Chapter 28. Nursing Care of Patients With Hematologic and Lymphatic Disorders My Nursing Test Banks

Chapter 28. Nursing Care of Patients With Hematologic and Lymphatic Disorders

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is caring for a patient with anemia. Which blood component is deficient in this patient?

a.

Plasma

b.

Platelets

c.

Red blood cells (RBCs)

d.

White blood cells (WBCs)

____ 2. A patient is diagnosed with anemia and asks the nurse what nutrients are important for RBC formation. The nurse bases an answer on the understanding that which nutrients are essential for production of healthy red cells?

a.

Iron, folic acid, and vitamin B12

b.

Vitamin C, vitamin D, and selenium

c.

Vitamin A, calcium, and phosphorus

d.

Aluminum, vitamin E, and beta carotene

____ 3. A patient with iron-deficiency anemia has been taking oral iron supplements. Which test should the nurse review to determine the effectiveness of this intervention?

a.

Hemoglobin and hematocrit

b.

WBC and platelet counts

c.

Electrolytes, blood urea nitrogen (BUN), and creatinine

d.

Thrombin clotting time (TCT) and prothrombin time (PT)

____ 4. The nurse is assisting in the development of a care plan for a patient with anemia. Which nursing diagnosis is most common in a patient with anemia?

a.

Activity Intolerance related to tissue hypoxia

b.

Ineffective Airway Clearance related to dyspnea

c.

Chronic Pain related to bone marrow dysfunction

d.

Risk for Infection related to reduction in circulating WBCs

____ 5. The nurse is providing dietary teaching to an individual with iron-deficiency anemia. Which patient statement indicates that teaching has been effective?

a.

I know I need to eat more green vegetables and dairy products.

b.

Berries and natural cereals are good for me because of my low iron levels.

c.

Im going to drink orange juice for breakfast and increase red meats in my diet.

d.

Yellow vegetables and green tea will be important to help build up my blood levels.

____ 6. The nurse is preparing to give an injection of iron (Imferon) to a patient with anemia. What is the rationale for using the Z-track method for injection?

a.

Prevent pain at the site

b.

Prevent tissue damage at the site

c.

Promote absorption of the medication

d.

Prevent discoloration of tissue at the site

____ 7. A patient with thrombocytopenia is having pain. If each of the following medications is ordered, which should the nurse choose to administer?

a.

Morphine SQ

b.

Meperidine (Demerol) IM

c.

Oxycodone with aspirin (Percodan) PO

d.

Acetaminophen with codeine (Tylenol No. 3) PO

____ 8. The nurse is caring for a patient with thrombocytopenia. Which activity should be avoided?

a.

Ambulation

b.

Intramuscular injections

c.

Visits from family members

d.

Eating fresh fruits and vegetables

____ 9. A patient with aplastic anemia is to receive an injection of erythropoietin (Epogen). The patient asks what the injection is intended to do. Which should the nurse respond to the patient?

a.

It will inhibit the protein that is attacking your blood cells.

b.

It works like a blood transfusion to give you extra red blood cells.

c.

It will stimulate your body to produce more of its own red blood cells.

d.

It will increase your energy while your body is recovering from the anemia.

____ 10. A patient is admitted in sickle cell crisis with symptoms of dyspnea and leg pain. The patients significant other asks, I dont really understand why he is hurting so badly. Which response by the nurse is best?

a.

The pain is due to a disturbance in cellular metabolism.

b.

The bone marrow is expanding with the sickled cells and that causes pain.

c.

Clumping of abnormal red blood cells blocks the flow of blood through the capillaries.

d.

Bleeding in the joints occurs because red blood cells are being rapidly destroyed by the bone marrow.

____ 11. The nurse is reviewing the current patient census on a care area. Which individual is most likely to present with signs or symptoms of sickle cell anemia?

a.

A 1-month-old boy who is Hispanic

b.

A 5-year-old girl of Hispanic origin

c.

A 1-year-old boy who is African American

d.

A 3-month-old girl who is African American

____ 12. The nurse is caring for a patient in sickle cell crisis. What is the rationale for providing warm compresses and blankets for this patient?

a.

Sickle cell crisis causes shivering and discomfort.

b.

Heat helps prevent the cells from becoming sickled.

c.

Heat speeds production of new healthy RBCs.

d.

Heat prevents vasoconstriction and impaired circulation.

