Deck 31: Nursing Management: Hematologic Problems

Question 1

The nurse is caring for a patient ITP who has an order for a platelet transfusion. Which patient information indicates that the nurse should consult with the health care provider before administering platelets?

A) Petechiae are present on the chest and back.
B) Blood pressure (BP) is 94/56 mm Hg.
C) Platelet count is 42,000/ml.
D) Blood is oozing from the venipuncture site.

Answer 1

Platelet count is 42,000/ml.

Question 2

The health care provider orders transfusion with packed RBCs for a patient who is hospitalized with severe anemia. The most important action by the nurse to prevent a transfusion reaction when administering the blood is to

A) verify the patient identification according to hospital policy.
B) administer the blood as soon as it arrives on the nursing unit.
C) initiate the blood transfusion at a rate of no more than 2 ml/min.
D) stay with the patient during the first 15 minutes of the transfusion.

Answer 2

verify the patient identification according to hospital policy.

Question 3

A patient with sickle cell anemia is admitted to the hospital with a sickle cell crisis. While caring for the patient during the crisis, it is important for the nurse to

A) limit the patient's intake of oral and IV fluids.
B) evaluate the effectiveness of opioid analgesics.
C) encourage the patient to ambulate as much as tolerated.
D) teach the patient about high-protein, high-calorie foods.

Answer 3

evaluate the effectiveness of opioid analgesics.

Question 4

A patient who is having a sickle cell crisis asks the nurse why the sickling causes such pain. The nurse explains that the pain of sickling is caused by

A) spasms of the blood cells as they change shape.
B) deposition of sickled red cells in the bone marrow.
C) tissue hypoxia caused by small blood vessel occlusion.
D) infectious processes in organs affected by the sickling.

Question 5

Which of these assessment data obtained by the nurse when caring for a patient with thrombocytopenia should be immediately communicated to the health care provider?

A) Platelet count is 52,000/ml.
B) There are bullae on the oral mucosa.
C) The patient is difficult to arouse.
D) There are large bruises on the back.

Question 6

A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious anemia, the nurse determines that the patient understands the disorder when the patient states,

A) "I will need to have cobalamin (B₁₂) injections regularly for the rest of my life."
B) "I will stop having a glass of wine with dinner."
C) "The numbness in my feet will go away once my hemoglobin level returns to normal."
D) "My diet should include more red meat or liver."

Question 7

A patient has a folic acid deficiency related to chronic alcohol abuse. The nurse would expect a complete blood cell count (CBC) to reveal

A) macrocytic, normochromic red cells.
B) normocytic, normochromic red cells.
C) microcytic, hypochromic red cells.
D) microcytic, normochromic red cells.

Question 8

All of the following patients are waiting to be admitted by the emergency department nurse. Which one requires the most rapid assessment and care by the nurse?

A) The patient with a history of sickle cell anemia who has had nausea and diarrhea for 24 hours
B) The patient who has chemotherapy-induced neutropenia and has a temperature of 100.8° F
C) The patient with thrombocytopenia who has oozing after having a tooth extracted
D) The patient with hemophilia A who has ankle swelling after twisting the ankle

Question 9

A patient with chronic lymphocytic leukemia is hospitalized for treatment of severe hemolytic anemia. An appropriate nursing intervention for the patient is to

A) provide a diet high in vitamin K.
B) isolate the patient from visitors.
C) plan care to alternate periods of rest and activity.
D) encourage increased intake of fluid and fiber in the diet.

Question 10

After teaching the patient about taking oral iron preparations for a moderate iron-deficiency anemia, the nurse determines that additional instruction is needed when the patient says,

A) "I will call the doctor if my stools start to turn black."
B) "I will take a stool softener if I feel constipated occasionally."
C) "I will increase my fluid and fiber intake while I am taking the iron tablets."
D) "I should take the iron with orange juice about an hour before eating."

Question 11

A patient admitted to the hospital in preparation for a splenectomy for treatment of immune thrombocytopenia purpura (ITP) asks the nurse about the benefits of the splenectomy. The nurse explains that the expected effect of the splenectomy is

A) reduced destruction of platelets by macrophages.
B) promotion of platelet sequesterization and release by the liver.
C) increased production of platelets by the bone marrow.
D) increased RBC production to compensate for blood loss.

Question 12

A patient with a history of iron-deficiency anemia who has not taken iron supplements for several years is experiencing increased fatigue and occasional palpitations. The nurse would expect the patient's laboratory findings to include

A) hematocrit (Hct) 38%.
B) red blood cell count (RBC) 4,500,000/ml.
C) hemoglobin (Hb) 8.6 g/dl (86 g/L).
D) normal RBC indices.

