Hematology practice questions

A patient with hematologic disorder has a smooth, shiny red tongue. Which lab result would the nurse expect to see? a. neutrophils 45% b. Hgb 9.6 c. WBC count 13,500 d. RBC count 6.4

hgb 9.6 iron deficiency anemia causes these symptoms. IDA has a low Hgb level

A patient is undergoing computed tomography CT of the spleen. What is the most important for the nurse to ask the patient about before the test? a. iodine sensitivity b. prior blood transfusions c. phobia of confined spaces d. internal metal implants or appliances

iodine sensitivity

8. A patient who was in a car accident had abdominal trauma. Which organs may be damaged and contribute to altered function of the hematologic system (select all that apply)? a. liver b. spleen c. stomach d. gallbladder e. lymph nodes

liver, spleen, lymph nodes

During physical assessment of a patient with thrombocytopenia, what would the nurse expect to find? a. sternal tenderness b. petechiae and purpura c. jaundiced sclera and skin d. tender, enlarged lymph nodes

petechiae and purpura

A patient is being treated with chemotherapy. The nurse revises the patient's care plan based on which result? a. WBC count 4000 b. RBC 3.8 x 10^6 c. Platelets 50,000 d. Hematocrit 39%

platelets 50000

If a patient with type O Rh+ blood is given AB Rh+ blood, what would the nurse expect to happen? a. The patients Rh factor will react with the RBCs of the donor blood b. The anti-A and anti-B antibodies in the patient's blood will hemolyze the donor blood c. the anti-A and the anti-B antibodies in the donor blood will hemolyze the patient's blood d. no adverse reaction is expected because the patient has no antibodies against the donor blood

pt blood will hemolyze donor blood

Using light pressure with the index and middle fingers, the nurse cannot palpate any of the patient's superficial lymph nodes. How should the nurse respond to this assessment? a. record as normal b. reassess the lymph nodes using deeper pressure c. ask the patient about any history of radiation therapy d. notify the HCP that xrays of the nodes will be necessary

record as normal

During the nursing assessment of a patient with anemia, what specific information should the nurse ask the patient about? a. stomach surgery b. recurring infections c. corticosteroid therapy d. oral contraceptive use

stomach surgery

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the NEED FOR FURTHER INSTRUCTION? 1. stress 2. trauma 3. infection 4. fluid overload

4. fluid overload Explanation: Dehydration, rather than hydration, is one cause of a sickle cell crisis.

When reviewing the results of an 83-year-old patients blood tests, which finding would be of most concern to the nurse? a. platelets 150,000 b. serum iron 50 c. PTT 60 seconds d. erythrocyte sedimentation rate 35 mm in 1 hour

PTT 60 seconds

Multiple drugs are often used in combo to treat leukemia and lymphoma because... a. there are fewer toxic and side effects b. the chance that one drug will be effective is increased c. the drugs are more effective without causing side effects d. the drugs work by different mechanisms to maximize killing off malignant cells

d. the drugs work by different mechanisms to maximize killing off malignant cells

Complications of transfusions that can be decreased by the use of leukocyte depletion or reduction of RBC transfusion are... a. chills and hemolysis b. leukocytosis and neutrophilia c. fluid overload and pulmonary edema d. transmission of cytomegalovirus and fever

d. transmission of cytomegalovirus and fever

The nurse is conducting staff in-service training on von Willebrand's disease. Which should the nurse include as characteristics of vWD? Select all that apply. 1. Easy bruising 2. Gum bleeding 3. It is a hereditary bleeding disorder 4. Treatment and care are similar to that for hemophilia 5. It is characterized by extremely high creatinine levels 6. The disorder causes platelets to adhere to damaged endothelium

1. Easy bruising 2. Gum bleeding 3. It is a hereditary bleeding disorder 4. Treatment and care are similar to that for hemophilia 6. The disorder causes platelets to adhere to damaged endothelium Explanation: Elevated creatinine is not associated with this disease.

The nurse is reviewing a health care provider's prescription for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescription documented in the child's chart should the nurse question? Select all that apply. 1. Restrict fluid intake 2. Position for comfort 3. Avoid strain on painful joints 4. Apply nasal oxygen at 2 L/min 5. Provide high calorie, high protein diet 6. Give demerol, 25 mg IV, q4hr for pain

1. Restrict fluid intake 6. Give demerol, 25 mg IV, q4hr for pain Explanation: SCA requires an increase in fluid to prevent a crisis. Demerol has a high risk for seizure and anxiety and should not be administered.