____ 13. The nurse is teaching a patient with sickle cell anemia how to prevent crises. Which foods should the nurse teach the patient to avoid?

a.

Citrus fruits

b.

Alcoholic beverages

c.

Chocolates and colas

d.

Whole grain products

____ 14. A patient is admitted to the hospital with hypertension and vertigo related to polycythemia vera (PV). For which treatment should the nurse prepare the patient?

a.

Myelogram

b.

Splenectomy

c.

Therapeutic phlebotomy

d.

Injection of colony-stimulating factors

____ 15. The nurse is caring for a patient with PV. Which laboratory study should the nurse monitor to help evaluate the effectiveness of treatment for this patient?

a.

Hematocrit

b.

Total protein

c.

Blood urea nitrogen (BUN)

d.

WBC differential

____ 16. The nurse is planning discharge teaching for a patient with polycythemia. Which nursing intervention should the nurse consider to help prevent complications in this patient?

a.

Monitor intake and output.

b.

Avoid use of injections for pain.

c.

Maintain bedrest during treatment.

d.

Encourage 3 L of water intake daily.

____ 17. The nurse is caring for a patient with a bleeding disorder. Which manifestation might first alert the nurse to the possibility of disseminated intravascular coagulation?

a.

Petechiae

b.

Absence of pulses in extremities

c.

Weakness or paralysis on one side

d.

Increasing blood pressure and pulse

____ 18. The nurse is caring for a patient with a bleeding disorder. Which medication order should the nurse question?

a.

Aspirin

b.

Morphine

c.

Digoxin (Lanoxin)

d.

Thyroid hormone (Synthroid)

____ 19. The nurse is caring for a patient with a clotting disorder. Which blood product should the nurse anticipate being prescribed?

a.

Albumin

b.

Normal saline

c.

Cryoprecipitates

d.

Packed WBCs

____ 20. The nurse is reviewing the care plan for a patient with disseminated intravascular coagulation. Which nursing intervention is most likely to cause an acute complication in this patient?

a.

Placing the patient on strict bedrest

b.

Providing a diet that is high in fat and sodium

c.

Administering intramuscular meperidine (Demerol) for pain

d.

Allowing a family member with a respiratory infection to visit

____ 21. The nurse is assessing a patient with a bleeding disorder and finds large purplish areas in the skin and oral mucosa. Which term should the nurse use to document this finding?

a.

Purpura

b.

Bleeding

c.

Petechiae

d.

Hemorrhage

____ 22. A comatose patient is admitted to the emergency department after an automobile accident. The nurse notes a Medic-Alert identification bracelet that states the patient has hemophilia. What should the nurse do first?

a.

Notify the physician of the bracelet.

b.

Tape the bracelet to the patients arm.

c.

Call the phone number on the bracelet.

d.

Remove the bracelet, and give it to the patients family member.

____ 23. A nurse is assisting with data collection on a newly admitted patient with a history of hemophilia. Which assessment finding indicates that the patient has experienced some severe episodes of bleeding in the past?

a.

Joint deformities

b.

Distended abdomen

c.

Ecchymoses on the extremities

d.

Elevated WBC count

____ 24. A patient walks into the urgent care clinic, stating that he has hemophilia and that he is bleeding. The triage nurse does a quick assessment and sees no signs of active bleeding. Several patients are already in the waiting area. Which action by the nurse is most appropriate?

a.

Palpate the suspected area for tenderness and edema.

b.

Ask the patient to sit in the waiting room until his name is called.

c.

Place the patient in an examination room and tell the physician that the patient may be bleeding.

d.

Send the patient for routine x-rays according to clinic protocol to look for a source of bleeding, and then place him in an examination room.

____ 25. A patient with hemophilia A is bleeding. Which treatment should the nurse anticipate being prescribed for this patient?

a.

IV infusion of factor IX

b.

IM injection of factor IX

c.

IV infusion of factor VIII

d.

IM injection of factor VIII

____ 26. A 54-year-old patient is admitted to the hospital in the final stage of chronic lymphocytic leukemia (CLL). Which manifestations of CLL should the nurse expect to find while collecting admission data?

a.

Nausea and vomiting

b.

Hypotension and alopecia

c.

Fever and abnormal bleeding

d.

Cervical lymphadenopathy and chest pain

____ 27. The nurse is identifying approaches to reduce the risk of infection in a patient with leukemia. Why is it important for the nurse to institute infection control measures for this patient?

a.

