Heme Questions
The nurse is developing a plan of care for a client who has leukemia. what instructions should the nurse include in the plan of care? A. monitor temp and report elevation B. recognize s/s of infection C. avoid crowds D. maintain integrity of skin and mucous membranes E. take a baby aspirin each day
A, B, C, D aspirin is an anticoagulant
The nurse is to admin subcut heparin to an underweight adult, what should the nurse keep in mind when administering this med? A. administer in the anterior area of the iliac crest B. the onset is immediate C. use a 27 gauge, 5/8 inch needle D. cephalosporin potentiates the effects of heparin E. verify the dose with another nurse
A, C, D, E cephalosporin and penicillin potentiate the effects of heparin. some policies may have 2 nurses check the dose bc of the risk of bleeding
A client with granulocytopenia has many visitors. the most important measure to prevent infection is for the visitors to: A. visit only if they do not have a cold B. wash their hands C. leave the children at home D. not to kiss the client
B. wash their hands primary prevention technique
A nurse is caring for a young male patient with lymphoma who is to begin treatment. What teaching topic is a priority? A) Genetic testing B) Infection prevention C) Sperm banking D) Treatment options
C. Sperm Banking
A client with pernicious anemia is receiving vitamin B12. the nurse should evaluate the client for which expected outcome if vitamin B12? A. increased energy B. healed tongue and lips C. absence of parasthesias D. improved clotting time
C. absence of parasthesias this is a common side effect of pernicious anemia. energy improvement is for iron deficiency
The nurse has just admitted a 35 y/o female client who has a serum B 12 concentration of 800 pg/ml. which lab finding should alert the nurse to focus the health hx to obtain specific info about drug or alcohol use? A. total bilirubin 0.3 mg/dl B. serum creatnine 0.5mg/dl C. hemoglobin 16 g/dl D. folate 1.5 ng/ml
D. normal range for folic acid is 1.8-9 for vitamin B is 200-900 low folic acid and normal B12 means primary folic acid deficiency anemia the rest are in normal ranges
A HCP prescribes vitamin B12 for a client with pernicious anemia. which sites are appropriate for the nurse to administer vitamin B12 to an adult? select all that apply A. median cutaneous B. greater femur trochanter C. acromian muscle D. ventrogluteal E. upper back F. dorsogluteal
D. ventrogluteal and F. dorsogluteal needs to be deep IM. the most comfortable position to administer an IM injection to a ventrogluteal region is the client laying on their abdomen with toes pointed inward
What lab value do you assess before giving epoetin injections? A. hematocrit B. PTT C. hemoglobin D. PT
A. hematocrit this drug will cause the hematocrit to rise, then the BP, so that also needs to be checked
A client with iron deficiency anemia is having trouble picking from the hospital menu. which foods should the nurse suggest to meet the client's iron needs? A. eggs B. brown rice C. dark green veggies D. tea E. oatmeal
A, B, C, E
Which is a finding associated with internal bleeding with DIC? A. bradycardia B. hypertension C. increasing abdominal girth D. petechiae
C. increasing abdominal girth as blood collects in the peritoneal cavity, it causes dilation and distention which is reflected in increased abdominal girth
When a client is taking aspirin (acetylsalicyclic) caplets, develops prolonged bleeding from a superficial skin injury on the forearm. the nurse should tell the client to do which action first? A. place the forearm under a running stream of luke warm water B. pat the injury with a dry washcloth C. wrap the entire forearm from the wrist to the elbow D. apply an ice pack for 20 mins
D. apply an ice pack for 20 mins aspirin has an antiplatelet effect, and bleeding time can consequently be prolonged.
Someone will acute leukemia and mucositis should use what after every meal and every 4 hours while awake?
saline
The nurse is obtaining consent for a bone marrow aspiration. What actions should the nurse take? A. witness the client signing the consent form B. evaluate that the client understands the procedure C. explain the risks of the procedure to the client D. verify that the client is signing the consent form at his/her own will E. determine that the client understands postprocedure care
A, B, D, E
A female client is receiving chemo and is experiencing pancytopenia. Which lab result most warrants that the nurse immediately contact the HCP? A. platelet count of 12,000 B. WBC count of 4,000 C. absolute neutrophil count of 1,500 D. hemoglobin of 12
A.
