Deck 5: Hematological

Question 1

Sanchez visited a clinic for his timely medical check-up and brought with him his hematology result. He informed the nurse that his physician is trying to assess him for polycythemia vera. The laboratory findings for a client with polycythemia vera include major and minor criteria. What is the major or defining hematological finding?

A)Leukocytosis >12,000/mm3
B)Thrombocytosis >400,000/mm3
C)RBC count >6 million/mm3
D)Elevated leukocyte alkaline phosphatase

Answer 1

RBC count >6 million/mm3

Question 2

Which clinical presentation is consistent with chronic anemia?

A)Fatigue, dyspnea at rest, pallor, tachycardia
B)Hemarthrosis, bruising, prolonged nose bleeds, hematuria
C)Enlarged lymph nodes, night sweats, fatigue, infections
D)Fever, lymphadenopathy, sore throat, decreased appetite

Answer 2

Fatigue, dyspnea at rest, pallor, tachycardia

Question 3

Danny, 15 years old, has hemophilia and is being discharged from the pediatric unit following a bleeding episode into a joint (hemarthrosis). Which discharge instruction, written by the pediatrician, should the nurse question?

A)"No aspirin or aspirin-related products."
B)"Tylenol 480 mg po q4-6h prn for pain."
C)"May resume adaptive physical education class upon return to school."
D)"May resume taking prophylactic antihemophilic factor at home and at H.S."

Answer 3

"May resume taking prophylactic antihemophilic factor at home and at H.S."

Question 4

The treatment of choice for clients under age 40 with leukemia is bone marrow transplant. Which statement about bone marrow transplantation is not correct?

A)The client is under local anesthesia during the procedure.
B)The aspirated bone marrow is mixed with heparin.
C)The aspiration site is the posterior or anterior iliac rest.
D)The recipient receives cyclophosphamide (Cytoxan) for 4 consecutive days before the procedure.

Question 5

Ana is diagnosed to have pernicious anemia. The physician orders 0.2 mg of Cyanocobalamin (Vitamin B12) IM. Available is a vial of the drug labeled 1 ml= 100 mcg. The nurse should administer:

A)0.5 ml
B)1.0 ml
C)1.5 ml
D)2.0 ml

Question 6

Clara is a 37-year-old cook. She is admitted for treatment of partial and full-thickness burns of her entire right lower extremity and the anterior portion of her right upper extremity. Her respiratory status is compromised and she is in pain and anxious. Performing an immediate appraisal, using the rule of nines, the nurse estimates the percent of Clara's body surface that is burned is:

A)4.5%
B)9%
C)18 %
D)22.5%

Question 7

The nurse applies mafenide acetate (Sulfamylon cream) to Clara, who has second and third degree burns on the right upper and lower extremities, as ordered by the physician. This medication will:

A)Inhibit bacterial growth
B)Relieve pain from the burn
C)Prevent scar tissue formation
D)Provide chemical debridement

Question 8

Clara, a burn client, receives a temporary heterograft (pig skin) on some of her burns. These grafts will:

A)Debride necrotic epithelium
B)Be sutured in place for better adherence
C)Relieve pain and promote rapid epithelialization
D)Frequently be used concurrently with topical antimicrobials

Question 9

Kaitlyn, 10 years old, was diagnosed with juvenile rheumatoid arthritis. The nurse is teaching her regarding measures that would reduce the risk of activity intolerance. Which of the following actions would best indicate that Kaitlyn has understood the nurse's teachings?

A)Delaying eating breakfast until after morning medications are taken
B)Increasing fluid intake
C)Taking a warm bath prior to going to school
D)Continuing to participate in activities of daily living, despite fatigue and persistent pain

Question 10

Kaitlyn, who was diagnosed with juvenile rheumatoid arthritis, must take long-term steroids. Through health teaching on the nurse's part, which adverse effect of the medications can be prevented?

A)Infection
B)Hyperglycemia
C)Hirsutism
D)Delayed growth

Question 11

An HIV-positive client presents with a CD4 count of <200/µl and invasive cervical cancer. How would the nurse evaluate these findings in terms of current CDC guidelines?

A)The client has seroconverted.
B)The client is HIV-positive.
C)The client in the latent period of the disease process.
D)The client has AIDS.

Question 12

Nursing care planning is based on the knowledge that the first 24-48 hours post-burn are characterized by:

A)An increase in the total volume of intracranial plasma
B)Excessive renal perfusion with diuresis
C)Fluid shift from interstitial space
D)Fluid shift from intravascular space to the interstitial space

Question 13

Shawn is an employee at a local factory who comes to the nurse's office with a large furuncle (boil) on his left upper arm. He has come to the office with the same complaint over the past 6 months. In addition to specific care for the boil itself, the nursing intervention should include:

A)Advising the client to bathe more regularly
B)Doing nothing else, as furuncles are not related to any other disease process
C)Calling in all employees and checking them for furuncles
D)Encouraging the client to see his family physician, as recurrent boils may be a sign of underlying disease

Question 14

Which of the following individuals is least likely to be at risk of developing psoriasis?

A)Kaleya, a 32-year-old African American
B)Mrs. Johnson, who is experiencing menopause
C)Mr. Sanchez, who has a family history of the disorder
D)Peter, who is experiencing a significant amount of emotional distress

Question 15

Charles calls the Emergency Department and tells the nurse that he had been cleaning a wooded area in the backyard and came directly into contact with poison ivy shrubs. He tells the nurse that he cannot see anything on the skin and asks the nurse what to do. Which of the following is the appropriate nursing response?

A)"Come to the Emergency Department."
B)"Apply calamine lotion immediately to the exposed skin areas."
C)"Take a shower immediately, lathering and rinsing several times."
D)"It is not necessary to do anything if you cannot see anything on your skin."

Question 16

Mikaela, 25 years old, is scheduled for a skin biopsy and asks the nurse how painful the procedure is. The appropriate response by the nurse is:

A)"There is no pain associated with this procedure."
B)"The local anesthetic may cause a burning or stinging sensation."
C)"A preoperative medication will be given so you will be sleeping and will not feel any pain."
D)"There is some pain, but the physician will prescribe an opioid analgesic following the procedure."

Question 17

Luis, 32 years old, obtained a third-degree circumferential arm burn after a pot of boiling oil was accidentally turned over. Escharotomy procedure was ordered for Luis. The nurse understands that the anticipated therapeutic outcome of the escharotomy is:

A)Return of distal pulses
B)Brisk bleeding from the site
C)Decreasing edema formation
D)Formation of granulation tissue

Question 18

The nurse is administering fluids intravenously as prescribed to a client who sustained superficial partial-thickness burn injuries of the back and legs. In evaluating the adequacy of fluid resuscitation, the nurse understands that which of the following would provide the most reliable indicator for determining the adequacy?

A)Vital signs
B)Urine output
C)Mental status
D)Peripheral pulses

Question 19

Swanson is admitted with full-thickness burns of the back and posterior thighs. Multiple dressing changes to the burns will be performed as part of the patient's care and the expected client outcome while hospitalized is absence of a wound infection. Which intervention is appropriate in meeting this outcome?

A)Gloves, gowns, masks, and caps must be worn during the care of this client and sterile gloves must be worn for the dressing changes.
B)The use of good hand washing technique is the only intervention that is needed.
C)Intubation and aggressive ventilatory management are needed to reverse the effects of an inhalation burn injury.
D)Prophylactic antibiotics must be administered to prevent an infection and colonization of wounds.