Infection can precipitate hemorrhage in the patient with leukemia.

b.

The drugs needed to fight infection have life-threatening side effects.

c.

Infection in the patient with leukemia can lead to permanent neurological damage.

d.

Leukemia seriously impairs the leukocytes and the bodys ability to fight infection.

____ 28. A patient is being tested for possible leukemia. With which diagnostic test should the nurse anticipate assisting?

a.

Liver biopsy

b.

Thoracentesis

c.

Bone marrow biopsy

d.

Arterial blood gas analysis

____ 29. The nurse is emptying the bedside commode of a patient with chronic leukemia and notes that the stool is very dark. Which assumption should guide the nurses action?

a.

The patient may be bleeding.

b.

The patient may be dehydrated.

c.

The patient is most likely on iron supplements.

d.

The patient ate something that turned the stool a dark color.

____ 30. A patient receiving chemotherapy for chronic myelocytic leukemia has irritated mucous membranes. Which mouth care intervention should the nurse include in the plan of care?

a.

Brush teeth twice a day with a firm toothbrush.

b.

Use waxed floss between meals and at bedtime.

c.

Use sponge Toothettes to clean teeth after meals.

d.

Swab teeth and mucous membranes four times daily with lemon-glycerin swabs.

____ 31. A patient with multiple myeloma is being cared for at home. Which nursing diagnosis should guide the nurse when teaching the family how to provide care for the patient?

a.

Risk for Injury related to compromised bone integrity

b.

Ineffective Tissue Perfusion related to vascular occlusion

c.

Risk for Deficient Fluid Volume related to bleeding disorder

d.

Ineffective Airway Clearance related to cervical lymphadenopathy

____ 32. A patient with multiple myeloma is at risk for hypercalcemia. Which nursing intervention is most important for the patient with hypercalcemia?

a.

Encourage fluids.

b.

Offer citrus juices and fruits.

c.

Place the patient on a low-sodium diet.

d.

Discourage intake of alcoholic beverages.

____ 33. The nurse is determining the effectiveness of treatment prescribed for a patient with anemia. Which question should the nurse use to make this evaluation?

a.

Is your appetite improving?

b.

Are you sleeping all night?

c.

Are you requiring many analgesics?

d.

Are you keeping up with your work schedule?

____ 34. A patient with Hodgkins disease has cervical lymph node enlargement. Which symptom should the nurse attend to first?

a.

Pain

b.

Fever

c.

Stridor

d.

Fatigue

____ 35. The nurse is preparing teaching for a patient with Hodgkins disease. Which beverage should the nurse instruct this patient to avoid?

a.

Wine

b.

Coffee

c.

Ginger ale

d.

Orange juice

____ 36. The nurse is assessing a patient with stage III Hodgkins disease. Where should the nurse expect to find enlarged lymph nodes?

a.

In the neck only

b.

Above the diaphragm only

c.

Below the diaphragm only

d.

Generalized throughout the body

____ 37. A patient with lymphoma wants to attend a family members wedding but is extremely fatigued. The nurse develops a plan for Activity Intolerance related to symptoms of lymphoma. How will the nurse know if the plan has been effective?

a.

The patient is able to sleep 8 hours at night.

b.

The patient can list three ways to combat fatigue.

c.

The patient attends the family members wedding.

d.

The patient verbalizes understanding of the importance of gradually increasing activity.

____ 38. A patient with terminal lymphoma says to the nurse, Im tired of being so fatigued all the time. Cant you just give me a big shot of morphine and help me end this suffering? Which response by the nurse is most appropriate?

a.

You sound frustrated. It must be difficult to feel so tired all the time.

b.

Are you sure that is what you want me to do? Maybe you should think about it first.

c.

That is really not appropriate to ask. Would you like a shot just to take away the pain?

d.

You have orders for morphine 10 to 15 mg. I dont think thats enough to end your suffering.

____ 39. A patient is being prepared for splenectomy. What is the purpose of the order for a vitamin K injection?

a.

It corrects a dietary deficiency.

b.

It helps correct underlying anemia.

c.

It corrects clotting factor deficiencies.

d.

It replaces vitamin K lost during night sweats.

____ 40. The nurse is providing care for a patient who has had a splenectomy. Which nursing action has the highest priority?

a.

Assess pain every shift.

b.

Provide a diet rich in fruits and vegetables.

c.

