Practice Questions for 401 Exam 1

A client on anticoagulant therapy is being discharged. Which statement by the client indicates an understanding of the anticoagulants drug action? "It will thin my blood." "It is used to dissolve blood clots." "It should prevent my blood from clotting." "It might cause me to get injured more often."

"It should prevent my blood from clotting." The statement that shows the client understands anticoagulant drug action is, "it will prevent my blood from clotting." Anticoagulants work by interfering with one or more steps involved in the blood clotting cascade. Thus, these agents prevent new clots from forming and limit or prevent extension of formed clots.Anticoagulants do not cause any change in the thickness or viscosity of the blood.Anticoagulants do not dissolve clots, fibrinolytics do. Anticoagulants do not cause more injuries but may cause more bleeding and bruising when the client is injured.

The nurse is teaching a client who is preparing for discharge after a bone marrow aspiration. The nurse provides which discharge instructions to the client? "Inspect the site for bleeding every 4 to 6 hours." "Place an ice pack over the site to reduce the bruising." "Avoid contact sports or activity that may traumatize the site for 24 hours." "Take a mild analgesic, such as two aspirin, for pain or discomfort at the site."

"Place an ice pack over the site to reduce the bruising." Discharge instructions after a bone marrow include placing an ice pack over the site to reduce bruising. Ice to the site will help limit bruising and tissue damage during the first 24 hours after the procedure.The client must carefully monitor the site every 2 hours for the first 24 hours after the procedure. Contact sports and traumatic activity must be excluded for 48 hours, or 2 days. A mild analgesic is appropriate, but it needs to be aspirin-free. Acetaminophen (Tylenol) would be a good choice.

A client with anemia asks the nurse, "Do most people have the same number of red blood cells?" Which is the nurse's best response to the client? "Yes, they do." "No, they don't." "The number varies with gender, age, and general health." "You have fewer red blood cells because you have anemia."

"The number varies with gender, age, and general health." The nurse's best response to the client with anemia about most people having the same number of blood cells is, "The number varies with gender, age, and general health." This statement is the most educational and reasonable response to the client's question.Responding "yes, they do." and "no, they don't." are not educational statements. Although telling the client that people do not have the same number of RBCs is true, it is not informative, and there is a better answer. While it may be true that the client has fewer red blood cells because of anemia, it does not answer the client's general question.

A transfusion of packed red blood cells is ordered for a client with anemia. List the following actions in the order in which they should be performed by the nurse. 1. Don a pair of clean gloves 2. Run the transfusion slowly 3. Determine the client's vital signs 4. Ensure that the client signed a consent for the transfusion 5. Compare the number on the blood product and laboratory record

4, 3, 5, 1, 2

During an employee health physical assessment, the patient reports noticing a large lymph node about a month ago. The patient states, "It doesn't hurt so I just ignored it." What questions would the nurse ask to find out if the patient has any of the constitutional symptoms of lymphoma? SATA A. "Have you had any unplanned weight loss?" B. "Have you had any headaches?" C. "Have you seen blood in your urine or stool?" D. "Have you noticed heavy night sweats?" E. "Have you had a fever greater than 101.5?" F. "Have you had any problems with balance?"

A. "Have you had any unplanned weight loss?" D. "Have you noticed heavy night sweats?" E. "Have you had a fever greater than 101.5?"

In assessing the patient's hematologic status, which questions would the nurse include? SATA A. "Have you had unusual or increased fatigue?" B. "Have you ever had any radiation therapy?" C. "Have you ever donated blood or plasma?" D. "Do you have a personal or family history of blood disorders?" E. "What drugs have you used in the past 3 days?" F. "Have you ever had a job that exposed you to chemicals?"

A. "Have you had unusual or increased fatigue?" B. "Have you ever had any radiation therapy?" D. "Do you have a personal or family history of blood disorders?" F. "Have you ever had a job that exposed you to chemicals?"

A patient with sickle cell crisis is admitted to the hospital. Which questions does the nurse ask the patient to elicit information about the cause of the current crisis? SATA A. "Have you recently traveled on an airplane?" B. "Have you ever had radiation therapy?" C. "In the past 24 hours, has any activity made you short of breath?" D. "Have you recently consumed alcohol or used recreational drugs?" E. "Have you had any symptoms of infection, such as fever?" F. "Lately have you increased strenuous physical activities?"

A. "Have you recently traveled on an airplane?" C. "In the past 24 hours, has any activity made you short of breath?" D. "Have you recently consumed alcohol or used recreational drugs?" E. "Have you had any symptoms of infection, such as fever?" F. "Lately have you increased strenuous physical activities?"

The new registered nurse is giving a blood transfusion to a patient. Which statement by the new nurse indicates the need for action by the supervising nurse? A. "I will complete the red blood cell transfusion within 6 hours" B. "I will check the patient verification with another registered nurse" C. "I will use normal saline solution to begin the blood transfusion" D. "I will remain with the patient for the first 15-30 minutes of the infusion"

A. "I will complete the red blood cell transfusion within 6 hours"

A patient has been taught how to care for his central venous catheter at home. Which statement by the patient indicates that further instruction is necessary? A. "I will flush the catheter with heparin once a day and after infusions." B. "I will change the luer-lok cap on each catheter every week" C. "I will look for and report any signs of infection" D. "I will wash my hands before working with the catheter"

A. "I will flush the catheter with heparin once a day and after infusions."

The nurse has instructed a patient at risk for bleeding about techniques to manage bleeding. Which statements by the patient indicate that teaching has been successful? SATA A. "I will take a stool softener to prevent straining during a bowel movement" B. "I won't take aspirin or aspirin-containing products" C. "I won't participate in any contact sports" D. "I will report a headache that is not responsive to acetaminophen" E. "I will avoid bending over at the waist" F. "If I am injured, I will apply a warm compress for at least 10 minutes"

A. "I will take a stool softener to prevent straining during a bowel movement" B. "I won't take aspirin or aspirin-containing products" C. "I won't participate in any contact sports" D. "I will report a headache that is not responsive to acetaminophen" E. "I will avoid bending over at the waist"

Which lab values would the nurse expect to see for a patient with sickle cell disease? SATA A. 80% hemoglobin S B. 90% red blood cell sickling C. Increased hematocrit D. Increased reticulocyte count E. Decreased total bilirubin F. Elevated total white blood cell count

A. 80% hemoglobin S B. 90% red blood cell sickling D. Increased reticulocyte count F. Elevated total white blood cell count

A patient has polycythemia vera. Which action by UAP requires intervention by the supervising nurse? A. Assisting the patient to floss his teeth B. Using an electric shaver on the patient C. Helping the patient with a soft-bristled toothbrush D. Assisting the patient to don support hose

A. Assisting the patient to floss his teeth

The nurse is assessing a patient who is newly diagnosed with anemia. Which assessment findings are typical of this disorder? SATA A. Dyspnea on exertion B. Systolic hypertension C. Intolerance to heat D. Concave appearance of nails E. Pallor of the ears F. Headache

A. Dyspnea on exertion D. Concave appearance of nails E. Pallor of the ears F. Headache

The nurse is interviewing a patient who has iron deficiency anemia. Which symptom is the patient most likely to report? A. Fatigue B. Night Sweats C. Calf Pain D. Blood in Urine

A. Fatigue

What equipment would the nurse need to perform a hematologic assessment? SATA A. Gloves B. Otoscope C. Stethoscope D. Blood pressure cuff E. Penlight F. Cotton-tip applicator

A. Gloves C. Stethoscope D. Blood pressure cuff E. Penlight

Which medication increases the risk for the patient to develop infection? A. Glucocorticoids B. Nonsteroidal anti-inflammatory agents C. Iron solutions D. Anticoagulants

A. Glucocorticoids

The nurse hears in report that the patient is diagnosed with autoimmune thrombocytopenic purpura. Which instruction is the nurse most likely to give to the UAP? A. Handle the patient very gently to minimize bruising B. Wear a mask when caring for the patient to prevent infection C. Encourage the patient to drink fluids to prevent dehydration D. Assist the patient to stand to prevent falls related to weakness

A. Handle the patient very gently to minimize bruising

The nurse is caring for a patient with acute leukemia. Which signs/symptoms is the nurse most likely to observe during the assessment? SATA A. Hematuria B. Orthostatic hypotension C. Bone pain D. Joint Swelling E. Fatigue F. Weight gain

A. Hematuria B. Orthostatic hypotension C. Bone pain D. Joint Swelling E. Fatigue

An older patient is receiving a blood transfusion. Which signs/symptoms suggest that the patient is experiencing transfusion-associated circulatory overload? A. Hypertension, bounding pulse, and distended neck veins B. Fever, chills, and tachycardia C. Urticaria, itching, and bronchospasm D. Headache, chest pain, and hemoglobinuria

A. Hypertension, bounding pulse, and distended neck veins

Which factors are associated with an increased risk for non-Hodgkin's lymphoma? SATA A. Immunosuppressive disorders B. Chronic infection from H. Pylori C. Epstein barr viral infection D. Chronic alcoholism E. Pesticides and insecticides F. Smoking cigars or cigarettes

A. Immunosuppressive disorders B. Chronic infection from H. Pylori C. Epstein barr viral infection E. Pesticides and insecticides

The nurse is caring for a patient in sickle cell crisis. What are the priority interventions for this patient? SATA A. Managing Pain B. Managing Nutrition C. Ensuring Hydration D. Administering platelets E. Assessing oxygen saturation F. Monitoring for signs/symptoms of infection

A. Managing Pain C. Ensuring Hydration E. Assessing oxygen saturation F. Monitoring for signs/symptoms of infection

Which patient is most likely to have severe manifestations of sickle cell disease even when triggering conditions are mild? A. Mother and father both have hemoglobin S gene alleles B. Mother has hemoglobin S gene alleles and father has hemoglobin A alleles C. Mother has sickle cell trait and father has hemoglobin A gene alleles D. Mother and father both have hemoglobin A gene alleles

A. Mother and father both have hemoglobin S gene alleles

The experienced nurse is supervising a new graduate nurse during administration of a blood product. In which circumstance would the experienced nurse intervene? A. New graduate nurse prepares to use blood administration tubing to infuse stem cells B. New graduate nurse obtains Y-tubing with a blood filter to administer packed red blood cells C. New graduate nurse uses a special shorter tubing with a smaller filter to deliver platelets D. New graduate nurse rapidly delivers fresh frozen plasma through regular straight filtered tubing

A. New graduate nurse prepares to use blood administration tubing to infuse stem cells

A patient is receiving a red blood cell transfusion through a double-lumen peripherally inserted central catheter. The patient has two other peripheral IVs: one is capped and the other has D5/.45NS running at a rate of 50 mL/hr. What can be given concurrently through the line that is selected for red blood cell transfusion? A. Normal Saline B. Infusion of platelets C. Dextrose in water D. Morphine 2mg IV push

