Deck 33: Management of Patients With Nonmalignant Hematologic Disorders

Question 1

A nurse is caring for a patient who has sickle cell anemia and the nurses assessment reveals the possibility of substance abuse. What is the nurses most appropriate action?

A) Encourage the patient to rely on complementary and alternative therapies.
B) Encourage the patient to seek care from a single provider for pain relief.
C) Teach the patient to accept chronic pain as an inevitable aspect of the disease.
D) Limit the reporting of emergency department visits to the primary health care provider.

Answer 1

Encourage the patient to seek care from a single provider for pain relief.

Question 2

A patient newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the patient asks the nurse to explain the disease. What should the nurse explain to this patient?

A) There could be an attack on the platelets by antibodies.
B) There could be decreased production of platelets.
C) There could be impaired communication between platelets.
D) There could be an autoimmune process causing platelet malfunction.

Answer 2

There could be decreased production of platelets.

Question 3

A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and his condition is now becoming life threatening. The nurse is aware that a treatment option in this case may include what?

A) Hepatectomy
B) Vitamin $\mathrm{K}$ administration
C) Platelet transfusion
D) Splenectomy

Answer 3

Splenectomy

Question 4

A nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education?

A) Take the iron with dairy products to enhance absorption.
B) Increase the intake of vitamin $E$ to enhance absorption.
C) Iron will cause the stools to darken in color.
D) Limit foods high in fiber due to the risk for diarrhea.

Question 5

The nurse is assessing a new patient with complaints of overwhelming fatigue and a sore tongue that is visibly smooth and beefy red. This patient is demonstrating signs and symptoms associated with what form of what hematologic disorder?

A) Sickle cell anemia
B) Hemophilia
C) Megaloblastic anemia
D) Thrombocytopenia

Question 6

A patient with renal failure has decreased erythropoietin production. Upon analysis of the patients complete blood count, the nurse will expect which of the following results?

A) An increased hemoglobin and decreased hematocrit
B) A decreased hemoglobin and hematocrit
C) A decreased mean corpuscular volume (MCV) and red cell distribution width (RDW)
D) An increased MCV and RDW

Question 7

A patient comes to the clinic complaining of fatigue and the health interview is suggestive of pica. Laboratory findings reveal a low serum iron level and a low ferritin level. With what would the nurse suspect that the patient will be diagnosed?

A) Iron deficiency anemia
B) Pernicious anemia
C) Sickle cell anemia
D) Hemolytic anemia

Question 8

A patient comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has?

A) A hypoproliferative anemia
B) A leukemia
C) Thrombocytopenia
D) A hemolytic anemia

Question 9

A nurse is caring for a patient with severe anemia. The patient is tachycardic and complains of dizziness and exertional dyspnea. The nurse knows that in an effort to deliver more blood to hypoxic tissue, the workload on the heart is increased. What signs and symptoms might develop if this patient goes into heart failure?

A) Peripheral edema
B) Nausea and vomiting
C) Migraine
D) Fever

Question 10

A patient is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications?

A) Folic acid
B) vitamin $\mathrm{B}_{12}$
C) Lactulose
D) Magnesium sulfate

Question 11

A patients blood work reveals a platelet level of $17,000 / \mathrm{mm}^{3}$ . When inspecting the patients integumentary system, what finding would be most consistent with this platelet level?

A) Dermatitis
B) Petechiae
C) Urticaria
D) Alopecia

Question 12

A nurse is admitting a patient with immune thrombocytopenic purpura to the unit. In completing the
Admission assessment, the nurse must be alert for what medications that potentially alter platelet function? Select all that apply.

A) Antihypertensives
B) Penicillins
C) Sulfa-containing medications
D) Aspirin-based drugs
E) NSAIDs

Question 13

A patient, 25 years of age, comes to the emergency department complaining of excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged PT but a vitamin K deficiency is ruled out. When assessing the patient, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the patients signs and symptoms?

A) Lymphoma
B) Leukemia
C) Hemophilia
D) Hepatic dysfunction

Question 14

A patient with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to order for this patient?

A) Packed red blood cells (PRBCs)
B) Vitamin $\mathrm{K}$
C) Oral anticoagulants
D) Heparin infusion

Question 15

The nurse on the pediatric unit is caring for a 10 -year-old boy with a diagnosis of hemophilia. The nurse knows that a priority nursing diagnosis for a patient with hemophilia is what?

