Ch. 31 MJ

Question 1

A patient with anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient’s laboratory findings to include

a. normal red blood cell (RBC) indices.
b. a hematocrit (Hct) of 38%.
c. a hemoglobin (Hb) of 8.6 g/dL (86 g/L).
d. an RBC count of 4,500,000/μL.

Answer 1

c. a hemoglobin (Hb) of 8.6 g/dL (86 g/L).

Question 2

Which menu choice indicates that the patient understands the nurse’s teaching about best dietary choices for iron-deficiency anemia?

a. Omelet and whole wheat toast
b. Cantaloupe and cottage cheese
c. Strawberry and banana fruit plate
d. Cornmeal muffin and orange juice

Answer 2

a. Omelet and whole wheat toast

Question 3

A patient who is receiving methotrexate develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of

a. iron.
b. folic acid.
c. cobalamin (vitamin B12).
d. ascorbic acid (vitamin C).

Answer 3

b. folic acid.

Question 4

A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious anemia, the nurse determines that the patient understands the disorder when the patient states,

a. “I need to start eating more red meat or liver.”
b. “I will stop having a glass of wine with dinner.”
c. “I will need to take a proton pump inhibitor like omeprazole (Prilosec).”
d. “I would rather use the nasal spray than have to get injections of vitamin B12.”

Answer 4

d. “I would rather use the nasal spray than have to get injections of vitamin B12.”

Question 5

A patient is hospitalized for treatment of severe hemolytic anemia. An appropriate nursing action for the patient is to

a. provide a diet high in vitamin K.
b. place the patient on protective isolation.
c. alternate periods of rest and activity.
d. teach the patient how to avoid injury.

Answer 5

c. alternate periods of rest and activity.

Question 6

After the nurse has finished teaching a patient about taking oral ferrous sulfate, which patient statement indicates that additional instruction is needed?

a. “I will call the doctor if my stools start to turn black.”
b. “I will take a stool softener if I feel constipated occasionally.”
c. “I should take the iron with orange juice about an hour before eating.”
d. “I should increase my fluid and fiber intake while I am taking the iron tablets.”

Answer 6

a. “I will call the doctor if my stools start to turn black.”

Question 7

A patient is admitted to the hospital with idiopathic aplastic anemia. Which of these collaborative problems will the nurse include when developing the care plan?

a. Potential complication: seizures
b. Potential complication: infection
c. Potential complication: neurogenic shock
d. Potential complication: pulmonary edema

Answer 7

b. Potential complication: infection

Question 8

A patient is admitted to the hospital with a sickle cell crisis. While caring for the patient during the crisis, it is important for the nurse to

a. limit the patient’s intake of oral and IV fluids.
b. evaluate the effectiveness of opioid analgesics.
c. encourage the patient to ambulate as much as tolerated.
d. teach the patient about high-protein, high-calorie foods.

Answer 8

b. evaluate the effectiveness of opioid analgesics.

Question 9

Which statement by a patient with sickle cell anemia indicates good understanding of the nurse’s teaching about prevention of sickle cell crisis?

a. “Home oxygen therapy is frequently used to decrease sickling.”
b. “There are no effective medications that can help prevent sickling.”
c. “Routine continuous dosage narcotics are prescribed to prevent a crisis.”
d. “Risk for a crisis can be lowered by having an annual influenza vaccination.”

Answer 9

d. “Risk for a crisis can be lowered by having an annual influenza vaccination.”

Question 10

When planning discharge teaching for the patient who was admitted with a sickle cell crisis, which instruction will the nurse include?

a. Limit fluids to 2 to 3 quarts a day.
b. Take a daily multivitamin with iron.
c. Avoid exposure to crowds as much as possible.
d. Drink only one or two caffeinated beverages daily

Answer 10

c. Avoid exposure to crowds as much as possible.

Question 11

During the admission assessment of a patient with hemolytic anemia, the nurse notes jaundice of the sclerae. The nurse will plan to check the laboratory results for

a. the Schilling test.
b. the bilirubin level.
c. the stool occult blood test.
d. the gastric analysis testing.

Answer 11

b. the bilirubin level.

Question 12

A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT). Which action will the nurse include in the plan of care?

a. Use low-molecular-weight heparin (LMWH) only.
b. Flush all intermittent IV lines using normal saline.
c. Administer the warfarin (Coumadin) at the scheduled time.
d. Teach the patient about the purpose of platelet transfusions.

Answer 12

b. Flush all intermittent IV lines using normal saline.

Question 13

During treatment of the patient with an acute exacerbation of polycythemia vera, a critical action by the nurse is to

a. place the patient on bed rest.
b. administer iron supplements.
c. avoid use of aspirin products.
d. monitor fluid intake and output.

Answer 13

d. monitor fluid intake and output.