A. Normal Saline

These activities are included in the care plan for a 78-year-old patient admitted to the hospital with anemia caused by possible gastrointestinal bleeding. Which activity can the nurse delegate to an experienced UAP? A. Obtaining stool specimens for fecal occult blood test B. Having the patient sign a colonoscopy consent form C. Giving the prescribed polyethylene glycol electrolyte solution D. Checking for allergies to contrast dye or shellfish

A. Obtaining stool specimens for fecal occult blood test

While reviewing the patient's medication list, the nurse notes that the patient is receiving parenteral enoxaparin. Which outcome statement reflects the goal of the enoxaparin therapy? A. Patient shows no signs/symptoms of a blood clot B. Patient reports a decrease in fatigue and dizziness C. Patient shows no signs/symptoms of infection D. Patient reports no shortness of breath on exertion

A. Patient shows no signs/symptoms of a blood clot

The nurse is caring for a patient who just had a bone marrow aspiration. Which outcome statement reflects the priority goal of care after the procedure? A. Patient will not experience excessive bleeding B. Patient's pain level will be 3/10 or less C. Patient will not show signs/symptoms of infection D. Patient will verbalize understanding of procedure results

A. Patient will not experience excessive bleeding

In caring for a patient with acute leukemia, what is the priority collaborative problem? A. Protecting the patient from infection B. Minimizing the side effects of chemotherapy C. Controlling the patient's pain D. Assisting the patient to cope with fatigue

A. Protecting the patient from infection

A deficiency in any of the anticlotting factors, such as protein C, protein S, and antithrombin III increases the patient's risk for which disorder(s)? SATA A. Pulmonary embolism B. Myocardial infarction C. Iron deficient anemia D. Pernicious anemia E. Stroke F. Hemolytic anemia

A. Pulmonary embolism B. Myocardial infarction E. Stroke

Which disorder poses the greatest risk of infection for the patient? A. Sickle cell crisis B. Vitamin B12 deficiency anemia C. Polycythemia vera D. Thrombocytopenia

A. Sickle cell crisis

A female client has a low hemoglobin level, which is attributed to an iron deficiency. Which foods should the nurse recommend that the client increase in the diet? SATA A. Spinach B. Brocoli C. Beef Liver D. Baked Beans E. Chicken Breast

A. Spinach C. Beef Liver D. Baked Beans

What is the first priority intervention when the nurse recognizes that a patient is having a transfusion reaction? A. Stop the transfusion B. Notify the rapid response team C. Flush the IV tubing with normal saline D. Apply oxygen via face mask

A. Stop the transfusion

The home care nurse is visiting a patient who had a stem cell transplant. Which observation by the nurse requires immediate action? A. The patient's grandson is visiting after receiving a MMR vaccine B. The patient bumps his toe on a chair and applies pressure to the toe for 10 minutes C. The patient with a platelet count of 48,000 mm follows platelet precautions D. The patient avoids going outdoors if conditions are icy or slippery

A. The patient's grandson is visiting after receiving a MMR vaccine

The student nurse is caring for a patient in sickle cell crisis. Which action by the student nurse warrants intervention by the supervising nurse? A. Turning down the thermostat to a cooler temperature B. Using distraction and relaxation techniques C. Positioning patient's painful areas with support D. Using therapeutic touch and aroma therapy

A. Turning down the thermostat to a cooler temperature

Which person is most likely to benefit from a referral for genetic counseling? A. Young woman who has an older brother who has hemophilia A B. Young woman whose sister is being treated for iron deficiency anemia C. Young man whose mother had a thromboembolic event after taking thalidomide D. Young man whose older brother is being treated for Hodgkin's lymphoma

A. Young woman who has an older brother who has hemophilia A

A patient admitted for sickle cell crisis is being discharged home. Which statement by the patient indicates the need for further post-discharge instruction? A. "I will walk rather than jog every morning" B. "I will visit my friends in Denver" C. "I will avoid the sauna at the gym" D. "I will not drink alcoholic beverages"

B. "I will visit my friends in Denver"

A patient has the signs/symptoms of hereditary hemochromatosis. The health care provider asks the nurse to immediately report relevant laboratory results, so the diagnosis can be confirmed. Which laboratory result is the health care provider waiting for? A. Complete blood count B. Blood ferritin level C. Platelet count D. Peripheral blood smear

B. Blood ferritin level -Ferritin is a blood cell protein that contains iron -Low = iron deficiency -High = excess iron (Hereditary Hemochromatosis)

When the nurse is assessing a patient with chronic kidney disease who is receiving epoetin alfa (erythropoietin) injections, which finding most indicates a need to talk with the health care provider before giving the medication? A. Hemoglobin level is 8.9 g/dL B. Blood pressure is 198/92 mmHg C. The patient does not like subcutaneous injections D. The patient has a history of myocardial infarction

B. Blood pressure is 198/92 mmHg

The patient is admitted for a chronic liver disorder and will be receiving vitamin K to address one of the problems associated with the disorder. Which clinical manifestation is the nurse most likely to observe before vitamin K therapy is initiated? A. Sore throat and a smooth tongue B. Bruising and bleeding at venipuncture sites C. Fever and increased white blood cell count D. Calf swelling due to deep vein thrombosis

B. Bruising and bleeding at venipuncture sites

Based on knowledge of albumin's role in maintaining osmotic pressure of the blood, which sign/symptom would the nurse look for if the patient has low albumin levels? A. Fever B. Edema C. Bruising D. Pain

B. Edema

For a patient who has a dysfunction of the bone marrow, which sign/symptom is the nurse most likely to observe? A. Long bone pain B. Fatigue C. Loss of appetite D. Weight Gain

B. Fatigue

A 32-year-old patient with sickle cell anemia is admitted to the hospital during a sickle cell crisis. Blood pressure is 104/62 mmHg, oxygen saturation is 92%, and the patient reports pain at a level 8. Which action prescribed by the health care provider will the nurse implement first? A. Administer morphine sulfate 4-8 mg IV B. Give oxygen at 4 L/min per nasal cannula C. Start an infusion of normal saline at 200 mL/hr D. Apply warm packs to painful joints

B. Give oxygen at 4 L/min per nasal cannula

A patient with lymphoma requires a hematopoietic stem cell transplant, and a donor is being sought. Which type of transplant is likely to yield the best results? A. Partially HLA-matched unrelated donor B. HLA-identical twin sibling C. HLA-matched first degree relative D. HLA-matched stem cells from an umbilical cord of a related donor

B. HLA-identical twin sibling

Which electrolyte imbalance can occur related to a blood transfusion? A. Hyponatremia B. Hyperkalemia C. Hypocalcemia D. High blood glucose

B. Hyperkalemia

Which drug disrupts platelet action? A. Vitamin K B. Ibuprofen C. Penicillin V D. Morphine

B. Ibuprofen

A nurse is caring for a client with a diagnosis of polycythemia vera. The client asks, "Why do I have an increased tendency to develop blood clot?" Which effect of the polycythemia vera should the nurse explain increases the risk of these thromboses? A. Elevated blood pressure B. Increased blood viscosity C. Fragility of the blood cells D. Immaturity of red blood cells

B. Increased blood viscosity

A patient who has sickle cell disease is admitted with vaso-occlusive crisis and reports severe abdominal and flank pain. Which of the analgesic medications on the pain treatment protocol will be best for the nurse to administer initially? A. Ibuprofen 800mg PO B. Morphine sulfate 4mg IV C. Hydromorphone liquid 5mg PO D. Fentanyl 25mcg/hr transdermal patch

B. Morphine sulfate 4mg IV

A patient reports fatigue, bone pain, and frequent bacterial infections. Further investigation reveals anemia and hypercalcemia, and x-ray findings show bone thinning with areas of bone loss that resemble Swiss cheese. The signs/symptoms and diagnostic findings are consistent with which disorder? A. Acute leukemia B. Multiple Myeloma C. Non-Hodgkin's Lymphoma D. Sickle Cell anemia

B. Multiple Myeloma

A patient in long-term care facility who has anemia reports chronic fatigue and dizziness with minimal activity. Which nursing activity will the nurse delegate to the UAP? A. Evaluating the patient's response to normal activities of daily living B. Obtaining the patient's blood pressure and pulse with position changes C. Determining which self-care activities the patient can do independently D. Assisting the patient in choosing a diet that will improve strength

B. Obtaining the patient's blood pressure and pulse with position changes

Which patient has the greatest risk for developing a febrile transfusion reaction? A. Patient is an older adult, and transfusion was given too rapidly B. Patient received multiple blood transfusions for chronic bleeding C. Patient received an intraoperative autologous transfusion D. Patient sustained multiple injuries and needed an emergency transfusion

B. Patient received multiple blood transfusions for chronic bleeding

Which of these patients who have just arrived at the emergency department should the nurse assess first? A. Patient who reports several dark, tarry stools and a history of peptic ulcer disease B. Patient with hemophilia A who is experiencing thigh swelling after a fall C. Patient who has pernicious anemia and reports paresthesia of the hands and feet D. Patient with thalassemia major who needs a scheduled blood transfusion

B. Patient with hemophilia A who is experiencing thigh swelling after a fall

The home health nurse notices that new medications were prescribed for a patient during a recent hospitalization. In addition, the patient reports taking daily low-dose aspirin, but aspirin is not on the medication reconciliation list. Because of the aspirin, the nurse is most likely to call the prescribing health care provider for clarification of which type of medication? A. Vitamin supplement B. Platelet inhibitor C. Antihypertensive D. Erythrocyte stimulating agent

B. Platelet inhibitor

The nurse is helping a patient prepare for induction therapy for acute leukemia. What information will the nurse give to the patient? A. A donor is needed for hematopoietic stem cell transplantation B. Prolonged hospitalization is common to protect against infection C. The therapy may last from months to years to maintain remission D. Success of the therapy results in remission and the intent is to cure

B. Prolonged hospitalization is common to protect against infection

The patient reports a history of splenectomy. Based on this information, what is the nurse most likely to assess for? A. Signs of bleeding B. Signs of infection C. Digestive problems D. Jaundice of the skin

B. Signs of infection

A nurse is teaching a client with Hodgkin disease about responses to whole-body radiation. Which clinical indicator increase should the nurse include? A. Blood viscosity B. Susceptibility to infection C. Red blood cell production D. Tendency for pathologic fractures

B. Susceptibility to infection

A patient is at high risk for the development of venoocclusive disease. What assessments does the nurse perform for early detection of this disorder? SATA A. Joint pain B. Weight gain C. Hepatomegaly D. Fluid retention E. Raynaud's like response F. Increase in abdominal girth

B. Weight gain C. Hepatomegaly D. Fluid retention F. Increase in abdominal girth

Which blood product is most likely to have stricter monitoring policies requiring that a physician be present on the unit during administration? A. Packed red blood cell transfusion B. White blood cell transfusion C. Fresh frozen plasma transfusion D. Platelet transfusion

B. White blood cell transfusion

Which outcome statement indicates successful engraftment of transplanted cells in the patient's bone marrow? A. There is no evidence of graft-versus-host disease B. White blood cell, red blood cell, and platelet counts are rising C. Laboratory results indicate probable regressive chimerism D. Laboratory results show decreasing percentage of donor cells

B. White blood cell, red blood cell, and platelet counts are rising

A patient is scheduled for surgery tells the nurse that he is fearful of the possibility of needing a blood transfusion. What is the nurse's best response? A. "Have you spoken with your health care provider about a family member donating blood for your transfusion?" B. "With today's technology, typing and receiving blood is a very safe procedure, and there is no need to worry" C. "Autologous transfusion, where you donate your own blood for later transfusion, may be an option for you" D. "Have you had previous unpleasant experiences with blood transfusions during past surgeries?"