When a client is diagnosed with aplastic anemia the nurse should assess the client for changes in what physical function? A. bleeding tendencies B. i/o C. peripheral sensation D. bowel function
A. bleeding tendencies
Which nursing action is most important in preventing cross-contamination? A. changing gloves immediately after use B. standing 2 feet from the client C. speaking minimally when in the room D. wearing protective coverings
A. changing gloves immediately after use protects the client from micro-organisms.
When a client is receiving a cephalosporin, the nurse must monitor the client for which finding? A. drug-induced hemolytic anemia B. purpura C. infectious emboli D. ecchymosis
A. drug-induced hemolytic anemia it's an aquired, antibody-mediated, RBC destruction precipitated by meds like cephalosporins, sulfa drugs, etc
Packed red blood cells have been prescribed for a client with low hemoglobin and hematocrit levels. The nurse takes the client's temperature before the blood transfusion and records 100.8 °F. Which action should the nurse take? A. Give an antipyretic and begin the transfusion. B. Proceed with the transfusion. C. Administer an antihistamine and begin the transfusion. D. Delay hanging the blood and inform the physician.
Answer: D. Delay hanging the blood and inform the physician. If the client has a temperature higher than 100 ° F, the unit of blood should be delayed until the physician is notified and has the opportunity to give further order. Options A and C are incorrect since the administration of the medicine will need the physician's prescription.
The nurse is developing a teaching plan for a client with aplastic anemia. What is most important thing to include in the plan?
Avoid exposed to others with acute infections 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 to prevent infection
Which lab values should the nurse report to the HCP when the client has anemia? A. schilling test result, elevated B. intrinsic factor, absent C. sedimentation rate, 16 mm/h D. RBC's within normal range
B. intrinsic factor, absent primary characteristic of pernicious anemia is lack of intrinsic factor which results from atrophy of the stomach wall. without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestine
A client who follows a vegetarian diet was referred to a dietitian for nutritional counseling for anemia. which client outcome indicates that the client does not understand nutritional couseling? the client: A. adds dried fruits 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. drinks coffee or tea with meals dried fruits are a non-animal iron source, cooking in iron based pots adds iron to the diet, vitamin C increases absorption of iron
A client is afraid of receiving vitamin B12 injections bc of potential toxic reactions. What is the nurses best response to relieve these fears? A. it will cause ringing in the ears before a toxic level is reached B. it may cause a mild rash initially C. it may cause mild nausea but nothing toxic D. it is generally free of toxicity bc it is water soluble
D. it is generally free of toxicity bc it 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. so it is considered to be nontoxic
The nurse should explain to the client with hodgkins disease that a bone marrow biopsy will be taken after the aspiration. what should the nurse explain about the biopsy?
You will feel a pressure sensation when the biopsy is taken, but should not feel actual pain. if you do, tell the HCP so that you can be given extra numbing medication
Which one is not a common site of bleeding for someone with leukemia and thrombocytopenia? A. biliary system B. GI tract C. brain and meninges D. pulmonary
A. biliary system
A client has an absolute Neutrophil count (ANC) of 900. what is the client's risk of infection? A. normal risk B. moderate risk C. high risk D. extremely high risk
B. moderate risk a client is at a moderate risk when the ANC is <1000. normal risk for infection is when the anc is 1,500 or greater. high risk is <500. ANC of 100 is life threatening
A client has fatigue, temp of 99.5, dark bronze skin, and dark urine. hemoglobin is 9, hematocrit is 49%, and RBC's are 2.75 million. what should the nurse do first? A. initiate I/O record B. place the client on bed rest C. place the client on contact isolation D. keep the client out of sunlight
A. initiate I/O record
The nurse should instruct the client with a platelet count of 31,000 to: A. pad sharp surfaces to avoid minor trauma when walking B. assess for spontaneous petechiae in the extremeties C. wear a mask when in crowds of people D. check for blood in the urine
A. pad sharp surfaces to avoid minor trauma when walking
Effects of protamine sulfate 0.5 mg in: 5, 10, 20, or 30 minutes?