Teach the patient to cough and deep breathe every hour.

d.

Encourage the patient to look at the incision during dressing changes.

____ 41. A patient who has had a splenectomy complains of malaise. The nurse checks the patients temperature and finds it is 102F (39C). Which action by the nurse should take priority?

a.

Notify the physician.

b.

Encourage fluids to reduce fever and prevent dehydration.

c.

Administer acetaminophen to reduce fever and relieve discomfort.

d.

Explain to the patient that low-grade fevers are common after splenectomy because the spleen is part of the immune system.

____ 42. The nurse is collaborating on discharge teaching needed for a patient recovering from a splenectomy. What follow-up care is most important for the nurse to emphasize with this patient?

a.

Monthly coagulation studies

b.

Yearly influenza vaccination

c.

Oral analgesics for pain control

d.

Routine transfusion of packed RBCs to prevent anemia

____ 43. The nurse is preparing to provide care to a patient recovering from surgery. What nursing action is the best way to prevent infection in a postoperative patient?

a.

Practice good hand washing.

b.

Encourage 2 L of fluid daily.

c.

Change wound dressings daily.

d.

Assess vital signs every 4 hours.

____ 44. The nurse is reviewing laboratory results for a patient with a blood disorder. Reduced fibrinogen and platelet levels, increased thrombin time, and reduced factor assays are laboratory results associated with which hematological disorders?

a.

Aplastic anemia

b.

Sickle cell anemia

c.

PV

d.

Disseminated intravascular coagulation

____ 45. A patient with anemia and a nursing diagnosis of activity intolerance due to tissue hypoxia and dyspnea is attempting to increase activity tolerance. What percentage of increase in pulse and respiratory rate should the nurse use to determine if the activity is too strenuous for the patient?

a.

5%

b.

10%

c.

20%

d.

30%

____ 46. A patient has a platelet count of 20,000/mm3. What action should the nurse take?

a.

Assist out of bed to a chair

b.

Draw another blood sample

c.

Measure a rectal temperature

d.

Place on bleeding precautions

____ 47. The nurse suspects a patient has polycythemia. Which hematocrit value is causing the nurse to have this concern?

a.

38%

b.

45%

c.

47%

d.

55%

____ 48. The nurse is preparing teaching materials for a patient with PV. How many liters of fluid should the nurse instruct the patient to consume each day?

a.

1

b.

2

c.

3

d.

4

____ 49. The daughter of a male patient with hemophilia is concerned about transmitting the genetic disorder to any future children. What percentage of chance of transmitting the gene to future children should the nurse instruct the daughter?

a.

10%

b.

25%

c.

50%

d.

100%

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 50. The nurse is providing education to an individual with sickle cell anemia. Which activities should the nurse instruct the patient to avoid? (Select all that apply.)

a.

Scuba diving

b.

Contact sports

c.

Sexual activity

d.

Long-distance driving

e.

Skiing in the mountains

f.

Standing for long periods

____ 51. The nurse is collecting information about sickle cell disease for an upcoming seminar. What should the nurse include as common triggers for a sickle cell crisis? (Select all that apply.)

a.

Anesthesia

b.

Chemotherapy

c.

Severe infection

d.

Strenuous exercise

e.

Use of nasal oxygen

f.

Blood loss during surgery

____ 52. The nurse suspects a patient is experiencing manifestations of Hodgkins disease. Which are characteristics of this health disorder? (Select all that apply.)

a.

Visual changes occur.

b.

It is the most curable of all lymphomas.

c.

Skeletal pain is a common symptom.

d.

It is distinguished by the presence of Reed-Sternberg cells.

e.

Painless swelling of cervical, axillary, or inguinal nodes occurs.

f.

It is distinguished by the presence of Philadelphia chromosome.

____ 53. During a home visit, the nurse becomes concerned that a child is developing idiopathic thrombocytopenic purpura (ITP). Which health problems could have precipitated the development of this disorder in the child? (Select all that apply.)

a.

HIV

b.

Rubella

c.

Hepatitis C

d.

Chickenpox

e.

Cystic fibrosis

____ 54. A patient is planning to have an allogeneic bone marrow transplant. What will the patient most likely have completed before this transplant occurs? (Select all that apply.)

a.

Electrophoresis

b.

Peritoneal dialysis

c.

Total body irradiation

d.

High-dose chemotherapy

e.