C. "Autologous transfusion, where you donate your own blood for later transfusion, may be an option for you"

A 67-year-old patient who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. Which statement made by the patient when the nurse is obtaining the admission history is of most concern? A. "I've noticed that I bruise more easily since the chemotherapy started." B. "My bowel movements are soft and dark brown." C. "I take ibuprofen every day because of my history of osteoarthritis." D. "My appetite has decreased since the chemotherapy started."

C. "I take ibuprofen every day because of my history of osteoarthritis."

The nurse has taught the patient about dietary modifications for his vitamin B12 deficiency anemia. Which statement by the patient indicates that additional teaching is needed? A. "Dairy products are a good source of vitamin B12" B. "Dried beans taste okay if they are prepared correctly" C. "Leafy green vegetables interferes with my therapy" D. "I like nuts, and I will gladly include them in my diet"

C. "Leafy green vegetables interferes with my therapy"

A 22-year-old patient with stage I Hodgkin disease is admitted to the oncology unit for radiation therapy. During the initial assessment, the patient tells the nurse, "Sometimes I'm afraid of dying." Which response is most appropriate at this time? A. "Many individuals with this diagnosis have some fears" B. "Perhaps you should ask the doctor about medication" C. "Tell me a little bit more about your fear of dying" D. "Most people with stage I Hodgkin disease survive"

C. "Tell me a little bit more about your fear of dying"

The charge nurse is making daily assignments on the med/surg unit. Which patient is best assigned to a float RN who has come from the PACU? A. A 30-year-old patient with thalassemia major who has an order for subcutaneous infusion of deferoxamine B. A 43-year-old patient with multiple myeloma who requires discharge teaching C. A 52-year-old patient with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy D. A 65-year-old patient with pernicious anemia who has just been admitted to the unit

C. A 52-year-old patient with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy

The nurse is caring for a patient with thrombocytopenia. Which order does the nurse question? A. Test all urine and stool for occult blood B. Avoid IM injections C. Administer enemas D. Apply ice to areas of trauma

C. Administer enemas

A client has a bone marrow aspiration performed. After the procedure, what is the first nursing action? A. Position the client on the affected side B. Cleanse the site with an antiseptic solution C. Briefly apply pressure over the aspiration site D. Begin frequent monitoring of the client's vital signs

C. Briefly apply pressure over the aspiration site

Based on knowledge of physiologic triggers for red blood cell production, the nurse would anticipate which chronic health condition to be associated with an increase in RBC production? A. Diabetes mellitus B. Osteoarthritis C. Chronic obstructive pulmonary disease D. Chronic kidney disease

C. Chronic obstructive pulmonary disease

The new registered nurse is identifying a patient for blood transfusion. Which action by the new nurse warrants intervention by the supervising nurse? A. Checks the health care provider's order before the blood transfusion B. Compares the identification name band and number to the blood component tag C. Cross-checks the patient's room number as a form of identification D. Compares blood bag label and requisition slip to ensure compatibility of ABO and Rh

C. Cross-checks the patient's room number as a form of identification

Which types of medications are used as premedication to prevent a reaction for patients receiving a stem cell transfusion? A. Vitamin K and a diuretic B. Aspirin and hydroxyurea C. Diphenhydramine and acetaminophen D. Hydrocortisone and an antihypertensive

C. Diphenhydramine and acetaminophen

The nurse notes that the patient's platelet count is 400,000/mm. What action is the nurse most likely to take? A. Immediately inform the health care provider because of possible spontaneous bleeding B. Instruct UAP to handle patient gently to minimize bruising C. Document the result because it is within the normal range and continue to monitor the patient D. Initiate protective isolation and monitor for signs/symptoms of systemic infection

C. Document the result because it is within the normal range and continue to monitor the patient

A patient with acute leukemia has been receiving an erythropoiesis-stimulating agent (ESA). The nurse sees that the hemoglobin level is 10.5 mg/dL. Why does the nurse call the health care provider to have the ESA discontinued? A. The hemoglobin level is below normal limits, and this increases the risk for side effects B. The ESA therapy is not effective, and an alternate medication should be ordered C. ESAs can cause hypertension and increase the risk for myocardial infarction D. The hemoglobin level of 10.5 mg/dL is the cutoff point recommended by the manufacturer

C. ESAs can cause hypertension and increase the risk for myocardial infarction

Which hematologic disorder is most likely to cause the patient to have joint problems? A. Thrombocytopenia B. Aplastic anemia C. Hemophilia D. Warm antibody anemia

C. Hemophilia

Which laboratory result would indicate that the prescription for epoetin alfa is having the desired therapeutic effect? A. Increase in platelet count B. Increase in white blood cell count C. Increase in Red Blood Cell count D. Increase in iron level

C. Increase in Red Blood Cell count

Which abnormal vital sign is the nurse most likely to see in a patient who has polycythemia vera? A. Elevated temperature B. Decreased respiratory rate C. Increased blood pressure D. Rapid thready pulse

C. Increased blood pressure

A client is admitted with a higher than expected red blood cell count. What physiological alteration does the nurse expect will result from this clinical finding? A. Increased serum pH B. Decreased hematocrit C. Increased blood viscosity D. Decreased immune response

C. Increased blood viscosity

A patient with sickle cell disease is admitted with splenic sequestration. The blood pressure is 86/40 mmHg and heart rate is 124 beats/min. Which of these actions will the nurse take first? A. Complete a head-to-toe assessment B. Draw blood fro type and cross-match C. Infuse normal saline at 250 mL/hr D. Ask the patient about vaccination history

C. Infuse normal saline at 250 mL/hr

The home health nurse is visiting a patient who was recently treated for leukemia. The patient says he feels fine and has been carefully following all discharge instructions. The patient's temperature is 1 degree above baseline. What should the nurse do? A. Tell the patient to recheck the temperature in 4 hours B. Administer two 325mg tablets of acetaminophen C. Initiate standard infection control and call the health care provider D. Document the temperature and other vital signs in the record

C. Initiate standard infection control and call the health care provider

The nurse notes that a 45-year-old woman has a low hemoglobin level. The nurse would perform a dietary assessment to identify a possible deficiency in which nutrient? A. Calcium B. Vitamin K C. Iron D. Vitamin D

C. Iron

A client with upper GI bleeding develops mild anemia. What should the nurse expect to be prescribed for this client? A. Epogen B. Dextran C. Iron salts D. Vitamin B12

C. Iron salts

The nurse is performing the immediate post-procedure care for a bone marrow donor. What is the priority assessment that the nurse will perform? A. Monitoring for activity intolerance B. Monitoring for infection C. Monitoring for fluid loss D. Monitoring platelet count

C. Monitoring for fluid loss

The UAP is assisting in the care of a patient in sickle cell crisis. Which action by the UAP requires intervention by the supervising nurse? A. Elevating the head of bed to 25 degrees B. Helping to remove any restrictive clothing C. Obtaining the blood pressure with an external cuff D. Offering the patient a caffeine-free beverage

C. Obtaining the blood pressure with an external cuff

The nurse routinely checks mental status on all patients, however, which patient has the greatest need for frequent neurologic assessment and checks of cognitive function? A. Elderly patient with chronic dementia has iron deficiency anemia due to poor diet B. Younger female patient has low hemoglobin and hematocrit related to heavy menses C. Older male with alcoholism sustains head injury during an episode of intoxication D. Young male has fever and elevated white blood cell count related to an upper respiratory infection

C. Older male with alcoholism sustains head injury during an episode of intoxication

The nurse has just received a handoff report and is planning care for several patients who must receive blood products during the shift. Which patient will require the most monitoring for the longest period of time? A. Young woman needs a unit of packed red blood cells for a hemoglobin of 5 mg/dL B. Patient with thrombocytopenia needed pooled platelets for a platelet count of 45,000 C. Older patient with heart failure needs washed red blood cells for chronic bleeding D. Patient with thrombocytopenic purpura needs fresh frozen plasma

C. Older patient with heart failure needs washed red blood cells for chronic bleeding

The patient is diagnosed with hereditary hemochromatosis. Which therapy does the nurse expect will be prescribed for this patient? A. Interferon alfa therapy to control RBC production B. Hydration to decrease "sludging" of blood C. Phlebotomy to reduce overall iron load of the blood D. Administration of folic acid and vitamin B12 to prevent anemia

C. Phlebotomy to reduce overall iron load of the blood

The nurse is providing orientation for a new RN who is preparing to administer packed red blood cells to a patient who had blood loss during surgery. Which action by the new RN requires that the nurse intervene immediately? A. Waiting 20 minutes after obtaining the RBC's before starting the infusion. B. Starting an IV line for transfusion using a 22-guage catheter C. Priming the transfusion set using 5% dextrose in LR solution D. Telling the patient that the RBC's may cause a serious transfusion reaction

C. Priming the transfusion set using 5% dextrose in LR solution

A transfusion of packed red blood cells has been infusing for 5 minutes when the patient becomes flushed and tachypneic and says, "I'm having chills. Please get me a blanket." Which action should the nurse take first? A. Obtain a warm blanket for the patient B. Check the patient's oral temperature C. Stop the transfusion D. Administer oxygen

C. Stop the transfusion

A patient is diagnosed with iron deficiency anemia. Which assessment finding is the nurse most likely to observe in this patient? A. Neck veins are distended and edema is present B. Lower extremities show signs of phlebitis C. Systolic blood pressure is lower than normal D. Palpation of ribs or sternum elicits tenderness

C. Systolic blood pressure is lower than normal

A patient is admitted to the intensive care unit with disseminated intravascular coagulation (DIC) associated with a gram-negative infection. Which assessment information has the most immediate implications for the patient's care? A. There is no palpable radial or pedal pulse B. The patient reports chest pain C. The patient's oxygen saturation is 87% D. There is mottling of the hands and feet

C. The patient's oxygen saturation is 87%

A patient with chemotherapy-related neutropenia is receiving filgrastim injections. Which finding by the nurse is most important to report to the health care provider? A. The patient says "My bones are aching" B. The patient's platelet count is 110,000 mm cubed C. The patient's white blood cell count is 39,000 mm cubed D. The patient reports that the medication stings when it is injected

C. The patient's white blood cell count is 39,000 mm cubed

The nurse is interviewing a patient who might be a candidate for fibrinolytic therapy for treatment of myocardial infarction. Why is determining the time of symptom onset essential for decision making? A. Fibrinolytic drugs will not dissolve clots that are older than 6 hours B. Clots that are older than 6 hours are tightly meshed and complete C. Tissue that is anoxic for more than 6 hours is unlikely to benefit D. After 6 hours, the patient is more likely to have excessive bleeding

C. Tissue that is anoxic for more than 6 hours is unlikely to benefit

The nurse would measure abdominal girth to monitor for which complication of hematopoietic stem cell transplantation? A. Failure to engraft B. Graft-versus-host disease C. Venoocclusive disease D. Septic shock

C. Venoocclusive disease

To avoid transfusion reaction, the nurse is carefully monitoring the patient during a blood transfusion. What are hemolytic reactions to blood transfusion most likely to occur? A. 1 mL is sufficient B. 5 mL is typical C. Within the first 50 mL D. After 100 mL

C. Within the first 50 mL

A patient is scheduled to undergo diagnostic testing for sickle cell anemia. Which educational brochure is the nurse most likely to provide to the patient? A. "What to expect during a bone marrow biopsy" B. "How your doctor interprets your platelet count" C. "What is a philadelphia chromosome analysis?" D. "How is hemoglobin S used to confirm my diagnosis?"

