute pain. Which of the following would be the most appropriate intervention based on the nursing diagnosis acute pain related to bleeding into tissues? 1. Administer desmopressin injections as prescribed prior to any invasive procedure. 2. Administer opioids as prescribed, avoiding IM injections. 3. Instruct the patient on bleeding precautions and signs and symptoms of bleeding. 4. Instruct the patient on community services and hemophilia treatment centers.

5. 2,3,5

The nurse is providing care to the patient who has arrived at the clinic to discuss his diagnostic results. The HCP suspects multiple myeloma. Which of the following results may confirm the HCP's suspicions? (Select all that apply.) 1. Reed-Stenberg cells are present in the bone marrow. 2. Magnetic resonance imaging (MRI) shows diffuse osteoporosis in the bones. 3. Blood chemistries reveal an increase in serum calcium. 4. Lymph node biopsies reveal Philadelphia chromosome. 5. Blood and urine studies are positive for M-type globulins.

12. 4

The nurse is providing care to the patient with Hodgkin disease who has cervical lymph node enlargement. Which of the following symptoms should the nurse attend to first? 1. Pain 2. Fever 3. Fatigue 4. Stridor

18. 2

The nurse is providing care to the patient with suspected aplastic anemia. The HCP has completed a bone marrow biopsy. Which of the following would be a description of the bone marrow that would signify a positive diagnosis of aplastic anemia? 1. The bone marrow is red and gelatinous. 2. The bone marrow is pale, fatty, and fibrous. 3. The bone marrow is thin and serosanguinous. 4. The bone marrow is pale pink and serous.

3. 4

The nurse is providing care to the patient with thrombocytopenia. Which of the following activities should the patient avoid? 1. Planting tulip bulbs in the garden 2. Using an electric razor to shave 3. Attending church services 4. Receiving an influenza vaccination

1. 2

The nurse is providing education to a patient newly diagnosed with iron deficiency anemia. Which of the following would be a component of the education? 1. Avoid green leafy vegetables as they will counteract the medication. 2. Include citrus fruits while taking the medication for this disorder. 3. Avoid immunizations with live viruses for 3 months. 4. Avoid intramuscular (IM) injections while on the medication.

26. 1

The nurse is providing education to a patient with mild hemophilia on how to avoid bleeding episodes. Which one of the following would be most appropriate to include in the teaching plan? 1. Administer desmopressin intranasally prior to any dental procedure or sports. 2. Carry an epinephrine pen (EpiPen) that is readily available for emergencies. 3. Maintain compression to injection sites for at least 4 hours with a sterile pads. 4. Prepare for blood transfusions after any invasive procedure such as dental extractions.

29. 1

The nurse is providing education to the patient with the nursing diagnosis of impaired oral membrane integrity related to chemotherapy and pancytopenia. The nurse is aware that the patient understands the teaching by which of the following actions? 1. The patient keeps her dentures in at all times except for cleaning. 2. The patient chooses orange juice and hot coffee for breakfast. 3. The patient avoids smoking and commercial mouthwash. 4. The patient chooses ice cream and popsicles for between-meal snacks.

15. 1

patient with pernicious anemia. The patient asks why this happened when she has regularly taken iron supplements while following a strict vegetarian diet. Which of the following would be the nurse's most appropriate response? 1. "Increase dairy products such as yogurt to increase your intake of vitamin B12." 2. "Drinking a glass of orange juice would facilitate the absorption of the iron supplements." 3. "Would you be able to take liver tablets to increase your intake of Vitamin B12?" 4. "Perhaps your HCP will prescribe an injection of erythropoietin."