Massive blood transfusions

____ 55. During a home visit, the nurse becomes concerned that a patient recovering from a splenectomy is at risk for infection. What did the nurse observe to come to this conclusion? (Select all that apply.)

a.

Received a manicure and pedicure

b.

Washed hands before preparing lunch

c.

Poured a cup of tea after petting the cat

d.

Had a hot tub installed on the back patio

e.

Planting tomato plants in an outside garden

____ 56. A patient is diagnosed with a folic acid deficiency. On what dietary changes should the nurse instruct this patient? (Select all that apply.)

a.

Snack on peanuts.

b.

Eat breads fortified with folic acid.

c.

Add green leafy vegetables to meals.

d.

Increase the intake of milk each day.

e.

Prepare soups with dried peas and beans.

____ 57. The nurse is caring for a patient scheduled for tests to confirm the diagnosis of lymphoma. For which diagnostic tests should the nurse prepare the patient? (Select all that apply.)

a.

CT scan

b.

Cerebral angiogram

c.

Lymph node biopsy

d.

Lymphangiography

e.

Complete blood count

Completion

Complete each statement.

58. The recommended dose of filgrastim (Neupogen) is 10 mcg/kg/day. It is supplied as 300 mcg/mL. A patient who weighs 132 lb should receive ____________________ mL.

Chapter 28. Nursing Care of Patients With Hematologic and Lymphatic Disorders

Answer Section

MULTIPLE CHOICE

1. ANS: C

The term anemia describes a condition in which there is a deficiency of RBCs, hemoglobin, or both, in the circulating blood. B. C. Deficiency of WBCs is called leukopenia, and deficient platelets is called thrombocytopenia. D. A deficiency of plasma would cause dehydration.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

2. ANS: A

Iron, folic acid, and vitamin B12 are all essential to production of healthy RBCs. A deficiency of any of these nutrients can cause anemia. B, C, and D are not associated with anemia.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

3. ANS: B

Hemoglobin and hematocrit are below normal in anemia. C. Electrolyte, BUN, and creatinine abnormalities usually indicate kidney pathology. D. Thrombin clotting time and PT monitor the effectiveness of anticoagulant therapy. B. WBC counts are used to monitor the effectiveness of antibiotic therapy for infections. Platelets are monitored to determine clotting ability.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

4. ANS: A

Patients with anemia are fatigued related to poor oxygenation, making Activity Intolerance the best diagnosis. B. Anemia generally does not cause airway clearance problems, although it may cause dyspnea. D. Anemia is low RBCs, not WBCs. C. Pain is not a typical problem with anemia.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

5. ANS: C

Red meat; dark green leafy vegetables; dried fruits; and enriched, fortified, or whole grain products are relatively good sources of iron that are commonly included in Western diets. Foods rich in vitamin C can be used to enhance absorption of iron from nonmeat sources. Likewise, stewing acidic foods such as tomatoes in iron cookware increases their iron content. A. Green vegetables may contain iron however dairy products are not an identified source of iron. B. Berries and natural cereals are not good sources of iron. D. Yellow vegetables and green tea are not good sources of iron.

PTS: 1 DIF: Moderate

KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

6. ANS: D

Administer intramuscular iron injections by Z-track method to avoid staining the injection site. A. C. Z-track will not prevent pain or improve absorption. B. Tissue damage is not usually a problem.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

7. ANS: D

Acetaminophen with codeine is an oral medication, making it the best choice. A. B. C. Injections increase risk for bleeding, as does oral aspirin. The patient with thrombocytopenia is already at risk for bleeding.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

8. ANS: B

The patient with thrombocytopenia is at risk for bleeding. Intramuscular injections can cause bleeding into the muscle. C. D. Visits from family and fresh produce are concerns with low WBC counts. A. Ambulation is not a concern.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

9. ANS: C

Erythropoietin (Epogen) stimulates the production of RBCs. A. B. It does not provide extra cells or stop the disease process. D. It may help increase energy however many patients do not recover from aplastic anemia.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

10. ANS: C

As sickling occurs, blood becomes sluggish and does not flow easily. It tends to collect in the capillaries and veins of the organs of the chest and abdomen, as well as joints and bones, and can cause infarction (tissue necrosis resulting from lack of blood supply). Tissue necrosis results in pain, fever, and swelling. A. B. Pain from sickle cell anemia is not associated with changes in cellular metabolism or bone marrow pathology. D. Bleeding into joints is more common with hemophilia.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