D. "How is hemoglobin S used to confirm my diagnosis?"

After the nurse receives a change of shift report, which patient should be seen first? A. A 26-year-old patient with thalassemia who has a hemoglobin level of 8 g/dL and orders for a blood transfusion B. A 44-year-old patient admitted 3 days previously for sickle cell crisis who is scheduled for a computed tomographic (CT) scan C. A 50-year-old patient with stage IV non-Hodgkin lymphoma who is crying and saying, "I'm not ready to die" D. A 69-year-old patient with chemotherapy-induced neutropenia who has an oral temperature of 100.1 degrees

D. A 69-year-old patient with chemotherapy-induced neutropenia who has an oral temperature of 100.1 degrees

Which food should a patient with low white blood cell count be encouraged to eat? A. Fresh blueberries B. Unpasteurized yogurt C. Green leaf lettuce D. Baked chicken

D. Baked chicken

The nurse knows that erythropoietin is a growth factor that is required for stem cell specialization. Which sign/symptom would the nurse observe if erythropoietin is lacking or not performing its role? A. Elevated body temperature B. Bruising and ecchymosis C. Swelling of lymph nodes D. Fatigue and exhaustion

D. Fatigue and exhaustion

Which dinner selection represents the best choice of foods to supply the nutrients required for good cell quality and clotting function? A. Fried chicken breast with mashed potatoes and gravy and green beans B. Mixed fruit and vegetable salad, French bread with butter and wine C. Small lean beef steak with cheese and hash brown potato casserole D. Grilled salmon with spinach salad and fresh strawberries for dessert

D. Grilled salmon with spinach salad and fresh strawberries for dessert

A patient has a suspected hematologic problem. Which instruction is the nurse most likely to give to the UAP? A. Record urine output for the shift B. Take the vital signs every 2 hours C. Assess the patient for fatigue after exertion D. Handle the patient gently to avoid bruising

D. Handle the patient gently to avoid bruising

Venous stasis is considered to be an intrinsic factor that can result in activating which physiologic process? A. Increased red blood cell production B. Adjustment of osmotic fluid pressure C. Initiation of anticlotting forces D. Initiation of blood clotting cascade

D. Initiation of blood clotting cascade

Which organ is most likely to become enlarged as a result of severe anemia? A. Gallbladder B. Kidneys C. Colon D. Liver

D. Liver

What instructions would the home health nurse give to the home health aide about helping a patient who needs to conserve energy? A. Assist the patient to complete activities and exercises when he gets short of breath B. Let the patient decide whether he has the energy to bathe every day C. Encourage people not to visit to allow the patient to rest and conserve energy D. Offer 4-6 small, easy to eat meals rather than serving three large meals

D. Offer 4-6 small, easy to eat meals rather than serving three large meals

When assessing the patient with darker skin for pallor and cyanosis, which area would the nurse examine? A. Chest and abdomen B. General appearance of face C. Fingertips and toes D. Oral mucous membranes

D. Oral mucous membranes

An experienced nurse is supervising a new nurse who is assessing a patient with a suspected hematologic problem. The experienced nurse would intervene if the new nurse performed which action? A. Palpated the edge of the liver in the right upper quandrant B. Auscultated the heart for abnormal heart sounds or irregular rhythm C. Used the fingertips to firmly press over the ribs or sternum D. Palpated the left upper quadrant to locate the enlarged spleen

D. Palpated the left upper quadrant to locate the enlarged spleen

A client is receiving Coumadin (warfarin). The nurse explains the need for careful regulation of dietary intake of vitamin K. What physiologic process does vitamin K promote that makes this instruction essential? A. Platelet aggregation B. Ionization of blood calcium C. Fibrinogen formation by the liver D. Prothrombin formation by the liver

D. Prothrombin formation by the liver

During physical assessment the nurse gently palpates the patient's sternum and the patient reports tenderness to touch. Why would the nurse report this finding to the health care provider? A. Hematology problems increase risk for rib fractures B. Pernicious anemia causes fissures in underlying structures C. Elicited tenderness could signal myocardial infarction D. Rib or sternal tenderness may occur with leukemia

D. Rib or sternal tenderness may occur with leukemia

The nurse is reviewing the complete blood count for a patient who has been admitted for knee arthroscopy. Which value is most important to report to the health care provider before surgery? A. Hematocrit of 33% B. Hemoglobin level of 10.9 g/dL C. Platelet count of 426,000 mm cubed D. White blood cell count of 16,000 mm cubed

D. White blood cell count of 16,000 mm cubed

The nurse is reviewing complete blood count (CBC) data for a 76-year-old client. Which decreased laboratory value would be of greatest concern to the nurse because it is not age-related? Hemoglobin level Red blood cell (RBC) count Platelet (thrombocyte) count White blood cell (WBC) response

Platelet (thrombocyte) count The decreased laboratory value of the greatest concern to the nurse is the 76-year-old client's platelet count. Platelet counts do not generally change with age.Hemoglobin levels in men and women fall after middle age. Iron-deficient diets may play a role in this reduction. Total RBC and WBC counts (especially lymphocyte counts) are lower in older adults. The WBC count does not rise as high in response to infection in older adults as it does in younger people.

Which task does the nurse delegate to unlicensed assistive personnel (UAP)? Refer a client with a daily alcohol consumption of 12 beers for counseling Obtain a partial thromboplastin time from a saline lock on a client with a pulmonary embolism Report any bleeding noted when catheter care is given to a client with a history of hemophilia Perform a capillary fragility test to check vascular hemostatic function on a client with liver failure

Report any bleeding noted when catheter care is given to a client with a history of hemophilia The task the nurse delegates to the UAP is to report any bleeding when catheter care is given to a client with a history of hemophilia. Reporting findings during routine care is expected and required of unlicensed staff members.Referring a client for alcohol counseling, drawing a partial thromboplastin time, and performing a capillary fragility test are more complex and would be done by licensed nursing staff.

A client is scheduled for a bone marrow aspiration. What is the priority nursing action before this procedure is performed? Hold the client's hand and ask about concerns. Review the client's platelet (thrombocyte) count. Verify that the client has given informed consent. Clean the biopsy site with an antiseptic or povidone-iodine (Betadine).

Verify that the client has given informed consent. The priority nursing action before a scheduled bone marrow aspiration is done is for the nurse to verify that the client has been given informed consent. A signed permit must be on the client's chart.Cleaning the biopsy site is done before the procedure, but this is not done until consent is verified. Cleaning the site will be done just before the procedure is performed. Holding the client's hand and offering verbal support may be done during the procedure, but the procedure cannot be completed until the consent is signed. Reviewing the client's platelet count is not imperative.

Which client statement indicates in-home stem cell transplantation is not a viable option? a. I was a nurse, so I can take care of myself b. I don't feel strong enough, but my wife said she would help c. We live 5 miles from the hospital d. I will have lots of medicine to take

a. I was a nurse so I can take care of myself The client statement that indicates that in-home stem cell transplantation is not a viable option is "I was a nurse, so I can take care of myself." Stem cell transplantation in the home setting requires support, assistance, and coordination from others. The client cannot manage this type of care on his own. It is acceptable for the client's spouse to support the client undergoing this procedure. It is not unexpected for the client to be taking several prescriptions. Five miles is an acceptable distance from the hospital, in case of emergency.

The nurse is transfusing a unit of whole blood to a client when the primary health care provider prescribes "Furosemide (Lasix) 20 mg IV push." Which intervention would the nurse perform? a. Administer the furosemide after completion of the transfusion. b. Give furosemide to the client intramuscularly (IM). c. Add furosemide to the normal saline that is infusing with the blood. d. Piggyback the furosemide into the infusing blood.

a. administer the furosemide after completion of the transfusion Completing the transfusion before administering furosemide is the best course of action in this scenario. Drugs are not to be administered with infusing blood products, because they can interact with the blood, causing risks for the client. Changing the admission route is not a nursing decision. Stopping the infusing blood to administer the drug and then restarting it is also not the best decision.

A client who is receiving a blood transfusion suddenly tells the nurse, "I don't feel right!" What is the nurse's first action? a. Stop the transfusion. b. Obtain vital signs and continue to monitor. c. Call the Rapid Response Team. d. Slow the infusion rate of the transfusion.

a. stop the transfusion The nurse's first action when a client receiving a blood transfusion says, "I don't feel right," is to stop the transfusion. The client may be experiencing a transfusion reaction, so the nurse must stop the transfusion immediately. Calling the Rapid Response Team or obtaining vital signs is not the first thing that must be done. The nurse would not slow the infusion rate but would stop it altogether.

The nurse is mentoring a recent graduate registered nurse (RN) about administering blood and blood products. What action does the nurse perform before starting the transfusion? a. Verify with another RN all of the data on blood products. b. Remain with the client who is receiving the blood for the first 5 minutes of the infusion. c. Use a 22-gauge needle to obtain venous access when starting the infusion. d. Obtain the client's initial set of vital signs (VS) within the first 10 minutes of the infusion.

a. very with another RN all of the data on blood products Before administering blood and blood products, the nurse must verify with another RN all of the data on blood products. All data are checked by two RNs. Human error is the most common cause of ABO incompatibilities when administering blood and blood products. A 20-gauge needle (or a central line catheter) is used. The 22-gauge needle is too small. Initial VS must be recorded before the start of infusion of blood, not after it has begun. The nurse remains with the client for the first 15 to 30 minutes (not 5) of the infusion. This is the period when any transfusion reactions are likely to happen.

