Exam 1: Hematologic Disorders

A client diagnosed with leukemia is being admitted for an induction course of chemotherapy. Which laboratory values indicate a diagnosis of leukemia? 1. A left shift in the white blood cell count differential. 2. A large number of WBCs that decrease after the administration of antibiotics. 3. An abnormally low hemoglobin (Hb) and hematocrit (Hct) level. 4. Red blood cells that are larger than normal.

1 A left shift indicates immature white blood cells are being produced and released into the circulating blood volume. This should be investigated for the malignant process of leukemia.

A client, diagnosed with chronic lymphocytic leukemia, is admitted to the hospital for treatment of hemolytic anemia. Which of the following measures, if incorporated into the nursing care plan, would best address the patient's needs? 1. Encourage activities with other patients in the day room. 2. Isolate him from visitors and patients to avoid infection. 3. Provide a diet high in Vitamin C 4. Provide a quiet environment to promote adequate rest.

4

The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following? A. Petechiae, fever, fatigue B. Headache, papilledema, irritability C. Muscle wasting, weight loss, fatigue D. Decreased intracranial pressure, psychosis, confusion

A Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia.

A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that a. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT). b. the transplant of the donated cells is painful because of the nerves in the tissue lining the bone. c. donor bone marrow cells are transplanted immediately after an infusion of chemotherapy. d. the transplant procedure takes place in a sterile operating room to minimize the risk for infection.

A The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drug.

A complication of the hyperviscosity of polycythemia is A. thrombosis. B. cardiomyopathy. C. pulmonary edema. D. disseminated intravascular coagulation (DIC).

A Thrombosis is the most likely complication. The patient with polycythemia may experience angina, heart failure, intermittent claudication, and thrombophlebitis, which may be complicated by embolization. The most common and serious acute complication is stroke due to thrombosis.

Which of the following findings yields a poor prognosis for a pediatric patient with leukemia? 1) Presence of a mediastinal mass 2) Late CNS leukemia 3) Normal WBC count at diagnosis 4) Disease presents between age 2 and 10

1

Which of the following laboratory values could indicate that a child has leukemia? 1. WBCs 32,000/mm3 2. Platelets 300,000/mm3 3. Hemoglobin 15g/dL 4. Blood pH of 7.35

1 A normal WBC count is approximately 4.5 mm3 - 11.0 mm3. In leukemia a high WBC count is diagnostic and is usually confirmed by a blood smear.

A child with leukemia is complaining of nausea. A nurse suspects that the nausea is related to the chemotherapy regimen. The nurse, concerned about the child's nutritional status, most appropriately would offer which of the following during this episode of nausea? 1. Cool, clear liquids 2. Low protein foods 3. Low-calorie foods 4. The child's favorite food

1 With nausea, cool and clear liquids are better tolerated. Do not offer foods when the child is nauseated so he doesn't associate if with being sick. Support nutrition with oral supplements and foods high in proteins and calories

A client has undergone a lymph node biopsy. the nurse anticipates that the report will reveal which result if the client has Hodgkin's lymphoma? 1. Reed-Sternberg cells. 2. Philadelphia chromosome. 3. Epstein-Barr virus. 4. Herpes simplex virus.

1 histological isolation of Reed-Sternberg cells in lymph node biopsy examination is a diagnostic feature of Hodgkin's lymphoma. Philadelphia chromosome is attribted to chronic myelogenous leukemia. viruses are much smaller than can be visualized with cytology.

A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. Which of the following is the appropriate and supportive response to the mother? 1. I'm not sure. I'll discuss it with the physician. 2. The child is too young to have radiation therapy. 3. It's very costly, and chemotherapy works just as well. 4. The physician would prefer that you discuss the treatment options with the oncologist.

2 Radiation therapy is usually delayed until a child is 8 years of age, if posssible, to prevent retardation of bone growth and soft tissue development.

Which medication is contraindicated for a client diagnosed with leukemia? 1. Bactrim, a sulfa antibiotic 2. Morphine, a narcotic analgesic 3. Epogen, a biologic response modifier 4. Gleevec, a genetic blocking agent

3 Epogen is a biologic response modifier that stimulates the bone marrow to produce RBCs. The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow would be generally ineffective for the desired results and would have the potential to stimulate malignant growth.

A 4 yo is admitted for abdominal pain. She has been pale and excessively tired and is bruising easily. On physical exam, lymphadenopathy and hepatosplenomaegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. Which diagnostic study would confirm this diagnosis 1. Platelet count 2. Lumbar puncture 3. bone marrow biopsy 4. WBC count

3 leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test is microscopic exam of bone marrow obtained by bone marrow aspirate and biopsy. a lumbar puncture may be done to look for blast cells in the scfluid that indicate CNS disease. The wbc count may be normal, high or low in leukemia an altered platelet count occurs as a result of the disease but also may occur as a result of chemotherapy and does not confirm the diagnosis

Which test is considered diagnostic for Hodgkin's lymphoma? 1. A magnetic resonance image (MRI) of the chest. 2. A computed tomography (CT) scan of the cervical area. 3. An erythrocyte sedimentation rate (ESR). 4. A biopsy of the cervical lymph nodes.

4 Cancers of all types are definitively diagnosed through biopsy procedures.The pathologist must identify ReedSternberg cells for a diagnosis ofHodgkin's disease

The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assessment data warrant immediate intervention? 1.T 99, P 102, R 22, and BP 132/68. 2.Hyperplasia of the gums. 3.Weakness and fatigue. 4.Pain in the left upper quadrant.

4 Pain is expected, but it is a priority, and pain control measures should be implemented. Weakness and fatigue are symptoms of the disease and are expected. Hyperplasia of the gums is a symptom of myeloid leukemia, but it is not an emergency.

A patient is being tested for sickle cell disease. As the nurse, you know the ________ will assess for abnormal hemoglobin on the red blood cell, but will not differentiate between sickle cell disease and sickle cell trait. Therefore, the patient will need to have what other test to determine this? A. dithionite test; hemoglobin electrophoresis B. hemoglobin electrophoresis; sickledex C. edrophonium test, dithionite test D. sickledex; edrophonium test

A

What solution or solutions below are compatible with red blood cells? A. Normal Saline B. Dextrose Solutions C. Any medications with normal saline D. No solutions are compatible with blood

A

As the nurse you know that there is a risk of a transfusion reaction during the administration of red blood cells. Which patient below it is at most RISK for a febrile (non-hemolytic) transfusion reaction? A. A 38 year old male who has received multiple blood transfusions in the past year. B. A 42 year old female who is immunocompromised. C. A 78 year old male who is B+ that just received AB+ blood during a transfusion. D. A 25 year old female who is AB+ and just received B+ blood.

A A febrile transfusion reaction is where the recipient's WBCs are reacting with the donor's WBCs. This causes the body to build antibodies. It is most COMMON in patients who have received blood transfusions in the past. Option B is at risk for GvHD (graft versus host disease). Option C is wrong because this places the patient at risk for a hemolytic transfusion reaction (not febrile). The patient is receiving incompatible blood. However, option D is not the patient at MOST risk compared to option A. Note the patient is receiving compatible blood in this option.

Which of the following blood components is decreased in anemia? A. Erythrocytes B. Granulocytes C. Leukocytes D. Platelets

A Anemia is defined as a decreased number of erythrocytes (red blood cells). Leukopenia is a decreased number of leukocytes (white blood cells). Thrombocytopenia is a decreased number of platelets. Lastly, granulocytopenia is a decreased number of granulocytes (a type of white blood cells)

When providing care for a patient with thrombocytopenia, you instruct the patient to A. dab his or her nose instead of blowing. B. be careful when shaving with a safety razor. C. continue with physical activities to stimulate thrombopoiesis. D. avoid aspirin because it may mask the fever that occurs with thrombocytopenia.

A Blowing the nose forcefully should be avoided; the patient should gently pat it with a tissue if needed. Patients with thrombocytopenia should avoid aspirin; aspirin reduces platelet adhesiveness, contributing to bleeding. Patients should not perform vigorous exercise or lift weights. If the patient is weak and at risk for falling, supervise the patient when out of bed. Patients should be instructed not to shave with a blade; an electric razor should be used.