11. ANS: C

In the United States, sickle cell anemia is most often found in those of African or eastern Mediterranean origin. B. Children of Hispanic origin are the least likely to demonstrate symptoms of sickle cell anemia. A. D. Symptoms are not present until after the age of 6 months due to the hemoglobin made during fetal life.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

12. ANS: D

Warm compresses help dilate vessels to reduce clumping of cells. A. Sickle cell crises are not associated with shivering. B. C. Heat will not prevent sickling or speed production of blood cells.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Analysis

13. ANS: B

Alcohol can trigger a sickle cell crisis. A. C. D. Citrus, chocolate, and whole grains are not known to trigger crises.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

14. ANS: C

Phlebotomy reduces the RBCs and viscosity of the blood and the patient usually feels more comfortable quickly. D. Colony-stimulating factors would stimulate more cell production, which would worsen symptoms. A. B. Splenectomy and myelogram are not treatments associated with PV.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

15. ANS: A

Hematocrit reflects the RBC count and monitors the thickness of the blood, the main concern in PV. B. C. D. Total protein, WBCs, and BUN are not generally affected in PV.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

16. ANS: D

Patients should drink 3 liters of water daily to reduce blood viscosity. A. Intake and output will not prevent complications. B. Injections are contraindicated in patients with bleeding disorders, not polycythemia. C. Bedrest will further hinder circulation.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

17. ANS: A

Petechiae indicate bleeding into the skin, a symptom of the reduced clotting that occurs in disseminated intravascular coagulation. B. C. Paralysis and pulse absence are too general and can be symptoms of many disorders. D. If the patient is bleeding, the blood pressure will decrease.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

18. ANS: A

Aspirin has antiplatelet action and could increase risk for bleeding. B. C. D. Digoxin, thyroid hormone, and morphine do not increase risk for bleeding.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

19. ANS: C

Cryoprecipitates replace specific missing clotting factors. D. A. Packed RBCs replace lost blood, and albumin expands volume. B. Normal saline is not a blood product.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

20. ANS: C

Intramuscular injections can cause bleeding into the muscle. A, B, and D are not desirable, but they do not cause the most immediate risk.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

21. ANS: A

Purpura is the correct term for hemorrhage into the skin, mucous membranes, and organs. C. Petechiae are small pinpoint hemorrhages. B. D. Hemorrhage and bleeding are more general terms that do not most accurately describe the symptoms.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

22. ANS: A

The physician should be notified immediately, because the information impacts type and urgency of care. D. Removing the bracelet places the patient at risk of inappropriate care. B. C. Taping the bracelet to the arm and calling the telephone number on the bracelet can be completed later.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

23. ANS: A

Bleeding into the muscles and joints (hemarthrosis) is common in hemophilia. Severe and repeated episodes of joint hemorrhage cause joint deformities. C. Ecchymosis indicates new, rather than past, bleeding. B. D. Elevated WBC and abdominal distention are not generally associated with hemophilia.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

24. ANS: C

Health care workers should pay careful attention to the patient who says that bleeding is starting, even when no outward signs are evident. The patient usually knows from experience if bleeding is starting. B. D. If treatment is delayed at this time, the results can be disastrous. A. Palpation can increase bleeding.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

25. ANS: C

Hemophilia A is treated with factor VIII. A. Hemophilia B is treated with factor IX. B. D. Each is available in a freeze-dried powder that is reconstituted with water and administered intravenously. IM injections would cause bleeding into muscles and are therefore avoided.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

26. ANS: C

During the acute phase of CLL, the patient may exhibit high fevers from infection and ecchymosis or petechiae from thrombocytopenia. A. B. Nausea, vomiting, and alopecia are side effects of chemotherapy. D. Lymphadenopathy and chest pain are not generally associated with leukemia.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

27. ANS: D

Leukemia is a malignant disease of the WBCs. The immature WBCs are abnormal and unable to effectively fight infection. A. C. Infection does not precipitate hemorrhage and does not typically lead to neurological damage. B. Chemotherapy, not antibiotics, has serious side effects.

PTS: 1 DIF: Moderate

KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Analysis

28. ANS: C

Although a simple complete blood count (CBC) often points toward the diagnosis, only bone marrow aspiration can show the extent of proliferation of the malignant WBCs and confirm the diagnosis of leukemia. B. D. Thoracentesis and arterial blood gases diagnose pulmonary problems A. Liver biopsy is used to detect liver cancer.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

29. ANS: A

.

