Hematologic

A health care professional is caring for a patient who is about to begin taking alteplase (activase) to treat acute myocardial infarction. The health care professional should understand the drug is most effective when the patient receives it

within 3 hours of symptom onset

A nurse is caring for a client who had a bone marrow aspiration. Which of the following interventions will the nurse include in her care plan? Select all that apply

• Apply direct pressure followed by a pressure dressing to the site after the needle has been withdrawn. • Instruct the client to lie on the site for at least 10 minutes or longer

Which of the following are included in the management of lymphadenitis? Select all that apply.

• Broad-spectrum antibiotic • Advise the client to elevate the extremity.

A nurse is caring for a client in the emergency department following an accident that caused severe blood loss. Which of the following are compensatory mechanisms for lost RBC function? Select all that apply.

• Constipation • Tachycardia • Dyspnea

A client is suspected of having leukemia and is having a series of laboratory and diagnostic studies performed. What does the nurse recognize as the hallmark signs of leukemia? Select all that apply.

• Fatigue from anemia • Easy bruising

Which assessment findings support the client's diagnosis of AML (acute myeloid leukaemia)? Select all that apply.

• Petechiae • Enlarged lymph nodes • Weakness and fatigue • Bone pain

Jeremiah, a 10-year-old boy with hemophilia, is a patient on the pediatric unit where you practice nursing. Jeremiah was admitted to your floor via the ED after sustaining an injury while playing outdoors with friends. Initially, he presented with severe bleeding but has since stabilized. Which of the following interventions will the nurse include in her care plan for Jeremiah? Select all that apply.

• Support painful joints on pillows. • Encourage client to use a soft toothbrush and rinse the mouth with warm water between and after meals.

Which of the following statements by the patient indicates an accurate understanding of the dietary restrictions he should observe while being treated with heparin?

"I should avoid eating tomatoes and onions."

The LPN has received an order from the physician for the patient to receive 8000 units of heparin by injection. The medication is available in a vial labeled "20,000 units=1 mL." The correct amount of the medication that should be drawn up in the syringe is which of the following?

0.4 mL

The LPN is preparing to administer a heparin injection to a patient. The highest priority action on the part of the nurse should be to select which of the following?

A 25-gauge needle

A patient who has idiopathic thrombocytopenia purpura (ITP) has a critically low platelet count. Which nursing intervention will be included in the care plan for a patient with ITP?

Administer eltrombopag (Promacta)

A Health care professional is caring for a patient who is about to begin alteplase (Activase) therapy to treat pulmonary embolism. Which of the following drugs should the health care professional have available in the event of a severe adverse reaction?

Aminocaproic (amicar)

Which of the following is an antiplatelet agent used as an emergency measure in patients with a suspected myocardial infarction?

Aspirin

G-CSF (filgrastim [Neupogen]) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client?

Assist the client in identifying appropriate subcutaneous injection sites.

A nurse is documenting skin findings in a client with lymphedema. Which of the following descriptions would be most consistent with the expected presentation?

Brawny

A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia?

Chronic lymphocytic leukemia

Post transfusion, the donor stands up immediately after the needle is withdrawn. The nurse should be alert for which vital sign change?

Decreased blood pressure

A patient who is taking ferrous sulfate (feosol) to treat iron-deficiency anemia develops severe nausea and vomiting due to iron toxicity. Which of the following drugs should the health care professional use to treat this complication?

Deferoxamine (desferal)

The patient is an adult male who needs to be placed on an anticoagulant as part of a program to prevent a myocardial infarction. The LPN expects that the patient will be placed on which of the following medications?

Dipyridamole (Persantine)

A patient with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention?

Evaluate the patient for potential infection.

A health care professional is caring for a patient who is about to begin factor VII (Advate) therapy to treat hemopilla A. When administering factor VIII, which of the following actions should the health care professional take?

Have emergency equipment ready

A health care professional is caring for a patient who is about to begin alteplase (Activae) therapy. The health care professional should monitor the patient for which of the following indications of a possible adverse effect?

Headache

A nursing student is interested in working with children who have blood disorders. Which of the following terms would the student recognize as "the manufacture and development of blood cells."

Hematopoiesis

A health care professional is caring for a patient who is about to begin taking epoetin alfa (Epogen). Which of the following laboratory values should increase with effective therapy?

Hgb

After withdrawing the needle from blood donor's arm, the site begins to bleed excessively. What is the nurse's first action?

Hold firm pressure on the venipuncture site.

A health care professional administers epoetin alfa (Epogen) subcutaneously to a patient who has renal failure.

