Chapter 17: Care of Patients with Hematologic Disorders My Nursing Test Banks

Chapter 17: Care of Patients with Hematologic Disorders

MULTIPLE CHOICE

1. The nurse cautions the 79-year-old male who had a gastrectomy a month ago that he is at risk for _____ anemia.

a.

aplastic

b.

pernicious

c.

iron deficiency

d.

nutritional

ANS: B

Pernicious anemia will result from the lack of the intrinsic factor found in the stomach lining. Without the intrinsic factor, the body is unable to absorb vitamin B12. Aplastic anemia is related to bone marrow suppression. Iron deficiency anemia is often related to a deficiency of iron in the diet.

DIF: Cognitive Level: Application REF: 347 | Clinical Cues

OBJ: 1 (theory) TOP: Pernicious Anemia: Etiology

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. Because of a deficiency of iron, the person with iron deficiency anemia is unable to make sufficient:

a.

plasma.

b.

WBCs.

c.

hemoglobin.

d.

antibodies.

ANS: C

Deficiency of iron causes reduced production of hemoglobin.

DIF: Cognitive Level: Comprehension REF: 347 OBJ: 1 (theory)

TOP: Iron Deficiency Anemia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse is aware that a common cause of reduced amounts of erythropoietin is:

a.

renal failure.

b.

liver cancer.

c.

emphysema.

d.

diabetes.

ANS: A

Renal failure results in reduced amounts of erythropoietin, a substance necessary for the production of RBCs in the bone marrow.

DIF: Cognitive Level: Comprehension REF: 347 OBJ: 1 (theory)

TOP: Causes of Anemia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The nurse anticipates that the patient with iron deficiency anemia will have red cells that are:

a.

normochromic and normocytic.

b.

hypochromic and microcytic.

c.

hyperchromic and macrocytic.

d.

normochromic and microcytic.

ANS: B

Iron deficiency anemia causes the RBCs to be small and have less color.

DIF: Cognitive Level: Application REF: 348 OBJ: 1 (theory)

TOP: Characteristics of RBCs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The home health nurse assesses the patient taking ferrous sulfate (Feosol). Which patient statement alerts the nurse that teaching is necessary regarding this medication?

a.

It tastes better when I take my medicine with milk.

b.

My wife says I should take my medicine with orange juice.

c.

I am always careful not to break open the capsule.

d.

I usually take my iron with my whole-grain toast during breakfast.

ANS: A

Milk products inhibit the absorption of iron. Iron is better absorbed if vitamin C is in the GI tract at the same time, so drinking orange juice with the ferrous sulfate is beneficial. Capsules and enteric-coated iron preparations should not be opened or crushed. Whole grains are not known as inhibitors of iron absorption.

DIF: Cognitive Level: Application REF: 349 | Table 17-3

OBJ: 2 (clinical) TOP: Anemia Treatment: Feosol

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. Change question stem, answer options, rationale, and cognitive level as follows:

The student nurse is preparing to administer an iron preparation via the intramuscular (IM) route. Which action by the student indicates the need for further instruction?

a.

The student changes needles after drawing up the medication.

b.

The student chooses a 1 1/2 inch needle.

c.

The student chooses a 20-gauge needle.

d.

The student uses the Z-track technique when administering the injection.

ANS: B

When administering an IM iron preparation, it is important to change the needle after drawing up the medication and use a 19- to 20-gauge, 3-inch needle for injection since iron is irritating to the tissues. A Z-track method will prevent staining of the skin.

DIF: Cognitive Level: Application REF: 349 | Table 17-3

OBJ: 2 (clinical) TOP: Absorption of Iron

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. The nurse frequently assesses for signs of infection on the patient with aplastic anemia because the patient will not be able to produce an inflammatory response related to the low level of:

a.

leukocytes.

b.

erythrocytes.

c.

histamine.

d.

hemopoietin.

ANS: A

The low level of leukocytes inhibits the inflammatory response, thus increasing the chance of the patient developing an infection.

