NCLEX PN - Hematology Questions

The nurse is doing discharge teaching with a client who has sickle cell disease. The nurse reinforces instructions to the client to avoid which factor that could precipitate a sickle cell crisis? A) infection B) mild exercise C) fluid overload D) warm weather

A) Infection Rationale: The client should avoid infections, which can increase metabolic demand and cause dehydration, precipitating a sickle cell crisis. The client should also avoid dehydration from other causes. Warm weather and mild exercise do not need to be avoided, but the client should take measures to avoid dehydration during these conditions. Fluids are important to prevent dehydration. The client should avoid being in areas of high altitude, or flying in a nonpressurized aircraft because of lesser oxygen tension in these areas.

A client with sickle cell disease has been admitted to the hospital complaining of a sudden onset of severe pain in the extremities, abdomen, back, and chest. In which priority order should the nurse perform the actions listed? administer an opioid analgesic hydrate the client with normal saline 0.9% administer oxygen keep room temperature at or above 72 F encourage the client to keep extremities extended

Administer oxygen Administer an opioid analgesic Hydrate the client with normal saline 0.9% Encourage the client to keep extremities extended keep room temperature at or above 72 F rationale: a client in a sickle cell crisis will have pain as the body's tissues become hypoxic. Oxygenation is important, so oxygen is applied first. To decrease the pain from the sickling process, the client is given an opioid analgesic. The client is then started on an isotonic solution to help prevent further sickling. Keeping the extremities extended and not bent decreases sickling risk as does keep the room warm.

the nurse is caring for a client with a diagnosis of aplastic anemia. which are the most likely signs/symptoms associated with aplastic anemia? Select all that apply. Pain Nausea Fatigue Infection Petechiae

Fatigue//Infection//Petechiae rationale: aplastic anemia is a decrease in RBC, WBC, and platelets. A reduced number of RBC will cause the hemoglobin to drop, and clients commonly report fatigue. A reduced number of WBC will make the client susceptible to infection. A reduced number of platelets will cause the blood to not clot properly and can result in bleeding manifested as petechiae. Pain is a symptom of sickle cell disease, chronic myelogenous leukemia, and multiple myeloma. Nausea is not a symptom of aplastic anemia.

The nurse is caring for a client with thrombocytopenia. Which data should the nurse monitor for related to this condition? Select all that apply. Purpura Ecchymoses Hemoglobin 14.0 g/dL Thrombocytes 300,000 cells/mm^3 prothrombin time 14 seconds platelet count less than 150,000 cells/mm^3

Purpura// Ecchymoses// Platelet count less than 150,000 cells/mm^3 rationale: Purpura, which is small areas of petechiae, is a sign of thrombocytopenia. Ecchymoses, areas of hemorrhage under the skin, are seen with thrombocytopenia. A platelet count under 150,000 cells/mm^3 is indicative of thrombocytopenia. A hemoglobin of 14.0 is within normal range for a male or female. Thrombocytes are platelets, and 300,000 cells/mm^3 is within normal range. A prothrombin time of 14 seconds is within the normal coagulation time of 12 to 14 seconds.

A client is admitted to the hospital with cobalamin (vitamin B12) deficiency. When taking the client's history, which symptoms would the nurse expect the client to report? Select all that apply. craving to eat ice muscle weakness dry and brittle hair difficulty in walking numbness in hands

Vitamin B12 is necessary for RBC production, myelin maintenance, and nerve function. Lack of Vitamin B12 can lead to anemia, as well as damage to the spinal cord, peripheral nerves, and brain. Neurological symptoms include muscle weakness, difficulty in walking, and numbness in hands. craving to eat ice and dry and brittle hair are symptoms of iron deficiency anemia.