What are the risk factors for the development of leukemia? (Select all that apply.) Select all that apply. a. Multiple blood transfusions b. Bone marrow hypoplasia c. Down syndrome d. Chemical exposure e. Ionizing radiation f. Prematurity at birth

b, c, d, e, Risk factors related to the development of leukemia include: Down syndrome, chemical exposure, ionizing radiation, and bone marrow hypoplasia. Certain genetic factors contribute to the development of leukemia. Down syndrome is one such condition. Exposure to chemicals through medical need or by environmental events can also contribute. Radiation therapy for cancer or other exposure to radiation, perhaps through the environment, also contributes. Reduced production of blood cells in the bone marrow is one of the risk factors for developing leukemia. Although some genetic factors may influence the incidence of leukemia, prematurity at birth is not one of them. There is no indication that multiple blood transfusions are connected to clients who have leukemia.

A client admitted with a diagnosis of acute myelogenous leukemia is prescribed intravenous (IV) cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this drug therapy? a. Nausea b. Bone marrow suppression c. Liver toxicity d. Stomatitis

b. Bone marrow suppression The major side effect of this drug therapy is bone marrow suppression. Intravenous cytosine arabinoside and daunorubicin are a commonly prescribed course of aggressive chemotherapy, and bone marrow suppression is a major side effect. The client is even more at risk for infection than before treatment began. Liver toxicity, nausea, and stomatitis are not the major problems with this therapy.

The nurse is caring for a client with neutropenia. Which clinical manifestation indicates that the client has an infection or an infection needs to be ruled out? a. Evidence of pus b. Wheezes or crackles c. Fever of 102°F (38.9°C) or higher d. Coughing and deep breathing

b. Wheezes or crackles The clinical manifestation that indicates the client with neutropenia has an infection or an infection that needs to be ruled out is wheezes or crackles. Wheezes or crackles in the neutropenic client may be the first symptom of infection in the lungs. Coughing and deep breathing are not indications of infection but can help prevent it. The client with leukopenia, not neutropenia, may have a severe infection without pus or with only a low-grade fever.

The nurse is caring for a client with neutropenia who has a suspected infection. Which intervention would the nurse implement first? a. Place the client on Bleeding Precautions. b. Obtain prescribed blood cultures. c. Initiate the administration of prescribed antibiotics. d. Give 1000 mL of IV normal saline to hydrate the client.

b. obtain prescribed blood cultures The intervention the nurse would first implement is to draw prescribed blood cultures. Obtaining blood cultures to identify the infectious agent correctly is the priority for this client. Placing the client on Bleeding Precautions is unnecessary. Administering antibiotics is important, but antibiotics must always be started after cultures are obtained. Hydrating the client is not the priority.

The nurse is to administer packed red blood cells to a client. How does the nurse ensure proper client identification? a. Check the client's armband b. Review all information with another registered nurse (RN) c. Ask the client's name d. Verify the client's room number

b. review all information with another registered nurse (RN) With another registered nurse, all information must be reviewed. This process includes verifying the client by name and number, checking blood compatibility, and noting the expiration time. Human error is the most common cause of ABO incompatibility reactions, even for experienced nurses. Asking the client's name and checking the client's armband are not adequate for identifying the client before transfusion therapy. Using the room number to verify client identification is never appropriate.

A 32-year-old client is recovering from a sickle cell crisis. The client's discomfort is controlled with pain medications and discharge planning has been initiated. What medication will the nurse anticipate to be prescribed before discharge? a. Tissue plasminogen activator (t-PA) b. Heparin (Heparin) c. Hydroxyurea (Droxia) d. Warfarin (Coumadin)

c. Hydroxyurea (Droxia) The nurse anticipates Hydroxyurea to be prescribed for pain for a sickle cell disease client who is being discharge. Hydroxyurea (Droxia) has been used successfully to reduce sickling of cells and pain episodes associated with sickle cell disease (SCD). Clients with SCD are not prescribed anticoagulants such as heparin or warfarin (Coumadin). t-PA is used as a "clot buster" in clients who have had ischemic strokes.

The nurse assess the client with which hematologic condition first? a. A 40-year-old with iron deficiency anemia who needs a Z-track iron injection b. A 32-year-old with pernicious anemia who needs a vitamin B12 injection c. An 81-year-old with thrombocytopenia and an increase in abdominal girth d. A 67-year-old with acute myelocytic leukemia with petechiae on both legs

c. an 81 yr old with thrombocytopenia with an increase in abdominal girth The nurse needs to first assess the 81-year-old client with thrombocytopenia and an increase in abdominal girth. An increase in abdominal girth in a client with thrombocytopenia indicates possible hemorrhage, and warrants further assessment immediately. The 32-year-old with pernicious anemia, the 67-year-old with acute myelocytic leukemia, and the 40-year-old with iron deficiency anemia do not indicate any acute complications, so the nurse can assess them after assessing the client with thrombocytopenia.

The nurse performs an assessment on a newly admitted client with thrombocytopenia. Which assessment finding requires immediate intervention by the nurse? a. Decreased urine output b. Increased temperature c. Bleeding from the nose d. Reports of pain

c. bleeding from the nose The assessment finding on a newly admitted client with thrombocytopenia that needs immediate intervention by the nurse is bleeding from the nose. The client with thrombocytopenia has a high risk for bleeding. The nosebleed would be attended to immediately. The client's report of pain, decreased urine output, and increased temperature are not the highest priority.

Which nursing intervention most effectively protects a client with thrombocytopenia a. take rectal temperatures b. avoid use of dentures c. encourage use of an electric shaver d. apply warm compresses on trauma sites

c. encourage use of electric razor The most effective nursing intervention that protects a client with thrombocytopenia is encouraging the client to use an electric shaver. This client must be advised to use an electric shaver instead of a razor. Any small cuts or nicks can cause problems because of the prolonged clotting time. To prevent rectal trauma, rectal thermometers would not be used. Oral or tympanic temperatures would be taken. Dentures may be used by clients with thrombocytopenia as long as they fit properly and do not rub. Ice (not heat) would be applied to areas of trauma.

Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP) working on a medical-surgical unit? a. Administer erythropoietin to a client with myelodysplastic syndrome b. Assess skin integrity on an anemic client who fell during ambulation c. Obtain vital signs on a client receiving a blood transfusion d. Assist a client with folic acid deficiency in making diet choices

c. obtain vital signs on a client receiving a blood transfusion The appropriate task for the nurse to delegate to a UAP is obtaining vital signs on a client receiving a blood transfusion. This activity is within the scope of practice for UAPs. Assisting with prescribed diet choices, administering medication, and assessing clients are complex actions that must be done by licensed nurses.

The nurse is caring for a client who is in sickle cell crisis. What action would the nurse perform first? a. Encourage the client's use of two methods of birth control. b. Apply cool compresses to the client's forehead. c. Provide pain medications as needed. d. Increase food sources of iron in the client's diet.

c. provide pain medication as needed The action the nurse would perform first for a client in sickle cell crisis is to provide pain medications as needed. Analgesics are needed to treat sickle cell pain. Cool compresses do not help the client in sickle cell crisis. Birth control is not the priority for this client. Increasing iron in the diet is not pertinent for the client in sickle cell crisis.

A client with leukemia is being discharged from the hospital. The nurse's discharge instructions say to keep regularly scheduled follow-up primary health care provider appointments. The client says, "I don't have transportation." Which is the most appropriate nursing response? a. You can take the bus b. I may be able to take you c. the local American Cancer Society may be able to help d. a pharmaceutical company might be able to help

c. the local American cancer society may be able to help The most appropriate nursing response to the client who does not have transportation for follow-up appointments is that "the local American Cancer Society may be able to help." Many local units of the American Cancer Society offer free transportation to clients with cancer, including those with leukemia. Telling the client to take the bus is dismissive and does not take into consideration the client's situation (e.g., the client may live nowhere near a bus route). Although the nurse offering to take the client is compassionate, it is not appropriate for the nurse to offer the client transportation. Suggesting a pharmaceutical company is not the best answer. Drug companies typically do not provide this type of service.

The nurse is teaching a client with vitamin B12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the client to eat? a. Grains b. Leafy vegetables c. Starchy vegetables d. Dairy products

d. Dairy products The nurse encourages the client to eat dairy products such as milk, cheese, and eggs. These foods will provide the vitamin B12 that the client needs. Grains, leafy vegetables, and starchy vegetables are not a source of vitamin B12.

The nurse is transfusing 2 units of packed red blood cells to a postoperative client. What electrolyte imbalance would the nurse monitor for after the blood transfusion? a. Hypomagnesemia b. Hyponatremia c. Hypercalcemia d. Hyperkalemia

d. Hyperkalemia The electrolyte imbalance the nurse needs to monitor after transfusing 2 units of blood to a postoperative client is hyperkalemia. During transfusion, some cells are damaged. These cells release potassium, thus raising the client's serum potassium level (hyperkalemia). This complication is especially common with packed cells and whole-blood products. High serum calcium levels, low magnesium levels, or low sodium levels are not expected with blood transfusions.

A client with thrombocytopenia is being discharged. Which instruction would the nurse include in a teaching plan for this client? a. "Drink at least 2 L of fluid per day." b. "Avoid large crowds." c. "Elevate your lower extremities when sitting." d. "Use a soft-bristled toothbrush."

d. use a soft bristled toothbrush Using a soft-bristled toothbrush reduces the risk for bleeding in the client with thrombocytopenia. Avoiding large crowds reduces the risk for infection but is not specific to the client with thrombocytopenia. Increased fluid intake reduces the risk for dehydration but is not particularly relevant to the client with thrombocytopenia. Elevating extremities reduces the risk for dependent edema but is not specific to the client with thrombocytopenia.

The nurse is assessing a client for hematologic risks. Which health history question would the nurse ask to determine if the risk cannot be reduced or eliminated? "Where do you work?" "Tell me what you eat in a day." "Does anyone in your family bleed a lot?" "Do you seem to have excessive bleeding or bruising?"

"Does anyone in your family bleed a lot?" To determine if hematologic risks exist while obtaining a health history from a client, the nurse asks if anyone in the client's family bleeds a lot. An accurate family history is important because many disorders that affect blood and blood clotting are inherited. Genetics cannot be changed.Work habits can be a risk, such as working near radiation, but these are behaviors that can be changed. Diet can affect risk, but it is a health behavior that can be changed.Excessive bleeding or bruising is a symptom, not a risk.

A client with a low platelet count asks the nurse, "Why are platelets important?" Which statement is the nurse's best response? "Platelets will make your blood clot." "Your platelets finish the clotting process." "Blood clotting is prevented by your platelets." "The clotting process begins with your platelets."

"The clotting process begins with your platelets." The nurse's best response to why platelets are important is that, "The clotting process begins with your platelets." Platelets begin the blood clotting process by forming platelet plugs, but these platelet plugs are not clots and cannot provide complete hemostasis.Platelets do not clot blood but are a part of the clotting process or cascade of coagulation. Platelets do not prevent the blood from clotting. Rather they function to help blood form clots. Platelets do not finish the clotting process, they begin it.

The nurse is teaching a client about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure? "The doctor will place a small needle in your back and will withdraw some fluid." "You will be sedated during the procedure, so you will not be aware of anything." "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." "You will be alone because the procedure is sterile; we cannot allow additional people to contaminate the area."