Question 14

Which nursing intervention will be included in the care plan for a patient with immune thrombocytopenic purpura (ITP)?

a. Assign the patient to a private room.
b. Avoid intramuscular (IM) injections.
c. Use rinses rather than a toothbrush for oral care.
d. Restrict activity to passive and active range of motion

Answer 14

b. Avoid intramuscular (IM) injections.

Question 15

Which laboratory information will the nurse monitor to detect heparin-induced thrombocytopenia (HIT) in a patient who is receiving a continuous heparin infusion?

a. Prothrombin time
b. Erythrocyte count
c. Fibrinogen degradation products
d. Activated partial thromboplastin time

Answer 15

d. Activated partial thromboplastin time

Question 16

A patient with type A hemophilia has been admitted to the hospital with severe pain and swelling in the right knee. During the initial care of the patient, the nurse should

a. immobilize the knee.
b. apply heat to the joint.
c. assist the patient with light weight bearing.
d. perform passive range of motion to the knee.

Answer 16

a. immobilize the knee.

Question 17

A patient with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the

a. platelet count.
b. bleeding time.
c. thrombin time.
d. prothrombin time.

Answer 17

b. bleeding time.

Question 18

A routine complete blood count indicates that a patient may have myelodysplastic syndrome. At this time, the nurse will plan to teach the patient about

a. packed red blood cells (PRBCs) transfusion.
b. bone marrow biopsy.
c. filgrastim (Neupogen) administration.
d. erythropoietin (Epogen) administration

Answer 18

b. bone marrow biopsy.

Question 19

Which action will be included in the care plan for a hospitalized patient who is neutropenic?

a. Avoid any IM or subcutaneous injections.
b. Check the oral temperature every 4 hours.
c. Omit all fruits or vegetables from the diet.
d. Place a “No Visitors” sign on the patient door.

Answer 19

b. Check the oral temperature every 4 hours.

Question 20

Which laboratory test will the nurse use to determine whether the prescribed filgrastim (Neupogen) is effective in the treatment of a patient who is receiving chemotherapy for acute lymphocytic leukemia?

a. Platelet count
b. Reticulocyte count
c. Total lymphocyte count
d. Absolute neutrophil count

Answer 20

d. Absolute neutrophil count

Question 21

A 64-year-old with acute myelogenous leukemia (AML) who has induction therapy prescribed asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate?

a. “If you do not want to have chemotherapy, there are other options for treatment such as stem cell transplantation.”
b. “The decision about chemotherapy is one that you and the doctor need to make rather than asking what I would do.”
c. “You don’t need to make a decision about treatment right now since leukemias in adults tend to progress quite slowly.”
d. “The side effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy.”

Answer 21

d. “The side effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy.”

Question 22

A patient who has a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action will the nurse take to decrease the risk for TRALI for this patient?

a. Infuse the PRBCs slowly over 4 hours.
b. Transfuse only leukocyte-reduced PRBCs.
c. Administer the scheduled oral diuretic before the transfusion.
d. Give the PRN dose of antihistamine before starting the transfusion

Answer 22

b. Transfuse only leukocyte-reduced PRBCs.

Question 23

A 45-year-old patient with acute myelogenous leukemia (AML) is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT). To assist the patient with treatment decisions, the best approach for the nurse to use is to

a. emphasize the positive outcomes of a bone marrow transplant.
b. discuss the need for adequate insurance to cover post-HSCT care.
c. ask the patient whether there are any questions or concerns about HSCT.
d. explain that a cure is not possible with any other treatment except HSCT.

Answer 23

c. ask the patient whether there are any questions or concerns about HSCT.

Question 24

Which nursing action will be included in the plan of care for a patient admitted with multiple myeloma?

a. Monitor fluid intake and output.
b. Administer calcium supplements.
c. Assess lymph nodes for enlargement.
d. Limit weight-bearing and ambulation.

Answer 24

a. Monitor fluid intake and output.

Question 25

A patient with non-Hodgkin’s lymphoma develops a platelet count of 18,000/µl during chemotherapy. An appropriate nursing intervention for the patient based on this finding is to a. provide oral hygiene every 2 hours. b. check all stools for occult blood. c. check the temperature every 4 hours. d. encourage fluids to 3000 mL/day.

Answer 25

b. check all stools for occult blood

Question 26

A 22-year-old with acute myelogenous leukemia who is receiving outpatient chemotherapy develops an absolute neutrophil count of 900/µl. Which action by the nurse in the outpatient clinic is most appropriate? a. Discuss the need for hospital admission to treat the neutropenia. b. Plan to discontinue the chemotherapy until the neutropenia resolves. c. Teach the patient how to administer filgrastim (Neupogen) injections at home. d. Obtain a high-efficiency particulate air (HEPA) filter for the patient for home use.

Answer 26

c. Teach the patient how to administer filgrastim (Neupogen) injections at home.

Question 27

Which of the following assessment data obtained by the nurse when caring for a patient with thrombocytopenia should be immediately communicated to the health care provider? a. The platelet count is 52,000/µl. b. The patient is difficult to arouse. c. There are large bruises on the back. d. There are purpura on the oral mucosa.