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action? a. The patient's visitors bring in some fresh peaches from home. b. The patient ambulates several times a day in the room. c. The patient uses soap and shampoo to shower every other day. d. The patient cleans with a warm washcloth after having a stool.

A Fresh, thinned-skin peaches are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help to prevent perineal skin breakdown and infection.

Which action by a nursing assistant (NA) when caring for a patient who is pancytopenic indicates a need for the nurse to intervene? a. The NA assists the patient to use dental floss after eating. b. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water. c. The NA adds baking soda to the patient's saline oral rinses. d. The NA puts fluoride toothpaste on the patient's toothbrush.

A Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

During history taking of a client admitted with newly diagnosed Hodgkin's disease, which of the following would the nurse expect the client to report? A) weight gain B) night sweats C) Severe lymph node pain D) Headache with minor visual changes

B Assessment of a client with Hodgkin's disease most often reveals enlarged, painless lymph nodes, fever, malaise, and night sweats. Weight loss may be present if metastatic disease occurs. Headache and visual changes may occur if brain metastasis is present.

A male client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment findings would the nurse expect to note specifically in the client? a. Fatigue b. Enlarged lymph nodes c. Weight gain d. Weakness

B Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.

A patient with a diagnosis of hemophilia fell down an escalator earlier in the day and is now experiencing bleeding in her left knee joint. Your immediate response should include A. immediate transfusion of platelets. B. resting the patient's knee to prevent hemarthroses. C. assistance with intracapsular injection of corticosteroids. D. range-of-motion exercises to prevent thrombus formation.

B In patients with hemophilia, joint bleeding requires resting of the joint to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered.

Caring for a patient with a diagnosis of polycythemia vera will likely require you to A. encourage deep breathing and coughing. B. assist with or perform phlebotomy at the bedside. C. teach the patient how to maintain a low-activity lifestyle. D. perform thorough and regularly scheduled neurologic assessments.

B Primary polycythemia often requires phlebotomy to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation.

A 68-year-old woman is diagnosed with thrombocytopenia due to acute lymphocytic leukemia. She is admitted to the hospital for treatment. The nurse should assign the patient: A. To a private room so she will not infect other patients and healthcare workers B. To a private room so she will not be infected by other patients and healthcare workers C. To a semiprivate room so she will have stimulation during her hospitalization D. To a semiprivate room so she will have the opportunity to express her feelings about her illness

B protects patient from exogenous bacteria, risk for developing infection from others due to depressed WBC count, alters ability to fight infection

A newly admitted client is diagnosed with Hodgkin's disease undergoes an excisional cervical lymph node biopsy under local anesthesia. What does the nurse assess first after the procedure? a. Level of consciousness b. Vital signs c. Airway d. Incision site

C Assessing for an open airway is the priority. The procedure involves the neck, the anesthesia may have affected the swallowing reflex or the inflammation may have closed in on the airway leading to ineffective air exchange.

A patient with multiple myeloma becomes confused and lethargic. You would expect that these clinical manifestations may be explained by diagnostic results that indicate A. hyperkalemia. B. hyperuricemia. C. hypercalcemia. D. CNS myeloma.

C Bony degeneration in multiple myeloma causes calcium to be lost from bones, eventually causing hypercalcemia. Hypercalcemia may cause renal, GI, or neurologic manifestations such as polyuria, anorexia, confusion, and ultimately seizures, coma, and cardiac problems.

Nursing considerations related to the administration of chemotherapeutic drugs include which of the following? A. Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells. B. Infiltration will not occur unless superficial veins are used for the intravenous infusion. C. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. D. Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary.

C Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary

Which nursing intervention should you prioritize in the care of a 30-year-old woman who has a diagnosis of immune thrombocytopenic purpura (ITP)? A. Administration of packed red blood cells B. Administration of clotting factors VIII and IX C. Administration of oral or intravenous corticosteroids D. Maintenance of reverse isolation and application of standard precautions

C Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages.

You are aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that A. Hodgkin's lymphoma occurs only in young adults. B. Hodgkin's lymphoma is considered potentially curable. C. non-Hodgkin's lymphoma can present in multiple organs. D. non-Hodgkin's lymphoma is treated only with radiation therapy.

C Non-Hodgkin's lymphoma can originate outside the lymph nodes, the method of spread can be unpredictable, and the majority of patients have widely disseminated disease.

After receiving the change-of-shift report, which client will you assess first? a. A 40-year-old with lymphedema who requests help to put on compression stockings before getting out of bed b. A 60-year-old with non-Hodgkin's lymphoma who is refusing the ordered chemotherapy regimen c. A 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit d. A 38-year-old with aplastic anemia who needs teaching about decreasing infection risk prior to discharge

C The newly admitted client should be assessed first, because the baseline assessment and plan of care need to be completed. The other clients also need assessments or interventions, but do not need immediate nursing care. Focus: Prioritization

You expect which laboratory finding to be abnormal for a patient with hemochromatosis? A. RBCs B. Platelets C. Iron D. Folic acid

C The normal range for total body iron is 2 to 6 g. Individuals with hemochromatosis accumulate iron at a rate of 0.5 to 1.0 g each year and may exceed total iron concentrations of 50 g.

When caring for a client with a diagnosis of thrombocytopenia, the nurse should plan to: a.Discourage the use of stool softeners b.Assess temperature readings every six hours c.Avoid invasive procedures d.Encourage the use of a hard, brittle toothbrush

C Thrombocytopenia is a deficiency of platelets, and leaves the patient more prone to hemmorrhage. For this reason, avoiding invasive procedures will limit the risk of hemorrhage. Stool softeners should be encouraged, while hard brittle toothbrushes should be avoided. Temperature is not the most important vital to track in this patient

A client has developed oral mucositis as a result of radiation to the head and neck. The nurse shouls teach the client to incorporate which of the following measures in his or her daily home care routine? a) oral hygiene should be performed in the morning and evening b) high-protein foods, such as peanut butter, should be incorporated in the diet c) a glass of wine per day will not pose any further harm to the oral cavity d) a combination of a weak saline and water solution should be used to rinse the mouth before and after each meal

D Oral mucositis (irritation, inflammation, and/or ulceration of the mucosa) commonly occurs in clients receiving radiation to the head and neck. Measures need to be taken to soothe the mucosa as well as provide effective cleansing of the oral cavity. A combination of a weak saline and water solution is an effective cleansing agent.

You have developed the nursing diagnosis Risk for Impaired Tissue Integrity related to effects of radiation for a client with Hodgkin's lymphoma who is receiving radiation to the groin area. Which nursing activity is best delegated to a nursing assistant caring for the client? a. Explain good skin care to the client and family. b. Check the skin for signs of redness or peeling. c. Apply alcohol-free lotion to the area after cleaning. d. Clean the skin over daily with a mild soap.

D Skin care is included in nursing assistant education and job description. Assessment and client teaching are more complex tasks that should be delegated to registered nurses. Use of lotions to the irradiated area is usually avoided during radiation therapy.

According to the American Association of Blood Banks, what is the recommended hemoglobin level for a blood transfusion? A. 5-7 g/dL B. 7-8 g/dL C. 4-7 g/dL D. 9-10 g/dL

B

Before starting a blood transfusion the nurse will perform a verification process with __________. This will include? A. any available personnel; physician's order, patient's identification, blood bank's information, expiration date of blood B. licensed personnel only (another RN); physician's order, patient's identification, blood bank's information, patient's blood type and donor's type along with Rh factor, expiration date, assess the bag of blood for damage or abnormal substances C. blood bank; patient's identification, blood bank's information, patient's blood type and donor's type along with Rh factor, expiration date, bag of blood for damage or abnormal substances D. licensed personnel only (another RN); blood compatibility, physician order, expiration date

B

What blood type is known as the "universal recipient"? A. Type A B. Type B C. Type AB D. Type O

C

What is the approximate NORMAL level range for an activated partial thromboplastin time (aPTT)? A. 20-25 seconds B. 2-3 seconds C. 30-40 seconds D. 60-80 seconds

C

Your patient needs 1 unit of packed red blood cells. You've completed all the prep and the blood bank notifies you the patient's unit of blood is ready. You send for the blood and the transporter arrives with the unit at 1200. You know that you must start transfusing the blood within _________.* A. 5 minutes B. 15 minutes C. 30 minutes D. 1 hour

C

A patient is receiving continuous IV Heparin. In order for this medication to have a therapeutic effect on the patient, the aPTT should be?* A. 0.5-2.5 times the normal value range B. 2-3 times the normal value range C. 1.5-2.5 times the normal value range D. 1-3.5 times the normal value range

C An aPTT should be 1.5-2.5 times the normal value range for Heparin to achieve a therapeutic effect in a patient to prevent blood clots. If the aPTT is too low, blood clots can form. If the aPTT is too high, bleeding can occur.