Hypertension

A health care professional is caring for a patient who is about to begin taking warfarin (Coumadin). The health care professional should caution the patient about taking which of the following over-the-counter drugs?

Ibuprofen (Motrin)

A client is receiving platelets. In order to decreased the risk of circulatory overload in this client, the nurse should do which of the following?

Infuse each unit over 30-60 minutes per client tolerance.

A health care professional is caring for a patient who is about to begin taking aspirin ( Ecotrin) to reduce the risk of a cardiovascular event. The health care professional should understand that the drug inhibits platlets aggragation by which of the following mechanism?

Inhibiting cyclooxygenase action in platlets

A health care professional is administering epoetin alfa (Epogen) subcutaneously to a patient who has renal failure. The health care professional should take which of the following actions?

Insert the needle into the vial once

A client is being treated for anemia and has a hemoglobin level of 9.6 g/dL. What does the nurse understand is the basic nutritional component of heme in hemoglobin that the client may be deficient in?

Iron

An 18-year-old diagnosed with Hodgkin's disease asks you what Hodgkin's disease is. What would be your best response?

It is a cancer that enlarges lymphoid tissue and invades other tissues.

A young client has just been diagnosed with lymphoma. The client asks you what a lymphoma is. What would be your best answer?

It is a group of cancers that affect the lymphatic system

Which of the following vitamins may be given for a coumarin overdose?

K

A client recovering from lymphedema asks the nurse to explain how the disorder developed. Place the steps in the development of this condition in the correct order, from first to last. You selected: Chronic deformities develop.

Lymph with high amounts of protein accumulate in lymphatic vessels. The volume of lymph exceeds the capacity of the lymphatic vessels. Lymph enters the interstitial spaces within soft tissues. Trapped fluid attracts fibroblasts and collagen. Nonpitting edema becomes massive. Chronic deformities develop

You are the nurse caring for a patient with acute leukaemia. What would you do to assess the risk for infection?

Monitor WBC count.

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide?

Observe stools for blood.

A health care professional is caring for a patient who is about to begin clopidogel (Plavix) to prevent thrombus formation. The healthcare professional should question the use of clopidogrel by a patient who has which of the following?

Peptic ulcer disease

The client is diagnosed with polycythemia vera. The nurse prepares the client for which procedure?

Phlebotomy

The client is planned to have a splenectomy. The nurse should prepare which medication to administer to this client?

Pneumococcal vaccine

You are caring for a patient with Hodgkin's lymphoma at the oncology clinic. While doing patient teaching you know you need to stress what?

Risk of infection

Of the following types of haemolytic anaemia, which is categorised as inherited disorder?

Sickle cell anaemia

The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia?

Smooth tongue

In order for the LPN to contribute information to a teaching plan for the patient who is being treated with anticoagulant therapy, the nurse must recognize that anticoagulant therapy is used to do which of the following?

Stop existing clots from growing in size

The LPN is caring for a patient who has just been ordered to be treated with heparin. The patient is also taking an antihistamine. The LPN expects that the antihistamine will do which of the following to the heparin's effect?

The effect of heparin will be decreased.

A health care professional is caring for a patient who is about to begin taking clopidogrel (Plavix) to prevent stent stenosis. The healthcare professional should monitor the patient for which of the following adverse reaction?

Thrombocytopenia

A health care professional should assess a patient who has megaloblastic anemia for indications of which of the following vitamin deficiencies?

Vitamin B12

For a patient diagnosed with pernicious anaemia, the nurse emphasises the importance of lifelong administration of which of the following?

Vitamin B12

The nurse should provide further teaching about post bone-marrow biopsy procedures when the client makes which of the following statements?

"I'll ask someone to drive me home when I awake from general anesthesia."

The nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What statement should the nurse include in patient education?

"Iron will likely cause your stools to darken in color."

The LPN is caring for a patient who has been treated with protamine sulfate. The patient complains of experiencing flushing of his face and warmth. The LPN recognizes that this indicates which of the following?

An adverse reaction to the medication

A nurse is caring for a client with a low platelet count. The nurse understands that a low platelet count affects which of the following?

Clotting of blood

Which is the following is the most obvious sign of anaemia?

Pallor

A patient is being treated with warfarin and reports experiencing frequent episodes of diarrhea. The LPN recognizes that this symptom is indicative of which of the following?

The medication is causing an adverse reaction.

A health care professional is preparing to administer the prescribed dose of filgrastim (Neupogen) to a patient. The patient's laboratory results indicate that the patient has a WBC count of 12,000. Which of the following actions should the health care professional take?