A) Hypothermia
B) Diarrhea
C) Ineffective coping
D) Imbalanced nutrition: Less than body requirements

Question 16

A group of nurses are learning about the high incidence and prevalence of anemia among different populations. Which of the following individuals is most likely to have anemia?

A) A 50-year-old African-American woman who is going through menopause
B) An 81-year-old woman who has chronic heart failure
C) A 48-year-old man who travels extensively and has a high-stress job
D) A 13-year-old girl who has just experienced menarche

Question 17

An adult patient has been diagnosed with iron-deficiency anemia. What nursing diagnosis is most likely to apply to this patients health status?

A) Risk for deficient fluid volume related to impaired erythropoiesis
B) Risk for infection related to tissue hypoxia
C) Acute pain related to uncontrolled hemolysis
D) Fatigue related to decreased oxygen-carrying capacity

Question 18

A patient has been living with a diagnosis of anemia for several years and has experienced recent declines in her hemoglobin levels despite active treatment. What assessment finding would signal complications of anemia?

A) Venous ulcers and visual disturbances
B) Fever and signs of hyperkalemia
C) Epistaxis and gastroesophageal reflux
D) Ascites and peripheral edema

Question 19

A woman who is in her third trimester of pregnancy has been experiencing an exacerbation of irondeficiency anemia in recent weeks. When providing the patient with nutritional guidelines and meal suggestions, what foods would be most likely to increase the womans iron stores?

A) Salmon accompanied by whole milk
B) Mixed vegetables and brown rice
C) Beef liver accompanied by orange juice
D) Yogurt, almonds, and whole grain oats

Question 20

A patient with poorly controlled diabetes has developed end-stage renal failure and consequent anemia. When reviewing this patients treatment plan, the nurse should anticipate the use of what drug?

A) Magnesium sulfate
B) Epoetin alfa
C) Low-molecular weight heparin
D) Vitamin $\mathrm{K}$

Question 21

A nurse is planning the care of a patient with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. What nursing diagnosis should the nurse prioritize in the patients plan of care?

A) Risk for disuse syndrome related to ineffective peripheral circulation
B) Functional urinary incontinence related to urethral occlusion
C) Ineffective tissue perfusion related to thrombosis
D) Ineffective thermoregulation related to hypothalamic dysfunction

Question 22

A patient is being treated on the medical unit for a sickle cell crisis. The nurses most recent assessment reveals an oral temperature of $100.5 \mathrm{~F}$ and a new onset of fine crackles on lung auscultation. What is the nurses most appropriate action?

A) Apply supplementary oxygen by nasal cannula.
B) Administer bronchodilators by nebulizer.
C) Liaise with the respiratory therapist and consider high-flow oxygen.
D) Inform the primary care provider that the patient may have an infection.

Question 23

The medical nurse is aware that patients with sickle cell anemia benefit from understanding what situations can precipitate a sickle cell crisis. When teaching a patient with sickle cell anemia about strategies to prevent crises, what measures should the nurse recommend?

A) Using prophylactic antibiotics and performing meticulous hygiene
B) Maximizing physical activity and taking OTC iron supplements
C) Limiting psychosocial stress and eating a high-protein diet
D) Avoiding cold temperatures and ensuring sufficient hydration

Question 24

A patient with a documented history of glucose-6-phosphate dehydrogenase deficiency has presented to the emergency department with signs and symptoms including pallor, jaundice, and malaise. Which of the nurses assessment questions relates most directly to this patients hematologic disorder?

A) When did you last have a blood transfusion?
B) What medications have taken recently?
C) Have you been under significant stress lately?
D) Have you suffered any recent injuries?

Question 25

A patients electronic health record notes that he has previously undergone treatment for secondary polycythemia. How should this aspect of the patients history guide the nurses subsequent assessment?

A) The nurse should assess for recent blood donation.
B) The nurse should assess for evidence of lung disease.
C) The nurse should assess for a history of venous thromboembolism.
D) The nurse should assess the patient for impaired renal function.

Question 26

A patients absolute neutrophil count (ANC) is $440 / \mathrm{mm}^{3}$ . But the nurses assessment reveals no apparent signs or symptoms of infection. What action should the nurse prioritize when providing care for this patient?

A) Meticulous hand hygiene
B) Timely administration of antibiotics
C) Provision of a nutrient-dense diet
D) Maintaining a sterile care environment

Question 27

A nurse is providing discharge education to a patient who has recently been diagnosed with a bleeding disorder. What topic should the nurse prioritize when teaching this patient?