The nurse is developing a plan of care for the client with multiple myeloma and includes which PRIORITY intervention in the plan? 1. encouraging fluid intake 2. providing frequent oral care 3. coughing and deep breathing 4. monitoring the RBC count

1. encouraging fluid intake Explanation: Multiple myeloma causes an increase in calcium in the blood. Increasing fluid intake will dilute the calcium and promote excretion through the kidneys.

The nurse is reviewing the lab results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. increased calcium level 2. increased WBC 3. decreased blood urea nitrogen level 4. decreased number of plasma cells in the bone marrow

1. increased calcium level Explanation: Bone tissue deteriorates in this disorder, increasing calcium levels in the blood.

The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the parents? 1. administer the iron at mealtimes 2. administer the iron through a straw 3. mix the iron with cereal to administer 4. add the iron to formula for easy administration

2. administer the iron through a straw Explanation: Iron needs an acidic environment to be absorbed, so it should be given at least 1 hour before meals, or 2 hours after. It should be given with a straw to avoid staining teeth.

A 10-year-old with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription? 1. injection of factor x 2. IV infusion of iron 3. IV infusion of factor VIII 4. IM injection of iron using the z-track method

3. IV infusion of factor VIII Explanation: Factor VIII is the missing clotting factor in hemophilia A. Without this, the child is at risk for bleeding into his joints.

The nurse analyzes the lab results of a child with hemophilia. The nurse understands that which result will MOST LIKELY be abnormal in this child? 1. Platelet count 2. Hematocrit count 3. Hemoglobin count 4. Partial thromboplastin time

4. Partial thromboplastin time Explanation: The platelet count, hematocrit and hemoglobin counts are all normal in hemophilia. Hemophilia is a disorder caused by a deficiency in the coagulation proteins.

The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? 1. Restrict all visitors 2. Restrict fluid intake 3. Teach the client and family about the need for hand hygiene 4. Insert and indwelling catheter to prevent skin breakdown

3. Teach the client and family about the need for hand hygiene Explanation: Hand hygiene is paramount to reduce risk for infection in a neutropenic patient. The only visitors that are restricted are those with known infections. Placement of an indwelling catheter increases the risk for infections and should therefore be avoided.

The nurse is providing home care instructions to the parents of a 10-year-old child with hemophilia. Which sport activity should the nurse suggest for this child? 1. soccer 2. basketball 3. swimming 4. field hocky

3. swimming Explanation: Sports should be non-contact to avoid bleeding.

A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder? 1. Altered RBC production 2. Altered production of lymph nodes 3. Malignant exacerbation in the number of leukocytes 4. Malignant proliferation of plasma cells within the bone

4. Malignant proliferation of plasma cells within the bone

Lab studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the lab results, knowing that which result indicates this type of anemia? 1. elevated hemoglobin level 2. decreased reticulocte 3. elevated RBC count 4. RBC that are microcytic and hypochromic

4. RBC that are microcytic and hypochromic

A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? 1. fatigue 2. weakness 3. weight gain 4. enlarged lymph nodes

4. enlarged lymph nodes Explanation: Hodgkin's disease is a form of lymphoma characterized by painless enlargement of lymph nodes

What are the characteristics of neutrophils (Select all that apply? A. also known as "segs" B. Band is immature cell C. First WBC at injury site D. Arises form megakaryocytes E. Increased in individuals with allergies F. 50% to 70% of WBC

A. also known as "segs" B. Band is immature cell C. First WBC at injury site F. 50% to 70% of WBC

The nurse receives a physician's order to transfuse fresh frozen plasma to a patient suffering from an acute blood loss. Which procedure is most appropriate for infusing this blood product? A. infuse the FFP as rapidly as the patient will tolerate B. hang the FFP as a piggyback to the primary IV solution C. Infuse the FFP as a piggyback to a primary solution of normal saline D. Hang the FFP as a piggyback to a new bag of primary IV solution without KCl

A. infuse the FFP as rapidly as the patient will tolerate

The nurse notes a physician's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? A. 11:45 AM B. 12:00 noon C. 12:30 PM D. 3:30 PM

B. 12:00 noon

When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 and a hematocrit level of 26%. What should the nurse place HIGHEST priority on initiating interventions to reduce? A. Thirst B. fatigue c. headache d. abdominal pain

B. fatigue

The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? A. Unit secretary B. A physician's assistant C. Another registered nurse D. An unlicensed assistive personnel

C. Another registered nurse

Before beginning a transfusion of RBCs, which action by the nurse would be of HIGHEST priority to avoid an error during this procedure? a. Check the identifying information on the unit of blood against the patient's ID bracelet. b. Select new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. c. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction. d. Add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow.

a. Check the identifying information on the unit of blood against the patient's ID bracelet.

