Immune and Hematologic Disorders PrepU
A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching?
"I can eat whatever I want as long as it's low in fat."
A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?
"It will get better and worse again."
A client with allergic rhinitis asks the nurse what to do to decrease rhinorrhea. Which instruction would be appropriate for the nurse to give the client?
"Keep a diary of when your symptoms occur. This can help you identify what precipitates your attacks."
A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?
"My finger joints are oddly shaped."
A client with pernicious anemia asks why she must take vitamin B12 injections forever. What is the nurse's best response?
"The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient amounts of a factor that allows the vitamin to be absorbed."
A family member of a client who is human immunodeficiency virus (HIV) positive is concerned about the possibility of also being HIV positive. What is the best response by the nurse?
"What's your understanding about how HIV is transmitted?"
The nurse is to administer subcutaneous heparin to an underweight older adult. What should the nurse consider when administering this medication? Select all that apply.
-It is administered in the anterior area of the iliac crest. -A 27-gauge, 5/8-inch (1.6-mm) needle should be used. -Cephalosporin potentiates the effects of heparin. -The dose should be verified with another nurse according to agency policy.
A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving
A-positive blood to an A-negative client.
After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first?
Administer epinephrine.
A 35-year-old female client is diagnosed with aplastic anemia. Which nursing measure should the nurse incorporate into the client's plan of care?
Alternate periods of activity with rest to decrease fatigue.
Following a splenectomy, a client has a hemoglobin (Hb) level of 7.5 g/dl and has vertigo when getting out of bed. The nurse suspects abnormal orthostatic changes. What vital sign values most support the nurse's analysis?
Blood pressure of 80/40 mm Hg and pulse of 130 beats per minute.
A parent asks the nurse if a child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which principle?
Children with iron deficiency anemia are more susceptible to infection than are other children.
A mother asks the nurse if her child's iron-deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following?
Children with iron-deficiency anemia are more susceptible to infection than are other children.
After one week in the hospital for chemotherapy treatment related to lymphocytic leukemia, a client develops abdominal pain, fever, and foul-smelling diarrhea. What priority recommendation does the nurse make to the healthcare provider?
Collect stool sample for clostridioides difficile.
The nurse is caring for a client being discharged following kidney transplantation. The client is ordered mofetil to prevent organ rejection. Which nursing instruction is essential regarding medication use?
Contact the health care provider at first signs of an infection.
A client from a Mediterranean country is admitted with thalassemia, jaundice, splenomegaly, and hepatomegaly. Which should be the primary focus of nursing care for this client?
Decrease cardiac demands by promoting rest.
A client with acute lymphocytic leukemia is receiving vincristine. Prior to infusing the drug, the nurse administers diphenhydramine. What should the nurse tell the client about the purpose of taking diphenhydramine?
Diphenhydramine decreases the incidence of a reaction to the vincristine.
A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). What is the expected outcome of AZT for this client?
Enable slow replication of the virus.
A college student comes to the campus health care center with reports of headache, malaise, and a sore throat that has worsened over the past 10 days. The nurse measures a temperature of 102.6° F (39.2° C) and finds an enlarged spleen and liver and exudative tonsillitis. Laboratory tests reveal a leukocyte count of 20,000/mm3, antibodies to Epstein-Barr virus, and abnormal liver function tests. What are the nurse's priority action(s)?
Encourage fluids and treat fever.
The nurse is preparing to administer platelets. What should the nurse do first?
Gently rotate the bag.
A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated?
IgE
A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that the client has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority?
Ineffective tissue perfusion: cerebral, cardiopulmonary, GI
A client diagnosed with osteoarthritis tells the nurse, "My friend takes steroid pills for their rheumatoid arthritis. Should I be taking steroids, too?" What should the nurse tell the client?
Intra-articular corticosteroid injections are used to treat osteoarthritis.
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?
Risk for injury
A nurse is administering an intravenous (IV) antineoplastic agent when the client says, "My arm is burning by the IV site." What should the nurse do first?
Stop infusing the medication.
A client who is receiving a blood transfusion suddenly experiences chills and a temperature of 101°F (38.3°C). The client also has a headache and appears flushed. Place the nursing actions in the order in which the nurse should perform them to properly respond to this client's situation. All options must be used.
Stop the blood infusion. Infuse normal saline to keep the vein open. Obtain a blood culture from the client. Send the blood bag and administration set to the blood bank.
A client who follows a vegetarian diet was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client needs further nutritional counseling?
The client drinks coffee or tea with meals.
The nurse has received a bag of platelets from the pharmacy and is preparing to administer them to a client. Which finding indicates that the nurse should contact the pharmacist?
The platelet bag is cold.