"You may experience a crunching sound or a scraping sensation as the needle punctures your bone." When describing a bone marrow biopsy procedure to a client, it is accurate to describe a crunching sound or scraping sensation when the needle punctures the bone. Proper expectations minimize the client's fear during the procedure.A very large-bore needle is used for a bone marrow biopsy, not a small needle, and the puncture is made in the hip or in the sternum, not the back. A local anesthetic agent is injected into the skin around the site. The client may also receive a mild tranquilizer or a rapid-acting sedative (such as lorazepam [Ativan]) but will not be completely sedated. The nurse, or sometimes a family member, is available to the client for support during a bone marrow biopsy. The procedure is sterile at the site of the biopsy, but others can be present without contamination at the site.

A client with anemia asks the nurse, "Why am I feeling tired all the time?" What is the nurse's best response? "You are not getting enough iron." "When you are sick you need to rest more." "How many hours are you sleeping at night?" "Your cells are delivering less oxygen than you need."

"Your cells are delivering less oxygen than you need." The nurse's best response to the client complaining about feeling tired all the time is "Your cells are delivering less oxygen than you need." The single most common symptom of anemia is fatigue, which occurs because oxygen delivery to cells is less than is required to meet normal oxygen needs.While it may be true that the client isn't getting enough iron, it does not relate to the client's fatigue. The statement about the client needing rest because of being sick is simply not true. Although assessment of sleep and rest is good, it does not address the cause related to the diagnosis.

After reviewing the laboratory test results, the nurse calls the primary care provider about which client? A 52-year-old who had a hemorrhage with a reticulocyte count of 0.8% A 49-year-old with hemophilia and a platelet count of 150,000/mm3 (150 × 109/L) A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 (1.5 × 109/L) A 44-year-old prescribed warfarin (Coumadin) with an international normalized ratio (INR) of 3.0

A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 (1.5 × 109/L) The nurse calls the PCP about a 46-year-old client with a fever and a WBC of 1500/mm3 (1.5 × 109/L). This client is neutropenic and is at risk for sepsis unless interventions such as medications to improve the WBC level and antibiotics are prescribed.An elevated reticulocyte count in the 52-year-old is expected after hemorrhage. A platelet count of 150,000/mm3 (150 × 109/L) in the 49-year-old is normal. The INR of 3.0 in the 44-year-old indicates a therapeutic warfarin level.

A client has a bone marrow biopsy performed. What is the priority postprocedure nursing action? Inspect the site for ecchymosis Apply pressure to the biopsy site Send the biopsy specimens to the laboratory Teach the client to avoid vigorous activity

Applying pressure to the biopsy site The initial action should be to stop bleeding by applying pressure to the site. Inspecting for ecchymoses, sending specimens to the laboratory, and teaching the client about activity levels will be done after hemostasis has been achieved.

The nurse is starting the shift by making rounds. Which client would the nurse assess first? A 52-year-old who just had a bone marrow aspiration and is requesting pain medication A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism A 47-year-old who had a Rumpel-Leede test and asks the nurse to "look at the bruises on my arm" A 42-year-old with a diagnosis of anemia who reports shortness of breath when ambulating down the hallway

A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism After rounds, the nurse would first assess the 59-year-old client who has a nosebleed and is getting heparin to treat a pulmonary embolism. The client with the nosebleed may be experiencing the bleeding as a result of excessive anticoagulation and must be assessed first for the severity of the situation.The client waiting for pain medication would be next on the nurse's "to do" list. Making clients wait for pain medication is not desirable, but in this scenario, the client who is bleeding is the higher priority. The client who had a Rumpel-Leede test and the client with anemia are more stable and can be assessed later. The Rumpel-Leede test is a tourniquet test used to determine the presence of vitamin C deficiency or thrombocytopenia.

The nurse is caring for a group of hospitalized clients. Which client is at highest risk for infection and sepsis? A client with hemolytic anemia A client with cirrhosis of the liver A client who had an emergency splenectomy A client with recently diagnosed sickle cell anemia

A client who had an emergency splenectomy The client who is at the highest risk for infection and sepsis is the client who had an emergency splenectomy. Removal of the spleen causes reduced immune function. Without a spleen, the client is less able to remove disease-causing organisms and is at increased risk for infection.A low red blood cell count with hemolytic anemia can contribute to a client's risk for infection, but this client is more at risk for low oxygen levels and ensuing fatigue. The liver plays a role in blood coagulation, so this client is more at risk for coagulation problems than for infection. Sickle cell anemia causes pain and discomfort because of the changed cell morphology, so acute pain, especially at joints, is the greatest threat to this client.

Which client does the medical unit charge nurse assign to a licensed practical nurse (LPN)/licensed vocational nurse (LVN)? A client with chronic microcytic anemia associated with alcohol use A client scheduled for a bone marrow biopsy with conscious sedation A client with a history of a splenectomy and a temperature of 100.9°F (38.3°C) A client with atrial fibrillation and an international normalized ratio of 6.6

A client with chronic microcytic anemia associated with alcohol use The medical unit charge nurse assigns the LPN/LVN a client with chronic microcytic anemia related to alcohol use. Chronic microcytic anemia is not considered life-threatening and is within the skill level of an LPN/LVN.The client with a bone marrow biopsy with conscious sedation, a history of splenectomy and a temperature, and atrial fibrillation require more complex assessment or nursing care and would be assigned to RN staff members.

The home health nurse is obtaining a history for a patient who has deep vein thrombosis and is taking warfarin 2mg/day. Which statement by the patient is the best indicator that additional teaching about warfarin may be needed? A. "I have started to eat more healthy foods like green salads and fruit." B. "The doctor said that it is important to avoid becoming constipated" C. "Warfarin makes me feel a little nauseated unless I take it with food" D. "I will need to have some blood testing done once or twice a week"

A. "I have started to eat more healthy foods like green salads and fruit."

A client is receiving epoetin (Epogen) for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary? A. "I realize it is important to take this medication because it will cure my anemia." B. "I know many ways to protect myself from injury because I am at risk for seizures" C. "I recognize that I may still need blood transfusions if my blood values are very low" D. "I understand that I will still have to take supplemental iron therapy with this medication"

A. "I realize it is important to take this medication because it will cure my anemia."

A group of patients is assigned to an RN-LPN/LVN team. The LPN/LVN should be assigned to provide patient care and administer medications to which patient? A. A 36-year old patient with chronic kidney failure who will need a subcutaneous injection of epoetin alfa B. A 39-year-old patient with hemophilia B who has been admitted to receive a blood transfusion C. A 50-year-old patient with newly diagnosed polycythemia vera who will require phlebotomy D. A 55-year-old patient with a history of stem cell transplantation who has a bone marrow aspiration scheduled

A. A 36-year old patient with chronic kidney failure who will need a subcutaneous injection of epoetin alfa

A client is diagnosed with Hodgkin disease. Which lymph nodes does the nurse expect to be affected first? A. Cervical B. Axillary C. Inguinal D. Mediastinal

A. Cervical

The nurse is making a room assignment for a newly arrived patient whose laboratory test results indicate pancytopenia. Which patient will be the best roommate for the new patient? A. Patient with digoxin toxicity B. Patient with viral pneumonia C. Patient with shingles D. Patient with cellulitis

A. Patient with digoxin toxicity

The nurse is performing a hematologic assessment. Which finding would be considered a normal change in an older adult? A. Progressive loss of body hair B. Loss of nails and cuticles C. Irregular pattern of ecchymosis D. Cyanosis of the lips and earlobes

A. Progressive loss of body hair

A client who has a low hemoglobin level, which is attributed to nutritional deficiency, and the nurse provides dietary teaching. Which food choices by the client indicate that the nurse's instructions are effective? SATA A. Raisins B. Squash C. Carrots D. Spinach E. Apricots

A. Raisins D. Spinach

When administering a blood transfusion to a patient, which action can the nurse delegate to the UAP? A. Take the patient's vital signs before the transfusion is started B. Assure that the blood is infused within no more than 4 hours C. Ask the patient at frequent intervals about presence of chills or dyspnea D. Assist with double-checking the patient's identification and blood tag number

A. Take the patient's vital signs before the transfusion is started

A client is started on a continuous infusion of heparin. Which finding does the nurse use to conclude that the intervention is therapeutic? A. INR is between 2 and 3 B. PT is 2.5 times the control value C. APTT is 2 times the control value D. ACT is in the range of 70-120

APTT is 2 times the control value

What group of clients should the nurse anticipate to have the highest incident of non-Hodgkin lymphomas? A. Children B. Older Adults C. Young Adults D. Middle-aged persons

B. Older Adults

The nurse in the outpatient clinic is assessing a 22-year old patient who needs a physical exam before starting a new job. The patient reports a history of a splenectomy several years previously after an accident but has otherwise been healthy. Which information obtained during the assessment will be of most immediate concern to the nurse? A. The patient engages in unprotected sex B. The oral temperature is 100 degrees C. The blood pressure is 148/76 mmHg D. The patient admits to daily marijuana use

B. The oral temperature is 100 degrees

After a car accident, a patient with a medical alert bracelet indicating hemophilia A is admitted to the emergency department. Which action prescribed by the health care provider will the nurse implement first? A. Transport to the radiology department for cervical spine radiography B. Transfuse factor VII concentrate C. Type and cross-match for 4 units of packed red blood cells D. Infuse normal saline at 250 mL/hr

B. Transfuse factor VII concentrate

Which task does the nurse delegate to unlicensed assistive personnel (UAP) who is assisting with the care of a female client with anemia? Monitor the oral mucosa for pallor, bleeding, or ulceration Ask about the amount of blood loss with each menstrual period Check for sternal tenderness while applying fingertip pressure Count the respiratory rate before and after ambulating 20 feet (6 m)

Count the respiratory rate before and after ambulating 20 feet (6 m) Counting the respiratory rate before and after ambulation is within the scope of practice for a UAP. The UAP will report this information to the RN.Monitoring oral mucosa requires skilled assessment techniques and knowledge of normal parameters, asking the client about the amount of blood loss with each menstrual period, and checking for sternal tenderness would be done by the RN.