20 minutes
The goal of nursing care for a client with AML is to prevent:
hemorrhage
Client is having a blood transfusion reaction. Priority from first to last: (4)
3, 4, 1, 2 stop the transfusion, keep the IV open with NS infusion, notify HCP and blood bank, complete transfusion reaction forms
A client is to have an infusion of packed RBC's from a designated donor. The client asks if any diseases can be transmitted by this donor. the nurse should inform the client that which diseases can be transmitted by a designated donor? A. Epstein-barr virus B. HIV C. cytomegalovirus D. Hepatitis A E. Malaria
A, B, C Hepatitis A is transmitted by the fecal/oral route not the blood route; however, hep B and C can be contracted from a designated donor. malaria is transmitted by misquitos
A client with thrombocytopenia has developed a hemorrhage. the nurse should assess the client for which finding? A. tachycardia B. bradycardia C. decreased O2 D. narrowed pulse pressure
A. tachycardia BC the heart beats faster to compensate for decreased circulating volume and decreased numbers of oxygen carrying RBC's. Bradycardia and decreased O2 are late signs of hemorrhage
Platelets should not be administered when: A. the platelet bag is cold B. platelets are two days old C. the platelet bag is at room temperature D. the platelets are 12 hours old
A. the platelet bag is cold platelets cannot survive cold temperatures. the platelets should not be stored at room temp and last for no more than 5 days
A nurse is caring for a patient who is about to receive a bone marrow transplant. To best help the patient cope with the long recovery period, what action by the nurse is best? A) Arrange a visitation schedule among friends and family. B) Explain that this process is difficult but must be endured. C) Help the patient find things to hope for each day of recovery. D) Provide plenty of diversionary activities for this time.
B. Explain that this process is difficult but must be endured
The nurse should assess the client at risk for acute DIC for which early sign? A. severe sob B. bleeding without hx or cause C. orthopnea D. hematuria
B. bleeding without history or cause there is no well-defined sequence for acute DIC other than the client starts bleeding without a history or cause and does not stop bleeding. the rest come later
A client who had received 25 ml of PRBC's has low back pain and pruritis. after stopping the infusion, the nurse should take what action next? A. administer prescribed antihistamine and antipyretic B. collect blood and urine samples to send to the lab C. administer prescribed diuretics D. administer prescribed vasopressors
B. collect blood and urine samples to send to the lab this is a hemolytic reaction
A client with DIC develops clinical manifestations of microvascular thrombosis. the nurse should assess the client for: A. hemoptysis B. focal ischemia C. petechiae D. hematuria
B. focal ischemia
A patient has a platelet count of 25,000/mm3 (25 × 109/L). What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) A)Assist with oral hygiene using a firm toothbrush B) Give the patient an enema if he or she is constipated. C) Help the patient choose soft foods from the menu. D) Shave the male patient with an electric razor. E) Use a lift sheet when needed to reposition the patient.
C, D, E
Which is contraindicated for a client diagnosed with DIC? A. treating the underlying cause B. administering heparin C. administering warfarin sodium D. replacing depleted blood products
C. administering warfarin sodium DIC has not been found to respond to oral anticoagulants such as warfarin sodium. treatments include: treating the underlying cause, administering heparin, replacing depleted blood products
The nurse should instruct the client with vitamin B12 deficiency to eat which foods to obtain the best supply of vitamin B12? A. whole grains B. green leafy veggies C. meats and dairy D. broccoli and Brussels sprouts
C. meats and dairy
A client had a resection of the terminal ileum 3 years ago. while obtaining a health history and physical assessment, the nurse finds that the client has weakness, sob, and a sore tongue. which additional info from the client indicates a need for 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 regular bowel movements on most days D. i take a vitamin B12 tablet every day
D. i take a vitamin b12 tablet every day vitamin b12 combines with the intrinsic factor in the stomach and is then carried to the ileum where it is absorbed into the bloodstream. this person cannot absorb it
Clinical manifestation of a client with Hodgkins?
painless, enlarged cervical lymph nodes
What age is someone most at risk to get ALL?