The nurse is assisting with a bone marrow aspiration and biopsy. Place the tasks in the order in which the nurse should perform them, from highest priority to least priority. All options must be used.
Verify the client has signed an informed consent. Position the client in a side-lying position. Clean the skin with an antiseptic solution. Apply ice to the biopsy site.
A client with granulocytopenia has many visitors. What is the most important thing the nurse should tell the visitors to do to prevent infection?
Wash their hands.
Which client is most likely to develop systemic lupus erythematosus (SLE)?
a 27-year-old black female
The nurse is planning an education program for a group of clients. Which person(s) would be at risk for developing rheumatoid arthritis (RA)? Select all that apply.
a client between the age of 20 and 50 years a client with the Epstein-Barr virus a client with the genetic link HLA-DR4
The nurse is caring for a client in sickle cell crisis. What nursing action is the highest priority?
administering analgesics as prescribed
The nurse is administering an intravenous (IV) infusion of packed red blood cells and normal saline solution to a client who is in hemorrhagic shock. Which is a priority for the nurse to assess for this client?
anaphylactic reaction
A sexually active client asks the nurse about using pre-exposure prophylaxis (PrEP) for HIV. The nurse should tell the client the drug, a combination of 300 mg tenofovir disoproxil fumarate and 200 mg emtricitabine (TDF/FTC) can be used for which group of people who are at risk for becoming infected with human immunodeficiency virus (HIV)?
anyone who is in an ongoing sexual relationship with an HIV-infected partner
When starting the client's intravenous infusion line, the nurse applies a tourniquet and selects the site for inserting the needle. When should the nurse remove the tourniquet?
as soon as the needle is in the vein
A client with a pleural effusion has a diagnostic thoracentesis. The nurse notifies the healthcare provider immediately upon discovering what assessment finding?
asymmetrical chest expansion
A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?
intrinsic factor
What nursing interventions should a nurse expect to implement when caring for a child in acute sickle cell crisis? Select all that apply.
maintaining adequate hydration providing adequate pain control frequently monitoring vital signs
A client with rheumatoid arthritis is receiving antiinflammatory drugs and physical therapy. What is the expected outcome of these actions?
manage joint pain and fatigue to perform activities of daily living.
A client is taking large doses of aspirin daily to treat rheumatoid arthritis. The nurse should instruct the client to tell the health care provider (HCP) when having:
tinnitus
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the health care provider (HCP) immediately?
urine output of 20 ml/hour
The nurse is teaching a client about preventing toxic shock syndrome (TSS). Which action is a risk factor for toxic shock syndrome?
using only tampons at night
A nurse applies standard precautions when caring for a client with human immunodeficiency virus (HIV). The nurse takes what action when applying standard precautions?
wearing gloves for providing mouth care
A client who is human immunodeficiency virus (HIV) positive has been told that the biopsies of facial lesions indicate Kaposi's sarcoma. The client asks, "Does this mean I have AIDS (acquired immunodeficiency syndrome) now?" How does the nurse respond?
"Because Kaposi's sarcoma is an indication of a failing immune system, this does meet the criteria for a diagnosis of AIDS."
The parent brings a child to the clinic after discharge from the hospital for Guillain-Barré syndrome. Which statement by the parent indicates that the discharge plan is being followed?
"I take them to the pool where it is possible to exercise with other children."
A client with iron-deficiency anemia is prescribed liquid iron supplements. The nurse evaluates the client's understanding of how to take this drug. Which statement indicates the client has adequate knowledge?
"I'll dilute the medication and drink it with a straw."
A client with mild dementia related to end-stage acquired immunodeficiency syndrome is preparing for discharge. The client has decided against further curative treatment and wishes to return home. Before discharge, the client develops ocular cytomegalovirus (CMV). The physician recommends treatment with a ganciclovir-impregnated implant, which requires a surgical procedure. The client's partner feels the implant won't help the client and asks the nurse if the implant will cure CMV. Which answer from the nurse best answers the partner's question reflecting client advocacy?
"The implant won't cure the virus, but it may help preserve your partner's vision. Not being able to see you or the surroundings may worsen your partner's dementia and make caring for your partner at home more difficult."
A client with a new diagnosis of human immunodeficiency virus (HIV) tells the nurse, "I did not think drinks, dinner, and great sex would lead to a life-threatening disease." Which of the following is a therapeutic response by the nurse?
"This sounds distressing for you. What questions do you have?"
A nurse is teaching a young adult female client about self-management of systemic lupus erythematosus (SLE). The client is prescribed ibuprofen, hydroxychloroquine, and cyclophosphamide. The client asks the nurse about the possibility of becoming pregnant while being treated for SLE. What is the nurse's best response?
