Hem/Oncology Prep Us
The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse? "I will eat clear liquids for the next 24 hours." "I can continue taking my vitamins and herbs because they make me feel better." "I will use birth control measures until after all treatment is completed." "Hair loss may not occur until after the second round of therapy."
"I can continue taking my vitamins and herbs because they make me feel better."
A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching? "I floss my teeth every morning." "I removed all the throw rugs from the house." "I use an electric razor to shave." "I take a stool softener every morning."
"I floss my teeth every morning."
Which statement indicates the client understands teaching about induction therapy for leukemia? "I will need to come every week for treatment." "I will be in the hospital for several weeks." "I know I can never be cured." "I will start slowly with medication treatment."
"I will be in the hospital for several weeks."
A nurse is caring for a 29-year-old female client, who was diagnosed with acute lymphocytic leukemia. The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment? "I always had a good appetite. Even with chemo I shouldn't have to make any changes to my diet." "I should be able to finally start a family after I'm finished with the chemo." "I'll have to remain in the hospital for about 3 months after my transplant." "I'll only need chemotherapy treatment before receiving my bone marrow transplant."
"I'll only need chemotherapy treatment before receiving my bone marrow transplant."
The nurse is caring for a client with a newly discovered tumor that may be benign or malignant. The client asks, "What makes a malignant tumor different from a benign one?" What should the nurse include in the response? Select all that apply. "The tumor may regress after its initial growth." "The tumor grows slowly and may stop." "It grows by invasion and infiltrates the surrounding tissues." "It does not spread to other areas of the body through blood and lymph channels." "The cells of the tumor bear little resemblance to the cells in the tissue where the tumor started."
"The cells of the tumor bear little resemblance to the cells in the tissue where the tumor started." "It grows by invasion and infiltrates the surrounding tissues."
The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? "Clients with alopecia will have delay in grey hair." "Wigs can be used after the chemotherapy is completed." "The hair loss is usually temporary." "New hair growth will return without any change to color or texture."
"The hair loss is usually temporary."
A nurse is teaching a client with bone marrow suppression about the time frame when bone suppression will be noticeable after administration of floxuridine. What is the time frame the nurse should include with client teaching? 7 to 14 days 21 to 28 days 2 to 4 days 24 hours
7 to 14 days
The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following? A normal reaction to the diagnosis of cancer. An aberrant psychologic reaction to the chemotherapy. A side effect of the neoplastic drugs. A psychiatric diagnosis everyone has at one time or another.
A normal reaction to the diagnosis of cancer.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? Adjuvant therapy is likely. Palliative care is likely. No further treatment is indicated. Repeat biopsy is needed before treatment begins.
Adjuvant therapy is likely.
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? Encouraging rhythmic breathing exercises Withholding fluids for the first 4 to 6 hours after chemotherapy administration Serving small portions of bland food Administering metoclopramide and dexamethasone as ordered
Administering metoclopramide and dexamethasone as ordered
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient? Syngeneic Autologous Allogeneic Homogenic
Allogeneic
Which is a sign or symptom of septic shock? Warm, moist skin Hypertension Increased urine output Altered mental status
Altered mental status
The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome? Onset of cancer after age 50 in family member An aunt and uncle diagnosed with cancer A first cousin diagnosed with cancer A second cousin diagnosed with cancer
An aunt and uncle diagnosed with cancer
5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? Mitotic spindle poisons Antimetabolite Nitrosoureas Alkylating
Antimetabolite
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client? Autologous Therapeutic Prophylactic Allogeneic
Autologous
The nurse is evaluating bloodwork results of a client with cancer who is receiving chemotherapy. The client's platelet count is 60,000/mm3. Which is an appropriate nursing action? Taking the client's temperature rectally Avoiding the use of products containing aspirin Providing a razor so the client can shave Providing commercial mouthwash to the client
Avoiding the use of products containing aspirin
A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan? Avoiding using soap on the irradiated areas Wearing a lead apron during direct contact with the client Applying talcum powder to the irradiated areas daily after bathing Removing thoracic skin markings after each radiation treatment
Avoiding using soap on the irradiated areas
When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? Berries and orange vegetables Dairy products Beans, dried fruits, and leafy, green vegetables Fruits high in vitamin C, such as oranges and grapefruits
Beans, dried fruits, and leafy, green vegetables
The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? D A E C
C
Which oncologic emergency involves the accumulation of fluid in the pericardial space? Tumor lysis syndrome Disseminated intravascular coagulation (DIC) Syndrome of inappropriate antidiuretic hormone release (SIADH) Cardiac tamponade
Cardiac tamponade
A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia? Monitor daily platelet counts. Check the client's history for a congenital link to thrombocytopenia. Perform a cardiovascular assessment every 4 hours. Closely observe the client's skin for petechiae and bruising.
