Module 2: Hematological Disorders

Question 1

Which part of a hematological history includes assessment of alcohol and illicit drug use?

A) Social and occupational history
B) Activities of daily living
C) Neurological history
D) Self-care history

Answer 1

✨Memory tip: “Self-care isn’t always bubble baths — sometimes it’s asking about the booze and the bad habits.”
When you’re assessing self-care, you’re looking at how well someone takes care of themselves — and that includes risky stuff like alcohol and drugs.

✅ Correct answer: D) Self-care history

Question 2

Which lymph node assessment finding is abnormal?

A) Fixed (not moveable)
B) Size 0.5 cm
C) Nontender
D) Firm texture

Answer 2

✅ Correct answer: A) Fixed (not moveable)

✨Memory tip: “Lymph nodes should party — not be stuck in place!”
Normal lymph nodes are like chill little jellybeans: small, mobile, nontender, and maybe a little firm. But when one is fixed in place (not moveable), that’s a red flag — could suggest malignancy or other pathology.

Question 3

Which skin assessment finding is indicative of a bleeding disorder?
Select all that apply. One, some, or all responses may be correct.

A) Petechiae
B) Purpura
C) Digit clubbing
D) Ecchymosis
E) Spider nevus

Answer 3

✅ Correct answers: A, B, D, E

Let’s break it down:

Petechiae – tiny red/purple dots from capillary bleeding. Think: “pinpoint problems.” ✅

Purpura – bigger than petechiae, but still from blood leaking under skin. Like a bruise’s cousin. ✅

Ecchymosis – classic bruising. Always a bleeding clue. ✅

Spider nevus – those little red spider-webby spots? Can be seen in liver disease, which messes with clotting. ✅

Digit clubbing – not a bleeding issue. That’s usually a sign of chronic hypoxia (like in lung or heart disease). ❌

Question 4

Which laboratory test is not typically used to evaluate iron metabolism?

A) Serum ferritin
B) Transferrin saturation
C) Serum iron
D) B-type natriuretic peptide (BNP)

Answer 4

D) B-type natriuretic peptide (BNP) – ❌ This is a heart test, not related to iron at all. BNP is released when the heart is under stress or stretched, like in heart failure. It has nothing to do with red blood cells or iron metabolism.

Question 5

Which laboratory tests are used in evaluating iron metabolism?
Select all that apply. One, some, or all responses may be correct.

A) Serum iron
B) Total iron-binding capacity (TIBC)
C) Serum ferritin
D) Transferrin saturation
E) Additional tests for nutritional deficiencies

Answer 5

Serum iron – the iron actually circulating in the blood. ✅

TIBC – how many open seats are available on transferrin (the iron Uber). More seats = less iron. ✅

Ferritin – iron storage levels. Low ferritin = body’s iron tank is empty. ✅

Transferrin saturation – % of transferrin that’s carrying iron. ✅

Additional tests – like B12, folate, and copper — these help detect other causes of poor RBC production (especially in macrocytic or mixed anemia). ✅

✅ Correct answers: A, B, C, D, E

Question 6

Which laboratory value is a measure of the packed cell volume of red blood cells (RBCs) expressed as a percentage of the total blood volume?

A) Platelet count
B) Hematocrit
C) Reticulocyte count
D) White blood cell (WBC) count

Answer 6

✅ Correct answer: B) Hematocrit

Here’s the real explanation:
Hematocrit = Think Hema (blood) + crit (cut/slice). It literally measures how much of your blood is made up of red blood cells, usually given as a %.

For example, a hematocrit of 42% means 42% of your blood volume is RBCs.

Platelet count = Number of platelets (helps with clotting), not red cell volume.

Reticulocyte count = Number of baby RBCs, used to assess bone marrow activity.

WBC count = Total number of white blood cells, used for infection/inflammation, not red cells.

Question 7

Which red blood cell (RBC) test is increased in the event of hemoconcentration?

A) White blood cells
B) RBC indices
C) Hemoglobin
D) Prothrombin time

Answer 7

✅ Correct answer: C) Hemoglobin

Here’s why:
💬 Okay so what’s hemoconcentration?
Think of your blood like soup. 🥣 If the water (plasma) gets boiled off — like from dehydration, burns, or fluid loss — the stuff left behind (like red blood cells and hemoglobin) looks more concentrated. You didn’t make more ingredients, you just lost the broth.

