Chapter 46- Patient Assessment- Hematological and Immune Systems. My Nursing Test Banks

 

1.

When obtaining a history for a patient who is being admitted for hematological or immune disorders, the nurse first inquires about the chief complaint and history of present illness. The nurse next inquires about which of the following?

A)

Medical history

B)

Surgical history

C)

Last pap smear

D)

Recent CD4 count

2.

When performing a physical examination of a hematological or immunocompromised patient, the critical care nurse focuses on which of the following major areas?

A)

Skin, liver, spleen, lymph nodes

B)

Skin, respiratory, cardiac, spleen

C)

Skin, liver, cardiac, lymph nodes

D)

Respiratory, kidney function, liver, spleen

3.

When examining a patients eyes for complaints of visual changes, which of the following indicates hyperviscosity from polycythemia or retinal infarcts?

A)

Sickle cell anemia

B)

Retinal hamartoma

C)

Stage one hypertension

D)

Iron deficiency anemia

4.

A patients smear sample in the lab shows spherocytes and elliptocytes. This is due to abnormally shaped red blood cells originating from red blood cell membrane defects. What predisposed factor could cause this to occur?

A)

Hemolytic anemia

B)

Hemophilia B

C)

von Willebrands disease

D)

Acute lymphoblastic anemia

5.

A nurse assessing the stat lab results realizes that an increase in the patients mean corpuscular volume could possibly be which of the following?

A)

Folate deficiency

B)

Sickle cell

C)

Chronic disease

D)

Endocarditis

6.

The critical care nurse promotes iron intake in the hematologic or immunocompromised patient to prevent which of the following?

A)

Iron deficiency anemia

B)

Acute cholecystitis

C)

Uremic frost

D)

Hyperspleenism

7.

A patient presents with a history of a congenital bleeding disorder. Upon assessment the patient states that he has frequent nosebleeds and notices several bruises. The following tests are ordered: PT, PTT, and factors VIIIR, VIII and IX. The results show a deficiency in VIIIR, which indicates which of the following?

A)

von Willebrands disease

B)

Hemophilia A

C)

Hemophilia B

D)

AIDS

8.

A patient presents to the unit with pallor, dyspnea, and dizziness. The patient has a history of fatigue. Lab test results show low counts in the TIBC and iron levels. Based on this information, which of the following is the likely disorder for this patient?

A)

Iron-deficient anemia

B)

Aplastic anemia

C)

Thalassemia

D)

Megaloblastic anemia

9.

Which of the following are important to assess in the immunocompromised patient? Select all that apply.

A)

Nutritional status

B)

Body temperature

C)

White blood cell count

D)

Skin assessment

10.

An immunocomprised patient presents with the following: chills, tachycardia, tachypnea, and hypotension. The critical care nurse suspects which of the following?

A)

Early septic shock

B)

Acute pancreatitis

C)

AIDS

D)

HIV

11.

The patient is being evaluated for a hematologic disorder. While collecting the history, what does the nurse expect the patient to complain of?

A)

Specific system-related deficits

B)

A particular pattern of symptoms

C)

Vague and unrelated symptoms

D)

No medication history

12.

The patient is being evaluated for oxygen deficit. What laboratory study will be most helpful to the nurse in this evaluation?

A)

Red blood cell count

B)

Complete blood count

C)

Complete blood count differential

D)

Serum carbon dioxide combining power

13.

The patient has iron deficiency anemia. What changes in red blood cell morphology would the nurse expect to find?

A)

Decreased mean corpuscular volume

B)

Elevated mean corpuscular hemoglobin

C)

Increased hemoglobin and hematocrit

D)

Decreased total iron-binding capacity

14.

The patient has been diagnosed with multiple myeloma. What abnormality on a laboratory test would the nurse most expect?

A)

Rouleaux formations on peripheral smear

B)

Reduced hemoglobin and hematocrit

C)

Nucleated red cells on peripheral smear

D)

Spherocytes on peripheral smear

15.

The nurse is interpreting a patients complete blood count. What does the CBC give an overall indication of?

A)

Coagulation cascade

B)

Cardiac output and index

C)

Bone marrow health

D)

Overall immune status

16.

The patient is seriously ill and has developed a fever, a cough productive of thick, yellow sputum, and respiratory insufficiency. What changes in the white blood cell differential count does the nurse expect to find?

A)

Increased neutrophils and bands

B)

Increased eosinophils and blasts

C)

Decreased neutrophils with bands

D)

Decreased lymphocytes and neutrophils

17.

A patient has a severe bacterial infection. What white blood cell does the nurse expect of be most active in antibody production?

A)

T lymphocytes

B)

Neutrophils

C)

B lymphocytes

D)

Eosinophils

18.

A critically ill patient has an elevated platelet count. What potential complication does the nurse assess for?

A)

Dehydration

B)

Thrombosis

C)

Hepatic impairment

D)

Disseminated intravascular coagulation

19.

Intradermal skin testing using a variety of antigens can be done to evaluate cell-mediated immunity. If the patient has a defect in cellular immunity, what test result does the nurse expect?

A)

Erythema and induration

B)

Itching and pain

C)

No change in skin assessment

D)

Increased B lymphocytes

20.

Because of an immune disorder, the patient is to undergo evaluation of bone marrow function. For what test does the nurse prepare the patient?

A)

Computed tomography (CT)

B)

Intradermal skin testing

C)

Bone marrow aspiration

D)

Magnetic resonance imaging (MRI)

21.

A female patient is in intensive care recovering from a severe illness and has these laboratory results: total white blood cells 2,000 cells/mm3, neutrophils 40%, lymphocytes 35%, monocytes 11%, eosinophils 4%, basophils 0%, red blood cell count 4.2 106 cells/mm3, hemoglobin 11.7 g/dL, hematocrit 38%, serum sodium 140 mEq/L, serum potassium 4.0 mEq/L. Based on the laboratory results, what is the highest-priority nursing action?

A)

Monitor cardiac rhythm closely.

B)

Measure intake and output carefully.

C)

Institute protective isolation.

D)

Obtain an order for antibiotic therapy.

22.

The patient has been diagnosed with severely compromised immune function. What nursing intervention is most important?

A)

Antibiotic therapy

B)

Adequate protein

C)

Coughing and deep breathing

D)

Restricted visits from family

Answer Key

1.

A

2.

A

3.

A

4.

A

5.

A

6.

A

7.

A

8.

A

9.

A, B, C

10.

A

11.

C

12.

A

13.

A

14.

A

15.

C

16.

A

17.

C

18.

B

19.

C

20.

C

21.

C

22.

B

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