Question 13

During the admission assessment of a patient who has an Hb of 7.6 g/dl (76 g/L), the nurse notes jaundice of the sclera. The nurse will plan to check the laboratory results for

A) the stool occult blood test.
B) the bilirubin level.
C) the gastric analysis testing.
D) the Schilling test.

Question 14

When planning discharge teaching for the patient who was admitted with a sickle cell crisis, which information will the nurse include?

A) Drink only one or two caffeinated beverages daily.
B) Take a daily multivitamin with iron.
C) Limit fluids to 2 to 3 quarts a day.
D) Avoid exposure to crowds as much as possible.

Question 15

A patient receiving a whole-blood transfusion develops chills and fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, the nurse will plan to

A) send a urine specimen to the laboratory.
B) administer acetaminophen (Tylenol).
C) give diphenhydramine (Benadryl).
D) draw blood for a new cross-match.

Question 16

A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia and thrombosis syndrome (HITTS). The nurse will anticipate a health care provider order to

A) use saline for flushing IV lines.
B) give low-molecular-weight (LMW) heparin.
C) discontinue the warfarin.
D) administer platelet transfusions.

Question 17

Fifteen minutes after a transfusion of packed red cells is started, a patient develops tachycardia and tachypnea and complains of back pain and feeling warm. The nurse first action should be to

A) disconnect the transfusion and infuse normal saline.
B) obtain a urine specimen to send to the laboratory.
C) administer oxygen therapy at a high flow rate.
D) notify the health care provider about the transfusion reaction.

Question 18

A patient is admitted to the hospital with idiopathic aplastic anemia. An appropriate collaborative problem for the nurse to identify for the patient is

A) potential complication: hemorrhage.
B) potential complication: neurogenic shock.
C) potential complication: pulmonary edema.
D) potential complication: seizures.

Question 19

When discussing appropriate food choices with a patient who has iron-deficiency anemia and follows a low-cholesterol diet, the nurse will encourage the patient to increase the dietary intake of

A) eggs and muscle meats.
B) nuts and cornmeal.
C) milk and milk products.
D) legumes and dried fruits.

Question 20

During treatment of the patient with an acute exacerbation of polycythemia vera, a critical action by the nurse is to

A) check oxygen saturation q4hr.
B) monitor fluid intake and output.
C) place the patient on bed rest.
D) administer iron supplements.

Question 21

A patient with myelodysplastic syndrome (MDS) is receiving chemotherapy. Which of these laboratory values will be of most concern to the nurse?

A) RBC 4,800,000/ml
B) Monocytes 560/ml
C) Neutrophils 2600/ml
D) WBC 2800/lL

Question 22

A patient's family member asks the nurse what caused the patient to develop disseminated intravascular coagulation (DIC). The nurse tells the family member that DIC

A) is caused by an abnormal activation of clotting.
B) occurs when the immune system attacks platelets.
C) is a complication of cancer chemotherapy.
D) is caused when hemolytic processes destroy erythrocytes.

Question 23

Which of these nursing actions included in the care plan for a patient with neutropenia is appropriate for the RN to delegate to an LPN/LVN who is assisting with patient care?

A) Teaching the patient the purpose of neutropenic precautions
B) Assessing the patient for signs and symptoms of infection
C) Developing a discharge teaching plan for the patient and family
D) Administer the ordered subcutaneous filgrastim (Neupogen) injection

Question 24

A patient recently diagnosed with Hodgkin's lymphoma undergoes extensive testing for staging of the disease and decisions regarding treatment. The nurse will plan to teach the patient about (Select all that apply.)

A) angiography.
B) lymph node biopsy.
C) radiographic studies.
D) peripheral blood analysis.
E) bone marrow examination.
F) laparotomy and splenectomy.

Question 25

The nurse suspects the development of heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) when a patient receiving heparin

A) develops a pancytopenia.
B) has a platelet count of 200,000/ml.
C) develops a spiking temperature and chills.
D) has decreasing activated partial thromboplastin times.

Question 26

The most appropriate nursing intervention to include in the care plan for a patient with neutropenia is to

A) omit fresh fruits or vegetables from the diet.
B) check the temperature q4hr.
C) avoid any IM or subcutaneous injections.
D) assess all wounds for redness and drainage.

Question 27

During care of the patient with multiple myeloma, an important nursing intervention is

A) limiting weight-bearing and ambulation.
B) maintaining a fluid intake of 3 to 4 L/day.
C) assessing lymph nodes for enlargement.
D) administration of calcium supplements.

