Chapter 29Hematological Dysfunction: Nursing Management My Nursing Test Banks

Chapter 29Hematological Dysfunction: Nursing Management

MULTIPLE CHOICE

1.A client is diagnosed with anemia. The nurse realizes that which of the following could be the treatment for this clients disorder?

1.

Erythropoietin therapy

2.

Leukemia

3.

Poor nutrition

4.

Trauma

ANS: 1

Anemia is caused for a variety of reasons such as nutrition, chronic illness, trauma, medication therapy, immune suppression, and alterations of erythropoiesis. Erythropoietin therapy stimulates red blood cell production in the bone marrow as a treatment for anemia.

PTS: 1 DIF: Analyze REF: Anemias: Epidemiology

2.A client is diagnosed with alpha- and beta- defect thalassemia. The nurse realizes that this disease is common within which of the following cultural groups?

1.

Persons from China

2.

People of Mediterranean ancestry

3.

African Americans

4.

Persons from the Philippines

ANS: 3

African Americans and Africans are more likely to have both alpha- and beta-defect thalassemia. Populations of Asian descent such as those from China or the Philippines more often have alpha-defect thalassemia. Populations of Mediterranean ancestry are more susceptible to beta-defect thalassemia.

PTS: 1 DIF: Analyze REF: Thalassemia: Epidemiology

3.The mother of a newborn is concerned since the baby is jaundiced. The nurse realizes that the infant should be assessed for which of the following anemias?

1.

Glucose-6-phosphate dehydrogenase (G6PD)

2.

Hereditary spherocytosis

3.

Sickle-cell anemia

4.

Thalassemia

ANS: 2

Hereditary spherocytosis is also known as congenital hemolytic anemia. This anemia begins in utero and manifests as anemia and hyperbilirubinemia. A client with Glucose-6-phosphate dehydrogenase may develop jaundice later in life but not upon birth. Thalassemia and sickle-cell anemia do not present with hyperbilirubinemia upon birth.

PTS:1DIF:Analyze

REF: Glucose-6-Phosphate Dehydrogenase Anemia: Assessment with Clinical Manifestations

4.During the health history portion of the assessment, the client states, I have sickle-cell trait. The nurse realizes that:

1.

precautions should be taken to prevent the cell from sickling.

2.

the client is a carrier.

3.

the client will show signs of the disease as she grows older.

4.

the client will transmit the disease to any offspring.

ANS: 2

Sickle-cell anemia is an autosomal recessive disorder passed from parent to offspring in this pattern. An individual with one HbS has the sickle-cell trait and has a 50% chance of transmitting the gene to each child. There are no precautions to take to prevent the cell from sickling. The client will not demonstrate signs of the disease as she grows older. It will depend upon the other parent having the trait if any offspring will be affected with the disorder.

PTS: 1 DIF: Analyze REF: Sickle-Cell Anemia: Etiology

5.A client diagnosed with acute myeloid leukemia is recovering from a bone marrow transplant. Which of the following nursing interventions would not be appropriate for this client?

1.

Assess for reactions to anesthesia.

2.

Assess vital signs.

3.

Maintain isolation precautions.

4.

Obtain a low-pressure mattress to prevent skin breakdown.

ANS: 1

The client having a bone marrow transplant does not receive anesthesia. Maintaining skin integrity, implementing isolation precautions, and monitoring vital signs are appropriate nursing measures for the client recovering from a bone marrow transplant.

PTS: 1 DIF: Apply REF: Leukemia: Planning and Implementation

6.A client diagnosed with chronic disseminated intravascular coagulation is prescribed heparin. The nurse realizes that this medication is used to:

1.

increase blood flow to the circulation.

2.

increase blood clot formation.

3.

decrease blood flow in the circulation.

4.

decrease blood clot formation.

ANS: 4

Heparin is given for its interference with the clotting processes and the chance of preventing further overuse of clotting factors. Heparin is usually only used when other methods of management are failing. Heparin does not increase or decrease blood flow in the circulation. Heparin does not increase blood clot formation.