So hemoglobin goes up, not because you made more RBCs, but because you’re low-key turning into blood gravy. Thick. 😬

Question 8

Which blood test is needed to reduce transfusion reaction prior to a blood transfusion?
Select all that apply. One, some, or all responses may be correct.

A) Screen
B) Bilirubin
C) Crossmatch
D) Group
E) Blood smear

Answer 8

✅ Correct answers: A, C, D

A) Screen – This detects unexpected antibodies in the patient’s blood that could react with donor cells. Super important. ✅
B) Bilirubin – That’s for checking liver function or hemolysis, not transfusion safety. ❌
C) Crossmatch: THE big one. We mix donor blood with the patient’s plasma to check for a reaction. It clumps?🚫No transfusion. ✅
D) Group – This checks the patient’s ABO and Rh type, so we know what blood they can receive. Basic but essential. ✅
E) Blood smear – This looks at RBC shape and size under a microscope. Doesn’t help with matching blood for transfusion. ❌

Question 9

Which clinical situation may increase the risk of blood transfusion reaction?

A) Multiple blood transfusions
B) Iron-deficiency anemia
C) Completing a cross and match blood test prior to the transfusion
D) Low red blood cell (RBC) count

Answer 9

A) Multiple blood transfusions – YES. The more transfusions someone gets, the more chances their immune system has to develop antibodies against foreign antigens in donor blood. This builds up the risk for transfusion reactions over time. ✅

Question 10

Which hematological assessment statement is accurate?

A) Liver enlargement is measured by the number of centimetres it can be palpated below the rib border.
B) Lymph node assessment should begin at the groin.
C) The spleen size can be assessed using gentle palpation of the abdomen.
D) Assess for petechiae by looking at the sclera.

Answer 10

A) Liver enlargement – YES ✅
We palpate the liver starting at the right lower abdomen and move up toward the ribs. If it’s felt below the right costal margin, we measure how many cm it’s enlarged by. This is standard liver assessment practice.

Question 11

Which hereditary disorder should be assessed in relation to hematological concerns?
Select all that apply. One, some, or all responses may be correct.

A) Sickle cell anemia
B) Hemophilia
C) Asplenia
D) Thalassemia
E) Hemochromatosis

Answer 11

A) Sickle cell anemia – ✅ 100% hereditary. A genetic mutation causes RBCs to form a sickle shape, leading to clotting, pain crises, and organ damage.

B) Hemophilia – ✅ A clotting disorder, usually inherited, where you’re missing certain clotting factors (like Factor VIII or IX). Cuts = way more dangerous.

C) Asplenia – ❌ Not hereditary on its own. It means you don’t have a spleen (either from surgery or a condition), but it’s anatomic, not genetic.

D) Thalassemia – ✅ Genetic blood disorder that affects hemoglobin production. Can range from mild to severe anemia depending on type.

E) Hemochromatosis – ✅ Inherited disorder where the body absorbs too much iron. That extra iron deposits in organs and can cause major damage if untreated.

Question 12

Which diagnostic test evaluates the morphological features of the blood cells?

A) Peripheral blood smear
B) Reticulocyte count
C) Oxygen saturation
D) Platelet count

Answer 12

A) Peripheral blood smear – ✅ Yesss! This is the test where a drop of blood is spread on a slide, stained, and looked at under a microscope. It lets us see:
Shape (like sickled or teardrop cells)
Size (microcytic, macrocytic)
Color (hypochromic or normal)
Even weird inclusions (like Howell-Jolly bodies)

Question 13

Which blood cell test is associated with risk of spontaneous hemorrhage if its counts fall below 10 × 10⁹/L?

A) Platelet count
B) Hemoglobin
C) White blood cells (WBCs)
D) Red blood cell (RBC) indices

Answer 13

Platelet count: They stop you from bleeding out when you get even a tiny papercut.

If your platelet count drops below 10 × 10⁹/L, you’re in danger zone territory — like you could bleed spontaneously without injury. 😳
Think: gums, GI tract, brain — terrifying stuff.
🩸 “Platelets plug holes.” No platelets? No plugs. You leak.