Which hematologic disorder is most likely to occur if the hormonal function of the kidneys is not working properly? A. Leukemia B. Thrombocytopenia C. Neutropenia D. Anemia

D. Anemia

The nurse obtains the following data about a patient admitted with multiple myeloma. Which information requires the most rapid action by the nurse? A. The patient reports chronic bone pain B. The blood uric acid level is very elevated C. The 24-hour urine test shows Bence Jones proteins D. The patient reports new-onset leg numbness

D. The patient reports new-onset leg numbness

A patient with iron deficiency anemia who is taking oral iron supplements is evaluated by the nurse in the outpatient clinic. Which finding by the nurse is of most concern? A. The patient reports that stools are black B. The patient complains of occasional constipation C. The patient takes a multivitamin tablet every day D. The patient takes an antacid with the iron to avoid nausea

D. The patient takes an antacid with the iron to avoid nausea

The nurse is assessing the nutritional status of a client with anemia. How does the nurse obtain information about the client's diet? Uses a prepared list and finds out the client's food preferences Asks the client to rate his or her diet on a scale of 1 (poor) to 10 (excellent) Has the client write down everything he or she has eaten for the past week Determines who prepares the client's meals and plans an interview with him or her

Has the client write down everything he or she has eaten for the past week The best way for the nurse to assess an anemic client's diet is to have the client write down everything he/she has eaten in the last week. Having the client provide a list of items eaten in the past week is the most accurate way to find out what the client likes and dislikes, as well as what the client has been eating. It will provide information about "junk" food intake, as well as protein, vitamin, and mineral intake.Determining food preferences from a prepared list provides information about what the client enjoys eating, not necessarily what the client has been eating. For instance, the client may like steak but may be unable to afford it. Rating scales are good for subjective data collection about some conditions such as pain, but the subjectivity of a response such as this does not provide the nurse with specific data needed to assess a diet. Interviewing the food preparer is time-consuming and poses several problems, such as whether a number of people are preparing meals, or if the client goes "out" for meals.

A newly admitted client has an elevated reticulocyte count. Which condition does the nurse suspect in this client? Leukemia Aplastic anemia Hemolytic anemia Infectious process

Hemolytic anemia The nurse suspects that the client has hemolytic anemia. An elevated reticulocyte count in an anemic client indicates that the bone marrow is responding appropriately to a decrease in the total red blood cell (RBC) mass and is prematurely destroying RBCs. Therefore, more immature RBCs are in circulation.A low white blood cell count is expected in clients with leukemia. Aplastic anemia is associated with a low reticulocyte count. A high white blood cell count is expected in clients with infection.

The nurse is assessing an adult client's endurance in performing activities of daily living (ADLs). What question would the nurse ask the client? "Can you prepare your own meals every day?" "How is your energy level compared with last year?" "Has your weight changed by 5 pounds (2.3 kg) or more this year?" "What medications do you take daily, weekly, and monthly?"

How is your energy level compared with last year?" The question the nurse needs to ask the client about endurance in performing ADLs is "How is your energy level compared with last year"? Asking the client how his or her energy level compares with last year is an activity exercise question that correctly assesses endurance compared with self-assessment in the past. It is most likely to provide data about the client's ability and endurance for ADLs.The client may never have been able to prepare his or her own meals, and the ability to prepare meals does not really address endurance. The question about weight change addresses nutrition and metabolic needs, rather than ADL performance. The question about how often the client takes medication addresses nutrition and metabolic needs and focuses on health maintenance through the use of drugs, not on the client's ability to perform ADLs.

The nurse is performing an assessment on a client with anemia. What are the typical clinical manifestations of anemia? (Select all that apply.) Select all that apply. a. Fatigue b. Decreased breath sounds c. Pallor d. Tachycardia e. Dyspnea on exertion f. Elevated temperature

a, c, d, e, The typical clinical manifestations of anemia are: pallor, fatigue, tachycardia, and dyspnea on exertion. Lowered O2 levels deliver less oxygen to all cells, making clients with anemia pale—especially their ears, nail beds, palms, and conjunctivae and around the mouth. Fatigue is a classic symptom of anemia because lowered O2 levels contribute to a faster pulse (i.e., cardiac rate) and tend to "wear out" a client's energy. Difficulty breathing—especially with activity—is common with anemia. Lower levels of hemoglobin carry less O2 to the cells of the body. Respiratory problems with anemia do not include changes in breath sounds. Skin is cool to the touch, and an intolerance to cold is noted. Elevated temperature would signify something additional, such as infection.

A client recovering from a sickle cell crisis is to be discharged. The nurse says to the client, "You and all clients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the primary health care provider (PHCP) will prescribe? a. Penicillin V (Pen-V K) b. Gentamicin (Garamycin) c. Cefaclor (Ceclor) d. Vancomycin (Vancocin)

a. Penicillin V ( Pen-V K) The nurse expects the PHCP to prescribe Penicillin V for a client recovering from sickle cell crisis who is at risk for infection. Prophylactic therapy with twice-daily oral penicillin reduces the incidence of pneumonia and other streptococcal infections and is the correct drug to use. It is a standard protocol for long-term prophylactic use in clients with sickle cell disease. Cefaclor (Ceclor) and vancomycin (Vancocin) are antibiotics more specific for short-term use and would be inappropriate for this client. Gentamicin (Garamycin) is a drug that can cause liver and kidney damage with long-term use.

The nurse is assessing several clients who are receiving transfusions of blood components. Which assessment finding requires immediate action by the nurse? a. Respiratory rate of 36 breaths/min in a client receiving red blood cells b. Temperature of 99.1°F (37.3°C) for a client with a platelet transfusion c. Sleepiness in a client who received diphenhydramine (Benadryl) as a premedication d. A partial thromboplastin time (PTT) that is 1.2 times normal in a client who received a transfusion of fresh-frozen plasma (FFP)

a. Respiratory rate of 36 breaths/min in a client receiving red blood cells The assessment finding that requires immediate action by the nurse is a respiratory rate of 36 breaths/min in a client receiving red blood cells. An increased respiratory rate indicates a possible hemolytic transfusion reaction. The nurse must quickly stop the transfusion and assess the client further. Temperature elevations are not an indication of an allergic reaction to a platelet transfusion, although the nurse may administer acetaminophen (Tylenol) to decrease the fever. Sleepiness is expected when Benadryl is administered. Because FFP is not usually given until the PTT is 1.5 times above normal, a PTT that is 1.2 times normal indicates that the FFP has had the desired response.

The nurse is teaching a client with newly diagnosed anemia about conserving energy. Which instructions would the nurse give to the client? (Select all that apply.) Select all that apply. a. "Perform your care activities in groups to conserve your energy." b. "Allow others to perform your care during periods of extreme fatigue." c. "Drink small quantities of protein shakes and nutritional supplements daily." d. "Perform a complete bath daily to reduce your chance of getting an infection." e. "Provide yourself with four to six small, easy-to-eat meals daily." f. "Stop activity when shortness of breath or palpitations is present."

b, c, e, f Having four to six small meals daily is preferred over three large meals. This practice conserves the body's expenditure of energy used in digestion and assimilation of nutrients. Stopping activities when strain on the cardiac or respiratory system is noted is critical. It is critical to have others help the anemic client who is extremely tired. Although it may be difficult for him or her to ask for help, this practice should be stressed to the client. Drinking small protein or nutritional supplements will help rebuild the client's nutritional status. A complete bath needs to be performed only every other day. On days in between, the client can be taught to take a "mini" sponge bath, which will conserve energy and still be safe in preventing the risks for infection. Care activities would be spaced every hour or so rather than in groups to conserve energy. Care activities need to be avoided just before and after meals.

A distant family member arrives to visit a female client recently diagnosed with leukemia. The family member asks the nurse, "What should I say to her?" Which responses does the nurse suggest? (Select all that apply.) Select all that apply. a. "Tell her what you know about leukemia." b. "Talk to her as you normally would when you haven't seen her for a long time." c. "Tell her to be brave and to not cry." d. "Ask her how she is feeling." e. "Ask her if she needs anything."

b, d, e The nurse suggests some comments a family member of a recently diagnosed client with leukemia might say to the client. The first statement may be, "ask her how she is feeling." This is a broad general opening and would be nonthreatening to the client. Or "ask her if she needs anything" Asking if she needs anything is a therapeutic communication of offering self and would be considered to be therapeutic and helpful to the client. The family member would talk to her as she normally would when she hasn't seen her in a long time. There is no need to act differently with the client. If she wants to offer her feelings, keeping a normal atmosphere facilitates that option. Telling her to be brave and not to cry is callous and unfeeling. If the client is feeling vulnerable and depressed, telling her to "be brave" shuts off any opportunity for her to express her feelings. There is no need to inform the client about her disease, unless she asks about it. Opening the conversation with discussion about leukemia would be the client's prerogative

The nurse is teaching a client about induction therapy for acute leukemia. Which client statement indicates a need for additional education? a. "I will need to avoid people with a cold or flu." b. "After this therapy, I will not need to have any more." c. "I will probably lose my hair during this therapy." d. "The goal of this therapy is to put me in remission."

b. After this therapy I will not need to have anymore The client statement that indicates a need for additional education about induction therapy is "after this therapy, I won't need to have any more". Induction therapy is not a cure for leukemia, it is a treatment. So, the leukemia client needs more education to understand this. Because of infection risk, clients with leukemia must avoid people with a cold or flu. Induction therapy will most likely cause the client with leukemia to lose his or her hair. The goal of induction therapy is to force leukemia into remission. Because of infection risk, clients with leukemia need to avoid people with a cold or flu. Induction therapy will most likely cause the client with leukemia to lose his or her hair. The goal of induction therapy is to force leukemia into remission.

A nurse is caring for a client with sickle cells disease. Which nursing action is most effective in reducing potential for sepsis in this client a. check vitals every 4 hours b. perform frequent and thorough hand washing c. administer prophylactic drug therapy d. monitor for abnormal laboratory values

b. Perform frequent and thorough hand washing The most effective nursing action to reduce the risk for sepsis in a client with sickle cell anemia is to perform frequent and thorough handwashing. Prevention and early detection strategies are used to protect the client in sickle cell crisis from infection. Frequent and thorough handwashing is of the utmost importance. Taking vital signs every 4 hours will help with early detection of infection but is not prevention. Drug therapy is a major defense against infections that develop in the client with sickle cell disease but is not the most effective way that the nurse can reduce the potential for sepsis. Continually assessing the client for infection and monitoring the daily complete blood count with differential white blood cell count is early detection, not prevention.

Which client does the nurse assign as a roommate for a client with aplastic anemia? a. A 23-year-old with sickle cell disease who has two draining leg ulcers b. A 28-year-old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol) c. A 34-year-old with idiopathic thrombocytopenia who is taking steroids d. A 30-year-old with leukemia who is receiving induction chemotherapy

b. a 28 yr old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol) The nurse assigns as a roommate to the client with aplastic anemia a 28-year-old with glucose-6-pgisphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol. Because clients with aplastic anemia usually have low white blood cell counts that place them at high risk for infection, roommates such as the client with G6PD deficiency anemia would be free from infection or infection risk. The client with sickle cell disease has two draining leg ulcer infections that would threaten the diminished immune system of the client with aplastic anemia. The client with leukemia who is receiving induction chemotherapy and the client with idiopathic thrombocytopenia who is taking steroids are at risk for development of infection, which places the client with aplastic anemia at risk, too.

A pediatric nurse is floated to a medical-surgical unit. Which client is assigned to the float nurse? a. A 55-year-old with folic acid deficiency anemia caused by alcohol abuse who needs counseling b. A 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells c. A 60-year-old with newly diagnosed polycythemia vera who needs teaching about the disease d. A 50-year-old with pancytopenia needing assessment of risk factors for aplastic anemia

b. a 42 yr old with sickle cell disease receiving a transfusion of packed red blood cells The client who is assigned to the pediatric float nurse is the 42-year-old sickle cell disease client receiving a transfusion of packed blood cells. Because sickle cell disease is commonly diagnosed during childhood, the pediatric nurse will be familiar with the disease and with red blood cell transfusion. Therefore, he or she would be assigned to the client with sickle cell disease. Polycythemia vera, aplastic anemia, and folic acid deficiency are problems more commonly seen in adult clients who would be cared for by nurses who are more experienced in caring for adults.