You're educating the parents of a 12 year-old, who was recently treated for sickle cell crisis, on ways to prevent further sickle cell crises in the further. Which statement by the parents demonstrates they understood your instructions? A. "We will limit fluid intake during the day to 1-2 L a day." B. "Cold showers are best to help with pain associated with sickling." C. "We will avoid traveling to high altitude locations." D. "It is important we refuse all future vaccinations unless absolutely necessary."

C Remember sickle cell crisis can be caused by blood loss, illness (it's important the patient is up-to-date with all vaccinations), high altitudes, stress, dehydration, elevated temperature, or extreme cold temperatures. All options are wrong except C.

What blood type is known as the "universal donor"? A. Type A B. Type B C. Type AB D. Type O

D

Your patient is started on a Heparin drip. You administer a bolus of Heparin and start the drip per protocol as ordered by the physician. What will be your next important nursing action?*\ A. Collect a PT level in 6 hours per protocol. B. Collect an INR level in 4 hours per protocol. C. Collect a Troponin level in 6 hours per protocol. D. Collect an aPTT level in 6 hours per protocol.

D An activated partial thromboplastin time (aPTT) is used to measure clotting time in patients who are on Heparin. It is important that the nurse collect an aPTT in 6 hours (some protocols may say 4 hours) after starting the drip. PT and INR are used to measure clotting times in patients who are taking Warfarin (Coumadin). Troponin levels are used in cardiac patients to detect a myocardial infarction.

A donor has AB- blood. Which patient or patients below can receive this type of blood safely? A. A patient with O- blood. B. A patient with A- blood. C. A patient with B- blood. D. A patient with AB- blood.

D Donors with AB type blood can only donate to others who have the AB type blood, in this case AB- blood. However, they are the universal recipients in that they can receive blood for every blood type but can only donate to their same exact blood type.

Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-deficiency anemia? Select all that apply. A. "He drinks over 3 cups of milk per day." B. "I can't keep enough apple juice in the house; he must drink over 10 ounces per day." C. "He refuses to eat more than 2 different kinds of vegetables." D. "He doesn't like meat, but he will eat small amounts of it." E. "He sleeps 12 hours every night and take a 2-hour nap."

AB Toddlers should have between 2 and 3 cups of milk per day and 8 ounces of juice per day. If they have more than that, then they are probably not eating enough other foods, including iron-rich foods that have the needed nutrients.

Select all the TRUE statements about the medication Heparin: A. Heparin can be used during pregnancy. B. Heparin has a short half-life. C. Heparin works to affect the intrinsic pathways of clotting. D. Heparin can be administered orally, intravenously, or subcutaneously.

ABC The option that is wrong is D. Heparin can NOT be administered orally....only subq or IV.

Your patient on Heparin develops Heparin-Induced Thrombocytopenia (HIT). What signs and symptoms in the patient confirm this diagnosis? Select all that apply: A. Decrease in platelet level B. Increase in platelet level C. Development of a new thrombus D. Increase in hemoglobin level

AC HIT is where the body makes antibodies against Heparin because it's binding to platelet factor 4 (a blood protein). This creates antibodies that will bind to the heparin and PF4 complex, which activate the platelets. Small clots will form (hence new clots or worsening of clots) and the platelet count falls...hence thrombocytopenia.

Which patients below would be at a HIGH risk for developing adverse effects of Heparin drug therapy? Select all that apply: A. A 55-year-old male patient who is post-op day 1 from brain surgery. B. A 45-year-old female patient with a pulmonary embolism. C. A 36-year-old male patient with active peptic ulcer disease. D. A 43-year-old female with uncontrolled atrial fibrillation.

AC These patients are both at risk for major bleeding if placed on an anticoagulant due to their condition (one patient is post-op from brain surgery and the other patient has ulcers that could bleed). Option B and D are candidates from Heparin therapy because the patient in option B has a blood clot (Heparin can prevent it from getting bigger and developing new blood clots), and the patient in option D is at risk for developing a blood clot.

A client with microcytic anemia is having trouble selecting food items from the hospital menu. Which food is best for the nurse to suggest for satisfying the client's nutritional needs and personal preferences? A. Egg yolks B. Brown rice C. Vegetables D. Tea

B Brown rice is a source of iron from plant sources (nonheme iron). Other sources of non heme iron are whole-grain cereals and breads, dark green vegetables, legumes, nuts, dried fruits (apricots, raisins, dates), oatmeal, and sweet potatoes. Egg yolks have iron but it is not as well absorbed as iron from other sources. Vegetables are a good source of vitamins that may facilitate iron absorption. Tea contains tannin, which combines with nonheme iron, preventing its absorption.

A patient who needs a unit of packed red blood cells is ordered by the physician to be premeditated with oral diphenhydramine and acetaminophen. You will administer these medications? A. 15 minutes before starting the transfusion B. Immediately after starting the transfusion C. Right before starting the transfusion D. 30 minutes before starting the transfusion

D For ORAL medications you will administer the medications 30 minutes before starting the transfusion.

A patient is receiving 1 unit of packed red blood cells. The unit of blood will be done at 1200. The patient is scheduled to have IV antibiotics at 1000. As the nurse you will: A. Stop the blood transfusion and administer the IV antibiotic, and when the antibiotic is done resume the blood transfusion. B. Administer the IV antibiotic via secondary tubing into the blood transfusion's y-tubing. C. Hold the antibiotic until the blood transfusion is done. D. Administer the IV antibiotic as scheduled in a second IV access site.

D If any IV medications will be needed while the blood is transfusing, the nurse will need to start another IV access site. The nurse would NEVER administer the IV antibiotic in the same tubing as the blood product or stop the transfusion. Remember blood is time sensitive and must be transfused within 4 hours. Also, holding the antibiotic is not correct because antibiotics are time sensitive as well and must be administered at the scheduled time to maintain blood levels.

You're providing seminar teaching to a group of nurses about sickle cell anemia. Which of the following is NOT a treatment for this condition? A. Blood transfusion B. Stem cell transplant C. Intravenous fluids D. Iron supplements E. Antibiotics F. Morphine

D Iron supplements are not prescribed (rather Folic Acid) because this type of anemia is not caused by low iron levels, and patients who take iron supplements with sickle cell disease are at risk for building up too much iron in the body, which will damage the organs.

A pediatric nurse health educator provides a teaching session to the nursing staff regarding hemophilia. Which of the following information regarding this disorder would the nurse plan to include in the discussion? A. Hemophilia is a Y linked hereditary disorder B. Males inherit hemophilia from their fathers C. Females inherit hemophilia from their mothers D. Hemophilia A results from a deficiency of factor VIII

D Males inherit hemophilia from their mothers, and females inherit the carrier status from their fathers. Hemophilia is inherited in a recessive manner via a genetic defect on the X-chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX.

You're gathering supplies to start a blood transfusion. You will gather? A. PVC free tubing and dextrose B. Polyethylene-line tubing and 0.9% Normal Saline C. Y-tubing with in-line filter and dextrose D. Y-tubing with in-line and 0.9% Normal Saline

D This is the type of tubing and solution you will use to transfuse blood. Normal Saline is the ONLY solution used to transfuse blood!!

A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching? A. "I have been drinking plenty of fluids." B. "I have been gargling with warm salt water for my sore tongue." C. "I have 3 to 4 loose stools per day." D. "I take a vitamin B12 tablet every day."