Closely observe the client's skin for petechiae and bruising.
The nurse is conducting a community education program using the American Cancer Society's colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which screening test every 10 years? Fecal occult blood test Papanicolaou (Pap) Colonoscopy Prostate-specific antigen (PSA)
Colonoscopy
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? Palliation Prevention Cure Control
Control
The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level? Bright red venous blood. Decreased oxygen level. Increased bruising. Elevated temperature.
Decreased oxygen level.
A home care nurse is caring for a client with multiple myeloma. Which nursing interventions are appropriate for this client? Select all that apply. Delay position changes and bathing if the client is experiencing pain. Limit fluid intake. Monitor renal function Instruct the client to avoid activities that may cause injury. Assist with ambulation because exercise can worsen loss of calcium from the bone.
Delay position changes and bathing if the client is experiencing pain. Monitor renal function Instruct the client to avoid activities that may cause injury.
An oncology nurse is caring for a client who relates that certain tastes have changed. The client states that "meat tastes bad." What nursing intervention can be used to increase protein intake for a client with taste changes? Encourage eating cheese, eggs, and legumes Encourage maximum fluid intake. Suck on hard candy during treatment. Stay away from protein beverages.
Encourage eating cheese, eggs, and legumes
A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue? Incisional biopsy Excisional biopsy Needle biopsy Punch biopsy
Excisional biopsy
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? Nausea and vomiting Bone pain Stomatitis Extravasation
Extravasation
A client is receiving radiation therapy and asks the nurse about oral hygiene. What teaching specific to the client's situation should the nurse include? Treat cavities immediately. Use a soft toothbrush and allow it to air dry before storing. Gargle after each meal. Floss before going to bed.
Floss before going to bed.
The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important? Shield your throat area when near others. Use disposable utensils for the next month. Flush the toilet several times after every use. Prepare food separately from family members.
Flush the toilet several times after every use.
When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? Inspect the skin frequently. Time, distance, and shielding The use of disposable utensils and wash cloths Avoid showering or washing over skin markings.
Inspect the skin frequently.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? Providing for frequent rest periods Inspecting the skin for petechiae once every shift Administering aspirin if the temperature exceeds 102° F (38.8° C) Placing the client in strict isolation
Inspecting the skin for petechiae once every shift
A client is receiving the cell cycle-nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of chemotherapy regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects? It interferes with DNA replication and RNA transcription. It interferes with ribonucleic acid (RNA) transcription only. It interferes with deoxyribonucleic acid (DNA) replication only. It destroys the cell membrane, causing lysis.
It interferes with DNA replication and RNA transcription.
A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? It prevents alopecia. It stimulates the immune system against the tumor cells. It treats drug-related anemia. It lowers serum and uric acid levels.
It lowers serum and uric acid levels.
A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells? Liver Colon White blood cells (WBCs) Reproductive tract
Liver
The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest? Malignant tumor with metastasis to surrounding tissue Normal finding Benign fibrocystic disease Malignant tumor
Malignant tumor
The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant? Monitor the client's heart rate. Monitor the client closely to prevent infection. Monitor the client's toilet patterns. Monitor the client's physical condition.
Monitor the client closely to prevent infection.