Clarify the prescription with the provider

A health care professional is caring for a patient who is about to begin taking oprelvekin (Neumega) to treat thrombocytopenia. The health care professional should tell the patient to report which of the following indications of an adverse reaction? (Select all that apply)

Conjuctivitis Swollen ankles Palpitations

An elderly client has urinary incontinence at least once a day and is scheduled for a Schilling test. The nurse

Consults the physician about insertion of a Foley catheter

Patient teaching for coumarin therapy includes which of the following? (Select all that apply.)

Contact the health care provider if bleeding from the gums occurs. Avoid alcohol and drugs containing acetylsalicylic acid.

A patient is about to begin therapy with recombinant factor X (BeneFix) to treat hemophila B. The patient asks the health care professional about the risk of disease transmission with recombinant factor IX, as compared with plasma-derived factor IV. The health care professional should explain that recom

Creutzfeldt-Jakob disease

A patient has come to the Ob-Gyn clinic with complaints of a heavy menstrual flow. The nurse knows that red blood cell production will be increased in the patient's body. Because of this, the nurse is aware that the patient may need to increase her daily intake of what?

Iron

A nurse is helping to prepare a client with lymphedema for a procedure in which an intravenous dye and radiography will be used to detect lymph node involvement and reveal the degree and extent of blockage in the lymph system. What procedure will the client be undergoing?

Lymphangiography

A client hospitalized with Hodgkin's disease is currently under visitor restrictions and asks the nurse why this is necessary. Which of the following explanations from the nurse is most accurate?

Restricting visitors and personnel reduces the risk of transmission of pathogens to the client.

You are assisting your client with multiple myeloma to ambulate. What is the most important nursing diagnosis to help prevent fractures in this client?

Safety

Which of the following is a symptom of Cooley's anemia?

Bronzing of the skin

For a patient with iron-deficiency anzemia, the nurse should advise the patient to do which of the following to prevent staining the teeth?

Dilute liquid preparations of iron with juice and drink with a straw

A health care professional is caring for a patient who is about to begin taking ferrous sulfate (Feosol) to treat iron-deficiency anemia. When talking with the patient about the frug, the health care professional should include which of the following instructions?

Eat iron-enriched foods Spread the dosage across each day Take the drug on an empty stomach Increases dietary fiber intake

The nurse caring for a client with acute liver failure should expect which assessment finding?

Generalized edema

A 71-year-old woman with a history of rheumatoid arthritis and chronic heart failure has been admitted to the hospital for the treatment of a suspected upper gastrointestinal bleed. When performing an assessment of this patient, which of the following questions most directly addresses a likely cause of the woman's bleeding disorder?

"Do you ever take aspirin to treat the pain of your arthritis?"

A patient has been scheduled for a bone marrow biopsy and admits to the nurse that she is worried about the pain involved with the procedure. What patient education is most accurate?

"Most people feel some brief, sharp pain when the needle enters the bone."

The LPN has received an order from the physician for the patient to receive 7500 units of heparin by injection. The medication is available in a vial labeled "15,000 units=1 mL." The correct amount of the medication that should be drawn up in the syringe is which of the following?

0.5 mL

The nurse is preparing to administer eptifibatide (Integrilin) intravenously to a patient with acute coronary syndrome. The patient weighs 175 pounds. The dosage for the infusion is 2 mcg/kg per minute. The nurse should set the infusion pump at which of the following flow rates?

159.1 mcg/min

Which of the following medications are classified as antiplatelet agents. (Select all that apply.)

Acetylsalicylic acid (ASA) Clopidogrel (Plavix) Cilostazol (Pletal)

A health care professional is caring for a patient who is about to begin iron dextran (InFed) therapy. When administering the drug IM, the healthcare professional should take which of the following actions? (Select all that apply)

Administer a test dose monitor blood pressure Have epinephrine available Use the Z track method

A client had a left radical mastectomy with an axillary node dissection 6 months ago and is having a large amount of edema in the left arm down to the fingers. What should the nurse inform the client is the reason for the edema?

An accumulation of lymphatic fluid that results from impaired lymph circulation.

The LPN is caring for a patient that will be treated with a thrombolytic agent. The nurse recognizes that such medications are used to treat which of the following conditions?

An acute ischemic stroke from arterial occlusion

A child has hemophilia A. After he has an accidental injury at home, his mother should administer which of the following medications?

Antihemophilic factor (Monoclate-P)

A nurse is explaining the processes related to hemoglobin to a client with a clotting disorder. Place the steps in the correct order from first to last that the nurse would outline

Erythrocytes pass through the lungs. Hemoglobin picks up oxygen and releases CO2. Oxygenated, bright red blood is carried by arteries, arterioles, and capllaries to all body tissues. Hemoglobin releases oxygen for use by the tissues. Dark red blood returns by way of the veins to the heart and lungs. CO2 is released and the blood is reoxygenated.