D Vitamin B12 combines with intrinsic factor in the stomach and is then carried to the ileum, where it is absorbed in the bloodstream. In this situation, vitamin B12 cannot be absorbed regardless of the amount of oral intake of sources of vitamin B12 such as animal protein or vitamin B12 tablets. Vitamin B12 needs to be injected every month, because the ileum has been surgically removed. Replacement of fluids and electrolytes is important when the client has continuous multiple loose stools on a daily basis. Warm salt water is used to soothe sore mucous membranes. Crohn's disease and small bowel resection may cause several loose stools a day.

The home health nurse is visiting a client with autoimmune thrombocytopenic purpura (ATP). The client's platelet count currently is 80. It will be most important to teach the client and family about: a. Bleeding precautions b. Prevention of falls c. Oxygen therapy d. Conservation of energy

A The normal platelet count is 120.000-400. Bleeding occurs in clients with low platelets. The priority is to prevent and minimize bleeding. Oxygenation in answer C is important. but platelets do not carry oxygen. Answers B and D are of lesser priority and are incorrect in this instance.

What is the antidote for Heparin? A. Protamine sulfate B. Vitamin K C. Flumazenil D. Narcan

A

The nurse is preparing to teach a client with iron deficiency anemia about the diet to follow after discharge. Which of the following foods should be included in the diet? a. Eggs b. Lettuce c. Citrus Fruits d. Cheese

A A rich source of iron is needed in the diet, and eggs are high in iron. Other foods high in iron include organ and muscle (dark) meats; shellfish, shrimp, and tuna; enriched, whole-grain, and fortified cereals and breads; legumes, nuts, dried fruits, and beans; oatmeal; and sweet potatoes. Dark green leafy vegetables and citrus fruits are good sources of vitamin C. Cheese is a good source of calcium.

A mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following? A. Little is known about iron-deficiency anemia and its relationship to infection in children B. Children with iron deficiency anemia are more susceptible to infection than are other children C. Children with iron-deficiency anemia are less susceptible to infection than are other children D. Children with iron-deficient anemia are equally as susceptible to infection as are other children.

B Children with iron-deficiency anemia are more susceptible to infection because of marked decreases in bone marrow functioning with microcytosis.

You're providing education to a patient with sickle cell anemia who is taking Hydroxyurea. You will make it priority to tell the patient to? A. Consume foods high in calcium and potassium B. Avoid sick people and maintain strict hand hygiene C. Take this medication with at least 8 oz of water D. Monitor your blood glucose level daily

B This medication can lower the white blood cell count. Therefore, the nurse should make it priority to tell the patient to avoid infection by avoiding sick people and performing hand hygiene regularly.

A client with anemia may be tired due to a tissue deficiency of which of the following substances? A. Carbon dioxide B. Factor VIII C. Oxygen D. T-cell antibodies

C Anemia stems from a decreased number of red blood cells and the resulting deficiency in oxygen and body tissues. Clotting factors, such as factor VIII, relate to the body's ability to form blood clots and aren't related to anemia, not is carbon dioxide of T antibodies.

Which statement about how sickle cell anemia is passed to offspring is CORRECT? A. This disease is an x-linked recessive disease. B. Sickle cell anemia is an autosomal dominant disease. C. This condition is an autosomal recessive disease. D. Sickle cell anemia is rarely passed to offspring and is an autosomal x-linked dominant disease.

C SCA is an autosomal recessive disease in that the offspring must receive TWO hemoglobin S genes (one for each parent). The parents usually don't have the disease but are carriers. For the disease to occur in the offspring they must receive both of those genes (Hbg SS). On the contrary, with autosomal dominant the offspring has to only receive an abnormal gene from one parent, who probably has signs and symptoms of the disease too.

Which type of hemoglobin is present in a patient who has sickle cell anemia? A. Hemoglobin AA B. Hemoglobin AS C. Hemoglobin SS C. Hemoglobin AC

C SCA is homozygous and the patient must have two abnormal alleles present to have sickle cell anemia. The patient receives each abnormal allele for each parent (hence one from each parent which is Hemoglobin SS). If a patient has Hemoglobin AS (normal allele (A) and abnormal allele (S)) this is known as sickle cell trait, which most patients with this don't present with signs and symptoms of the disease...it's rare because they usually have just enough hemoglobin A to prevent the RBCs from sickling.

Which of the following cells is the precursor to the red blood cell (RBC)? A. B cell B. Macrophage C. Stem cell D. T cell

C The precursor to the RBC is the stem cell. B cells, macrophages, and T cells and lymphocytes, not RBC precursors

Which of the following disorders results from a deficiency of factor VIII? A. Sickle cell disease B. Christmas disease C. Hemophilia A D. Hemophilia B

C Hemophilia A results from a deficiency of factor VIII. Sickle cell disease is caused by a defective hemoglobin molecule. Christmas disease, also called hemophilia B, results in a factor IX deficiency.

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy . The nurse notes that the platelet count is 20,000/ul. Based on the laboratry result, which intervention will the nurse document in the plan of care? 1 Monitor closely for signs of infection 2. Monitor the temperature every 4hours 3. Initiate protective isolation precautions 4. Use soft small toothbrush for mouth care

4 If a child is severely thrombocytopenic and has a platelet count less than 20,000/ul, bleeding precautions need to be initated because of increased risk of bleeding or hemorrhage. Options 1,2,3 are related to the prevention of infection rather than bleeding

When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions? A. Bleeding tendencies B. Intake and output C. Peripheral sensation D. Bowel function

A Aplastic anemia decreases the bone marrow production of RBCs, WBCs, and platelets. The client is at risk for bruising and bleeding tendencies. A change in the intake and output is important, but assessment for the potential for bleeding takes priority. Change in the peripheral nervous system is a priority problem specific to clients with vitamin B12 deficiency. Change in bowel function is not associated with aplastic anemia.

Because of the risks associated with administration of factor VIII concentrate, the nurse would teach the client's family to recognize and report which of the following? A. Yellowing of the skin B. Constipation C. Abdominal distention D. Puffiness around the eyes

A Because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present. Clinical manifestations of hepatitis include yellowing of the skin, mucous membranes, and sclera. Use of factor VIII concentrate is not associated with constipation, abdominal distention, or puffiness around the eyes.

Which of the following assessments in a child with hemophilia would lead the nurse to suspect early hemarthrosis? A. Child's reluctance to move a body part B. Cool, pale, clammy extremity C. Eccymosis formation around a joint D. Instability of a long bone in passive movement

A Bleeding into the joints in the child with hemophilia leads to pain and tenderness, resulting in restricted movement. Therefore, an early sign of hemarthrosis would be the child's reluctance to move a body part. If the bleeding into the joint continues, the area becomes hot, swollen, and immobile—not cool, pale, and clammy. Ecchymosis formation around a joint would be difficult to assess. Instability of a long bone on passive movement is not associated with joint hemarthrosis.

A client has autoimmune thrombocytopenic purpura. To determine the client's response to treatment. the nurse would monitor: a. Platelet count b. White blood cell count c. Potassium levels d. Partial prothrombin time (PTT)

A Clients with autoimmune thrombocytopenic purpura (ATP) have low platelet counts. making answer A the correct answer. White cell counts. potassium levels. and PTT are not affected in ATP; thus. answers B. C. and D are incorrect.

A mother brings in her 8 month-old child to the ER. The mother reports the baby has recently started being extremely fussy, has a fever, and swelling in the hands and feet. The child is diagnosed with sickle cell disease. As the nurse you know that the swelling in the hands and feet in the infant is termed? A. Dactylitis B. Erythromelaglia C. Dyshidrotia D. Phalitis

A Dactylitis (also called hand-foot syndrome) occurs mainly in infants who are newly diagnosed with sickle cell anemia.

A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection? A. Hematocrit B. Partial thromboplastin time C. Hemoglobin concentration D. Prothrombin time

A Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked. The PTT, hemoglobin level, and PT are not monitored for this drug.