Black stools are a sign of gastrointestinal bleeding. C. D. Iron supplements and some foods may change stool color, but if the patient has leukemia, the nurse cannot assume that the cause is unimportant. B. Dehydration is associated with constipation, not dark stools.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

30. ANS: C

Toothettes are soft and will not further irritate the mucous membranes. A. B. A firm toothbrush or flossing can cause bleeding. D. Lemon-glycerin swabs are drying.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

31. ANS: A

Multiple myeloma causes destruction of the bone and widespread osteoporosis. B. C. D. It does not directly affect airway clearance, tissue perfusion, or fluid volume.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

32. ANS: A

Fluids dilute calcium and flush the kidneys to reduce risk of kidney stones. B. C. D. Citrus, low-sodium diet, and alcohol do not directly affect calcium levels.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

33. ANS: D

A patient with anemia is easily fatigued, so keeping up with a work schedule indicates adequate energy to work. A. C. Anemia does not affect appetite and is not painful. B. Patients may sleep more if fatigued rather than have trouble sleeping all night.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Evaluation

34. ANS: C

Stridor indicates airway involvement due to enlarged lymph nodes. Airway is always a priority, as airway compromise is life-threatening. A. B. D. Fever, fatigue, and pain are important but should be addressed only once the airway is open.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

35. ANS: A

Alcohol can induce pain in patients with Hodgkins disease. B. C. D. Coffee, orange juice, and sodas do not cause pain in the patient with Hodgkins disease.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

36. ANS: D

Stage III Hodgkins disease is characterized by nodes on both sides of the diaphragm, with or without organ involvement. A. B. C. Lymph nodes are enlarged beyond the neck, above, and below the diaphragm.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

37. ANS: C

The patients goal is to attend the wedding, so attendance tells the nurse the patient had enough energy to go. A. Sleep does not guarantee relief from fatigue. B. D. Listing or verbalizing things is not evidence of tolerance to activity.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Evaluation

38. ANS: A

It is not the role of the nurse to end a lifeit is appropriate to help lessen suffering. The nurses response allows the patient to further verbalize concerns, which the nurse can then address. B, C, and D do not address the patients concern.

PTS: 1 DIF: Moderate

KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

39. ANS: C

Vitamin K is important in the clotting process and is often ordered prior to a splenectomy to correct clotting factor deficiencies. D. Vitamin K is not lost during night sweats. A. There is no evidence of dietary deficiency in the question. B. Blood transfusions are ordered to correct anemia.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

40. ANS: C

Coughing and deep breathing will mobilize secretions and help prevent respiratory infection. Patients are at risk for serious infection following splenectomy. A. Pain should be assessed more frequently than every shift. D. Body image changes are considered a lower priority than the physical risk of respiratory infection. B. Fruits and vegetables are a good idea but will not directly prevent infection.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

41. ANS: A

D. Fever in the post-splenectomy period signals overwhelming post-splenectomy infection. This can be deadly if not recognized and treated quickly, so notifying the physician is essential. B and C can be done after the physician has been contacted. D. 102F is not low-grade fever.

PTS: 1 DIF: Moderate

KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Analysis

42. ANS: B

Without a spleen to assist in the immune response, the patient is at risk for infection, making flu vaccination important. A. D. Coagulation studies and transfusions are not necessary. C. Oral analgesics may be needed for a short time but are not as essential as preventing infection.

PTS: 1 DIF: Moderate

KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application|

43. ANS: A

Hand washing is the best defense against infection. D. Assessing vital signs will detect, not prevent, infection. C. Hanging dressings is important, but without hand washing, this is not helpful in preventing infection. B. Fluids prevent dehydration but do not directly affect infection risk.

PTS: 1 DIF: Moderate

KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

44. ANS: D

Disseminated intravascular coagulation is associated with clotting abnormalities. C. PV is associated with elevated RBCs, hemoglobin, and hematocrit. A. RBCs, WBCs, and platelets are reduced in aplastic anemia. B. Sickle cell anemia is characterized by sickle-shaped RBCs.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

45. ANS: C

If the pulse or respiratory rate increases more than 20% from baseline during activity, the activity is too strenuous, and the level should be reduced. A. B. The activity is not too strenuous. D. The activity could cause the patient to develop cardiac or respiratory symptoms.

