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A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? a) "I will receive parenteral vitamin B12 therapy for the rest of my life." b) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." c) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." d) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear."
"I will receive parenteral vitamin B12 therapy for the rest of my life." Explanation: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.
Which of the following is the only curative treatment for chronic myeloid leukaemia (CML)? a) Allogeneic stem cell transplant b) Cytarabine c) Imatinib d) Idarubicin
Allogeneic stem cell transplant Explanation: Allogeneic stem cell transplantation remains the only curative treatment for CML. The efficacy of Imatinib as first-line treatment and the treatment-related mortality of stem cell transplant limits use of transplant to patients with high risk or relapsed disease, or in those patients who did not respond to therapy with TKI. Cytarabine and idarubicin are part of induction therapy for acute myeloid leukemia (AML).
The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse a) Assigns the client to a private room b) Places the client in isolation and allows no visitors c) Allows unlicensed assistive personnel who reports having a sore throat to provide care d) Changes the water in the humidifier for oxygen therapy every 48 hours
Assigns the client to a private room Explanation: The client with an absolute neutrophil count less than 1000/mm³ is to be placed in a private room. Staff with a sore throat or cold should not be assigned to provide care for this client. The client does not need to be placed in isolation, but other neutropenic precautions needs to be followed, such as allowing no visitors with infection. Water in oxygen humdifiers should be changed every 24 hours
A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed? a) Red blood cell phenotyping b) Chelation therapy c) Hepatitis B immunization d) White blood cell filter
Chelation therapy Explanation: Chelation therapy is prescribed to treat iron overload. Hepatitis B immunization helps immunize against hepatitis B. Red blood cell phenotyping helps decreased sensitization. A white blood cell filter protects against cytomegalovirus and some sensitization and febrile reactions.
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? a) Calcium level of 9.4 mg/dL b) Creatinine level of 6 mg/100 mL c) Magnesium level of 2.5 mg/dL d) Potassium level of 5.2 mEq/L
Creatinine level of 6 mg/100 mL Explanation: The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.
A patient's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which of the following statements made by the nurse correctly explains the cause of DIC? a) DIC is caused by an abnormal activation of clotting pathway causing excessive amounts of tiny clots to form inside organs. b) DIC occurs when the immune system attacks platelets and causes massive bleeding. c) DIC is caused when haemolytic processes destroy erythrocytes. d) DIC is a complication of an autoimmune disease that attacks the body's own cells.
DIC is caused by an abnormal activation of clotting pathway causing excessive amounts of tiny clots to form inside organs. Explanation: The inflammatory response initiates the process of inflammation and coagulation. The natural anticoagulant pathways within the body are simultaneously impaired, and the fibrinolytic system is suppressed so that a massive amount of tiny clots forms in the microcirculation. As the platelets and clotting factors form microthrombi, coagulation fails. Thus, the paradoxical result of excessive clotting is bleeding. Decline in organ function is usually a result of excessive clot formation (with resultant ischemia to all or part of the organ).
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? a) Increased mean corpuscular volume b) Increased reticulocyte count c) Decreased level of erythropoietin d) Decreased total iron-binding capacity
Decreased level of erythropoietin Explanation: Differentiation of the primitive myeloid stem cell into an erythroblast is stimulated by erythropoietin, a hormone produced primarily by the kidney. If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (i.e., anemia), or with people living at high altitudes with lower atmospheric oxygen concentrations, erythropoietin levels increase. The increased erythropoietin then stimulates the marrow to increase production of erythrocytes. The entire process of erythropoiesis typically takes 5 days (Cook, Ineck, & Lyons, 2011). For normal erythrocyte production, the bone marrow also requires iron, vitamin B12, folate, pyridoxine (vitamin B6), protein, and other factors. A deficiency of these factors during erythropoiesis can result in decreased red cell production and anemia.
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? a) Dilute the liquid preparation with another liquid such as juice and drink with a straw. b) Discontinue the use of iron if your stool turns black. c) Do not take medication with orange juice because it will delay absorption of the iron. d) Iron may cause indigestion and should be taken with an antacid such as Mylanta.
Dilute the liquid preparation with another liquid such as juice and drink with a straw. Explanation: Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption. Expect iron to color stool dark green or black.
