Ch.31 MD

Question 1

A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient’s laboratory findings to include

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

Answer 1

d.a hemoglobin (Hgb) 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 for severe rheumatoid arthritis 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. The nurse determines that the patient understands the teaching about the disorder when the patient states, “I

a. need to start eating more red meat and liver.”
b. will stop having a glass of wine with dinner.”
c. could choose nasal spray rather than injections of vitamin B12.”
d. will need to take a proton pump inhibitor like omeprazole (Prilosec).”

Answer 4

c.could choose nasal spray rather than injections of vitamin B12.”

Question 5

An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to

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

Answer 5

b.alternate periods of rest and activity.

Question 6

Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate?

a. “I will call my health care provider if my stools 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 iron tablets.”

Answer 6

a.“I will call my health care provider if my stools turn black.”

Question 7

Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia?

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

It is important for the nurse providing care for a patient with sickle cell crisis 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 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 is decreased by having an annual influenza vaccination.”

Answer 9

d.“Risk for a crisis is decreased by having an annual influenza vaccination.”

Question 10

Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis?

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

Answer 10

c.Avoid exposure to crowds when possible.

Question 11

The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the

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

Answer 11

b.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) when her platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care?

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

Answer 12

d.Discontinue heparin and flush intermittent IV lines using normal saline.

Question 13

A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia vera 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 intervention will be included in the nursing 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 soft 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 result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)?

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

Answer 15

d.Activated partial thromboplastin time

Question 16

The nurse caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee will

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

Answer 16

a.immobilize the joint.

Question 17

A 28-year-old man 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 an active 80-year-old man may have myelodysplastic syndrome. The nurse will plan to teach the patient about

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

Answer 18

b.bone marrow biopsy.

Question 19

Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic?

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

Answer 19

b.Check temperaturevery 4 hours.

Question 20

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

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

Answer 20

d.Absolute neutrophil count

Question 21

A 68-year-old woman with acute myelogenous leukemia (AML) 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, other treatment options include stem cell transplantation.”
b. “The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy.”
c. “The decision about treatment is one that you and the doctor need to make rather than asking what I would do.”
d. “You don’t need to make a decision about treatment right now because leukemias in adults tend to progress quite slowly.”

Answer 21

b.“The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy.”

Question 22

A patient with a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will 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 diuretic before the transfusion.
d. Give the PRN dose of antihistamine before the transfusion.

Answer 22

b.Transfuse only leukocyte-reduced PRBCs.

Question 23

A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision 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 action will the nurse include in the plan of care for a 72-year-old woman 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

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

Answer 25

a.check all stools for occult blood.

Question 26

A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate? a. Discuss the need for hospital admission to treat the neutropenia. b. Teach the patient to administer filgrastim (Neupogen) injections. c. Plan to discontinue the chemotherapy until the neutropenia resolves. d. Order a high-efficiency particulate air (HEPA) filter for the patient’s home.

Answer 26

b.Teach the patient to administer filgrastim (Neupogen) injections

Question 27

Which information obtained by the nurse 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 purpura on the oral mucosa. d. There are large bruises on the patient’s back.

Answer 27

b.The patient is difficult to arouse.

Question 28

The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)? 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 postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take? a. Draw blood for a new crossmatch. b. Send a urine specimen to the laboratory. c. Administer PRN acetaminophen (Tylenol). d. Give the PRN diphenhydramine (Benadryl).

Answer 29

c.Administer PRN acetaminophen (Tylenol).

Question 30

A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. 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 patient should the nurse assign as the roommate for a patient who has aplastic anemia? a. A patient with chronic 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 chronic heart failure

Question 32

Which patient requires the most rapid assessment and care by the emergency department nurse? a. The patient with hemochromatosis who reports abdominal pain b. The patient with neutropenia who has a temperature of 101.8° F c. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours d. The patient with thrombocytopenia who has oozing after having a tooth extracted

Answer 32

b.The patient with neutropenia who has a temperature of 101.8° F

Question 33

A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets? a. The platelet count is 42,000/μL. b. Petechiae are present on the chest. c. Blood pressure (BP) is 94/56 mm Hg. d. Blood is oozing from the venipuncture site.