Question 28

A patient with von Willebrand's disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the

A) bleeding time.
B) platelet count.
C) prothrombin time.
D) thrombin time.

Question 29

During treatment of the patient who has sepsis-induced DIC with moderate bleeding, the nurse will expect that the initial collaborative care will focus on

A) administration of heparin to reduce intravascular clotting.
B) treatment of the infectious process with IV antibiotics.
C) infusion of whole blood to replace clotting factors and RBCs.
D) supportive management of symptoms until the DIC is resolved.

Question 30

A 45-year-old patient with chronic myelogenous leukemia (CML) is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT) from an HLA-matched sibling. To assist the patient with treatment decisions, the best approach for the nurse to use is to

A) emphasize the positive outcomes of a bone marrow transplant.
B) ask the patient whether there are any questions or concerns about HSCT.
C) explain that a cure is not possible with any other treatment except HSCT.
D) discuss the need for adequate insurance to cover post-HSCT care.

Question 31

A 22-year-old patient with acute myelogenous leukemia develops neutropenia after receiving outpatient chemotherapy. Which action by the nurse in the outpatient clinic is most appropriate?

A) Plan to admit the patient to the hospital for treatment of the neutropenia.
B) Schedule the patient to come into the hospital daily for filgrastim (Neupogen) injections.
C) Teach the patient or family how to administer filgrastim (Neupogen) injections at home.
D) Obtain a high-efficiency particulate-air (HEPA) filter for the patient to use at home.

Question 32

The nurse caring for a patient with hemophilia teaches the patient to seek immediate medical attention upon experiencing

A) sore throat.
B) skin abrasions.
C) bleeding gums.
D) dark tarry stools.

Question 33

A 26-year-old patient with stage II Hodgkin's lymphoma asks the nurse, "How long do I have to live?" The nurse's best response to the patient is

A) "Since no one can predict how long someone will live, try to focus on the present."
B) "It will depend on how your disease responds to radiation, but most patients do well."
C) "With ongoing maintenance chemotherapy, the 10-year survival rate is very good."
D) "Most patients with your stage of Hodgkin's disease are treated successfully."

Question 34

A patient with non-Hodgkin's lymphoma develops a platelet count of 10,000/ml during chemotherapy. An appropriate nursing intervention for the patient, based on this finding, is to

A) encourage fluids to 3000 ml/day.
B) provide oral hygiene q2hr.
C) check the temperature q4hr.
D) check all stools for occult blood.

Question 35

A 64-year-old patient with newly diagnosed acute myelogenous leukemia (AML) who is undergoing induction therapy with chemotherapeutic agents tells the nurse, "I feel so sick that I don't know if the treatment is worth completing." The nurse's best response to the patient is

A) "I know you feel really ill right now, but after this therapy your disease will go into a remission and you will feel normal again."
B) "Induction therapy is very aggressive and causes the most side effects, so when this phase is completed you won't feel so ill."
C) "Your type of leukemia has an 80% survival rate if aggressive therapy is started, so the effects of treatment will be worth it to you."
D) "The chemotherapy is difficult, but it is necessary to put the disease into remission and give you time to make choices about your life."

Question 36

A patient receiving chemotherapy for acute lymphocytic leukemia has pancytopenia, and filgrastim (Neupogen) is prescribed. The nurse teaches the patient that the reason for the use of the medication is

A) to help promote remission of the acute leukemia.
B) to improve the number and function of neutrophils.
C) replacement of abnormal stem cells in the bone marrow with normal cells.
D) prevention of hemorrhage complications in patients with thrombocytopenia.

Question 37

A patient with newly diagnosed leukemia is receiving chemotherapy. Which intervention will the nurse include in the plan of care?

A) Avoid the intake of fresh fruits and vegetables.
B) Administer oral prophylactic antibiotics.
C) Teach visitors hand washing techniques.
D) Place the patient in a laminar airflow room.

Question 38

A patient with type A hemophilia has been admitted to the hospital with severe pain and swelling in the right knee. During the initial care of the patient, the nurse should

A) immobilize the knee.
B) apply heat to the joint.
C) perform passive range of motion (ROM) to the knee.
D) assist the patient with light weight-bearing.

Question 39

Which nursing intervention will be included in the care plan for a patient with ITP?

A) Use rinses rather than a toothbrush for oral care.
B) Restrict activity to passive and active range of motion.
C) Place patient in a private room.
D) Avoid intramuscular (IM) and subcutaneous injections.