A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance? A. "What activities were you able to do 6 months ago compared with the present?" B. "How long have you had this problem?" C. "Have you been able to keep up with all your usual activities?" D. "Are you more tired now than you used to be?"

A It is difficult to determine activity intolerance without objectively comparing activities from one time frame to another. Because iron deficiency anemia can occur gradually and individual endurance varies, the nurse can best assess the client's activity tolerance by asking the client to compare activities 6 months ago and at the present. Asking a client how long a problem has existed is a very open-ended question that allows for too much subjectivity for any definition of the client's activity tolerance. Also, the client may not even identify that a "problem" exists. Asking the client whether he is staying abreast of usual activities addresses whether the tasks were completed, not the tolerance of the client while the tasks were being completed or the resulting condition of the client after the tasks were completed. Asking the client if he is more tired now than usual does not address his activity tolerance. Tiredness is a subjective evaluation and again can be distorted by factors such as the gradual onset of the anemia or the endurance of the individual.

What nursing diagnosis is seen with acute lymphocytic leukemia and thromocytopenia? A. potential for injury B. self-care deficit C. potential for self harm D. alteration in comfort

A Low platelet increases risk of bleeding from even minor injuries. Safety measures: shave with an electric razor, use soft tooth brush, avoid SQ or IM meds and invasive procedures (urinary drainage catheter or a nasogastric tube), side-rails up, remove sharp objects, frequently assess for signs of bleeding, bruising, hemorrhage.

Which of the following symptoms is expected with hemoglobin of 10 g/dl? A. None B. Pallor C. Palpitations D. Shortness of breath

A Mild anemia usually has no clinical signs. Palpitations, SOB, and pallor are all associated with severe anemia.

A 21-year-old male with Hodgkin's lymphoma is a senior at the local university. He is engaged to be married and is to begin a new job upon graduation. Which of the following diagnoses would be a priority for this client? a. Sexual dysfunction related to radiation therapy b. Anticipatory grieving related to terminal illness c. Tissue integrity related to prolonged bed rest d. Fatigue related to chemotherapy

A Radiation therapy often causes sterility in male clients and would be of primary importance to this client. The psychosocial needs of the client are important to address in light of the age and life choices. Hodgkin's disease. however. has a good prognosis when diagnosed early. Answers B. C. and D are incorrect because they are of lesser priority.

A patient develops Heparin-Induced Thrombocytopenia (HIT). As the nurse, you would expect the Heparin to be discontinued and the patient to be started on what other type of anticoagulant? A. Direct thrombin inhibitor B. Protamine sulfate C. Switched to subcutaneous Heparin injections D. Vitamin-K agonist

A The Heparin is discontinued and direct thrombin inhibitors can be started like: Argatroban, Bivalirudin etc.

The nurse is teaching the client with polycythemia vera about prevention of complications of the disease. Which of the following statements by the client indicates a need for further teaching? a. "I will drink 500mL of fluid or less each day." b. "I will wear support hose when I am up." c. "I will use an electric razor for shaving." d. "I will eat foods low in iron."

A The client with polycythemia vera is at risk for thrombus formation. Hydrating the client with at least 3L of fluid per day is important in preventing clot formation. so the statement to drink less than 500mL is incorrect. Answers B. C. and D are incorrect because they all contribute to the prevention of complications. Support hose promotes venous return. the electric razor prevents bleeding due to injury. and a diet low in iron is essential to preventing further red cell formation.

A patient started receiving their first unit of blood at 1000. It is now 1010 and the patient is reporting itching, chills, and a headache. In addition, the patient's temperature is now 99.8'F from 98'F. Your next nursing action is: A. Stop the transfusion B. Notify the physician C. Decrease the rate of the transfusion D. Reassure the patient that this is normal and will resolve in 30 minutes.

A The patient is possibly having a transfusion reaction. FIRST, the nurse should STOP the transfusion and then disconnect the IV tubing at the access site and replace it with NEW tubing. In addition, have normal saline infusing to keep the vein open. THEN the nurse will notify the physician and blood bank.

Before a blood transfusion you educate the patient to immediately report which of the following signs and symptoms during the blood transfusion that could represent a transfusion reaction: A. Sweating B. Chills C. Hives D. Poikilothermia E. Tinnitus F. Headache G. Back pain H. Pruritus I. Paresthesia J. Shortness of Breath K. Nausea

ABCFGHJK As the nurse you want to educate the patient to report signs and symptoms associated with blood transfusion reactions, which would include: sweating, chills, hives, headache, back pain, pruritus (itching), shortness of breath, and nausea.

A patient is on a continuous IV Heparin drip. As the nurse you are monitoring for any adverse reactions. Select all the signs and symptoms that would indicate this patient is having an adverse reaction to this medication: A. Hematuria B. Decreasing platelets C. Increased blood glucose D. Low hemoglobin and hematocrit E. Positive stool guaiac test

ABDE Hematuria, low hbg/hct and positive stool guaiac test all indicate the patient is bleeding. A decrease in platelet level could indicate the patient is developing Heparin-induced thrombocytopenia, which is also an adverse reaction to Heparin.

A 6 year-old is admitted with sickle cell crisis. The patient has a FACE scale rating of 10 and the following vital signs: HR 115, BP 120/82, RR 18, oxygen saturation 91%, temperature 101.4'F. Select all the appropriate nursing interventions for this patient at this time? A. Administer IV Morphine per MD order B. Administer oxygen per MD order C. Keep NPO D. Apply cold compresses E. Start intravenous fluids per MD order F. Administer iron supplement per MD order G. Keep patient on bed rest H. Remove restrictive clothing or objects from the patient

ABEGH When a patient is in sickle cell crisis, the abnormal RBCs are sickling and sticking together, which blocks blood flow. To help alleviate the RBCs from clumping together and sickling, oxygen and hydration are priority. This will help dilute the blood (hence decrease the sticking of RBCs) and help supply oxygen to the RBCs (remember abnormal RBCs with hemoglobin S are very sensitive to low oxygen levels and will sickle when there is low oxygen). In addition, pain needs to be addressed. Opioid medication is the best on a scheduled basis rather than PRN (as needed). Avoid keeping patient NPO unless needed (remember patient needs hydration). Avoid cold compresses (can lead to more sickling) but instead use warm compresses. The patient will need FOLIC ACID supplements to help with RBC creation rather than iron (iron can actually build up in the body and collect in the organs in patients with sickle cell disease). Patients definitely need to be on bedrest, and restrictive clothing or objects (blood pressure cuff etc.) should be removed to help blood flow.

An 18 year-old male is taking Hydroxyurea for treatment of sickle cell anemia. Which options below indicate this medication is working successfully? Select all that apply: A. The patient needs fewer blood transfusions. B. The patient experiences diuresis. C. The patient experiences an increase in fetal hemoglobin (Hbg F). D. The patient experiences a decrease in hemoglobin S.

AC This medications actually treats cancer, but it will help with SCA in that it will help create fetal hemoglobin hgb F (this helps decrease sickling episodes) and helps with anemia (decreasing the need for so many blood transfusions).

A patient needs 2 units of packed red blood cells. The patient is typed and crossmatched. The patient has B+ blood. As the nurse you know the patient can receive what type of blood? Select all that apply: A. B- B. A+ C. O- D. B+ E. O+ F. A- G. AB+ H. AB-

ACDE The patient must receive blood from either a donor that has O or B blood. Since the patient is B+ (Rh factor is positive), they can receive both negative or positive blood. So, the patient can receive B-, B+, O-, and O+ blood.

The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance? A. Eat animal protein and dark leafy vegetables each day B. Avoid exposure to others with acute infection C. Practice yoga and meditation to decrease stress and anxiety D. Get 8 hours of sleep at night and take naps during the day

B Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia. Strict aseptic technique and reverse isolation are important measures to prevent infection. Although diet, reduced stress, and rest are valued in supporting health, the potentially fatal consequence of an acute infection places it as a priority for teaching the client about health maintenance. Animal meat and dark green leafy vegetables, good sources of vitamin B12 and folic acid, should be included in the daily diet. Yoga and meditation are good complimentary therapies to reduce stress. Eight hours of rest and naps are good for spacing and pacing activity and rest.