DIF: Cognitive Level: Application REF: 352 OBJ: 1 (theory)

TOP: Aplastic Anemia: Infection KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The nurse instructs the 20-year-old female patient with sickle cell trait that:

a.

the condition will evolve into sickle cell anemia as she ages.

b.

all of her children will have sickle cell anemia.

c.

the trait will be transmitted to male children only.

d.

the trait can be passed on to all children.

ANS: D

A person who has the trait can pass it on to male or female children, even if there are no symptoms. Fifty percent of the patients total hemoglobin may be affected. Age does not increase the chance of the trait evolving into the disease.

DIF: Cognitive Level: Application REF: 353 OBJ: 3 (theory)

TOP: Sickle Cell Trait KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

9. The nurse stresses to the patient with sickle cell anemia that one of the most elementary home interventions to help prevent sickle cell crisis is to:

a.

take iron supplements daily.

b.

maintain adequate fluid intake.

c.

engage in daily exercise.

d.

eat leafy green vegetables.

ANS: B

The maintenance of an adequate fluid intake keeps the circulating blood volume hydrated, which discourages clumping of the sickle cells.

DIF: Cognitive Level: Application REF: 354 OBJ: 3 (theory)

TOP: Sickle Cell Crisis: Prevention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

10. The nurse is conscientious in the care of the feet and legs of a patient with sickle cell anemia because:

a.

stasis ulcers are a constant threat.

b.

bleeding may occur on the soles of the feet.

c.

edema of the feet increases activity intolerance.

d.

toenails must be kept short to avoid ingrown nails.

ANS: A

Because of the sluggish flow of blood, stasis ulcers are a constant threat and are very difficult to heal.

DIF: Cognitive Level: Comprehension REF: 354 OBJ: 3 (theory)

TOP: Sickle Cell Anemia: Stasis Ulcers KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

11. The nurse evaluates a need for further instruction to the patient with sickle cell anemia when he says:

a.

I know Im not supposed to drink iced drinks.

b.

I surely do miss my three beers in the afternoon.

c.

I walk every day rather than doing other strenuous exercise.

d.

I am looking forward to my annual ski trip to Colorado.

ANS: D

People with sickle cell anemia should avoid cold temperatures and high altitudes, which can bring on a crisis due to thickening of the blood. Avoidance of iced drinks, alcohol, and strenuous exercise is beneficial.

DIF: Cognitive Level: Analysis REF: 354 OBJ: 3 (theory)

TOP: Sickle Cell Anemia: Lifestyle Changes

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

12. The nurse assessing a patient with polycythemia vera would anticipate:

a.

pale complexion.

b.

low blood pressure.

c.

high hemoglobin.

d.

normal energy level.

ANS: C

The person with polycythemia vera will have high hemoglobin and hematocrit related to the large number of red cells. The complexion is ruddy with blue lips; there is fatigue and weakness and high blood pressure.

DIF: Cognitive Level: Application REF: 354 OBJ: 4 (theory)

TOP: Polycythemia Vera: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. The nurse takes into consideration that the patient with polycythemia vera will have a phlebotomy to thin the blood:

a.

every 2 to 3 weeks.

b.

monthly.

c.

every 2 to 3 months.

d.

semiannually.

ANS: C

The phlebotomies are scheduled about every 2 to 3 months in order to thin the blood to reduce hypertension and threat of stroke.

DIF: Cognitive Level: Comprehension REF: 354-355 OBJ: 4 (theory)

TOP: Polycythemia Vera: Treatment KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

14. The home health nurse caring for the patient with polycythemia vera will focus care on:

a.

maintenance of high fluid intake.

b.

daily exercise to reduce weight.

c.

daily dose of anticoagulants.

d.

adequate intake of vitamin C.

ANS: A

The major focus is maintaining a high fluid intake to keep the circulating fluid well hydrated.