According to the tumor-node-metastasis (TNM) classification system, T0 means there is No regional lymph node metastasis No evidence of primary tumor No distant metastasis Distant metastasis
No evidence of primary tumor
Which type of surgery is used in an attempt to relieve complications of cancer? Palliative Reconstructive Prophylactic Salvage
Palliative
A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action? Place the client in a private room. Have visitors wear dosimeters for safety. Allow visitors to telephone only. Place a chair next to the bed to allow the spouse to sit.
Place the client in a private room.
A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis? Provide a solution of viscous lidocaine for use as a mouth rinse. Check regularly for signs and symptoms of stomatitis. Recommend that the client discontinue chemotherapy. Monitor the client's platelet and leukocyte counts.
Provide a solution of viscous lidocaine for use as a mouth rinse.
A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? Counsel the patient about the possibility of losing her breast. Clarify information provided by the physician. Provide aseptic care to the incision postoperatively. Provide time for the patient to discuss her concerns.
Provide time for the patient to discuss her concerns.
A male client has been unable to return to work for 10 days following chemotherapy as the result of ongoing fatigue and inability to perform usual activities. Laboratory test results are WBCs 2000/mm³, RBCs 3.2 x 10¹²/L, and platelets 85,000/mm³. The nurse notes that the client is anxious. Which of the following is the priority nursing diagnosis? Fatigue related to deficient blood cells Risk for infection related to inadequate defenses Activity intolerance related to side effects of chemotherapy Anxiety related to change in role function
Risk for infection related to inadequate defenses
A client with multiple myeloma presents to the emergency department and reports excessive thirst and constipation. Family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? Hemoglobin of 9.8 g/dl Serum calcium level 13.8 mg/dl Platelet count 300,000/mm3 Serum sodium level of 133 mEq/L
Serum calcium level 13.8 mg/dl
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? Sodium level of 142 mEq/L Serum potassium level of 2.6 mEq/L Blood pressure of 120/64 to 130/72 mm Hg Urine output of 400 ml in 8 hours
Serum potassium level of 2.6 mEq/L
The nurse is caring for a client with cancer. The client asks the nurse why colony-stimulating factors are being administered in addition to chemotherapy. Which response by the nurse is appropriate? Decrease the need for additional adjuvant therapies Shorten the period of neutropenia Suppression of the bone marrow Enhance action of the chemotherapy
Shorten the period of neutropenia
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? Ate 75% of all meals during the day White blood cell (WBC) count of 9,000 cells/mm3 Stage 3 pressure ulcer on the left heel Temperature of 98.3° F (36.8° C)
Stage 3 pressure ulcer on the left heel
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? Histology of tissue Staging of disease Total blood cell count Involvement of lymph nodes
Staging of disease
A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately Gives prednisolone IV Places the client on oxygen by nasal cannula Stops the chemotherapeutic infusion Administers diphenhydramine
Stops the chemotherapeutic infusion
The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks? Hand washing and infection prevention Pool and water safety Breast and testicular self-exams Sun safety and use of sunscreen
Sun safety and use of sunscreen
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? The client states he is nauseous. The I.V. site is red and swollen. The laboratory reports a white blood cell (WBC) count of 1,000/mm3. The client begins to shiver.
The I.V. site is red and swollen.
What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? The hair will grow back the same as it was before treatment. The hair will grow back within 2 months post therapy. The client should consider getting a wig or cap prior to beginning treatment. Alopecia related to chemotherapy is relatively uncommon.
The client should consider getting a wig or cap prior to beginning treatment.
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? The client with painful lymph nodes in the groin. The client with a painful sore throat. The client with enlarged lymph nodes in the neck. The client with painful lymph nodes under the arm.
The client with enlarged lymph nodes in the neck.
A client with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective? The client's PT is within reference ranges. The client's platelet level is below 100,000/mm3. Arterial blood sampling tests positive for the presence of factor XIII. The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.
The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.
Which statement is true about malignant tumors? They gain access to the blood and lymphatic channels. They demonstrate cells that are well differentiated. They usually grow slowly. They grow by expansion.
They gain access to the blood and lymphatic channels.