Red blood cells are very vital for survival. Which statement below is NOT correct about red blood cells? A. "Red blood cells help carry oxygen throughout the body with the help of the protein hemoglobin." B. "Extreme loss of red blood cells can lead to a suppressed immune system and clotting problems." C. "Red blood cells help remove carbon dioxide from the body." D. "Red blood cells are suspended in the blood's plasma."

B Extreme loss of red blood cells leads to anemia which can cause a patient to experience shortness of breath (there is a decreased ability to carry oxygen throughout the body), tachycardia, fatigue, pale skin color etc. Suppressed immune system can be from LOW white blood cells, and clotting problems can be from LOW platelets.

A 25 year-old pregnant female and her partner both have sickle cell trait. What is the percentage that their offspring will develop sickle cell anemia? A. 50% B. 25% C. 75% D. 100%

B If both parents have the sickle cell trait it means they each have normal hemoglobin A and abnormal hemoglobin S on their RBCs....so both present with hbg AS. Remember they don't have sickle cell disease just the abnormal gene that can be passed to their child. Sickle cell anemia is autosomal recessive, therefore there is a 25% chance their child will obtain both abnormal genes (the Hbg S) from EACH parent and develop sickle cell anemia.

Which of the following diagnostic findings are most likely for a client with aplastic anemia? A. Decreased production of T-helper cells B. Decreased levels of white blood cells, red blood cells, and platelets C. Increased levels of WBCs, RBCs, and platelets D. Reed-Sternberg cells and lymph node enlargement

B In aplastic anemia, the most likely diagnostic findings are decreased levels of all the cellular elements of the blood (pancytopenia). T-helper cell production doesn't decrease in aplastic anemia. Reed-Sternberg cells and lymph node enlargement occur with Hodgkin's disease.

A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse's first response? A. Assess for potential abuse B. Check for diminished sensations C. Document the findings D. Clean and dress the area

B Macrocytic anemias can result from deficiencies in vitamin B12 or ascorbic acid. Only vitamin B12 deficiency causes diminished sensations of peripheral nerve endings. The nurse should assess for peripheral neuropathy and instruct the client in self-care activities for her diminished sensation to heat and pain. The burn could be related to abuse, but this conclusion would require more supporting data. The findings should be documented, but the nurse would want to address the client's sensations first. The decision of how to treat the burn should be determined by the physician.

A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response? A. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid." B. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." C. "The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction." D. "The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."

B Most clients with pernicious anemia have deficient production of intrinsic factor in the stomach. Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestine. The stomach is producing enough acid, there is not an excessive excretion of the vitamin, and there is not a rapid production of RBCs in this condition.

You're providing care to a patient who has been receiving long-term doses of Heparin. What finding in this patient demonstrates the patient may be experiencing a complication that can occur due to long-term use of this drug? A. Uncontrolled hypertension B. Bone fractures C. Hyperkalemia D. Raynaud's Syndrome

B Osteoporosis can occur due to long-term, high doses of Heparin. Bone fractures would indicate this patient is experiencing this complication. Heparin can stimulate osteoclasts and inhibits osteoblast, which affects the strength of the bones.

Which of the following foods would the nurse encourage the mother to offer to her child with iron deficiency anemia? A. Rice cereal, whole milk, and yellow vegetables B. Potato, peas, and chicken C. Macaroni, cheese, and ham D. Pudding, green vegetables, and rice

B Potato, peas, chicken, green vegetables, and rice cereal contain significant amounts of iron and therefore would be recommended. Milk and yellow vegetables are not good iron sources. Rice by itself also is not a good source of iron.

Which type of hemoglobin is present in a patient who has sickle cell TRAIT? A. Hemoglobin AA B. Hemoglobin AS C. Hemoglobin SS D. Hemoglobin AC

B Sickle cell TRAIT is heterozygous, which means the patient has one NORMAL allele (which is Hemoglobin A...this is NORMAL hemoglobin) and one ABNORMAL allele (which is Hemoglobin S).....this is the abnormal hemoglobin that leads to the abnormal construction of the RBC). However, most patients with sickle cell trait don't show signs and symptoms related to sickle cell anemia because they have just enough of the normal hemoglobin A to prevent sickling of the RBC.

You're assisting a physician with sickle cell anemia screening. As the nurse you know that which patient population listed below is at risk for sickle cell disease? A. Native Americans B. African-Americans C. Pacific Islanders D. Latino

B Sickle cell anemia is most common in African-Americans along with Middle Eastern, Asian, Caribbean, and Eastern Mediterranean. WHY? According to the CDC, 1 in 12 African-Americans have the sickle cell trait, so it can easily be passed to their offspring. Remember if both parents have sickle cell trait there is a 25% chance they will pass it to their child.

Which of the following would be the priority nursing diagnosis for the adult client with acute leukemia? a. Oral mucous membrane altered related to chemotherapy b. Risk for injury related to thrombocytopenia c. Fatigue related to the disease process d. Interrupted family processes related to life-threatening illness of a family member

B The client with acute leukemia has bleeding tendencies due to decreased platelet counts. and any injury would exacerbate the problem. The client would require close monitoring for hemorrhage. which is of higher priority than the diagnoses in answers A. C. and D. which are incorrect.

A client with acute leukemia is admitted to the oncology unit. Which of the following would be most important for the nurse to inquire? a. "Have you noticed a change in sleeping habits recently?" b. "Have you had a respiratory infection in the last 6 months?" c. "Have you lost weight recently?" d. "Have you noticed changes in your alertness?"

B The client with leukemia is at risk for infection and has often had recurrent respiratory infections during the previous 6 months. Insomnolence. weight loss. and a decrease in alertness also occur in leukemia. but bleeding tendencies and infections are the primary clinical manifestations; therefore. answers A. C. and D are incorrect.

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? A. Schilling's test, elevated B. Intrinsic factor, absent C. Sedimentation rate, 16 mm/hour D. RBCs 5.0 million

B The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to determine the primary cause of the anemia. An elevated excretion of the injected radioactive vitamin B12, which is protocol for the first and second stage of the Schilling test, indicates that the client has the intrinsic factor and can absorb vitamin B12 into the intestinal tract. A sedimentation rate of 16 mm/hour is normal for both men and women and is a nonspecific test to detect the presence of inflammation. It is not specific to anemias. An RBC value of 5.0 million is a normal value for both men and women and does not indicate anemia.

The nurse is assessing a client's activity intolerance by having the client walk on a treadmill for 5 minutes. Which of the following indicates an abnormal response? A. Pulse rate increased by 20 bpm immediately after the activity B. Respiratory rate decreased by 5 breaths/minute C. Diastolic blood pressure increased by 7 mm Hg D. Pulse rate within 6 bpm of resting phase after 3 minutes of rest.

B The normal physiologic response to activity is an increased metabolic rate over the resting basal rate. The decrease in respiratory rate indicates that the client is not strong enough to complete the mechanical cycle of respiration needed for gas exchange. The post activity pulse is expected to increase immediately after activity but by no more than 50 bpm if it is strenuous activity. The diastolic blood pressure is expected to rise but by no more than 15 mm Hg. The pulse returns to within 6 bpm of the resting pulse after 3 minutes of rest.

A patient is ordered to start an IV continuous Heparin drip. Prior to starting the medication, the nurse would ensure what information is gathered correctly before initiating the drip? A. Vital signs B. Weight C. PT/INR level D. EKG

B The nurse would want to make sure the documented weight of the patient is current and accurate. This medication is weight-based. Therefore, for proper dosing to be administered, a correct weight should be used.

A patient is ordered to receive 2 units of packed red blood cells. The first unit was started at 1400 and ended at 1800. You send for the other bag of red blood cells. As the nurse you know it is priority to: A. obtain signed informed consent for the second unit of blood from the patient B. obtain a new y-tubing set for this unit of blood C. type and crossmatch the patient D. hang a new bag of dextrose to transfuse with the blood

B The patient has already received 1 unit of blood and another unit is needed. It took 4 hours for the first unit to transfuse and the nurse needs to obtain new y-tubing for the next unit of blood. Y-tubing sets are only good for 4 hours. Some hospitals require new tubing sets with each unit transfusion or after 4 hours....always check your hospital's protocol.