Nursing care for a patient immediately after a bone marrow biopsy and aspiration includes (select all that apply)... a. administering analgesics as necessary b. preparing to administer a blood transfusion c. instructing on need to lie still with a sterile pressure dressing intact d. monitoring vital signs and assessing the site for excess drainage or bleeding e. instructing on the need for preprocedure and post procedure antibiotic medication

a. administering analgesics as necessary c. instructing on need to lie still with a sterile pressure dressing intact

Priority nursing actions when caring for a hospitalized patient with a new onset temp of 102.2 and sever neutropenia include (select all that apply).... a. administering the prescribed antibiotic STAT b. drawing peripheral and central line blood cultures c. ongoing monitoring of the patient's vital signs for septic shock d. taking a full set of vitals and notifying the physician immediately e. administering transfusions of WBCs treated to decrease immunogenicity

a. administering the prescribed antibiotic STAT b. drawing peripheral and central line blood cultures c. ongoing monitoring of the patient's vital signs for septic shock d. taking a full set of vitals and notifying the physician immediately

When caring for a patient with thrombocytopenia, the nurse instructs 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. dab his or her nose instead of blowing

In a severely anemic patient, the nurse would expect to find.... a. dyspnea and tachycardia b. cyanosis and pulmonary edema c. cardiomegaly and pulmonary fibrosis d. ventriclar dysrhythmias and wheezing

a. dyspnea and tachycardia Explanation:

Significant information obtained from the patient's health history that relates to the hematologic system includes... a. jaundice b. bladder surgery c. early menopause d. multiple pregnancies

a. jaundice (hemolysis of RBC leads to jaundice)

When reviewing lab results of an 83-year-old patient with an INFECTION, the nurse would expect to find... a. minimal leukocytes b. decreased platelet count c. increased hemoglobin and hematocrit levels d. decreased erythrocyte sedimentation rate (ESR)

a. minimal leukocytes

The nursing management of a patient in sickle cell crisis includes (select all that apply)... a. monitoring CBC b. optimal pain management and O2 therapy c. blood transfusions if requires and iron chelation d. rest as needed and DVT prophylaxis e. administration of IV iron and diet high in iron content

a. monitoring CBC b. optimal pain management and O2 therapy c. blood transfusions if requires and iron chelation d. rest as needed and DVT prophylaxis

Nursing interventions for a patient with severe anemia related to peptic ulcer disease include (select all that apply)... a. monitoring stools for guaiac b. instruction for high-iron diet c. taking vital signs every 8 hours. d. teaching self-injection of erythropoietin e. administration of cobalamin (vit b12) injections

a. monitoring stools for guaiac b. instruction for high-iron diet

A complication of the hyperviscosity of polycythemia is... a. thrombosis b. cardiomyopathy c. pulmonary edema d. disseminated intravascular coagulation

a. thrombosis

Before starting a transfusion of packed RBCs for an OLDER ANEMIC PATIENT, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion? a. 5 b. 15 c. 30 d. 60

b. 15

Which patient is MOST likely to experience anemia related to an increased destruction of RBCs? a. A 59-year-old man whose alcoholism has precipitated folic acid deficiency b. A 23-year-old African American man who has a diagnosis of sickle cell disease c. A 30-year-old woman with a history of "heavy periods" accompanied by anemia d. A 3-year-old child whose impaired growth and development is attributable to thalassemi

b. A 23-year-old African American man who has a diagnosis of sickle cell disease

The blood bank notifies the nurse that the two units of blood ordered for an anemic patient are ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? a. Immediately pick up both units of blood from the blood bank. b. Infuse the blood slowly for the first 15 minutes of the transfusion. c. Regulate the flow rate so that each unit takes at least 4 hours to transfuse. d. Set up the Y-tubing of the blood set with dextrose in water as the flush solution.

b. Infuse the blood slowly for the first 15 minutes of the transfusion.