Which statement best describes the function of stem cells in the bone marrow? They produce antibodies against foreign antigens. They are active against hypersensitivity reactions. They defend against bacterial infection. They produce all blood cells.
They produce all blood cells.
After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? Anemia Leukopenia Thrombocytopenia Neutropenia
Thrombocytopenia
The physician is attending to a client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation? To analyze the lymph nodes involved To destroy marginal tissues To prevent the formation of new cancer cells To remove the tumor from the brain
To prevent the formation of new cancer cells
The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? Random, rapid growth of the tumor Tumor pressure against normal tissues Cells colonizing to distant body parts Emission of abnormal proteins
Tumor pressure against normal tissues
What is the best way for the nurse to assess the nutritional status of a patient with cancer? Monitor daily caloric intake. Weigh the patient daily. Assess BUN and creatinine levels. Observe for proper wound healing.
Weigh the patient daily.
Which of the following would be inconsistent as a common side effect of chemotherapy? Myelosuppression Alopecia Weight gain Fatigue
Weight gain
The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? works as a secretary at a medical radiation treatment center eats red meat such as steaks or hamburgers every day uses the treadmill for 30 minutes on 5 days each week drinks one glass of wine at dinner each night
eats red meat such as steaks or hamburgers every day
The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply. environmental factors age dietary substances viruses gender
environmental factors dietary substances viruses
An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching? cryosurgery prophylactic local excision palliative
prophylactic
A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse? -"You will have to decide if refusing the blood transfusion is worth the risk to your health." -"I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion." -"I understand your concern. The blood is carefully screened but is not completely risk free." -"The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood."
"I understand your concern. The blood is carefully screened but is not completely risk free."
A nurse is teaching a client with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which statement by the client? -"I will eat a spinach salad with lunch and dinner." -"I will eat more dairy products such as milk, yogurt, and ice cream every day." -"I will increase my daily intake of orange vegetables such as sweet potatoes and carrots." -"I will eat a meat source such as chicken or pork with each meal."
"I will eat a meat source such as chicken or pork with each meal."
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." "I will receive parenteral vitamin B12 therapy for the rest of my life."
"I will receive parenteral vitamin B12 therapy for the rest of my life."
A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse? "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children." "I'll see a genetic counselor before starting a family." "I need to learn how to give myself vitamin B12 injections." "Thalassemia is treated with iron supplements."
"I'll see a genetic counselor before starting a family."
A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching? "My family will donate blood, because it's safer." "Donated blood is tested for blood type and infections." "I should expect blood withdrawal to take about 15 minutes." "I could donate my own blood in case I need a transfusion."
"My family will donate blood, because it's safer."
The physician orders a transfusion with packed red blood cells (RBCs) for a client hospitalized with severe iron deficiency anemia. When blood is administered, what is the most important action the nurse can take to prevent a transfusion reaction? Assess the client 30 minutes after the start of the initial transfusion Premedicate the client with acetaminophen Verify the client's identity according to hospital policy Administer the blood as soon as it arrives
Verify the client's identity according to hospital policy
A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem? Folic acid deficiency Vitamin B12 deficiency Vitamin A deficiency Vitamin C deficiency
Vitamin B12 deficiency
The most common cause of iron deficiency anemia in men and postmenopausal women is bleeding. iron malabsorption. menorrhagia. chronic alcoholism.
bleeding
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? Pancreas Liver Kidney GI tract
liver
A client with sickle cell anemia has a low hematocrit. normal blood smear. high hematocrit. normal hematocrit.
low hematocrit.
A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse? To detect the evidence of infection such as fever and tachycardia To detect the evidence of dehydration that might have triggered a sickle cell crisis To detect the abnormal sounds suggestive of acute chest syndrome and heart failure To detect the motor strength and stroke-related signs and symptoms
To detect the abnormal sounds suggestive of acute chest syndrome and heart failure
When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature? Increased blood viscosity, resulting from an overproduction of white cells Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Compensatory polycythemia stimulated by thrombocytopenia Reduced plasma volume in response to a reduced production of cellular elements
Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements
A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client? Bone marrow decreases the erythrocyte production causing decrease in hypoxia. Overhydration enlarges the red blood cells. The client has a decreased tolerance of pain related to the chronic nature of the illness. Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.
Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.
Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called megaloblasts. blast cells. mast cells. monocytes.
megaloblasts
A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: to the bedside commode. to a standing position so he can urinate. onto the bedpan. to the bathroom.
onto the bedpan.
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? pathologic bone fractures. chronic liver failure. acute heart failure. hypoxemia.
pathologic bone fractures.
The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? Iron may cause indigestion and should be taken with an antacid such as Mylanta. Do not take medication with orange juice because it will delay absorption of the iron. Discontinue the use of iron if your stool turns black. Dilute the liquid preparation with another liquid such as juice and drink with a straw.
Dilute the liquid preparation with another liquid such as juice and drink with a straw.
A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine? -Add the morphine to the blood to be slowly administered. -Disconnect the blood tubing, flush with normal saline, and administer morphine. -Inject the morphine into a distal port on the blood tubing. -Administer the morphine into the closest tubing port to the client for fast delivery.
Disconnect the blood tubing, flush with normal saline, and administer morphine.
The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction? Documenting the reaction in the client's medical record. Informing the client to leave a urine sample after the client's next void. Notifying the blood bank of the reaction. Disposing of the blood container and tubing in biohazard waste.
Disposing of the blood container and tubing in biohazard waste.
What food should the nurse recommend for a client diagnosed with vitamin B12 deficiency? Citrus fruit Whole-grain bread Lean meat Green vegetables
Lean meat
The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? Vitamin B12 Fresh frozen plasma Folate Iron
Iron
While assessing a client, the nurse will recognize what as the most obvious sign of anemia? Pallor Flow murmurs Jaundice Tachycardia
Pallor
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. What is the most common complication of the pathology resulting from this process? Increased mobility Pathologic fractures Calcified bones Osteoporosis
Pathologic fractures
The client is diagnosed with polycythemia vera. The nurse prepares the client for which procedure? Apheresis Platelet infusion Phlebotomy Blood transfusion
Phlebotomy
A client is returning home after having a bone marrow aspiration and biopsy. Which statement indicates that teaching by the nurse has been effective? "I should take aspirin if I have any pain." "I can go to the gym to lift weights later." "The area might ache for 1 to 2 days." "I can resume my normal activities."
"The area might ache for 1 to 2 days."
A nurse is caring for a client who will undergo total knee replacement and will have an autologous transfusion. Which statement will the nurse include when teaching the client about the transfusion? "You will likely not need the blood that is donated." "You typically donate blood the day of the surgery." "You typically donate blood 4 to 6 weeks before the surgery." "You will be prescribed calcium to replace what is lost during donation."
"You typically donate blood 4 to 6 weeks before the surgery."
The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise? -This type of exercise increases arterial circulation as it returns to the heart. -Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. -Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. -Isometric exercise decreases the workload of the heart and restores oxygenated blood flow.
Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.
A nurse cares for a client with myelodysplastic syndrome (MDS). Which assessment finding does the nurse recognize is the most common finding with this condition? Proliferative anemia Microcytic anemia Hemolytic anemia Macrocytic anemia
Macrocytic anemia
A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? Potassium level of 5.2 mEq/L Creatinine level of 6 mg/100 mL Calcium level of 9.4 mg/dL Magnesium level of 2.5 mg/dL
Creatinine level of 6 mg/100 mL
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. Provide a clear liquid, low-sodium diet. Put on a mask, gown, and gloves when entering the client's room. Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.
Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.
The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? WBC count of 4,200 cells/uL Platelet count of 9,000/mm3 Creatinine level of 1.0 mg/dL Hematocrit of 38%
Platelet count of 9,000/mm3
The nurse recognizes the clinical assessment of a patient with acute myeloid leukemia (AML) includes observing for signs of infection early. What nursing action will most likely help prevent infection? Practice vigilant handwashing. Monitor the client's temperature every shift. Maintain contact precautions. Encourage increased fluid consumption.
Practice vigilant handwashing.