PTS:1DIF:Analyze

REF: Disseminated Intravascular Coagulation: Pharmacology

7.The nurse should assess a client diagnosed with multiple myeloma for which of the following electrolyte imbalances?

1.

Hypercalcemia

2.

Hyperkalemia

3.

Hypermagnesemia

4.

Hypernatremia

ANS: 1

Destruction of the bone leads to elevated calcium levels. The other electrolyte imbalances are not characteristic of multiple myeloma.

PTS:1DIF:Apply

REF:Multiple Myeloma: Assessment with Clinical Manifestations

8.A client is receiving treatment for the diagnosis of hemophilia. Which of the following should the nurse assess in this client?

1.

Appetite

2.

Urine output

3.

Muscle and joint pain

4.

Respiratory rate

ANS: 3

The clinical features of hemophilia include joint and muscle hemorrhages. The weight-bearing joints are most frequently affected. The nurse should assess the client for muscle and joint pain, which occurs with bleeding. Appetite, urine output, and respiratory rate are not specifically affected by hemophilia.

PTS:1DIF:Apply

REF: Hemophilia: Assessment with Clinical Manifestations

9.A client is diagnosed with emphysema. For which of the following hematologic disorders should the nurse include in the assessment of this client?

1.

Hemolytic anemia

2.

Disseminated intravascular coagulation

3.

Polycythemia

4.

Hemophilia

ANS: 3

One type of polycythemia is caused by an increase in the number of red blood cells in response to a reduced amount of oxygen in the body. The client with emphysema could develop this type of polycythemia. Hemolytic anemia, disseminated intravascular coagulation, and hemophilia are not associated with emphysema.

PTS: 1 DIF: Apply REF: Polycythemia: Secondary Polycythemia

10.A client, diagnosed with acute lymphoblastic leukemia, is receiving the first phase of chemotherapy. The nurse realizes this client is in which phase of treatment for the disorder?

1.

Induction

2.

Consolidation

3.

Maintenance

4.

Central nervous system prophylaxis

ANS: 1

The primary goal of therapy for this type of leukemia is complete remission with restoration of normal hematopoiesis. Induction chemotherapy is administered first. Consolidation occurs afterwards. Maintenance therapy then occurs followed by central nervous system prophylaxis.

PTS: 1 DIF: Analyze REF: Acute Lymphoblastic Leukemia: Pharmacology

11.The nurse is encouraging a client diagnosed with chronic leukemia to join a support group. Which of the following would a support group address?

1.

Fatigue

2.

Infection

3.

Anxiety

4.

Social isolation

ANS: 4

Social isolation is a common concern for clients with this diagnosis. The client should be encouraged to join a support group. A support group will not help with fatigue, infection, or anxiety.

PTS:1DIF:Apply

REF: Box 29-6 Common Problems of Patients with Chronic Lymphocytic Leukemia

12.A client is diagnosed with stage II Hodgkins lymphoma. The nurse realizes that this diagnosis means the disease is:

1.

terminal.

2.

limited to lymph nodes on the same side of the diaphragm.

3.

in the bone marrow.

4.

easily treated.

ANS: 2

Stage II Hodgkins lymphoma means that the disease is located in two or more lymph node regions on the same side of the diaphragm. This diagnosis does not mean the client is terminal or easily treated. Stage IV of the disease would mean the disease is in the bone marrow.

PTS: 1 DIF: Analyze REF: Box 29-8 Staging Hodgkins and NHL

13.A client is diagnosed with disseminated low-grade non-Hodgkins lymphoma. Which of the following treatments would be indicated for this client?

1.

Administration of CHOP

2.

Radiation therapy

3.

Bone marrow transplant

4.

Watch and wait

ANS: 4

In disseminated low-grade non-Hodgkins lymphoma, early intervention does not prolong survival, so watch and wait is an acceptable approach. The reason to delay is that the client may remain stable for years without treatments that could cause adverse reactions and decrease quality of life. CHOP is standard treatment for intermediate-grade non-Hodgkins lymphoma. Radiation therapy is appropriate for both intermediate-grade and high-grade non-Hodgkins lymphoma. Bone marrow transplant is used for a client with a recurrence of the disease.