Your patient is being discharged home and will be required to self-administer injectable Heparin. You are observing the patient administer their scheduled dose of Heparin to confirm that the patient knows how to do it correctly. What action by the patient requires you to re-educate them about how to administer Heparin? A. The patient injects the needle into the fatty tissue of the abdomen. B. The patient injects the needle 1 inch away from the umbilicus. C. The patient rotated the injection site from the previous dose of Heparin. D. The patient does not massage the injection site after administering the medication.

B The patient should inject the needle 2 inches (NOT 1 inch) away from the umbilicus.

Your patient is having a transfusion reaction. You immediately stop the transfusion. Next you will: A. Notify the physician. B. Disconnect the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. C. Collect urine sample. D. Send the blood tubing and bag to the blood bank.

B This question wants to know your NEXT nursing action. AFTER stopping the transfusion, the nurse will DISCONNECT the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. This will limit any more blood from entering the patient's system. THEN the nurse will notify the MD and blood bank.

The nurse implements which of the following for the client who is starting a Schilling test? A. Administering methylcellulose (Citrucel) B. Starting a 24- to 48 hour urine specimen collection C. Maintaining NPO status D. Starting a 72 hour stool specimen collection

B Urinary vitamin B12 levels are measured after the ingestion of radioactive vitamin B12. A 24-to 48- hour urine specimen is collected after administration of an oral dose of radioactively tagged vitamin B12 and an injection of non-radioactive vitamin B12. In a healthy state of absorption, excess vitamin B12 is excreted in the urine; in a malabsorption state or when the intrinsic factor is missing, vitamin B12 is excreted in the feces. Citrucel is a bulk-forming agent. Laxatives interfere with the absorption of vitamin B12. The client is NPO 8 to 12 hours before the test but is not NPO during the test. A stool collection is not part of the Schilling test. If stool contaminates the urine collection, the results will be altered.

In formulating a nursing diagnosis of risk for infection for a client with chronic lymphoid leukemia (CLL), nursing measures should include: (Select all that apply.) A. Maintaining a clean technique for all invasive procedures. B. Placing the client in protective isolation. C. Limiting visitors who have colds and infections. D. Ensuring meticulous handwashing by all persons coming in contact with the client."

BCD Chronic lymphoid leukemia (CLL) is characterized by a proliferation and accumulation of small, abnormal mature lymphocytes in bone marrow, peripheral blood, and body tissues. Infections and fever are frequent complications of CLL."

The nurse is teaching a client with polycythemia vera about potential complications from this disease. Which manifestations would the nurse include in the client's teaching plan? Select all that apply. A. Hearing loss B. Visual disturbance C. Headache D. Orthopnea E. Gout F. Weight loss

BCDE Polycythemia vera, a condition in which too many RBCs are produced in the blood serum, can lead to an increase in the hematocrit and hypervolemia, hyperviscosity, and hypertension. Subsequently, the client can experience dizziness, tinnitus, visual disturbances, headaches, or a feeling of fullness in the head. The client may also experience cardiovascular symptoms such as heart failure (shortness of breath and orthopnea) and increased clotting time or symptoms of an increased uric acid level such as painful swollen joints (usually the big toe). Hearing loss and weight loss are not manifestations associated with polycythemia vera.

A 14 year-old female has sickle cell anemia. Which factors below can increase the patient's risk for developing sickle cell crisis? Select all that apply: A. Shellfish B. Infection C. Dehydration D. Hypoxia E. Low altitudes F. Hemorrhage G. Strenuous exercise

BCDFG Sickle cell crisis can occur when the body experiences low amounts of oxygen in the body (so think about something that increases the body's need for oxygen or affects how oxygen is being transported). Therefore, infection (especially respiratory infections), dehydration, hypoxia, HIGH (not low) altitudes, hemorrhage (blood loss), or strenuous exercise can lead to a sickle cell crisis.

A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the lab results, knowing that which of the following would be increased in this disease? A. Platelet count B. Hematocrit level C. Reticulocyte count D. Hemoglobin level

C A diagnosis is established based on a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin and hematocrit levels and a decreased platelet count, and increased reticulocyte count, and the presence of nucleated red blood cells. Increased reticulocyte counts occur in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? A. Autoimmune reaction complicated by hypoxia B. Lack of oxygen in the red blood cells C. Obstruction to circulation D. Elevated serum bilirubin concentration.

C Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of RBCs. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.

A vegetarian client was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client: A. Adds dried fruit to cereal and baked goods B. Cooks tomato-based foods in iron pots C. Drinks coffee or tea with meals D. Adds vitamin C to all meals

C Coffee and tea increase gastrointestinal motility and inhibit the absorption of nonheme iron. Clients are instructed to add dried fruits to dishes at every meal because dried fruits are a nonheme or nonanimal iron source. Cooking in iron cookware, especially acid-based foods such as tomatoes, adds iron to the diet. Clients are instructed to add a rich supply of vitamin C to every meal because the absorption of iron is increased when food with vitamin C or ascorbic acid is consumed.

A client with a pituitary tumor has had a transsphenoidal hypophysectomy. Which of the following interventions would be appropriate for this client? a. Place the client in Trendelenburg position for postural drainage b. Encourage coughing and deep breathing every 2 hours c. Elevate the head of the bed 30° d. Encourage the Valsalva maneuver for bowel movements

C Elevating the head of the bed 30° avoids pressure on the sella turcica and alleviates headaches. Answers A. B. and D are incorrect because Trendelenburg. Valsalva maneuver. and coughing all increase the intracranial pressure.

Which of the following would the nurse identify as the priority nursing diagnosis during a toddler's vaso-occlusive sickle cell crisis? A. Ineffective coping related to the presence of a life-threatening disease B. Decreased cardiac output related to abnormal hemoglobin formation C. Pain related to tissue anoxia D. Excess fluid volume related to infection

C For the child in a sickle cell crisis, pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusion and subsequent tissue ischemia. Although ineffective coping may be important, it is not the priority. Decreased cardiac output is not a problem with this type of vaso occlusive crisis. Typically, a sickle cell crisis can be precipitated by a fluid volume deficit or dehydration.

The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? A. Whole grains B. Green leafy vegetables C. Meats and dairy products D. Broccoli and Brussels sprouts

C Good sources of vitamin B12 include meats and dairy products. Whole grains are a good source of thiamine. Green leafy vegetables are good sources of niacin, folate, and carotenoids (precursors of vitamin A). Broccoli and Brussels sprouts are good sources of ascorbic acid (vitamin C).

You're providing care to a 36 year old male. The patient experienced abdominal trauma and recently received 2 units of packed red blood cells. You're assessing the patient's morning lab results. Which lab result below demonstrates that the blood transfusion was successful? A. Hemoglobin level 7 g/dL B. Platelets 300,000 µl C. Hemoglobin level 15 g/dL D. Prothrombin Time 12.5 seconds

C Hemoglobin levels are used to assess the effectiveness of a blood transfusion. A normal Hgb level for a MALE is 14 to 18 g/dL. For a FEMALE, the level is 12 to 16 g/dL.

A patient with O+ blood received A+ blood. The patient is at risk for? A. Febrile transfusion reaction B. None: O+ and A+ are compatible blood types C. Hemolytic transfusion reaction D. Allergic transfusion reaction

C O+ and A+ are NOT compatible blood types. Patients with O+ can only receive blood from others with O blood. This patient is at risk for a hemolytic reaction. This is where the immune system is killing the donors RBCs. The antibodies in the recipient's blood match the antigens on the donor's blood cells....the patient has been mistyped!!

A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions? A. Infection B. Trauma C. Fluid overload D. Stress

C Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1 ½ to 2 times the daily requirement to prevent dehydration.

The primary purpose of the Schilling test is to measure the client's ability to: A. Store vitamin B12 B. Digest vitamin B12 C. Absorb vitamin B12 D. Produce vitamin B12

C Pernicious anemia is caused by the body's inability to absorb vitamin B12. This results in a lack of intrinsic factor in the gastric juices. Schilling's test helps diagnose pernicious anemia by determining the client's ability to absorb vitamin B12.