The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia? "I have difficulty breathing when walking 30 feet." "I have a difficult time falling asleep at night." "I have an increase in my appetite." "I feel hot all of the time."
"I have difficulty breathing when walking 30 feet."
A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? Check the client's history. Assess the client's hemoglobin and platelets. Assess the client's skin. Assess the client's pulse and blood pressure.
Assess the client's hemoglobin and platelets.
Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? Plasma cell Basophils B lymphocyte Neutrophil
Basophils
A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention? -Monitoring the client's heart rate and reviewing the client's hemoglobin -Monitoring the client's blood pressure and reviewing the client's hematocrit -Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential -Monitoring the client's breathing and reviewing the client's arterial blood gases
Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Pancytopenia Thrombocytopenia Anemia Neutropenia
Neutropenia
The nurse provides care for an older adult client, diagnosed with anemia, who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine the cause of the client's blood loss, which is the priority nursing action? Evaluate the client's dietary intake. Monitor the client's body temperature. Monitor the client's blood pressure. Observe the client's stools for blood.
Observe the client's stools for blood.
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? "Treatment is simple and consists of single-drug therapy." "The goal of therapy is palliation." "Intrathecal chemotherapy is used primarily as preventive therapy." "Side effects are rare with therapy."
"Intrathecal chemotherapy is used primarily as preventive therapy."
A nurse is teaching a client with multiple myeloma about the therapeutic benefits of radiation therapy. Which statements will the nurse include in the teaching? Select all that apply. "It helps to strengthen the bone." "It decreases excess calcium." "It helps to decrease bone pain." "It decreases the bone malignancy." "It helps to activate an immune response."
"It helps to strengthen the bone." "It helps to decrease bone pain."
The nurse is caring for a client who has a unit of whole blood removed every 6 weeks as treatment for polycythemia vera. Which laboratory test will the nurse monitor to determine if the procedure is adversely affecting the client? Iron Potassium Calcium White blood cell count
Iron
A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC? -"DIC is a complication of an autoimmune disease that attacks the body's own cells." -"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." -"DIC occurs when the immune system attacks platelets and causes massive bleeding." -"DIC is caused when hemolytic processes destroy erythrocytes."
"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."
A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? -Electrolyte imbalance that could affect the blood's ability to coagulate properly -Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels -Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels -Low levels of urine constituents normally excreted in the urine
Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? Eliminate direct contact with others who are infectious Implement neutropenic precautions Monitor temperature at least once per shift Apply prolonged pressure to needle sites or other sources of external bleeding
Apply prolonged pressure to needle sites or other sources of external bleeding
A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? ECG antibiotic CBC chest radiograph
CBC
A nurse cares for a client with early Hodgkin lymphoma. While assessing the client, the nurse will most likely find painless enlargement of which lymph node? Inguinal Popliteal Axillary Cervical
Cervical
A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? Decreased level of erythropoietin Increased reticulocyte count Increased mean corpuscular volume Decreased total iron-binding capacity
Decreased level of erythropoietin
The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption? Eating a steak with mushrooms Eating apple slices with carrots Eating leafy green vegetables with a glass of water Eating calf's liver with a glass of orange juice
Eating calf's liver with a glass of orange juice
A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider? Ensure there is an oxygen delivery device at the bedside. Place the client in a recumbent position with legs elevated. Administer prescribed PRN anti-anxiety agent. Remove the intravenous line.
Ensure there is an oxygen delivery device at the bedside.