PTS:1DIF:Analyze

REF:Non-Hodgkins Lymphoma: Planning and Implementation

MULTIPLE RESPONSE

1.A client is diagnosed with G6PD anemia. Which of the following medications should the nurse instruct the client to avoid? (Select all that apply.)

1.

Acetaminophen

2.

Aspirin

3.

Chloroquine

4.

Nitrofurantoin

5.

Sulfonamides

6.

Vitamin K

ANS: 2, 3, 4, 5, 6

Medications that heighten the hemolytic affects of G6PD are antimalarial drugs (e.g., chloroquine), common coal tar analgesics (including aspirin), nitrofurantoin, oral hypoglycemics, sulfonamides, thiazides, diuretics, and vitamin K. Acetaminophen has only analgesic and antipyretic properties.

PTS:1DIF:Apply

REF: Box 29-1 Medications that Heighten the Hemolytic Affects of G6PD

2.A client diagnosed with sickle-cell anemia is experiencing vaso-occlusive crisis. Which of the following interventions would be appropriate for this client? (Select all that apply.)

1.

Administering oxygen

2.

Decreasing hydration

3.

Managing pain

4.

Promoting activity

5.

Encouraging rest

6.

Restricting calories

ANS: 1, 3, 5

The nursing management of sickle-cell anemia is to manage pain and prevent sickling. This type of management is accomplished by adequate hydration, oxygenation, adequate nutrition, rest, medications, management of fever and complications, and use of transfusions. Restricting fluids and calories could be detrimental to the clients recovery. The client should be encouraged to rest and not engage in activity.

PTS: 1 DIF: Apply REF: Sickle-Cell Anemia: Planning and Implementation

3.A client is having diagnostic tests to determine the cause of anemia. The nurse realizes that these tests will focus on which of the following? (Select all that apply.)

1.

Presence of bleeding

2.

Fluid balance

3.

Disorders that cause red blood cell destruction

4.

Cardiac functioning

5.

Disorders that reduce the production of red blood cells

6.

Digestion

ANS: 1, 3, 5

Anemias have three causes: 1) bleeding that results in red blood cell loss, 2) conditions that cause red blood cell destruction, and 3) conditions that cause a reduction in the number of red blood cells made by the body. Diagnostic tests will focus on these three causes. Testing for anemia will not focus on fluid balance, cardiac functioning, or digestion.

PTS: 1 DIF: Analyze REF: Anemias: Pathophysiology

4.A client tells the nurse that he is anemic because of a poor diet. Which deficiencies cause nutritional anemias? (Select all that apply.)

1.

Iron deficiency

2.

Folic acid deficiency

3.

Vitamin C deficiency

4.

Vitamin D deficiency

5.

Vitamin A deficiency

6.

Vitamin B-12 deficiency

ANS: 1, 2, 6

Nutritional anemias can be caused by deficiencies in iron, folic acid, or vitamin B-12. A vitamin D deficiency can cause osteomalacia or rickets. Vitamin C or vitamin A deficiencies do not cause anemia.

PTS:1DIF:AnalyzeREF:Nutritional Anemias

5.Which of the following should the nurse instruct a client who is receiving treatment for the diagnosis of leukemia? (Select all that apply.)

1.

See a dentist regularly.

2.

Increase fluids.

3.

Report any fatigue to the physician.

4.

Expect to have frequent coughs and colds.

5.

Use a sunblock when outdoors.

6.

Report gastrointestinal distress to the physician.

ANS: 1, 2, 5, 6

Nursing care for a client diagnosed with leukemia should include regular dental care, increasing fluids, using a sunblock when outdoors, and reporting gastrointestinal distress to the physician. Fatigue is common with this illness and does not need to be reported to the physician. Frequent coughs and colds could be signs of a severe infection and should be reported to the physician.

PTS:1DIF:Apply

REF:Box 29-5 General Nursing Care for Patients with Leukemia

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