4-12 years old
The nurse is assisting with a bone marrow biopsy and aspiration. in which order, from first to last, should the nurse complete these tasks? 1. position the client in a side lying position 2. clean the skin with an antiseptic solution 3. verify the client has signed an informed consent 4. apply ice to the biopsy site
3, 1, 2, 4
A client with chronic myelogenous leukemia is taking imatinib. The nurse should instruct the client to report which adverse effect of this drug? A. edema B. numbness and tingling in extremities C. bloody stools D. persistent cough
A. edema Adverse effects of this drug are edema and GI disturbance
The nurse is preparing to teach a client with iron deficiency anemia about the diet to follow after discharge. what food should be included in the diet? A. eggs B. lettuce C. citrus fruits D. cheese
A. eggs eggs are high in iron, and so are organ meats, shellfish, shrimp, tuna, whole grain, legumes, nuts, dried fruits, oatmeal, sweet potatoes
A client had a mastectomy followed by chemo 6 months ago. she reports that she is now "unable to concentrate at her card game" and "it seems harder and harder to finish her errands bc of exhaustion" based on this info the nurse should suggest that the client: A. take frequent naps B. limit activities C. increase fluid intake D. avoid contact with others
A. take frequent naps
The nurse is developing a discharge plan with a client who has lymphoma. What should the nurse emphasize to the client? A. use analgesics as needed B. take a shower with perfumed shower gel C. wear a mask when outside of the home D. take an antipyretic every morning
A. use analgesics as needed relieves painful encroachment of enlarged lymph nodes
What should the nurse teach the client with neutropenia and the family to avoid? A. using suppositories or enemas B. using a high-efficiency particulate air filter mask (HEPA) C. performing perianal care after every bowel movement D. performing oral care after every meal
A. using suppositories or enemas this is a direct portal of entry for infection
A client was admitted to the hospital 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 daily 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. what daily activities were you able to do 6 months ago compared with the present? have to compare one time frame to another, and iron deficiency anemia can occur slowly
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. Reticulocyte count A diagnosis is established based on a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Increased reticulocyte counts occur in children with sickle cell disease because the life span of their sickled red blood cells is shortened. Options A, B, and D: 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.
Nurse is making a plan of care for a patient with Hodgkins lymphoma who's getting radiation. Whats the primary goal of care for them? A. maintain fluid balance B. obtain sufficient exercise C. prevent infection D. avoid depression
C. prevent infection
What is a late symptom of polycythemia vera? A. headache B. dizziness C. pruritis D. sob
C. pruritis this is a late symptom that results from abnormal histamine metabolism. headache and dizziness are early symptoms from enlarged veins. SOB is an early symptom from congested mucous membranes and ineffective gas exchange
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
B, C, D, E Polycythemia vera, a condition in which too many RBCs are produced in the blood serum, can lead to 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).
