Chapter 49- Common Hematologic Disorders. My Nursing Test Banks

 

1.

Secondary polycythemia is often the result of increased RBC production that can develop as a result of which of the following?

A)

Chronic chemotherapy

B)

Obesity hypoventilation system

C)

Myocardial infarction

D)

Sleep apnea

2.

The nurse completes a physical assessment of a 40-year-old female patient who presents with a history of anemia. What is the most important aspect of the assessment to determine if the patient has hemodilution?

A)

A stool guiac test

B)

BUN and creatinine

C)

Intake and output

D)

Bilirubin

3.

A 22-year-old male is in the ICU with sepsis. The physicians are trying to rule out acute DIC. The nurse performs a primary assessment of the patient at the beginning of shift. Which of the following items would be part of the initial assessment for this patient? Select all that apply.

A)

Check for signs of bleeding in the gums and/or mouth.

B)

Check pupils for reaction.

C)

Check IV sites or any areas where the patient may have had labs drawn for bleeding.

D)

Check for altered level of consciousness.

4.

A 4-year-old female patient who is accompanied by her mother presents with bruising and petechiae all over her legs and trunk. The diagnosis is immune thrombocytopenia purpura (ITP). The mother asks about the cause of the bruising. What is the nurses best response to this question?

A)

Dont worry. She probably just fell on the playground.

B)

She is presenting with thrombocytopenia due to an acute episode of platelet consumption. What medications is your child taking and has she recently received a platelet transfusion?

C)

Its OK. This disease frequently is accompanied by bruising.

D)

The bruises indicate a problem with white blood cells.

5.

A nurse is doing an assessment of a 50-year-old female. She complains of abdominal pain and the nurse suspects that the patient may be bleeding into her abdomen because of a complication with a coagulation disorder. The nurse notifies the physician. What is the nurses greatest concern about this patient?

A)

Hypotension, hypovolemic shock

B)

Kidney disorder

C)

Ectopic pregnancy

D)

Infection

6.

A nurse is caring for a patient with severe aplastic anemia. The patient was otherwise healthy up until about 2 weeks ago and just returned from a trip to Mexico where she received some medication for a dog bite. The patient asks when she will be able to go home and how serious this is. What is the nurses best response? Select all that apply.

A)

You may have a serious adverse event from the medication you received in Mexico, which caused your bone marrow to alter or stop producing red blood cells.

B)

The physicians may be talking to you about a bone marrow transplant as that is the best treatment for your diagnosis.

C)

This is something that is easily treated with a blood transfusion.

D)

You will need to get a white cell transfusion.

7.

A nurse is working in the emergency department when a 17-year-old patient presents in acute sickle cell crisis. He tells the nurse he is just getting over the flu and has been vomiting for three days. What is the nurses highest priority for this patient?

A)

Start an IV and give fluids to hydrate the patient.

B)

Give morphine before completing the assessment because he is in pain.

C)

Give the patient some food because he has been vomiting.

D)

Leave the patient alone because he is in pain and doesnt want to be bothered.

8.

A nurse is caring for a 29-year-old female who has labs drawn. The results come back indicating that the neutrophil count is below 1,500 cells/mm3. What is the most likely diagnosis for this patient?

A)

Aplastic anemia

B)

Chronic ideopathic thrombocytopenia

C)

Sickle cell disease

D)

Leukopenia

9.

Further testing is being done to determine if a patient has Hodgkins lymphoma or non-Hodgkins lymphoma. Which test result would be conclusive in this case?

A)

Elevated platelet count

B)

White count of 10,000

C)

Presence of abnormal Reed-Sternberg cells in biopsied tissue

D)

Fever and a white count of 0

10.

A patient is admitted to the ICU with a history of general malaise for two weeks. A nurse does the initial assessment and suspects leukemia. What are the signs and symptoms that will identify if this patient has leukemia? Select all that apply.

