Chapter 30: Nursing Assessment: Hematologic System My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 30: Nursing Assessment: Hematologic System

Test Bank

MULTIPLE CHOICE

1. When doing discharge teaching for a patient who has had an emergency splenectomy following an automobile accident, the nurse will teach the patient about the increased risk for

a.

infection.

b.

lymphedema.

c.

chronic anemia.

d.

prolonged bleeding.

ANS: A

Splenectomy increases the risk for infection, especially with gram-positive bacteria. The risks for lymphedema, bleeding, and anemia are not increased after splenectomy.

DIF: Cognitive Level: Application REF: 647

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

2. While obtaining a health history from a patient with numerous petechiae on the skin, the nurse asks the patient specifically about the patients use of

a.

salicylates.

b.

contraceptives.

c.

antiseizure drugs.

d.

antihypertensives.

ANS: A

Salicylates interfere with platelet function and can lead to petechiae and ecchymoses. Antiseizure drugs may cause anemia, but not bleeding. Oral contraceptives increase clotting risk. Antihypertensives do not commonly cause problems with decreased clotting.

DIF: Cognitive Level: Comprehension REF: 649

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

3. The nurse who is reviewing laboratory data for an 86-year-old patient will be most concerned about

a.

a white blood cell (WBC) count of 3500/mL.

b.

a hematocrit of 37%.

c.

a platelet count of 400,000/mL.

d.

a hemoglobin of 11.8 g/dL.

ANS: A

The total WBC count is not usually affected by aging, and the low WBC here would indicate that the patients immune function may be compromised. The platelet count is normal. The slight decrease in hemoglobin and hematocrit are not unusual for an older patient.

DIF: Cognitive Level: Application REF: 648

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

4. The health care provider performs a bone marrow aspiration from the left posterior iliac crest on a patient with pancytopenia. Following the procedure, the nurse should

a.

elevate the head of the bed to 45 degrees.

b.

apply a sterile Band-Aid at the aspiration site.

c.

use half-inch sterile gauze to pack the wound.

d.

have the patient lie on the left side for an hour.

ANS: D

To decrease the risk for bleeding, the patient should lie on the left side for 30 to 60 minutes. The wound after bone marrow biopsy is small and will not be packed with gauze. A pressure dressing is used to cover the aspiration site. There is no indication that the head needs to be elevated for this patient.

DIF: Cognitive Level: Application REF: 658

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

5. When caring for a patient with a chronic iron deficiency anemia, the nurse will assess for

a.

yellow-tinged sclerae.

b.

shiny, smooth tongue.

c.

numbness of the extremities.

d.

gum bleeding and tenderness.

ANS: B

Loss of the papillae of the tongue occurs with chronic iron deficiency. Scleral jaundice is associated with hemolysis, gum bleeding and tenderness occur with thrombocytopenia or neutropenia, and extremity numbness is associated with vitamin B12 deficiency or pernicious anemia.

DIF: Cognitive Level: Application REF: 652-653

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

6. A patients complete blood count shows a hemoglobin of 20 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?

a.

Has there been any recent weight loss?

b.

Do you have any history of lung disease?

c.

What is your intake of fruits and vegetables?

d.

Have you noticed any dark or bloody stools?

ANS: B

The hemoglobin and hematocrit results indicate polycythemia, which can be associated with chronic lung disease. The other questions will be appropriate for patients who are anemic.

DIF: Cognitive Level: Application REF: 650-651

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

7. When caring for a patient who is receiving heparin, the nurse will monitor

a.

prothrombin time (PT).

b.

fibrin degradation products (FDP).

c.

international normalized ratio (INR).

d.

activated partial thromboplastin time (aPTT).

ANS: D

aPTT testing is used to determine whether heparin is at a therapeutic level. FDP is useful in diagnosis of problems such as disseminated intravascular coagulation (DIC). PT and INR are most commonly used to test for therapeutic levels of warfarin (Coumadin).