A client receiving a blood transfusion complains of 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 healthcare provider? a) Administer prescribed PRN anti-anxiety agent. b) Remove the intravenous line. c) Ensure there is an oxygen delivery device at the bedside. d) Place the client in a recumbent position with legs elevated.
Ensure there is an oxygen delivery device at the bedside. Explanation: The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.
A patient with severe anemia is admitted to the hospital. Due to religious beliefs, the patient is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells? a) Sargramostim (Leukine) b) Filgrastim (Neupogen) c) Epoetin alfa (Epogen) d) Eltrombopag (Promacta)
Epoetin alfa (Epogen) Explanation: Erythropoietin (epoetin alfa [Epogen, Procrit]) is an effective alternative treatment for patients with chronic anemia secondary to diminished levels of erythropoietin. This medication stimulates erythropoiesis.
A client tells the nurse that he would like to donate blood before his abdominal surgery next week. What should be the nurse's first action? a) Explain the time frame needed for autologous donation. b) Remind the client to take supplemental iron before donation. c) Provide the client with a list of the nearest donation centers. d) Tell the client that 2 units of blood will be needed.
Explain the time frame needed for autologous donation. Explanation: Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery. The nurse should first explain that time frame to this client. Surgery is scheduled in one week which means that autologous blood donation may not be an option for this client. A list of donation centers can be provided to the client; and even though iron is recommended and 2 units of blood may be suggested, the first action is to tell the client about the needed time frame for donation.
A client is receiving platelets. In order to decreased the risk of circulatory overload in this client, the nurse should do which of the following? a) Infuse each unit over 30-60 minutes per client tolerance. b) Flush the intravenous line with a liter of saline between units. c) Administer each unit slowly over 3-4 hours. d) Monitor vital signs closely before transfusion and once per shift.
Infuse each unit over 30-60 minutes per client tolerance. Explanation: Infuse each unit of FFP over 30-60 minutes per client tolerance. Platelet clumping will occur if administered too slowly. Vital signs should be monitored before and throughout the transfusion, not just once per shift. A liter of saline is too large an amount to flush the intravenous line and would contribute to fluid overload.
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? a) Jackknife position b) Lithotomy position c) Lateral position with one leg flexed d) Supine with head of the bed elevated 30 degrees
Lateral position with one leg flexed Explanation: Bone marrow aspiration procedure. The posterior superior iliac crest is the preferred site for bone marrow aspiration and biopsy because no vital organs or vessels are nearby. The patient is placed either in the lateral position with one leg flexed or in the prone position.
A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate? a) Neurologic involvement b) Loss of vibratory and position senses c) Insufficient intake of dietary nutrients d) Severity of the disease
Neurologic involvement Explanation: In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms
What assessment findings best indicate that the patient has recovered from induction therapy? a) Neutrophil and platelet counts within normal limits b) Absence of bone pain c) Vital signs within normal ranges d) No evidence of oedema
Neutrophil and platelet counts within normal limits Explanation: Recovery from induction therapy is indicated when the neutrophil and platelet counts have returned to normal and any infection has resolved. Stable vital signs, lack of oedema, and absence of pain are not indicative of recovery from induction therapy.
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? a) Platelet count, prothrombin time, and partial thromboplastin time b) Fibrinogen level, WBC, and platelet count c) Platelet count, blood glucose levels, and white blood cell (WBC) count d) Thrombin time, calcium levels, and potassium levels
Platelet count, prothrombin time, and partial thromboplastin time Explanation: The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, and fibrinogen level as well as client history and other assessment factors. Blood glucose levels, WBC count, calcium levels, and potassium levels aren't used to confirm a diagnosis of DIC.
Which nursing intervention is most appropriate for a client with multiple myeloma? a) Monitoring respiratory status b) Preventing bone injury c) Restricting fluid intake d) Balancing rest and activity
Preventing bone injury Explanation: When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict his fluid intake
The nurse is screening donors for blood donation. The client who is an acceptable donor for blood is the client who a) Has a history of viral hepatitis as a teenager 10 years ago b) Had a dental extraction 2 days ago for caries in a tooth c) Received a blood transfusion within 1 year d) Reports having a cold 1 month ago that resolved quickly
Reports having a cold 1 month ago that resolved quickly Explanation: Donors must meet certain requirements to be able to donate blood. A client should be in good health, such as the client who had a cold more than 1 month ago that resolved quickly. Those excluded from donating blood have a history of viral hepatitis, report a blood transfusion within 12 months, and had a dental extraction within 72 hours. The reason for exclusion is that they are at increased risk of transmitting an infectious disease.