A)

Anemia, general malaise, bleeding

B)

Tachycardia, hypotension and shortness of breath

C)

Hypertension, very high fever, and low heart rate

D)

Bone pain, headache, vomiting, papilledema

11.

A patient in a critical care unit who is intubated and on mechanical ventilation has developed anemia. What nursing action has the highest priority to prevent this complication?

A)

Monitor hemoglobin and hematocrit every 4 hours.

B)

Increase oral iron in diet.

C)

Reduce frequency and amount of blood samples drawn.

D)

Draw blood sample for type and cross-match.

12.

A trauma patient is found to be profoundly anemic. What is the nurses primary focus in planning care?

A)

Draw laboratory sample for type and cross-match for blood replacement.

B)

Initiate therapy with erythropoietin and iron.

C)

Contact family to begin solicitation for blood donors.

D)

Assess for and collaboratively treat the source of blood loss.

13.

A patient admitted to critical care is found to have an absolute neutrophil count of 1,235 cells/mm3. What is the most important nursing intervention?

A)

Institute strict isolation to prevent disease transmission from the patient.

B)

Evaluate the patient for bone marrow transplantation for replacement.

C)

Institute reverse isolation to prevent disease transmission to the patient.

D)

Administer hematopoietic growth factor stimulation medications.

14.

A critically ill patient has an absolute neutrophil count of 1,000 cells/mm3. The nurse assesses a single patient temperature of 101F; subsequent temperatures were normal, and the patient reports no other new symptoms. What is the best nursing action?

A)

Assume that the elevated temperature was erroneous.

B)

Evaluate for acute infection.

C)

Assess vital signs more frequently.

D)

Document the temperature results as usual.

15.

A critically ill patient has been diagnosed with heparin-induced thrombocytopenia (HIT). What symptoms would the nurse expect?

A)

Gastric aspirate with positive guaiac test

B)

Oozing of blood around intravenous sites

C)

Sudden severe hypoxia and lateral chest pain

D)

Red blood cells in urine

16.

A critical care patient has been receiving a continuous heparin drip for treatment of possible deep vein thrombosis for 4 days. The patient now has developed symptoms consistent with heparin-induced thrombocytopenia (HIT). What change in therapy does the nurse anticipate?

A)

None, as the patient needs anticoagulation for deep vein thrombosis

B)

Change of heparin to subcutaneous low-molecular-weight heparin

C)

Discontinuation of all heparin and heparin-coated devices

D)

Replacement of platelets by transfusion and addition of aspirin therapy

17.

A critically ill patient with a severe burn has developed disseminated intravascular coagulation (DIC). What is the precipitating event for this complication?

A)

Reaction to medications such as heparin or antineoplastic agents

B)

Heat and direct damage of blood cells and vessels

C)

Autoimmune disease causing destruction or clumping of platelets

D)

Blood and fluid loss from the burn causing hemoconcentration

18.

A critically ill patient has been diagnosed with disseminated intravascular coagulation (DIC). What pattern of abnormal laboratory results does the nurse expect? Select all that apply.

A)

Low absolute neutrophil count and red blood cell count

B)

High prothrombin time (PT) and partial thromboplastin time (PTT)

C)

Increased fibrin degradation products and presence of D-dimers

D)

Decreased fibrinogen and thrombocytes

E)

Increased fibrinogen and fibrin degradation products

F)

Decreased total white cell count and hematocrit

19.

A critically ill patient is at risk for developing disseminated intravascular coagulation (DIC). What presenting symptoms would the nurse expect if this occurs?

A)

Elevated core temperature and neutrophil count

B)

Sudden increase in dyspnea and hemoptysis

C)

Continued need for opioid analgesia after trauma

D)

Increase in purulent pulmonary secretions and cough

Answer Key

1.

B

2.

C

3.

A, C, D

4.

B

5.

A

6.

A

7.

A

8.

D

9.

C

10.

A, D

11.

C

12.

D

13.

C

14.

B

15.

C

16.

C

17.

B

18.

B, C, D

19.

B

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