DIF: Cognitive Level: Comprehension REF: 656

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

8. When evaluating the red cell indices of a patient, the nurse knows that a low mean corpuscular volume (MCV) indicates

a.

hypochromic red blood cells (RBCs).

b.

inadequate numbers of RBCs.

c.

low hemoglobin in the RBCs.

d.

small size of the RBCs

ANS: D

The MCV is low when the RBCs are smaller than normal. Inadequate numbers of RBCs are an indication of anemia. Low levels of hemoglobin in the RBCs and hypochromic RBCs result in a low mean corpuscular hemoglobin (MCH).

DIF: Cognitive Level: Comprehension REF: 655

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

9. While examining the lymph nodes during physical assessment, the nurse would be most concerned about

a.

a 2-cm nontender supraclavicular node.

b.

a 1-cm mobile and nontender axillary node.

c.

an inability to palpate any superficial lymph nodes.

d.

firm inguinal nodes in a patient with an infected foot.

ANS: A

Enlarged and nontender nodes are most suggestive of malignancy such as lymphoma. Firm nodes are an expected finding in an area of infection. The superficial lymph nodes are usually not palpable in adults, but if they are palpable, they are normally 0.5 to 1 cm and nontender.

DIF: Cognitive Level: Application REF: 649-650 | 651

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

10. In the patient who had an intraoperative hemorrhage 12 hours ago, the nurse would expect to find hematology results indicating

a.

a hematocrit of 45%.

b.

a hemoglobin of 13.2 g/dL.

c.

a decreased white blood cell (WBC) count.

d.

an elevated reticulocyte count.

ANS: D

Hemorrhage causes the release of more immature RBCs from the bone marrow into the circulation. The hematocrit and hemoglobin levels are normal. The WBC count is not affected by bleeding.

DIF: Cognitive Level: Comprehension REF: 644

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

11. The complete blood count (CBC) and differential indicate that a patient is neutropenic. Which action should the nurse include in the plan of care?

a.

Avoid intramuscular injections.

b.

Encourage increased oral fluids.

c.

Check temperature every 4 hours.

d.

Increase intake of iron-rich foods.

ANS: C

Neutropenic patients are at high risk for infection and sepsis and should be monitored frequently for signs of infection. The other actions would not address the patients neutropenia.

DIF: Cognitive Level: Application REF: 655

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

12. The history and physical for a newly admitted patient states that the complete blood count (CBC) shows a shift to the left. The nurse will plan to monitor the patient for

a.

cool extremities.

b.

pallor and weakness.

c.

elevated temperature.

d.

low oxygen saturation.

ANS: C

The term shift to the left indicates that the number of immature polymorphonuclear neutrophils, or bands, is elevated and is a sign of severe infection. There is no indication that the patient is at risk for hypoxemia, pallor/weakness, or cool extremities.

DIF: Cognitive Level: Application REF: 655 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

13. The health care provider orders an ultrasound of the spleen for a patient who has been in a car accident. Which action should the nurse take before this procedure?

a.

Check for any iodine allergy.

b.

Insert a large-bore IV catheter.

c.

Place the patient on NPO status.

d.

Assist the patient to a flat position.

ANS: D

The patient is placed in a flat position before splenic ultrasound. The patient does not have to be NPO or have an IV line. No iodine-containing materials are used for ultrasound.

DIF: Cognitive Level: Application REF: 658

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

14. A confused patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse should contact the patients family member to sign a consent form before the

a.

ABO blood typing.

b.

bone marrow biopsy.

c.

abdominal ultrasound.

d.

complete blood count (CBC).

ANS: B

Bone marrow biopsy is a minor surgical procedure that requires the patient or guardian to sign a surgical consent form. The other procedures do not require a signed consent by the patient or family.

DIF: Cognitive Level: Application REF: 658

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

15. When reviewing the complete blood count (CBC) for a patient admitted with abdominal pain, which information will be most important for the nurse to communicate to the health care provider?

a.

Monocytes 4%

b.

Hemoglobin 11.6 g/dL

c.

Platelet count 145,000/L

d.

White blood cells (WBCs) 13,500/L

ANS: D

The elevation in WBCs indicates that an abdominal infection may be the cause of the patients pain and that further diagnostic testing is needed. The monocytes are at a normal level. The slight decreases in hemoglobin and platelet count also would be reported but would not require any immediate action.

DIF: Cognitive Level: Application REF: 653-656

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

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