Which of the following is the hallmark of polycythaemia vera (PV)? a) Ruddy complexion b) Headache c) Blurred vision d) Splenomegaly
Splenomegaly Explanation: Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, paresthesias, and blurred vision).
The nurse began transfusing the first unit of packed red blood cells (PRBCs) fifteen minutes ago. The client begins complaining of shortness of breath, nausea, and is restless. What is the nurse's priority action? a) Discontinue the intravenous line. b) Stop the infusion. c) Flush the blood tubing with normal saline. d) Notify the primary care provider.
Stop the infusion. Explanation: The client's symptoms are consistent with a possible blood transfusion reaction. The infusion should be stopped immediately, then the primary care provider should be notified. The intravenous line should not be discontinued in case the client needs any emergency intravenous medications. Flushing the blood tubing with normal saline would allow the blood in the tubing to be infused; the IV line should be maintained with normal saline through brand new tubing.
The nurse is assessing several patients. Which patient does the nurse determine is most likely to have Hodgkin lymphoma? a) The patent with painful lymph nodes under the arm. b) The patient with a painful sore throat. c) The patient with painful lymph nodes in the groin. d) The patient with enlarged lymph nodes in the neck.
The patient with enlarged lymph nodes in the neck. Explanation: Lymph node enlargement in Hodgkin lymphoma is not painful. The patient with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.
The client is to receive a unit of packed red blood cells. The first intervention of the nurse is to a) Observe for gas bubbles in the unit of packed red blood cells. b) Verify that the client has signed a written consent form. c) Ensure that the intravenous site has a 20-gauge or larger needle. d) Check the label on the unit of blood with another registered nurse.
Verify that the client has signed a written consent form. Explanation: All the options are interventions the nurse will do to ensure the blood transfusion is safe. The question asks about the first action of the nurse. The first action would be verifying that the client has signed a written consent form. Then, the nurse would ensure the intravenous site has a 20-gauge or larger needle. The nurse would proceed to obtain the unit of blood, check the blood with another registered nurse, and observe for gas bubbles in the unit of blood.
During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? a) Vitamin A b) Vitamin E c) Vitamin K d) Vitamin D
Vitamin K Explanation: Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.
Which of the following medications is the antidote to Warfarin? a) Aspirin b) Clopidogrel (Plavix) c) Protamine sulfate d) Vitamin K
Vitamin K Explanation: The antidote for Coumadin is vitamin K. Protamine sulfate is the antidote for heparin. Aspirin and Plavix are both antiplatelet medications.
The most common cause of iron deficiency anaemia in men and postmenopausal women is a) chronic alcoholism. b) iron malabsorption. c) menorrhagia. d) bleeding.
bleeding. Explanation: The most common cause of iron deficiency anaemia in men and postmenopausal women is bleeding from ulcers, gastritis, inflammatory bowel disease or GI tumors. Menorrhagia is the most common cause in premenopausal women. Iron malabsorption is another cause, which is seen in patients with celiac disease. Patients with chronic alcoholism often have chronic blood loss from the GI tract.
A patient with sickle cell anemia has a a) high hematocrit. b) normal blood smear. c) low hematocrit. d) normal hematocrit.
low hematocrit. Explanation: The patient with sickle cell anemia has a low hematocrit and sickled cells on the smear. The patient with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.
Choice Multiple question - Select all answer choices that apply. A patient with polycythemia vera is complaining of severe itching. What triggers does the nurse know can cause this distressing symptom? (Select all that apply.) a) Temperature change b) Aspirin c) Alcohol consumption d) Allergic reaction to the red blood cell increase e) Exposure to water of any temperature
• Temperature change • Alcohol consumption • Exposure to water of any temperature Explanation: Pruritus is very common, occurring in up to 70% of patients with polycythemia vera (Saini, Patnaik & Tefferi, 2010) and is one of the most distressing symptoms of this disease. It is triggered by contact with temperature change, alcohol consumption, or, more typically, exposure to water of any temperature but seems to be worse with exposure to hot water.
