Chapter 27 & 28 Med Surge

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The nurse is teaching a client who has iron deficiency anemia about nutrition. Which statement made by the client indicates an understanding of the teaching?

"For dinner, I am eating legumes and chicken."

The nurse is reinforcing teaching for a client with hemophilia A. Which statement made by the client indicates a need for further teaching?

"I am signed up to play football this year."

A client asks the nurse to explain sickle cell anemia. Which response by the nurse is accurate?

"It is an inherited anemia that causes blood cells to take on a crescent shape and clump."

How many liters of blood are contained in the human body?

4-6

The nurse is caring for a group of clients. Which client is at highest risk for developing Hodgkin lymphoma (HL)?

A 30-year-old man

The nurse is caring for a group of clients. Which client will the nurse see first?

A client with hemophilia having a nosebleed

The nurse is caring for a client in sickle cell crisis. Which intervention will the nurse implement?

Administer opioid analgesics as ordered

The nurse is caring for a client with leukemia. Which interventions will the nurse implement? Select all that apply.

Allow periods of rest between activities. Encourage increased fluid intake. Monitor client for signs of infection. Ensure a dietitian is consulted for planning meals.

The nurse is caring for a group of clients. Which client is at highest risk for developing leukemia?

An individual with Down syndrome

Which of these changes is a component of the hematologic system?

Bone marrow

The nurse reads that a client has stage III Hodgkin lymphoma (HL). Which statement accurately describes stage III HL?

Disease affects nodes on both sides of the diaphragm.

The nurse is caring for a client with leukemia who is undergoing chemotherapy and is neutropenic. Which intervention will the nurse implement?

Ensure all staff and visitors wash hands before visiting

The nurse is caring for a client receiving a blood transfusion who suddenly develops a fever, chills, headache, and back pain. The nurse recognizes this as which type of reaction?

Febrile nonhemolytic

The nurse is reinforcing teaching for a client who underwent a splenectomy. Which statement made by the client indicates a need for further teaching?

I am at high risk for bleeding now."

The nurse is caring for a client with multiple myeloma. Which clinical manifestations can the nurse expect to find?

Joint Swelling

The nurse is caring for a client with suspected lymphoma. For which diagnostic tool will the nurse prepare the client next?

Lymphangiography

The nurse is caring for a client who underwent a splenectomy. This procedure places the client at risk for which of these illnesses?

Meningitis

The nurse is caring for a client who underwent a bone marrow biopsy. Which intervention will the nurse implement following the procedure?

Monitor the site for bleeding and infection.

The nurse is caring for a client with multiple myeloma who reports loss of bladder function. Which action will the nurse take?

Notify the health-care provider

The nurse is caring for a client with Hodgkin lymphoma (HL). Which clinical manifestations can the nurse expect to find? Select all that apply.

Painless swollen lymph node Generalized pruritus Malaise Cough

The nurse is assessing a client with anemia. The nurse will expect to document which assessment finding on the client's skin?

Pallor

The nurse is caring for a client who is in disseminated intravascular coagulation (DIC). Which clinical manifestations will the nurse expect to find? Select all that apply.

Petechiae Painful joints Dyspnea Abnormal bleeding

The nurse is caring for a client with a hematologic disorder. Which clinical manifestations can the nurse expect to find? Select all that apply.

Petechiae Weakness Dyspnea

The nurse is reviewing lab values for a client experiencing disseminated intravascular coagulation (DIC). Which of these conditions will the nurse expect to find?

Prolonged prothrombin time (PT)

The nurse is reviewing lab results for a female client with anemia. Which lab result will concern the nurse the most?

Red blood cell (RBC) count of 3.1 million/mm3

The nurse is caring for a client admitted with sickle cell crisis. Which assessment will the nurse expect to find?

Severe pain in the joints

Which disease process causes an accelerated destruction of red blood cells?

Sickle cell anemia

The nurse is caring for a client with pernicious anemia. Which classic clinical manifestation can the nurse expect to find?

Sore, beefy red tongue

The nurse is caring for a client undergoing chemotherapy for non-Hodgkin lymphoma (NHL). Which assessment finding will concern the nurse?

The client has a fever and cough

The nurse is caring for a client with polycythemia vera (PV). Which clinical manifestation can the nurse expect to find?

Tinnitus

The nurse is preparing to administer red blood cells (RBCs) to a client with anemia. Which interventions should the nurse implement? Select all that apply.

Transfuse each unit over 2 hr, and no more than 4 units Use tubing that contains a filter


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