"You should speak with your healthcare provider about alternatives to taking cyclophosphamide."
A client is about to undergo bone marrow aspiration of the sternum. What should the nurse tell the client?
"You will feel a pulling type of discomfort for a few seconds."
The wife of a client with end-stage acquired immunodeficiency syndrome (AIDS) is caring for her husband at home. The hematologist recommends hospice care and the couple agrees. During the initial admission visit, the hospice nurse provides information to the client and his family about an advance directive. During the next day's visit, the client states that since he and his wife filled out the advance directive form, he feels abandoned by his physician. Which statement by the hospice nurse best addresses the client's concerns?
"Your physician will continue to care for you. The advance directive simply puts in writing the care you want, so the physician will be able to provide it if you can't tell him yourself."
A client is having a blood transfusion reaction. What must the nurse do in order of priority from first to last? All options must be used.
-Stop the transfusion. -Keep the intravenous (IV) line open with normal saline infusion. -Notify the health care provider (HCP) and blood bank. -Complete the appropriate transfusion reaction form(s).
A client had an anaphylactic reaction and requires intravenous fluids. The order calls for 1000 mL of normal saline to be administered over 8 hours using an infusion set with a drop factor of 10 gtt/mL. How many drops per minute should the client receive? Record the answer using a whole number.
21
A nurse is preparing to administer a unit of blood to a client with anemia. After removal of the blood from the refrigerator, the transfusion of the blood must be completed within:
4 hours.
A client infected with human immunodeficiency virus (HIV) has a low CD4+ level. What intervention should the nurse implement?
Place the client in reverse isolation.
The nurse explains to the client that a biopsy of the enlarged lymph node is important because, if Hodgkin's disease is present, the histologic examination will reveal which of the following?
Reed-Sternberg cells.
The nurse is preparing to start an intravenous (IV) infusion and has raised the head of the client's bed. After the nurse applies gloves to insert an IV catheter, the client begins to rub the eyes and wipe away nasal drainage. What should the nurse do first?
Remove the gloves, and assess the client's vital signs.
A nurse is providing care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis?
Risk for impaired skin integrity
The nurse is teaching a client with rheumatoid arthritis about measures to conserve energy in activities of daily living involving the small joints. Which activity, if observed by the nurse, indicates the need for additional teaching?
carrying a laundry basket with clenched fingers and fists
A nurse is caring for several clients on an oncology unit. Which client should the nurse see first?
client with a white blood cell count of 2000 µL
The nurse is assessing a client with anemia. To plan nursing care, the nurse should focus the assessment on which sign or symptom?
cold intolerance
A client with aplastic anemia is instructed to eat foods rich in iron. The nurse should instruct the client to include which food in the diet to increase iron intake?
dark green leafy vegetables
A multidisciplinary oncology team of health care providers, nurses, and the social worker notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the laboratory data, which values support this diagnosis? Select all that apply.
decreased white blood cells decreased platelets decreased RBCs
The nurse is assessing a client for signs of a blood transfusion reaction. Which finding indicates the client is having a transfusion reaction?
diaphoresis
A nurse is teaching a client who has a severe allergy to bee stings how to manage a reaction. What medication does the nurse encourage the client to take first after being stung by a bee?
epinephrine
The couple with the lowest risk of having a child with sickle cell anemia disease is the one in which the
father is HbA and the mother is HbS.
The nurse is educating a client with systemic lupus erythematosus (SLE) about self-management. For what sign or symptom does the nurse tell the client to seek immediate medical attention?
having decreased urine output
The nurse is teaching a client with osteoarthritis when to take ibuprofen to minimize gastric mucosal irritation. What time is best?
immediately after a meal
The nurse is teaching a client about possible side effects when taking a diuretic. Which is an early indication that the client's serum potassium level is below normal?
muscle cramps in the legs
A client with multiple sclerosis is taking baclofen. Which sign indicates the drug is having the intended outcome?
obtains relief from muscle spasms
The nurse is caring for a client who has a history of aplastic anemia. Which information from the nursing history indicates that the anemia is not being managed effectively?
pallor of the skin and mucous membranes
The nurse examines laboratory findings for a client. What result should the nurse investigate further?
platelet count of 115,000/mm3 (115 x109/L)
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?
platelet count, prothrombin time, and partial thromboplastin time
A client with AIDS develops a fever, severe headache, and stiff neck and begins to vomit. Family members state they have noticed that the client does not seem to be as alert and oriented as before. What is the nurse's priority intervention?
protecting the client's airway
A client with acquired immunodeficiency syndrome is receiving zidovudine. Which laboratory value indicates an adverse reaction to zidovudine?
red blood cell (RBC) count of 1.8 million/μl (1.8 million x 10 to the 12th/L)
A client is admitted with paranoia and visual hallucinations related to progressive dementia. The client continues to be restless and have hallucinations. The nurse calls the health care provider (HCP) and, after explaining the situation, background, and assessment, recommends that the HCP consider writing a prescription for which medication?
sertraline
A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to
sit upright, leaning slightly forward.
