Chapter 8 - Hematologic Problems

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A 22 yr old with stage I-Hodgkin's disease is admitted to the oncology unit for radiation therapy. During the initial assessment, the patient tells you, "Sometimes I'm afraid of dying." Which response is most appropriate at this time? 1. Many individuals with this diagnosis have some fears 2. Perhaps you should ask the doctor about medication 3. Tell me a little bit more about your fear of dying 4. Most people with stage I-Hodgkin's disease survive

2

A 32 yr old patient with sickle cell anemia is admitted to the hospital during a sickle cell crisis. Which action prescribed by the HCP will you implement first? 1. give morphine sulfate 4-8 mg IV every hour as needed 2. administer 100% O2 using a nonrebreather mask 3. start a 14-gauge IV line and infuse NS at 200 mL/hr 4. give pneumococcal (Pneumovax) and Haemophilus influenzae (ActHIB) vaccines

3

A 67 yr old who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. Which statement made by the patient when you are obtaining the admission history is of most concern? 1. I've noticed that I bruise more easily since the chemo started. 2. My bowel movements are soft and dark brown. 3. I take one aspirin every morning because of my history of angina. 4. My appetite has decreased since the chemo started.

1

A group of patients is assigned to an RN-LPN/LVN team. The LPN/LVN should be assigned to provide patient care and administer medications to which patient? 1. 36 yr old with chronic kidney failure who will need a subcutaneous injection of epoetin alfa (Procrit) 2. 39 yr old with hemophilia B who has been admitted to receive PRBCs 3. 50 yr old with newly diagnosed polycythemia vera who will require phlebotomy 4. 55 yr old with a history of stem cell transplantation who has a bone marrow aspiration schedule

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A patient in a long-term care facility who has chronic lymphocytic leukemia has a nursing diagnosis of Activity Intolerance r/t weakness and anemia. Which nursing activity will you delegate to the UAP? 1. evaluating the patient's response to normal ADLs 2. checking the patients' BP and pulse after ambulation 3. determining which self-care activities the patient can do independently 4. assisting the patient in choosing a diet that will improve strength

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A patient is admitted to the ICU with DIC associated with a gram-negative infection. Which assessment information has the most immediate implications for the patient's care? 1. there is no palpable radial or pedal pulse 2. the patient reports chest pain 3. the patient's O2 saturation is 87% 4. there is mottling of the hands and feet

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A patient who has been receiving cyclosporine (Sandimmune) following an organ transplantation is experiencing the following symptoms. Which one is of most concern? 1. bleeding of the gums while brushing the teeth 2. nontender lump in the right groin 3. occasional nausea after taking the medication 4. numbness and tingling of the feet

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A patient wit ha graft-versus-host disease (GVHD) after bone marrow transplantation is being cared for on the medical unit. Which nursing activity is best delegated to a travel RN? 1. administering oral cyclosporine (Sandimmune) to the patient 2. assessing the patient for signs of infection caused by GVHD 3. infusing 5% dextrose in 0.45% saline at 125 mL/hr into the patient 4. educating the patient about ways to prevent and detect infection

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A patient with Hodgkin lymphoma who is receiving radiation therapy to the groin area has skin redness and tenderness in the area being irradiated. Which nursing activity should you delegate to the UAP caring to the patient? 1. checking the skin for signs of redness or peeling 2. assisting the patient in choosing appropriate clothing 3. explaining good skin care to the patient and family 4. cleaning the skin over the area daily with a mild soap

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A patient with acute myelogenous leukemia is receiving induction-phase chemotherapy. Which assessment finding requires the most rapid action? 1. serum potassium level 7.8 mEq/L 2. urine output less than intake by 400 mL 3. inflammation and redness of oral mucosa 4. ecchymoses present on the anterior trunk

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A transfusion of PRBCs has been infusing for 5 minutes when the patient becomes flushed and tachypneic and says, "I'm having chills. Please get me a banket." Which action should you take first? 1. obtain a warm blanket for the patient 2. check the patient's oral temperature 3. stop the transfusion 4. administer O2

2

After a car accident, a patient with a medical alert bracelet indicating hemophilia A is admitted to the ED. Which action prescribed by the HCP will you implement first? 1. transport to the radiology department for cervical spine radiography 2. transfuse factor VII concentrate 3. type and cross-match for 4 units of PRBCs 4. infuse normal saline at 250 mL/hr