Answer 27

b. The patient is difficult to arouse.

Question 28

Which nursing action should the nurse delegate to nursing assistive personnel (NAP) when administering a transfusion of packed red blood cells (PRBCs) to a patient with blood loss? a. Verify the patient identification (ID) according to hospital policy. b. Obtain the temperature, blood pressure, and pulse before the transfusion. c. Double-check the product numbers on the PRBCs with the patient ID band. d. Monitor the patient for shortness of breath or chest pain during the transfusion.

Answer 28

b. Obtain the temperature, blood pressure, and pulse before the transfusion.

Question 29

A patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, what is the first action that the nurse should take? a. Draw blood for a new crossmatch. b. Send a urine specimen to the laboratory. c. Give the PRN diphenhydramine (Benadryl). d. Administer the PRN acetaminophen (Tylenol).

Answer 29

d. Administer the PRN acetaminophen (Tylenol).

Question 30

Fifteen minutes after a transfusion of packed red blood cells is started, a patient complains of back pain and dyspnea. The pulse rate is 124. The nurse’s first action should be to a. administer oxygen therapy at a high flow rate. b. obtain a urine specimen to send to the laboratory. c. notify the health care provider about the symptoms. d. disconnect the transfusion and infuse normal saline.

Answer 30

d. disconnect the transfusion and infuse normal saline.

Question 31

Which newly admitted patient should the nurse assign as a roommate for a patient who has aplastic anemia? a. A patient with severe heart failure b. A patient who has viral pneumonia c. A patient who has right leg cellulitis d. A patient with multiple abdominal drains

Answer 31

a. A patient with severe heart failure

Question 32

All of the following patients are waiting to be admitted by the emergency department nurse. Which one requires the most rapid assessment and care by the nurse? a. The patient with hemochromatosis who is complaining of abdominal pain b. The patient with thrombocytopenia who has oozing after having a tooth extracted c. The patient with chemotherapy-induced neutropenia who has a temperature of 100.8° F d. The patient with a history of sickle cell anemia who has had nausea and diarrhea for 24 hours

Answer 32

c. The patient with chemotherapy-induced neutropenia who has a temperature of 100.8° F

Question 33

The nurse is caring for a patient with immune thrombocytopenic purpura (ITP) who has an order for a platelet transfusion. Which patient information indicates that the nurse should consult with the health care provider before administering platelets? a. The platelet count is 42,000/μL. b. Blood pressure (BP) is 94/56 mm Hg. c. Blood is oozing from the venipuncture site. d. Petechiae are present on the chest and back.

Answer 33

a. The platelet count is 42,000/μL.

Question 34

A patient with hemophilia calls the nurse in the hemophilia clinic to discuss all of these problems. Which problem is most important to communicate to the physician? a. Skin abrasions b. Bleeding gums c. Multiple bruises d. Dark tarry stools

Answer 34

d. Dark tarry stools

Question 35

A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take? a. Notify the patient’s physician. b. Avoid unnecessary venipunctures. c. Apply sterile dressings to the sites. d. Give prescribed proton-pump inhibitors.

Answer 35

a. Notify the patient’s physician.

Question 36

A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature 102° F (38.9° C), and severe back pain. Which of these physician orders will the nurse implement first? a. Administer morphine sulfate 4 mg IV. b. Infuse normal saline 500 mL over 30 minutes. c. Draw blood for complete blood count and coagulation studies. d. Give acetaminophen (Tylenol) 650 mg for temperature 102° F or higher.

Answer 36

b. Infuse normal saline 500 mL over 30 minutes.

Question 37

Which of the following nursing actions included in the care plan for a patient with neutropenia is appropriate for the RN to delegate to an LPN/LVN who is assisting with patient care? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of neutropenic precautions c. Developing a discharge teaching plan for the patient and family d. Administering the ordered subcutaneous filgrastim (Neupogen) injection

Answer 37

d. Administering the ordered subcutaneous filgrastim (Neupogen) injection

Question 38

All of these patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first? a. 19-year-old with no previous health problems who has a nontender lump in the axilla b. 46-year-old with sickle cell anemia who says “that my eyes always look sort of yellow” c. 21-year-old with hemophilia who wants to learn how to self-administer factor VII replacement d. 50-year-old with early-stage chronic lymphocytic leukemia who has complaints of chronic fatigue

Answer 38

a. 19-year-old with no previous health problems who has a nontender lump in the axilla

Question 39

After receiving change-of-shift report for the following four patients with neutropenia, which patient should the nurse assess first? a. 66-year-old who has white pharyngeal lesions b. 35-year-old who has a fever of 100.8° F (38.2° C) c. 56-year-old who has frequent explosive diarrhea d. 23-year old who is complaining of severe fatigue

Answer 39

b. 35-year-old who has a fever of 100.8° F (38.2° C)