The nurse is developing the plan of care for a client newly diagnosed with aplastic anemia. Which is a realistic goal for this client?
Perform activities of daily living without excessive fatigue or dyspnea.
The nurse is planning care for a client who has an allergy to latex. What intervention would be the priority for the nurse to include in the plan of care?
Place latex-free, powder-free gloves at client's bedside.
A client being treated for leukemia has an absolute neutrophil count of 400 cells/mm3. What precautions would the nurse include in the plan of care?
Place sign on client's door reminding all persons to wash hands prior to entering.
Allopurinol is prescribed for a client who has chronic gout. Which comment indicates that the client understands how to take the allopurinol?
"I should drink plenty of fluids when taking allopurinol."
The client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my health care provider (HCP) let me try that?" Which response by the nurse would be most appropriate?
"Every person is different. What works for one client may not always be effective for another."
The nurse is teaching the client who is undergoing induction therapy for leukemia. The nurse realizes the client needs additional instruction when the client makes which statement?
"I cannot wait to get home to my cat!"
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?
Pallor, tachycardia, and a sore tongue
A client with a suspected diagnosis of Hodgkin disease is to have a lymph node biopsy. What should the nurse make sure that personnel involved with the procedure do?
Maintain sterile technique.
A client's arterial blood gas values are as shown on the accompanying chart. These findings indicate which of the following acid-base imbalances?
Metabolic acidosis.
A nurse is caring for a client receiving radiation for Hodgkin's lymphoma who begins to exhibit confusion. Upon further assessment, the nurse notes that the client has warm, flushed, dry skin; a heart rate of 110 beats per minute; and a temperature of 101.8° F (38.8° C). Which is the nurse's next best action?
Notify the healthcare provider.
The nurse is developing a teaching plan for a client with viral hepatitis. What information should the nurse include in the plan?
Obtain adequate bed rest.
A home care nurse is making the initial home visit to a client with lung cancer who had a peripherally inserted central catheter placed during hospitalization for an upper respiratory infection. During the visit, the nurse must administer an antibiotic, teach the client how to care for the catheter, and provide information about when to notify the home care agency and physician. When the nurse arrives at the client's home, the client's face is flushed and he complains of feeling tired. Which actions should the nurse take first?
Obtain the client's vital signs and assess breath sounds.
A nurse preparing to discharge a child with leukemia observes a family member who has a cold sharing a meal with the child. How should the nurse approach the situation?
Offer a face mask to the person with the cold and use this as an opportunity for further teaching.
A client has been taking a decongestant for allergic rhinitis. Which finding suggests that the decongestant demonstrates maximum therapeutic effective?
reduced sneezing
A client with severe arthritis has been receiving maintenance therapy of prednisone 10 mg/day for the past 6 weeks. The nurse should instruct the client to immediately report which symptom?
respiratory infection
A client with rheumatoid arthritis has been on aspirin therapy for an extended time. Which assessment is the most important for the nurse to obtain?
hearing
A client with autoimmune thrombocytopenia and a platelet count of 8,000/μl develops epistaxis and melena. Treatment with corticosteroids and immunoglobulins has been unsuccessful, and the physician recommends a splenectomy. The client states, "I don't need surgery — this will go away on its own." In considering her response to the client, the nurse must depend on the ethical principle of:
autonomy
A client with rheumatoid arthritis reports gastrointestinal irritation after taking piroxicam. To prevent gastrointestinal upset, the nurse should provide which instruction?
"Take piroxicam with food or an antacid."
A nurse is caring for a client who is having an allergic reaction to a blood transfusion. In what order from first to last should the nurse provide care for this client? All options must be used.
Stop the transfusion. Keep the vein open with normal saline solution. Administer an antihistamine as directed. Send the blood bag and blood slip to the blood bank.
A client is diagnosed with human immunodeficiency virus (HIV). What information does the nurse provide to best protect the client from advancing to the acquired immunodeficiency syndrome (AIDS) phase of this infection?
Strictly adhere to antiviral medication therapy.
A young adult has been bitten by a human, and the skin on the forearm is broken. The client's last tetanus shot was about 8 years ago. What should the nurse tell the client about the anticipated treatment plan?
"You'll need an injection of tetanus toxoid."
A client with chronic progressive multiple sclerosis is learning to use a walker. What instruction will best ensure the client's safety?
"Place the walker directly in front of you and step into it as you move it forward."