A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for? Extreme leukocytosis Renal transplantation Sickle cell anemia Essential thrombocythemia
Essential thrombocythemia
A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host? Remission Graft-versus-host disease Acute respiratory distress syndrome Bone marrow depression
Graft-versus-host disease
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? Neutrophil Monocyte Lymphoid stem cell Myeloid stem cell
Myeloid stem cell
A client with a diagnosis of pernicious anemia comes to the clinic reporting of numbness and tingling in his arms and legs. What do these symptoms indicate? Severity of the disease Neurologic involvement Insufficient intake of dietary nutrients Loss of vibratory and position senses
Neurologic involvement
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Neutropenia Pancytopenia Thrombocytopenia Anemia
Neutropenia
A client is awaiting test results to diagnose Hodgkin lymphoma. The nurse knows that which result is the hallmark for the diagnosis of this condition? Increased basophils Misshaped red blood cells Elevated platelet count Reed-Sternberg cells
Reed-Sternberg cells
One hour after a transfusion of packed red blood cells (RBCs) is started, a client develops redness on the trunk and reports itching. The nurse stops the RBC infusion and administers diphenhydramine 25 mg po, as ordered. Thirty minutes later, the redness and itching are gone. What action should the nurse take next? Position the client in an upright position with the feet in a dependent position Send the blood back to the blood bank Resume the transfusion Obtain blood and urine samples from the client
Resume the transfusion
What does the nurse recognize as secondary sites of hematopoiesis that is unique to embryonic development? Select all that apply. Spleen Kidney Pancreas Bone marrow Liver
Spleen Liver
The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells? -The bone marrow is stimulated by low oxygen levels in the blood to produce erythropoietin, maturing the red blood cells. -The brain senses low oxygen levels in the blood and produces hemoglobin, which binds to more red blood cells. -The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. -The kidneys sense low oxygen levels in the blood and produce hemoglobin, stimulating the marrow to produce more red blood cells.
The kidneys sense low oxygen levels in the blood and produce hemoglobin, stimulating the marrow to produce more red blood cells.
The nurse assesses a patient for late-stage chronic lymphocytic leukemia (CLL) by looking for what? Hepatomegaly. Thrombocytopenia. Splenomegaly. Lymphadenopathy.
Thrombocytopenia
A nurse cares for a client who has had a bone marrow aspiration. In addition to the client's aspiration site, what locations on the body does the nurse recognize as having bone marrow? Select all that apply. Vertebrae Sternum Ribs Tibia Pelvis
Vertebrae Sternum Ribs Pelvis
A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client has leukopenia. may be developing anemia. has thrombocytopenia. may be developing an infection.
may be developing an infection.
A nursing instructor in a BSN program is preparing for a lecture on disorders of the hematopoietic system. Included in the lecture are conditions caused by reduced levels or absence of blood-clotting proteins. Which of the following is the instructor most likely referring to? Sickle cell disease Coagulopathy Pancytopenia Aplastic anemia
Coagulopathy
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? Angina pectoris, double vision, and anorexia Sore tongue, dyspnea, and weight gain Pallor, tachycardia, and a sore tongue Pallor, bradycardia, and reduced pulse pressure
Pallor, tachycardia, and a sore tongue
The hospitalized client is experiencing gastrointestinal bleeding with a platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take? Teach the client to vigorously floss the teeth to prevent infections. Request a prescription of diphenoxylate and atropine for loose stools. Perform a neurologic assessment with vital signs. Use contact precautions with this client.
Perform a neurologic assessment with vital signs.
The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing intervention to help prevent fractures in the client? Promote safety. Provide adequate hydration. Increase mobility. Encourage adequate nutrition.
Promote safety.
Which medication is the antidote to warfarin? Protamine sulfate Clopidogrel Aspirin Vitamin K
Protamine sulfate
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction? Rh-positive mother; Rh-positive child Rh-positive mother; Rh-negative child Rh-negative mother; Rh-positive child Rh-negative mother; Rh-negative child
Rh-negative mother; Rh-positive child
A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? Sensory-perception disturbance Impaired tissue integrity Risk for falls Acute pain
Risk for falls
A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching? Decrease intake of fruits and juices Decrease intake of dietary fiber Take with dairy products Take 1 hour before breakfast
Take 1 hour before breakfast
A nurse is caring for a client with a diagnosis of lymphocytopenia. Which assessment finding will the nurse consider most concerning when caring for this client? Prothrombin time 12 seconds Temperature of 37.7 degrees Celsius INR 0.9 Blood pressure 132/92
Temperature of 37.7 degrees Celsius
The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption? Myelodysplastic syndrome Neutropenia Thrombocytopenia Anemia
Anemia
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? Elevate the client's legs. Keep the feet cool. Encourage ambulation. Assess for signs of injury.