1

After you receive the change-of-shift report, which patient will you assess first? 1. 20 yr old with possible acute myelogenous leukemia who has just arrived on the medical unit 2. 38 yr old with aplastic anemia who needs teaching about decreasing infection risk before discharge 3. 40 yr old with lymphedema who requests help in putting on compression stockings before getting out of bed 4. 60 yr old with non-Hodgkin lymphoma who is refusing the prescribed chemotherapy regimen

1

As a home health nurse you are obtaining an admission history for a patient who has DVT and is taking warfarin (Coumadin) 2 mg daily. Which statement by the patient is the best indicator that additional teaching about warfarin may be needed? 1. I have started to eat more healthy foods like green salads and fruit 2. The doctor said that it is important to avoid becoming constipated 3. Coumadin makes me feel a little nauseated unless I take it with food 4. I will need to have some blood testing done once or twice a week

3

As charge nurse, you are making the daily assignments on the medical-surgical unit. Which patient is best assigned to a float nurse who has come from the PACU? 1. 30 yr old with thalassemia major who has an order for SQ infusion of deferoxamine (Desferal) 2. 43 yr old patient with multiple myeloma who requires discharge teaching 3. 52 yr old patient with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy 4. 65 yr old patient with pernicious anemia who has just been admitted to the unit

2

The nurse in the outpatient clinic is assessing a 22 yr old who required a splenectomy after a recent MVA. Which information obtained during the assessment will be of most immediate concern to the nurse? 1. patient engages in unprotected sex 2. oral temp is 100 F (37.8) 3. there is abdominal pain with light palpation 4. patient admits to occasional marijuana use

1

These activities are included in the care plan for a 78 yr old patient admitted to the hospital with anemia caused by possible GI bleeding. Which activity can you delegate to an experienced UAP? 1. obtaining stool specimens for fecal blood test (Hemoccult) slides 2. having the patient sign a colonscopy consent form 3. giving the prescribed polyethylene glycol electrolyte solution (GoLYTELY) 4. checking for allergies to contrast dye or shellfish

1

You are making a room assignment for a newly arrived patient whose laboratory test results indicate pancytopenia. Which patient will be the best roommate for the new patient? 1. patient with digoxin toxicity 2. patient with viral pneumonia 3. patient with shingles 4. patient with cellulitis

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You are providing orientation for a new RN who is preparing to administer PRBCs to a patient who had blood loss during surgery. Which action by the new RN requires that you intervene immediately? 1. waiting 20 minutes after obtaining the PRBCs before starting the infusion 2. starting an IV line for the transfusion using a 22-gauge catheter 3. priming the transfusion set using 5% dextrose in LR solution 4. telling the patient that the PRBCs may cause a serious transfusion reaction

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You are reviewing the CBC for a patient who has been admitted for knee arthroscopy. Which value is most important to report to the physician before surgery? 1. Hct 33% 2. Hgb 10.9 3. platelet 426,000/mm3 4. WBC 16,000/mm3

3

You are the charge nurse on an oncology unit when a patient with an absolute neutrophil count of 300/microL is admitted. Which staff member should you assign to provide care for this patient, under the supervision of an experienced oncology RN? 1. LPN/LVN who has floated from the same-day surgery unit 2. RN from a staffing agency who is being oriented to the oncology unit 3. LPN/LVN with 2 years of experience on the oncology unit 4. RN who recently transferred to the oncology unit from the ED

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You are transferring a patient with newly-diagnosed chronic myeloid leukemia to an LTC facility. Which information is most important to communicate to the LTC charge nurse before transferring the patient? 1. Philadephia chromosome is present in the patient's blood smear 2. Glucose level is elevated as a result of prednisone (Deltasone) therapy 3. There has been a 20-lb weight loss over the last year 4. The patient's chemotherapy has resulted in neutropenia

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You obtain the following data about a patient admitted with multiple myeloma. Which information has the most immediate implications for the patient's care? 1. the patient reports chronic bone pain 2. the blood uric acid level is very elevated 3. the 24-hour urine test shows Bence Jones proteins 4. the patient reports new-onset leg numbness

4

You receive a change-of-shift report about the following patients. Which one will you assess first? 1. 26 yr old with thalassemia who has a Hgb of 8 and orders for PRBC transfusion 2. 44 yr old who was admitted 3 days ago in a sickle cell crisis and has orders for a computed tomographic scan 3. 50 yr old with stage IV non-Hodgkin lymphoma who is crying and saying, "I'm not ready to die" 4. 69 yr old with chemo-induced neutropenia who has an oral temp of 100.1 F (37.8 C)