A client is about to undergo a bone marrow aspiration of the sternum. what should the nurse tell the client? A. you may feel solution being wiped over your entire front from your neck down to your navel and out to your shoulders B. you will not feel the local anasthetic being applied bc it will be sprayed on C. You will feel a pulling type of discomfort for a few seconds D. after the needle is removed, you will feel a bandage being applied around your chest
C. you will feel a pulling type of discomfort for a few seconds
What directions should the nurse provide to a young adult female with sickle cell anemia? select all that apply A. drink plenty of fluids when outside in hot weather B. avoid being in high altitudes where less oxygen is available C. be aware that she is homozygous for hbS, she carries the sickle cell trait D. know that pregnancy with sickle cell disease increases the risk of a crisis E. avoid flying on commercial airlines
A, B, D ppl who are homozygous for hbs have sickle cell anemia; heterozygous for is the sickle cell carrier trait. they can fly, there's adequate oxygen
The nurse is administering 2 units PRBC's to a patient with a low hemoglobin. The nurse will prepare which of the following in order to transfuse the blood? A. Microfusion set. B. Polyvol Pro Burette Set. C. Photofusion set. D. Tubing with an in-line filter.
Answer: D. Tubing with an in-line filter. The in-line filter helps ensure that any particles larger than the size of the filter are caught in the filter and are not infused. Option A is incorrect since the tubing that should be used is a macro drip. Option B is used for administration of IV medication infusion. Option C is incorrect since blood does not need any protection from light.
What safety measures would be most important to implement when caring for a client who is receiving 2 units of packed RBC's? select all that apply A. verify that the ABO and Rh of the two units are the same B. infuse a unit of PRBC's in <4 hours C. stop the transfusion if a reaction occurs, but keep the line open D. take vital signs every 15 minutes while the unit is transfusing E. Inspect the blood bag for leaks, abnormal color, clots F. Use a 22 gauge catheter for optimal flow of a blood transfusion
B, C, E when a unit of PRBC's are being infused, vital signs are assessed before the transfusion, after the first 15 minutes, then every hour until 1 hour after the transfusion's completed
24 hours after a bone marrow aspiration, the nurse evaluates which client outcome as an appropriate one? A. the client maintains bed rest B. there is redness and swelling at the aspiration site C. the client requests a strong analgesic for the pain D. there is no bleeding at the aspiration site
D. there is no bleeding at the aspiration site. after a BM aspiration, the site should be checked every 10 to 15 mins for bleeding
The client with ALL is at risk for infection. what action should the nurse take?
place the client in a private room
A client with iron deficiency anemia is refusing to take the prescribed oral iron medication bc the medication is causing nausea; the client is also constipated. what actions should the nurse take? select all that apply A. suggest that the client use ginger when taking the med B. ask the client what is causing the nausea C. tell the client to use stool softeners to minimize constipation D. offer to administer the med by an IM injection E. suggest that the client take the iron with orange juice
A, B, E N/V are common adverse effects of oral iron preparations. the nurse should first ask the client why they do not want to take the oral med and then suggest ways to decrease the n/v. ginger may help minimize nausea. iron should be taken on an empty stomach but can be taken with orange juice. Stool softeners should not be used in clients with iron deficiency anemia. constipation can be prevented by following a high fiber diet
The nurse is preparing to administer platelets. the nurse should: A. check the ABO compatability B. administer the platelets slowly C. gently rotate the bag D. use a whole-blood tubing set
C. gently rotate the bag the bag for platelets needs to be gently rotated to prevent clumping. ABO is not necessary, and platelets are administered as fast as tolerated to prevent aggregation.
The family of a neutropenic patient reports that the patient "is not acting right." What action by the nurse is the priority? A) Ask the patient about pain. B )Assess the patient for infection. C) Delegate taking a set of vital signs. D) Look at today's laboratory results.
B. Assess the patient for signs of infection
The nurse is teaching a client and his family about the client's new diagnosis of hemochromotosis. which info should the nurse include in the teaching plan? A. hemochromotosis is an autoimmune disorder that effects the HFE gene B. individuals who are heterozygous for hemochromotosis rarely develop the disease C. individuals who are homozygous for hemochromotosis are carriers of hemochromotosis D. men are at greater risk of getting it
B. individuals who are heterozygous for hemochromotosis rarely develop the disease risk for men and women is the same but women don't show usually until menopause. most common genetic disorder in the US and Canada. Individuals who are homozygous for hemochromotosis received a defective gene from each parent, those with homozygous genes may develop the disease