DIF: Cognitive Level: Application REF: 354-355 OBJ: 4 (theory)

TOP: Polycythemia Vera: Home Care KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

15. The patient with acute myelogenous leukemia (AML) asks why he is making more WBCs when he already has so many. The nurse clarifies that the large number of leukemic white cells he already has:

a.

are not as effective as normal white cells would be.

b.

protect against infection.

c.

attempt to take over the functions of RBCs.

d.

are produced by the lymphatic system.

ANS: A

The many leukemic white cells cannot function as normal WBCs do. The bone marrow rushes production of immature white cells (blasts) to try to create adequate protection. These cells do not protect against infection, nor do they take over the functions of the RBCs. AML originates in the bone marrow.

DIF: Cognitive Level: Application REF: 355 | Table 17-5

OBJ: 5 (theory) TOP: AML: WBC Production

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. The nurse explains that induction therapy for acute lymphocytic leukemia (ALL) is a(n):

a.

intensive protocol of chemotherapy in high doses to achieve remission.

b.

long-term protocol with smaller doses of chemotherapy to achieve a cure.

c.

2- to 5-year low-dose chemotherapy regimen to reduce painful symptoms.

d.

combination of chemotherapy and radiation to achieve remission.

ANS: A

A combination of several antileukemic drugs in high doses has been found to induce a remission.

DIF: Cognitive Level: Application REF: 356 OBJ: 5 (theory)

TOP: ALL: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

17. Extreme care is used by the nursing staff when repositioning or transporting a patient with advanced multiple myeloma to prevent:

a.

pain to the patient.

b.

bruising and hematomas.

c.

muscle spasms.

d.

pathologic fractures.

ANS: D

Pathologic fractures of osteoporotic bones are an ongoing concern in the patient with multiple myeloma.

DIF: Cognitive Level: Comprehension REF: 360 OBJ: 1 (clinical)

TOP: Multiple Myeloma: Safety KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. Blood must be started within _____ minutes of its arrival on the unit.

a.

10

b.

15

c.

30

d.

60

ANS: C

To reduce the risk of infection, the blood must be started within 30 minutes of its arrival on the unit.

DIF: Cognitive Level: Comprehension REF: 363 OBJ: 2 (theory)

TOP: Transfusion: Starting Blood KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

19. The nurse is aware that the patient with a nutritional anemia is lacking the nutrients: (Select all that apply.)

a.

proteins.

b.

vitamin B12.

c.

folic acid.

d.

zinc.

e.

iron.

ANS: A, C, E

Nutritional anemia occurs due to the lack of proteins, folic acid, and iron.

DIF: Cognitive Level: Comprehension REF: 347 OBJ: 1 (theory)

TOP: Nutritional Anemia: Etiology KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. The nurse makes a visual aid differentiating between mild, moderate, and severe anemia. The signs and symptoms of mild anemia include: (Select all that apply.)

a.

hemoglobin of 14.4 g/dL.

b.

palpitations.

c.

dyspnea on exertion.

d.

pallor.

e.

fatigue.

ANS: B, C

In mild anemia, hemoglobin is below 14 g/dL. The mild anemic is not pale or abnormally fatigued.

DIF: Cognitive Level: Analysis REF: 348 OBJ: 1 (theory)

TOP: Mild Anemia: Signs and Symptoms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. The nurse recommends to a patient with iron deficiency anemia to include foods high in iron, such as: (Select all that apply.)

a.

liver.

b.

lima beans.

c.

prune juice.

d.

cabbage.

e.

dried apricots.

ANS: A, B, C, E

Cabbage is not high in iron.

DIF: Cognitive Level: Application REF: 348 | Nutrition Considerations

OBJ: 2 (theory) TOP: Iron Deficiency Anemia: Diet

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

22. Aplastic anemia has its etiology in a variety of drugs, such as: (Select all that apply.)

a.

antimetabolite cancer drugs.

b.

phenylbutazone (Butazolidin).

c.

oral contraception drugs.

d.

chloramphenicol (Chloromycetin).

e.

sulfonamides.