A health care professional is caring for a patient who has mild hemophilla A and is about to begin taking desmopressin (DDVAP) to prevent bleeding. The health care professional should monitor for which of the following adverse reactions?

Edema

A health care professional is caring for a patient who is about to begin filgrastim (Neupogen) to treat neutropenia. The health care professional should assess the patient for which of the following adverse effects?

Enlarged spleen

A physician has arrived on the floor to perform a bone marrow aspiration. The nurse first

Ensures that the client has signed the informed consent form

A nurse is completing a detailed health history and assessment in the electronic medical record (EMR) on a patient with a disorder of the hematopoietic system. Based on the patient's responses, which of the following symptoms is the most common complaint associated with hematologic diseases?

Extreme fatigue

A health care professional is caring for a patient who has a known sensitivity to Escheria coli-derived proteins. This sensitivity is a contraindication for which of the following drugs?

Filgrastim (Neupogen)

A health care professional is caring for a patient who is undergoing bone marrow transplantation following high-dose chemotherapy. Which of the following drugs should the health care professional expect the primary care provider to prescribe to reduce the patient's risk of infection?

Filgrastim (Neupogen)

A health care professional is caring for a patient who is about to begin taking oprelvekin (Neumega). The health care professional should explain to the patient that the drug has which of the following effects?

Increases platelet production

The nurse will be assisting the physician with a bone marrow aspiration. Where should the nurse cleanse, clip hair, and drape the skin prior to the procedure?

Over the posterior superior iliac crest

A 16-year-old girl has been brought to her primary care provider by her mother due to the daughter's recent malaise and lethargy. Which of the following assessments should the clinician perform in an effort to confirm or rule out infectious mononucleosis?

Palpating the patient's lymph nodes

Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. Which of the following is the most common complication of the pathology resulting from this process?

Pathologic fractures

The nurse is caring for a client who is developing hypovolemic shock from a duodenal ulcer bleed. What is the first intervention the nurse can provide to facilitate blood flow to the brain?

Place the client in a modified Trendelenburg position.

A patient was transported to the emergency department with symptoms of excessive bleeding. The patient reports she is self-administering heparin at home for treatment of a deep vein thrombosis. It is determined that the patient is having a heparin overdose. Which of the following medications will antagonize the action of heparin and is the appropriate treatment?

Protamine sulfate

Your client was admitted to the emergency department after an accident with a chain saw. The client is exhibiting signs and symptoms of acute hypovolemic anemia from severe blood loss. What signs and symptoms would you assess for?

Reduced urine output

The patient is being treated with heparin. She complains to the LPN that her period seems to be especially heavy. The LPN recognizes that this symptom is probably indicative of which of the following

The patient is experiencing an overdose of the medication.

A nurse reviews the recent lab values for a patient receiving heparin 800 units/hr IV. The most recent activated partial thromboplastin time (aPPT) is 90 seconds (control value is 20 to 26 seconds). A call is made to the primary health care provider because the nurse anticipates an order for which of the following?

To decrease the heparin dose

The nurse caring for an older adult with a diagnosis of leukemia would encourage the client to use an electric razor. Why?

Trauma and microabrasions may contribute to anemia

A client is in the hospital with a bleeding gastric ulcer and requires a blood transfusion. He has been typed and crossmatched for 2 units of packed red blood cells and found to have type O blood. What type of blood will the nurse administer to this client?

Type O

Wilkins Booth, a 70-year-old male, is a client in the long-term care facility where you practice nursing. Mr. Booth has a history of lymphedema. What is an important part of your assessment as a result of impaired nutrition to his tissues?

Ulcers and infection in the edematous area

A patient who is taking warfarin (Coumadin) arrives at the emergency department and reports rectal bleeding. Which of the following drugs should the health care professional have available?

Vitamin K

The nurse is managing care for a client with respiratory distress secondary to Hodgkin's disease. What equipment should the nurse have available? Select all that apply.

• Endotracheal tube • Laryngoscope • Bag-valve mask

Which of the following reports from the client during the health history would lead the nurse to suspect that the client has a disorder of the hematopoietic or lymphatic system? Select all that apply.

• Frequently becomes dizzy or faints. • Bruises easily. • Has frequent infections. • Has difficulty swallowing.

You are caring for a client with Hodgkin's disease who has developed associated respiratory problems. Which of the following interventions by the nurse are appropriate? Select all that apply.

• Keep the neck in midline. • Assess respiratory status each shift and as needed. • Place an endotracheal tube, laryngoscope, and bag-valve mask at the bedside for intubation.