A 56-year-oldclient admitted with a diagnosis of acute myelogenous leukemia (AML) has been prescribed intravenous (IV) cytosine arabinoside and an IV infusion of daunorubicin. The client develops an infection. Which action would the nurse take to determine that the appropriate antibiotic has been prescribed to treat this condition? a. Evaluate the client's liver function tests (LFTs) and serum creatinine levels b. Check the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection c. Recognize that vancomycin (Vancocin) is the drug of choice used to treat all infections in clients with AML d. Monitor the client's white blood cell (WBC) count level

b. check the culture sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection The best action the nurse takes to determine if the appropriate antibiotic has been prescribed is to check the culture and sensitivity test results to be sure that the prescribed antibiotic is effective against the organism causing the infection. Drug therapy is the main defense against infections that develop in clients undergoing therapy for AML. Agents used depend on the client's sensitivity to various antibiotics for the organism causing the infection. Although the WBC count is elevated in infection, this test does not influence which antibiotic will be effective in fighting the infection. Although LFTs and kidney function tests may be influenced by antibiotics, these tests do not determine the effectiveness of the antibiotic. Vancomycin may not be effective in all infections. Culturing of the infection site and determining the organism's sensitivity to a cohort of drugs are needed. This will provide data on drugs that are capable of eradicating the infection in this client

What are serious side effects of antiviral agents prescribed for a client with acute myelogenous leukemia? (Select all that apply.) Select all that apply. a. Cardiomyopathy b. Diarrhea c. Ototoxicity d. Nephrotoxicity e. Stroke

c, d Antiviral agents, although helpful in combating severe infection, have serious side effects, especially nephrotoxicity and ototoxicity. Cardiomyopathy and stroke are not serious side effects of antiviral agents. Diarrhea is a mild side effect associated with antibiotic therapy.

An 82-year-oldclient with anemia is prescribed 2 units of whole blood. Which assessment findings cause the nurse to discontinue the transfusion because it is unsafe for the client? (Select all that apply.) Select all that apply. a. Capillary refill less than 3 seconds b. Decreased pallor c. Rapid, bounding pulse d. Flattened superficial veins e. Hypertension f. Hypotension

c, e, f, The assessment findings that are unsafe for the nurse to continue the blood transfusion for the client are: hypotension, hypertension, and rapid, bounding pulse. In an older adult receiving a transfusion, low blood pressure is a sign of a transfusion reaction, hypertension is a sign of overload, and a rapid and bounding pulse is a sign of fluid overload. In this scenario, 2 units, or about a liter of fluid, could be problematic. Increased (not decreased) pallor and cyanosis are signs of a transfusion reaction, while swollen (not flattened) superficial veins are present in fluid overload in older adult clients receiving transfusions. Capillary refill time that is less than 3 seconds is considered to be normal and would not pose a problem.

Which client is at greatest risk for experiencing a hemolytic transfusion reaction? a. A 58-year-old immune-suppressed client b. A 42-year-old client with allergies c. A 34-year-old client with type O blood d. A 78-year-old client with arthritis

c. A 34-year-old client with type O blood The client at greatest risk for experiencing a hemolytic transfusion reaction is the 34-year-old client with type O blood. Hemolytic transfusion reactions are caused by blood type or Rh incompatibility. When blood that contains antigens different from the client's own antigens is infused, antigen-antibody complexes are formed in the client's blood. Type O is considered the universal donor, but not the universal recipient. The client with allergies would be most susceptible to an allergic transfusion reaction. The older adult client with arthritis would be most susceptible to circulatory overload. The immune-suppressed client would be most susceptible to a transfusion-associated graft-versus-host disease.

The nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant. What procedure does the nurse follow for administering this blood product? a. Give intravenous corticosteroids before starting the transfusion. b. Allow the platelets to stabilize at the client's bedside for 30 minutes. c. Infuse the transfusion over a 15- to 30-minute period. d. Set up the infusion with the standard transfusion Y tubing.

c. Infuse the transfusion over a 15-30 minute period The procedure the nurse follows to administer platelets to a hematopoietic stem cell transplant is to infuse the transfusion over a 15-to-30-minute period. The volume of platelets—200 or 300 mL (standard amount)—needs to be infused rapidly over a 15- to 30-minute period. A special transfusion set with a smaller filter and shorter tubing is used to get the platelets into the client quickly and efficiently. Administering steroids is not standard practice in administering platelets. Platelets must be administered immediately after they are received because they are considered to be quite fragile.

What is the most important environmental risk for developing leukemia? a. Living near high-voltage power lines b. Direct contact with others with leukemia c. Smoking cigarettes d. Family history

c. Smoking cigarettes The most important environmental risk for developing leukemia is smoking cigarettes. According to the American Cancer Society (ACS), the only proven lifestyle-related risk factor for leukemia is cigarette smoking. Genetics is a strong indicator, but it is not an environmental risk factor. According to the ACS, living near high-voltage power lines is not a proven risk factor for leukemia. Leukemia is not contagious.

The nurse is assessing the endurance level of a client in a long-term care facility. What question does the nurse ask to get this information? a. "Are your feet or hands cold, even when you are in bed?" b. "How much exercise do you get?" c. "Do you feel more tired after you get up and go to the bathroom?" d. "What is your endurance level?"

c. do you feel more tired after you get up and go to the bathroom Asking about feeling tired after using the bathroom is the best question to ask to assess a client's endurance level. This question is pertinent to the client's activity and provides a comparison. The specific activity helps the client relate to the question and provides needed answers. The hospitalized client typically does not get much exercise. This would be a difficult assessment for a client in long-term care facility to make. Asking the client about his or her endurance level is too vague. The client may not know how to answer this question. Asking about cold feet or hands does not address the client's endurance.

A client who has been newly diagnosed with leukemia is admitted to the hospital. Avoiding which potential problem takes priority in the client's nursing care plan? a. Fluid overload (overhydration) b. Hemorrhage c. Infection d. Hypoxia

c. infection Avoiding infection is the priority potential problem when caring for a newly diagnosed client with leukemia. Fluid overload, hemorrhage, and hypoxia are not priority problems for the client with leukemia.

The nurse is reinforcing information about genetic counseling to a client with sickle cell disease who has a healthy spouse. What information would the nurse explain to the parents about the risk of a child having sickle cell disease? a. "Your children will have the disease, but your grandchildren will not." b. "Sickle cell disease will be inherited by your children." c. "The sickle cell trait will be inherited by your children." d. "Your children will not have the disease, but your grandchildren could."

c. the sickle cell trait will be inherited by your children The statement that explains to parents about the risk of a child having sickle cell disease is that the children of the client with sickle cell disease will inherit the sickle cell trait but may not inherit the disease. If both parents have the sickle cell trait, their children could get the disease. The children of the client with sickle cell disease will inherit the sickle cell trait but may not inherit the disease. If both parents have the sickle cell trait, their children could get the disease.

A hematology unit is staffed by registered nurse's (RNs), licensed practical nurses (LPNs)/licensed vocational nurse (LVNs), and unlicensed assistive personnel (UAP). When the nurse manager is reviewing staff documentation, which entry indicates the need for staff education for his or her appropriate level of responsibility and client care? a, "Abdominal pain relieved by morphine 4 mg IV; client resting comfortably and denies problems. B.C., RN" b. "Ambulated in hallway for 40 feet (12 m) and denies shortness of breath at rest or with ambulation. T.Y., LPN" c. "Vital signs 98.6°F (37.0°C), heart rate 60, respiratory rate 20, blood pressure 110/68, and oximetry 98% on room air. L.D., UAP" d. "Client reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP"

d. client reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula The documentation entry that needs education is the one from the UAP that states that the "client reports increased shortness of breath and that oxygen was increased to 4 L by nasal cannula." Determination of the need for oxygen and administration of oxygen must be done by licensed nurses who have the education and scope of practice required to administer it. All other documentation entries reflect appropriate delegation and assignment of care.

The nurse is educating a group of young women who have sickle cell disease (SCD). Which statement from a class member indicates further teaching is necessary? a. "The pneumonia vaccine is protection that I need." b. "I must take my penicillin pills as prescribed, all the time." c. "Frequent handwashing is an important habit for me to develop." d. "Getting an annual 'flu shot' would be dangerous for me."

d. getting an annual flu shot would be dangerous for me Further teaching is needed when a young women with sickle cell disease says, "Getting an annual 'flu shot' would be dangerous for me." The client with SCD can receive annual influenza and pneumonia vaccinations. This helps prevent the development of these infections, which could cause a sickle cell crisis. The pneumonia vaccine is also appropriate for the client with sickle cell disease to receive. Prophylactic penicillin is given to clients with SCD orally twice a day to prevent the development of infection. Handwashing is a very important habit for the client with SCD to develop because it reduces the risk for infection.

A recently admitted client who is in sickle cell crisis requests "something for pain." What medication would the nurse be prepared to administer? a. Oral ibuprofen (Motrin) b. Intramuscular (IM) morphine sulfate c. Oral morphine sulfate (MS-Contin) d. Intravenous (IV) hydromorphone (Dilaudid)

d. intravenous (IV) hydromorphone (dilaudid) The client with sickle cell disease needs IV pain relief, and it needs to be administered on a routine schedule (i.e., before the client has to request it). Nonsteroidal anti-inflammatory drugs may be used for clients with SCD for pain relief once their pain is under control. However, in a crisis, this choice of analgesic is not strong enough. Moderate pain may be treated with oral opioids, but this client is in a sickle cell crisis. IV analgesics would be used until his or her condition stabilizes. Morphine is not administered intramuscularly (IM) to clients with sickle cell disease (SCD). In fact, all IM injections are avoided because absorption is impaired by poor perfusion and sclerosed skin.

A client with multiple myeloma reports bone pain that is unrelieved by analgesics. What is the most appropriate response by the nurse? a. "Ask your doctor to prescribe more medication." b. "It is too soon for additional medication to be given." c. "I'll turn on some soothing classical music for you." d. "Would you like to try some relaxation techniques?"

d. would you like to try some relaxation techniques he most appropriate response by the nurse to the client with multiple myeloma is "would you like to try some relaxation techniques"? Because most clients with multiple myeloma have local or generalized bone pain, analgesics, and alternative approaches for pain management, such as relaxation techniques are used for pain relief. This also offers the client a choice. Before prescribing additional medication, other avenues would be explored to relieve this client's pain. Although music therapy can be helpful, this response does not give the client a choice. Even if it is too soon to give additional medication, telling that to the client is not helpful because it dismisses the client's pain concerns.