A) Avoiding buses, subways, and other crowded, public sites
B) Avoiding activities that carry a risk for injury
C) Keeping immunizations current
D) Avoiding foods high in vitamin $\mathrm{K}$

Question 28

A nurse is a long-term care facility is admitting a new resident who has a bleeding disorder. When planning this residents care, the nurse should include which of the following?

A) Housing the resident in a private room
B) Implementing a passive ROM program to compensate for activity limitation
C) Implementing of a plan for fall prevention
D) Providing the patient with a high-fiber diet

Question 29

The results of a patients most recent blood work and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This patient should undergo testing for which of the following potential causes? Select all that apply.

A) Hepatitis
B) Acute renal failure
C) HIV
D) Malignant melanoma
E) Cholecystitis

Question 30

A patient with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to
Administer platelets, stating, I have low platelets, so why not give me a transfusion of exactly what Im missing? How should the nurse best respond?

A) Transfused platelets usually arent beneficial because theyre rapidly destroyed in the body.
B) A platelet transfusion often blunts your bodys own production of platelets even further.
C) Finding a matching donor for a platelet transfusion is exceedingly difficult.
D) A very small percentage of the platelets in a transfusion are actually functional.

Question 31

A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the patients previous medication regimen may have contributed to the development of this disorder?

A) Calcium carbonate
B) $\quad$ Vitamin $\mathrm{B}_{12}$
C) Aspirin
D) Vitamin D

Question 32

A young man with a diagnosis of hemophilia A has been brought to emergency department after suffering a workplace accident resulting in bleeding. Rapid assessment has revealed the source of the patients bleeding and established that his vital signs are stable. What should be the nurses next action?

A) Position the patient in a prone position to minimize bleeding.
B) Establish IV access for the administration of vitamin $\mathrm{K}$ .
C) Prepare for the administration of factor VIII.
D) Administer a normal saline bolus to increase circulatory volume.

Question 33

A nurse is planning the care of a patient who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurses choice of interventions?

A) Gabapentin (Neurontin) is effective because of the neuropathic nature of the patients pain.
B) Opioids partially inhibit the patients synthesis of clotting factors.
C) Opioids may cause vasodilation and exacerbate bleeding.
D) NSAIDs are contraindicated due to the risk for bleeding.

Question 34

A night nurse is reviewing the next days medication administration record (MAR) of a patient who has hemophilia. The nurse notes that the MAR specifies both oral and subcutaneous options for the administration of a PRN antiemetic. What is the nurses best action?

A) Ensure that the day nurse knows not to give the antiemetic.
B) Contact the prescriber to have the subcutaneous option discontinued.
C) Reassess the patients need for antiemetics.
D) Remove the subcutaneous route from the patients MAR.

Question 35

A patient with Von Willebrand disease (vWD) has experienced recent changes in bowel function that suggest the need for a screening colonoscopy. What intervention should be performed in anticipation of this procedure?

A) The patient should not undergo the normal bowel cleansing protocol prior to the procedure.
B) The patient should receive a unit of fresh-frozen plasma 48 hours before the procedure.
C) The patient should be admitted to the surgical unit on the day before the procedure.
D) The patient should be given necessary clotting factors before the procedure.

Question 36

A patients low prothrombin time (PT) was attributed to a vitamin K deficiency and the patients PT normalized after administration of vitamin $\mathrm{K}$ . When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize?

A) The need for adequate nutrition
B) The need to avoid NSAIDs
C) The need for constant access to factor concentrate
D) The need for meticulous hygiene

Question 37

A patient with a history of atrial fibrillation has contacted the clinic saying that she has accidentally overdosed on her prescribed warfarin (Coumadin). The nurse should recognize the possible need for what antidote?

A) IVIG
B) Factor $\mathrm{X}$
C) Vitamin $\mathrm{K}$
D) Factor VIII

Question 38

An intensive care nurse is aware of the need to identify patients who may be at risk of developing disseminated intravascular coagulation (DIC). Which of the following ICU patients most likely faces the highest risk of DIC?

A) A patient with extensive burns
B) A patient who has a diagnosis of acute respiratory distress syndrome
C) A patient who suffered multiple trauma in a workplace accident
D) A patient who is being treated for septic shock

Question 39

A patient is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met?

A) Assess for edema.
B) Assess skin integrity frequently.
C) Assess the patients level of consciousness frequently.
D) Closely monitor intake and output.

Question 40

A patient with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective?

A) The patients PT is within reference ranges.
B) Arterial blood sampling tests positive for the presence of factor XIII.
C) The patients platelet level is below $100,000 / \mathrm{mm}^{3}$ .
D) The patients activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.