ANS: A, B, D, E

Oral contraceptives are not known to cause aplastic anemia.

DIF: Cognitive Level: Comprehension REF: 352 OBJ: 1 (theory)

TOP: Aplastic Anemia: Etiology KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

23. Some of the causes of leukemia are thought to be: (Select all that apply.)

a.

exposure to radiation.

b.

exposure to pesticides.

c.

exposure to benzene.

d.

frequent bacterial infections.

e.

virulent viral infections.

ANS: A, B, C

Bacterial and viral infections are not considered to be causes of leukemia.

DIF: Cognitive Level: Comprehension REF: 355 OBJ: 5 (theory)

TOP: Leukemia: Etiology KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

24. The patient with AML has a platelet count of 95,000. What interventions should be included in the plan of care for this patient? (Select all that apply.)

a.

Observe for melena and hematuria.

b.

Brush and floss at least twice daily.

c.

Measure abdominal girth daily.

d.

Apply ice and pressure to puncture sites.

e.

Use electric razor.

ANS: A, C, D, E

A low platelet makes the patient prone to excessive bleeding. The nurse should monitor for bleeding into the stool and urine. Soft toothbrushes will decrease the likelihood of the gums bleeding. An increase in the abdominal girth will alert the nurse to the possibility of internal bleeding. Ice and pressure on puncture sites aid in stopping bleeding. An electric razor reduces the chance of the patient being cut during shaving.

DIF: Cognitive Level: Analysis REF: 357-358 | Nursing Care Plan 17-1

OBJ: 5 (theory) TOP: Thrombocytopenic Precautions

KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

25. The nurse monitoring a patient who is receiving a transfusion will stop the transfusion in the event of the patient complaining of: (Select all that apply.)

a.

feeling cold.

b.

a headache.

c.

back pain.

d.

a rash.

e.

urticaria.

ANS: B, C, D, E

The complaint of feeling chilled is caused by the infusion of the chilled blood. The transfusion is not stopped; the patient is given a blanket. All other options are events that indicate a reaction to the transfusion and should cause the infusion to be stopped and the saline infusion to be opened into the line to keep the IV line open.

DIF: Cognitive Level: Application REF: 363-364 | 365 | Table 17-7

OBJ: 7 (theory) TOP: Transfusion: Complications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

COMPLETION

26. The nurse is aware that bone marrow transplantation (BMT) is a treatment alternative for aplastic anemia for people under the age of ____________________.

ANS:

45

forty-five

People under the age of 45 are considered candidates for BMT.

DIF: Cognitive Level: Comprehension REF: 352 OBJ: 1 (clinical)

TOP: Aplastic Anemia: Treatment KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

27. When assessing a complete blood count (CBC) of a patient with acute lymphocytic leukemia (ALL), the nurse would anticipate large numbers of immature white cells, called ____________________.

ANS:

blasts

Immature white cells are released from the bone marrow in response to the bodys need for more effective WBCs.

DIF: Cognitive Level: Comprehension REF: 355 OBJ: 5 (theory)

TOP: ALL: CBC KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. The patient with acute myelogenous leukemia (AML) has a volume of blood extracted by machine, white cells are extracted in the machine, and the blood is then returned to the patient. This process is called ____________________.

ANS:

leukapheresis

Leukapheresis is a process by which blood is withdrawn from the patient by an extractor machine, the excess diseased WBCs are extracted, and the blood is returned to the patient.

DIF: Cognitive Level: Comprehension REF: 356 OBJ: 5 (theory)

TOP: Leukapheresis KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

29. The nurse explains to a person who has undergone bone marrow transplantation (BMT) that engraftment takes up to ____________________ weeks.

ANS:

5

five

Engraftment takes from 2 to 5 weeks to begin to make stem cells.

DIF: Cognitive Level: Comprehension REF: 366 OBJ: 2 (clinical)

TOP: BMT: Engraftment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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