Answer 33

a.The platelet count is 42,000/μL.

Question 34

Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the physician? a. Leg bruises b. Tarry stools c. Skin abrasions d. Bleeding gums

Answer 34

b.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. Avoid venipunctures. b. Notify the patient’s physician. c. Apply sterile dressings to the sites. d. Give prescribed proton-pump inhibitors.

Answer 35

b.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 physician order will the nurse implement first? a. Administer morphine sulfate 4 mg IV. b. Give acetaminophen (Tylenol) 650 mg. c. Infuse normal saline 500 mL over 30 minutes. d. Schedule complete blood count and coagulation studies.

Answer 36

c.Infuse normal saline 500 mL over 30 minutes.

Question 37

Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of neutropenic precautions c. Administering subcutaneous filgrastim (Neupogen) injection d. Developing a discharge teaching plan for the patient and family

Answer 37

c.Administering subcutaneous filgrastim (Neupogen) injection

Question 38

Several 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. 44-year-old with sickle cell anemia who says “my eyes always look sort of yellow” b. 23-year-old with no previous health problems who has a nontender lump in the axilla c. 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue d. 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement

Answer 38

b.23-year-old with no previous health problems who has a nontender lump in the axilla

Question 39

After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? a. 56-year-old with frequent explosive diarrhea b. 33-year-old with a fever of 100.8° F (38.2° C) c. 66-year-old who has white pharyngeal lesions d. 23-year old who is complaining of severe fatigue

Answer 39

b.33-year-old with a fever of 100.8° F (38.2° C)

Question 40

Which action will the nurse include in the plan of care for a patient who has thalassemia major? a. Teach the patient to use iron supplements. b. Avoid the use of intramuscular injections. c. Administer iron chelation therapy as needed. d. Notify health care provider of hemoglobin 11g/dL.

Answer 40

c.Administer iron chelation therapy as needed.

Question 41

Which patient information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis? a. Skin color b. Hematocrit c. Liver function d. Serum iron level

Answer 41

d.Serum iron level

Question 42

Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider? a. Hematocrit 55% b. Presence of plethora c. Calf swelling and pain d. Platelet count 450,000/μL

Answer 42

c.Calf swelling and pain

Question 43

Following successful treatment of Hodgkin’s lymphoma for a 55-year-old woman, which topic will the nurse include in patient teaching? a. Potential impact of chemotherapy treatment on fertility b. Application of soothing lotions to treat residual pruritus c. Use of maintenance chemotherapy to maintain remission d. Need for follow-up appointments to screen for malignancy

Answer 43

d.Need for follow-up appointments to screen for malignancy

Question 44

A patient who has non-Hodgkin’s lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse? a. Anorexia b. Vomiting c. Oral ulcers d. Lip swelling

Answer 44

d.Lip swelling

Question 45

Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider? a. Serum calcium level is 15 mg/dL. b. Patient reports no stool for 5 days. c. Urine sample has Bence-Jones protein. d. Patient is complaining of severe back pain.

Answer 45

a.Serum calcium level is 15 mg/dL.

Question 46

When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care? a. Discourage deep breathing to reduce risk for splenic rupture. b. Teach the patient to use ibuprofen (Advil) for left upper quadrant pain. c. Schedule immunization with the pneumococcal vaccine (Pneumovax). d. Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery.

Answer 46

c.Schedule immunization with the pneumococcal vaccine (Pneumovax).

Question 47

The nurse has obtained the health history, physical assessment data, and laboratory results shown in the accompanying figure for a patient admitted with aplastic anemia. Which information is most important to communicate to the health care provider? a. Neutropenia b. Increasing fatigue c. Thrombocytopenia d. Frequent constipation

Answer 47

a.Neutropenia