The nurse is caring for a client with a suspected diagnosis of aplastic anemia. Which tests should the nurse anticipate to be performed to confirm the diagnosis? A) schilling test B) sickle cell screen C) Bone marrow aspiration D) complete blood cell count

C) Bone marrow aspiration rationale: a bone marrow aspiration will identify aplastic anemia and will identify pancytopenia, a deficiency in erythrocytes, leukocytes, and thrombocytes. A Schilling Test is diagnostic for pernicious anemia. A sickle cell screen is diagnostic for sickle cell anemia. A complete blood cell count will identify anemia but may not identify the specific type

Which test should the nurse expect to have done for a client suspected of having pernicious anemia? A) D-dimer B) Myoglobin C) Schilling Test D) Hemoglobin A1C

C) Schilling Test rationale: the schilling test determines the ability to absorb vitamin B12 and is used to diagnose pernicious anemia. D-dimer is used for diagnosis of pulmonary embolism and disseminated intravascular coagulation. Myoglobin is to detect damage to the myocardium. Hemoglobin A1C is a test to tell average glucose control over a 3-month period

A client has experienced several episodes of sickle cell crisis. Which reinforced instruction should be included in the client's teaching plan to prevent recurrence? A) vigorous exercise is encouraged to maintain cardiovascular function B) iced liquids will combat dehydration and should be consumed regularly C) wear shoes and socks when walking outside to prevent damage to the feet D) to prevent opioid tolerance, avoid taking pain medication at the beginning of the crisis.

C) wear shoes and socks when walking outside to prevent damage to the feet rationale: wearing socks and shoes will prevent wounds to the legs and feet, which heal slowly and frequently become infected in clients with sickle cell disease. Vigorous exercise and iced liquids can precipitate a crisis and should be avoided. Opioid tolerance is not a priority or immediate concern for clients experiencing a sickle cell crisis. These clients experience a great deal of pain and require opioids for pain relief.

the nurse is reviewing the laboratory results of a client receiving chemotherapy. The nurse prepares to initiate neutropenic precautions when the nurse notes which laboratory result? A) a bleeding time of 3 minutes B) an ammonia level of 20 mcg/dL C) a platelet count of 200,000 cells/ mm^3 D) a white blood cell count of 2000 cells/mm^3

D) a white blood cell count of 2000 cells/mm^3 rationale: the normal WBC count is 5000 to 10,000 cells/mm^3. When the WBC count drops, neutropenic precautions need to be implemented. This includes protective isolation measures to protect the client from infection. Bleeding precautions need to be initiated when the platelet count drops. Bleeding precautions include avoiding all trauma such as rectal temperatures or injections. The normal platelet count is 150,000 to 450,000 cells/mm^3. The normal bleeding time is 1 to 6 minutes, depending on laboratory method used. The normal ammonia value is 10 to 80 mcg/dL

A client has been diagnosed with disseminated intravascular coagulation (DIC). Which laboratory tests should the nurse anticipate being prescribed? Select all that apply. D-dimer Hemoglobin Albumin Potassium Prothrombin time Amylase

D-dimer// hemoglobin// prothrombin time rationale: the D-dimer is elevated with DIC. There is decreased hemoglobin due to bleeding. The prothrombin time is increased because clotting factors are being used up. Albumin is checked for disorders of the liver and/or edema, and amylase is checked for disorders of the liver or pancreas, not for DIC. The potassium level should not be greatly affected by DIC either

The nurse is reinforcing instructions to a client with iron deficiency anemia about iron-rich foods. Which food sources should the nurse include in the discharge plan of a client with iron deficiency anemia? Select all that apply milk fish eggs liver cheese

Eggs// Liver rationale: liver and muscle meats; eggs; dried fruits; and dark green, leafy vegetables are iron-rich foods. Milk, fish, and cheese are not significant sources of iron.

Which food sources should the nurse include in the discharge teaching plan for a client with cobalamin (vitamin b12) deficiency anemia? Select all that apply. Eggs Liver Ice Cream Red Meats Citrus Fruits

Eggs// Liver// Red Meats rationale: red meats, especially liver; eggs; and enriched grain products are food sources high in vitamin B12. Ice cream (high in calcium and fat) and citrus fruits (high in vitamin C) are not food sources high in vitamin B12.