PTS: 1 DIF: Moderate

KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

46. ANS: D

A platelet count of less than 20,000/mm3 (nl 150,000 to 450,000/mm3) places the patient at risk for bleeding. A. B. C. Because the patient is at risk for bleeding, the patient most likely should not be transferred to a chair. The patient is at risk for bleeding after a venipuncture. C. Rectal temperatures increase the risk for bleeding and should not be done.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

47. ANS: D

A hematocrit level greater than 55% is characteristic of polycythemia. A. B. C. A normal hematocrit is 38% to 47% for females and 40% to 54% for males.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

48. ANS: C

Patients should drink 3 liters of water daily to reduce blood viscosity. A. B. One or two liters of fluid will not ensure a reduction in blood viscosity. D. Four liters of fluid is not necessary to reduce blood viscosity.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

49. ANS: C

The daughter of an affected father has a 50% chance of transmitting the gene to each son or daughter. Daughters who receive the gene are carriers, and sons who receive the gene are born with hemophilia. It is technically possible for daughters to be affected with hemophilia, although it is very rare. A. B. D. These are incorrect percentages for the transmission of the genetic disorder of hemophilia.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

MULTIPLE RESPONSE

50. ANS: A, E

Factors that contribute to the development of a sickle cell crisis include those related to decreased oxygenation. At high altitudes or in scuba diving, there is less oxygen available, making skiing in the mountains or scuba diving unsafe for someone with sickle cell anemia. B. C. D. F. Sexual activity, driving, standing, and contact sports should not alter oxygenation.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

51. ANS: A, C, D, F

Factors that contribute to the development of a sickle cell crisis include those related to decreased oxygenation. Some examples include pneumonia with hypoxia, strenuous exercise, exposure to cold, diabetic acidosis, and severe infection. E. Use of oxygen will increase, not decrease, oxygenation. B. Chemotherapy should not affect oxygenation.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

52. ANS: B, D, E

Hodgkins disease is a lymphoma, which is a cancer of the lymph system. Its distinguishing feature is Reed-Sternberg cells, which make it different from all the other forms of lymphoma. Of all the lymphomas, Hodgkins disease is the most curable type, even when the disease is widely spread at the time of diagnosis. Painless swelling in one or more of the common lymph node chains is a usual presentation. Swelling can range from barely perceptible to the size of a softball, occasionally even larger. F. Chronic myelogenous leukemia is characterized by the Philadelphia chromosome. C. Skeletal pain is a symptom of leukemias and multiple myeloma. A. Visual changes are associated with PV.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

53. ANS: A, B, C, D

Acute ITP usually affects children between ages 2 and 6 and usually occurs after an acute viral illness such as rubella or chickenpox. Hepatitis C virus and human immunodeficiency virus (HIV) can also be triggers. E. ITP is not associated with cystic fibrosis.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

54. ANS: C, D

Preparation for bone marrow transplant includes high-dose chemotherapy and/or total body irradiation. The goal is to destroy all of the patients malignant bone marrow and then, at the last possible moment, replace it with a donors clean and healthy bone marrow. A. Electrophoresis is a treatment to remove impurities from the blood stream. B. Peritoneal dialysis is a treatment for chronic renal failure. E. Massive blood transfusions are not indicated prior to bone marrow transplant.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

55. ANS: A, C, D, E

Patient at risk for infection should be instructed to void working with dirt or soil, to avoid manicures and pedicures, to avoid hot tubs or Jacuzzis, and to wash hands after contact with pets, fresh flowers, or plants. B. Washing hands before preparing lunch decreases the risk for developing an infection.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

56. ANS: A, B, C, E

Good food sources of folic acid include fortified flours, grains, cereals, wheat germ; liver; green leafy vegetables: asparagus, endive, lettuce; and legumes: peanuts, dried peas, beans, and lentils. D. Milk is not a good source of folic acid.

PTS: 1 DIF: Moderate

KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

57. ANS: A, C, D, E

Tests used to aid in the diagnosis of lymphoma include CT scan, lymph node biopsy, lymphangiography, and complete blood count. B. Cerebral angiogram is not a test used to diagnose lymphoma.

PTS: 1 DIF: Moderate

KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

COMPLETION

58. ANS:

2, two

10 mcg

1 kg

132 lb

1 mL

= 2 mL

1 kg

2.2 lb

300 mcg

PTS: 1 DIF: Moderate

KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

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