Assess for signs of injury.
The nurse cares for a client with a coagulation factor deficiency who is actively bleeding. Which blood component replacement does the nurse anticipate administering? Antithrombin III PRBCs FFP IV gamma-globulin
FFP
Which term describes the percentage of blood volume that consists of erythrocytes? Hematocrit Erythrocyte sedimentation rate (ESR) Hemoglobin Differentiation
Hematocrit
A client's electronic health record states that the client receives regular transfusions of factor IX. The nurse would be justified in suspecting that this client has what diagnosis? Hodgkin lymphoma Hemophilia Leukemia Hypoproliferative anemia
Hemophilia
A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for? Shock Hemorrhage Blood transfusion reaction Splintering of bone fragments
Hemorrhage
When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. Dietary intake Herbal supplements Hair color Ethnicity Medication use
Dietary intake Herbal supplements Ethnicity Medication use
A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for? Laryngeal edema Hair loss Diarrheal stools Adventitious lung sounds
Diarrheal stools
A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition? "The condition is likely caused by a folate deficiency." "The condition is likely caused by a vitamin B12 deficiency." "The condition causes abnormally small red blood cells." "The condition causes abnormally rigid red blood cells."
"The condition is likely caused by a vitamin B12 deficiency."
Which client is not a candidate to be a blood donor according to the American Red Cross? 18-year-old male weighing 52 kg 26-year-old female with hemoglobin 11.0 g/dL 50-year-old female with pulse 95 beats/minute 86-year-old male with blood pressure 110/70 mm Hg
26-year-old female with hemoglobin 11.0 g/dL
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A 52-year-old patient with acute kidney injury A 40-year-old patient with a history of hypertension A 72-year-old patient with a history of cancer A 24-year-old female taking oral contraceptives
A 72-year-old patient with a history of cancer
The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? A decrease in granulocytes A general reduction in neutrophils and basophils Too many erythrocytes A general reduction in all white blood cells
A general reduction in all white blood cells
The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? Pain and tenderness in calf area Crackles auscultated bilaterally Oral temperature of 97°F Respiratory rate of 10 breaths/minute
Crackles auscultated bilaterally
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? Hypercalcemia Hypermagnesemia Hyperkalemia Hypernatremia
Hypercalcemia
Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? Microcytic Hypochromic Normocytic Hyperchromic
Hypochromic
A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive? Antimicrobial therapy Induction therapy Standard therapy Supportive therapy
Induction therapy
The nurse is caring for a client at high risk for thrombocythemia. Which treatments will the nurse anticipate being prescribed for this client? Select all that apply. Interferon-alfa Aspirin Hydroxyurea Anagrelide Diphenhydramine
Interferon-alfa Aspirin Hydroxyurea Anagrelide
The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have? Aplastic anemia Megaloblastic anemia Iron deficiency anemia Sickle cell anemia
Iron deficiency anemia
A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which reason? Hypervolemia Lack of erythropoietin Preparation for likely nephrectomy Increases the effectiveness of dialysis
Lack of erythropoietin
The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in? Supine with head of the bed elevated 30 degrees Lithotomy position Jackknife position Lateral position with one leg flexed
Lateral position with one leg flexed
During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? Elevated hematocrit concentration Elevated red blood cell (RBC) count Enlarged mean corpuscular volume (MCV) Low ferritin level concentration
Low ferritin level concentration
The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client? The client is experiencing vascular collapse. The client is having decrease in tissue perfusion from a shock state. The client is having an allergic reaction to the blood. The client is having a febrile nonhemolytic reaction.
The client is having a febrile nonhemolytic reaction.
A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that destroy marrow can resume production of blood cells. Which explanation by the students is correct? -Fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required. -The three cell types—erythrocytes, leukocytes, and platelets—can resume production of stem cells. -The remaining stem cells have the ability to continue with the process of self-replication, creating an endless supply. -The liver and spleen can resume production of blood cells through extramedullary hematopoiesis.
The liver and spleen can resume production of blood cells through extramedullary hematopoiesis.