Which of the following nursing assessments is a late symptom of polycythemia vera? A. Headache B. Dizziness C. Pruritus D. Shortness of breath

C Pruritus is a late symptom that results from abnormal histamine metabolism. Headache and dizziness are early symptoms from engorged veins. Shortness of breath is an early symptom from congested mucous membrane and ineffective gas exchange.

A 33-year-old male is being evaluated for possible acute leukemia. Which of the following would the nurse inquire about as a part of the assessment? a. The client collects stamps as a hobby. b. The client recently lost his job as a postal worker. c. The client had radiation for treatment of Hodgkin's disease as a teenager. d. The client's brother had leukemia as a child.

C Radiation treatment for other types of cancer can result in leukemia. Some hobbies and occupations involving chemicals are linked to leukemia. but not the ones in these answers; therefore. answers A and B are incorrect. Answer D is incorrect because the incidence of leukemia is higher in twins than in siblings.

When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate? A. Check the dressing and drains for frank bleeding B. Call the physician C. Continue to monitor vital signs D. Start oxygen at 2L/min per NC

C The nurse should continue to monitor the client, because this value reflects a normal physiologic response. The physician does not need to be called, and oxygen does not need to be started based on these laboratory findings. Immediately after surgery, the client's hematocrit reflects a falsely high value related to the body's compensatory response to the stress of sudden loss of fluids and blood. Activation of the intrinsic pathway and the renin-angiotensin cycle via antidiuretic hormone produces vasoconstriction and retention of fluid for the first 1 to 2 day post-op. By the second to third day, this response decreases and the client's hematocrit level is more reflective of the amount of RBCs in the plasma. Fresh bleeding is a less likely occurrence on the third post-op day but is not impossible; however, the nurse would have expected to see a decrease in the RBC and hemoglobin values accompanying the hematocrit.

Before initiating the blood transfusion, you obtain the patient's baseline vital signs, which are: heart rate 100, blood pressure 115/72, respiratory rate 18, and temperature 100.8'F. Your next action is to: A. Administer the blood transfusion as ordered. B. Hold the blood transfusion and reassess vital signs in 1 hour. C. Notify the physician before starting the transfusion. D. Administer 200 mL of the blood and then reassess the patient's vital signs.

C The patient has an elevated temperature. Any temperature greater than 100'F (before the administration of the blood) the physician should be notified

The physician has ordered several laboratory tests to help diagnose an infant's bleeding disorder. Which of the following tests, if abnormal, would the nurse interpret as most likely to indicate hemophilia? A. Bleeding time B. Tourniquet test C. Clot retraction test D. Partial thromboplastin time (PTT)

D PTT measures the activity of thromboplastin, which is dependent on intrinsic clotting factors. In hemophilia, the intrinsic clotting factor VIII (antihemophilic factor) is deficient, resulting in a prolonged PTT. Bleeding time reflects platelet function; the tourniquet test measures vasoconstriction and platelet function; and the clot retraction test measures capillary fragility. All of these are unaffected in people with hemophilia.

During an outpatient well visit with a patient who has sickle cell anemia, you make it PRIORITY to assess the patient's? A. hemoglobin A1C level B. heart rate C. reflexes D. vaccination history

D Patients will sickle cell anemia are at risk for infection because of spleen compromise. Many patients with SCA experience splenomegaly because blood flow is compromised to the spleen due to sickling of RBCs and the spleen is overworked from recycling the old RBCs (remember a patient with sickle cell anemia does NOT have long-living RBCs...the RBCs tend to die in 20 days rather than 120 days). Therefore, vaccination history is very important. The patient should be up-to-date with the flu, pneumococcal, and meningococcal vaccines.

An African American client is admitted with acute leukemia. The nurse is assessing for signs and symptoms of bleeding. Where is the best site for examining for the presence of petechiae? a. The abdomen b. The thorax c. The earlobes d. The soles of the feet

D Petechiae are not usually visualized on dark skin. The soles of the feet and palms of the hand provide a lighter surface for assessing the client for petechiae. Answers A. B. and C are incorrect because the skin might be too dark to make an assessment.

A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan? A. "Take the medication with an antacid." B. "Take the medication with a glass of milk." C. "Take the medication with cereal." D. "Take the medication on an empty stomach."

D Preferably, ferrous gluconate should be taken on an empty stomach. Ferrous gluconate should not be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption.

The mothers asks the nurse why her child's hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate? A. "The placenta bars passage of the hemoglobin S from the mother to the fetus." B. "The red bone marrow does not begin to produce hemoglobin S until several months after birth." C. "Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." D. "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

D Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborns hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term. The fetus produces all its own hemoglobin from the earliest production in the first trimester. Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy.

A patient, who is receiving continuous IV Heparin, has an aPTT of 105 seconds. What is your next nursing action per protocol? A. Continue with the infusion because no change is needed based on this aPTT. B. Increase the drip rate per protocol because the aPTT is too low. C. Re-draw the aPTT STAT. D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too high.

D The aPTT is 105 seconds, which is too high. Any aPTT value greater than 80 seconds places the patient at risk for bleeding. Most Heparin protocols dictate that the nurse would hold the infusion for 1 hour and to decrease the rate of infusion. If the aPTT is less than 60 seconds, the dose would need to be increased and a bolus may be needed. aPTT values should be around 60-80 seconds to achieve a therapeutic response for Heparin.

You've started the first unit of packed red blood cells on a patient. You stay with the patient during the first 15 minutes and: A. run the blood at 100 mL/min and then increase the rate after 15 minutes, if tolerated by the patient. B. run the blood at 20 mL/min and then increase the rate after 15 minutes, if tolerated by the patient. C. run the blood at 200 mL/min and then decrease the rate after 15 minutes, if tolerated by the patient. D. run the blood at 2 mL/min and then increase the rate after 15 minutes, if tolerated by the patient.

D The blood will be started on an infusion pump at 2 mL/min, and if the blood is tolerated by the patient, it will be increased AFTER 15 minutes. Remember the blood must be transfused within 2-4 hours....most bags are 250 to 300 mL. During the first 15 minutes is when the patient is most likely to have a transfusion reaction. Running the blood slowly during the first 15 minutes allows the patient to receive the LEAST amount of blood possible if a reaction does occur.

The nurse has just admitted a 35-year-old female client who has a serum B12 concentration of 800 pg/ml. Which of the following laboratory findings would cue the nurse to focus the client history on specific drug or alcohol abuse? A. Total bilirubin, 0.3 mg/dL B. Serum creatinine, 0.5 mg/dL C. Hemoglobin, 16 g/dL D. Folate, 1.5 ng/mL

D The normal range of folic acid is 1.8 to 9 ng/mL, and the normal range of vitamin B12 is 200 to 900 pg/mL. A low folic acid level in the presence of a normal vitamin B12 level is indicative of a primary folic acid-deficiency anemia. Factors that affect the absorption of folic acid are drugs such as methotrexate, oral contraceptives, antiseizure drugs, and alcohol. The total bilirubin, serum creatinine, and hemoglobin values are within normal limits.

Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia? A. An elevated hemoglobin level B. A decreased reticulocyte count C. An elevated RBC count D. Red blood cells that are microcytic and hypochromic

D The results of a CBC in children with iron deficiency anemia will show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.

A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic reactions. What is the nurse's best response to relieve these fears? A. "Vitamin B12 will cause ringing in the eats before a toxic level is reached." B. "Vitamin B12 may cause a very mild skin rash initially." C. "Vitamin B12 may cause mild nausea but nothing toxic." D. "Vitamin B12 is generally free of toxicity because it is water soluble."

D Vitamin B12 is a water-soluble vitamin. When water-soluble vitamins are taken in excess of the body's needs, they are filtered through the kidneys and excreted. Vitamin B12 is considered to be nontoxic. Adverse reactions that have occurred are believed to be related to impurities or to the preservative in B12 preparations. Ringing in the ears, skin rash, and nausea are not considered to be related to vitamin B12 administration.