An anticoagulant such as warfarin (coumadin) that interferes with prothrombin production will alter the clotting mechanism during... a. platelet aggregation b. activation of thrombin c. the release of tissue thromboplastin d. stimulation of factor activation complex

b. activation of thrombin

What nursing intervention should be the priority in the care of a 30-year-old woman who has a Dx of immune thrombocytopenic purpura? a. administration of pRBCs b. administration of oral or IV corticosteroids c. administration of clotting factors VIII and IX d. maintenance of reverse isolation and application of standard precautions

b. administration of oral or IV corticosteroids

What will caring for a patient with a diagnosis of polycythemia vera likely require the nurse to do? 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 neuro assessments

b. assist with or perform phlebotomy at the bedside

When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would question that patient about.... a. folic acid intake b. dietary intake of iron c. a history of gastric surgery d. a history of sickle cell anemia

b. dietary intake of iron

If a lymph node is palpated, what is a normal finding? a. hard, fixed nodules b. firm, mobile nodules c. enlarged, tender nodes d. hard, nontender nodes

b. firm, mobile nodules

An individual who lives at a high altitude may normally have an increased RBC count because... a. high altitudes cause vascular fluid loss, leading to hemoconcentration. b. hypoxia caused by decreased atmospheric oxygen stimulates erythropoiesis. c. the function of the spleen in removind old RBCs is impaired at high altitudes d. impaired production of leukocytes and platelets leads to proportionally higher red cell counts

b. hypoxia caused by decreased atmospheric oxygen stimulates erythropoiesis.

A patient with a Dx of hemophilia had a fall down an escalator earlier in the day and now is experiencing bleeding in her left knee joint. What should be the ER nurse's IMMEDIATE response to this? a. immediate transfusion of platelets b. resting the patient's knee to prevent hemarthroses c. assistance with intracapsular injection of corticosteroids d. ROM exercises to prevent thrombus formation

b. resting the patient's knee to prevent hemarthroses

A patient with bone marrow disorder has an overproduction of myeloblasts. The nurse would expect the results of a complete blood count (CBC) to include an increase in which cell types (select all that apply)? a. basophils b. eosinophils c. monocytes d. neutrophils e. lymphocytes

basophils, eosinophils, neutrophils

Lab test results indicate increased fibrin split products (FSPs). An appropriate nursing action is to monitor the patient for... a. fever b. bleeding c. faintness d. thrombotic episodes

bleeding

when teaching a patient about bone marrow examinations, what should the nurse explain? a. the procedure will be done under general anesthetic because it is so painful b. the patient will not have any pain after the area at the puncture site is anesthetized c. the patient will experience a brief, very sharp pain during aspiration of the bone marrow d. there will be no pain during the procedure, but an ache will be present several days afterwards

brief, very sharp pain

When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? a. lactated ringer's b. 5% dextrose in water c. 0.9% sodium chloride d. 0.45% sodium chloride

c. 0.9% sodium chloride

the nurse is 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 manifest in multiple organs d. non-hodgkin's lymphoma is treated only with radiation therapy.

c. Non-Hodgkin's lymphoma can manifest in multiple organs

A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate... a. hyperkalemia b. hyperuricemia c. hypercalcemia d. CNS myeloma

c. hypercalcemia

While assessing the lymph nodes, the nurse should... a. apply gentle, firm pressure to deep lymph nodes b. palpate the deep cervical and supraclavicular nodes last. c. lightly palpate superficial lymph nodes with the pads of the fingers. d. use the tips of the second, third and fourth fingers to apply deep palpation

c. lightly palpate superficial lymph nodes with the pads of the fingers.

You are taking care of a male patient who has the following lab values from his CBC: WBC 6.5, Hgb 13.4, Hct, 40%, platelets 50000. What are you most concerned about? a. your patient is neutropenic b. your patient has an infection c. your patient is at risk for bleeding d. your patient is at fall risk due to his anemia

c. your patient is at risk for bleeding Platelets are well below normal

Malignant disorders that arise from granulocytic cells in the bone marrow will have the primary effect of causing... a. risk for hemorrhage b. altered oxygenation c. decreased production of antibodies d. decreased phagocytosis of bacteria

d. decreased phagocytosis of bacteria

The nurse would anticipate that a patient with von Willebrand disease undergoing surgery would be treated with administration of vWF and... a. thrombin b. factor VI c. factor VII d. factor VIII

d. factor VIII

When reviewing the patient's hematological lab values after a splenectomy, the nurse would expect to find... a. leukopenia b. RBC abnorms c. decreased hemoglobin d. increased platelet count

d. increased platelet count *** the spleen serves as a storage space for platelets. Getting rid of it leads to increased platelets in the blood stream