Question 14

Which nursing care should be prioritized when caring for a patient recovering from a bone marrow biopsy?
Select all that apply. One, some, or all responses may be correct.

A) Assess for excess bleeding
B) Provide analgesics
C) Administer sedatives
D) Monitor vital signs
E) Avoid pressure on the site of puncture for 24 hours

Answer 14

✅ Correct answers: A, B, D

After a bone marrow biopsy, you’re basically the bleeding watchdog, pain manager, and vital sign detective. 🕵️‍♀️💉

Question 15

What does hematology study?

A) The digestive system and liver
B) Blood and blood-forming tissues including bone marrow, spleen, and lymph system
C) The nervous system and brain
D) Muscles and bones

Answer 15

✅ Correct answer: B) Blood and blood-forming tissues including bone marrow, spleen, and lymph system

Question 16

What is bone marrow and what happens there?

A) Hard outer layer of bones where blood clotting occurs
B) Soft material inside bones where blood cell production (hematopoiesis) happens
C) Muscle tissue that supports bone movement
D) Fluid inside joints that lubricates bones

Answer 16

B) Soft material inside bones where blood cell production (hematopoiesis) happens

Question 17

What is hematopoiesis and where does it occur?

A) The process of breaking down old blood cells, happening in the spleen
B) The production of blood cells, occurring in the soft material (bone marrow) inside bones
C) The movement of blood through vessels, controlled by the heart
D) The formation of bone tissue, happening in the bone surface

Answer 17

B) The production of blood cells, occurring in the soft material (bone marrow) inside bones
“Hema-” sounds like “hemo” = blood
“-poiesis” sounds like “poise” = to make or create
So, hematopoiesis = “to make blood with poise” — fancy blood cells being created perfectly inside your bone marrow! 🎨🩸
Imagine a little artist carefully painting blood cells inside your bones, making sure each one is just right. That’s hematopoiesis doing its magic! 🖌️✨

Question 18

Which of the following are functions of blood?
Select all that apply.

A) Transport oxygen and nutrients to body tissues
B) Regulate body temperature
C) Produce hormones
D) Protect the body by fighting infections

Answer 18

A: Transport oxygen and nutrients to body tissues
B: Regulate body temperature
D: Protect body by fighting infections

Question 19

What are the primary functions of erythrocytes (red blood cells)?

A) Transport oxygen (O₂) and carbon dioxide (CO₂), and help maintain acid–base balance
B) Fight infections and produce antibodies
C) Clot blood to stop bleeding
D) Store nutrients and release hormones

Answer 19

✅ Correct answer: A) Transport oxygen (O₂) and carbon dioxide (CO₂), and help maintain acid–base balance

💡 Memory Tip for Erythrocytes:
Think: “Erythro = red” + “cyte = cell” = red cells that are the body’s oxygen taxis. 🚕
They pick up oxygen in the lungs and drop it off where your muscles and organs are waiting.
Then, they grab the CO₂ ‘garbage’ to bring back to the lungs for you to exhale.
Bonus: They help keep your blood’s pH balanced (acid–base balance) so everything runs smoothly.
Imagine a fleet of little red taxis zipping around inside you, delivering oxygen and picking up carbon dioxide — and making sure the “traffic” (pH) stays smooth. 🚖💨

Question 20

Which type of bone marrow is present in the flat and irregular bones?

A. Red (hematopoietic)
B. Yellow (adipose)
C. Red (adipose)
D. Yellow (hematopoietic)

Answer 20

✅ Correct Answer: A. Red (hematopoietic)

Explanation:
Flat and irregular bones (like the sternum, ribs, pelvis, and vertebrae) contain red bone marrow, which is hematopoietic—meaning it produces blood cells.

Question 21

Which percentage of the blood is made up by plasma?

A. 15%
B. 20%
C. 45%
D. 55%

Answer 21

✅ Correct Answer: D. 55%

Explanation:
Plasma makes up about 55% of total blood volume. It’s the liquid component that carries cells, nutrients, hormones, and waste products throughout the body. The remaining 45% is mostly red blood cells, with a small portion made up of white blood cells and platelets.

Question 22

In which organ can iron be stored?
Select all that apply. One, some, or all responses may be correct.

A. Liver
B. Spleen
C. Lungs
D. Bone marrow
E. Duodenum

Answer 22

✅ Correct Answers: A. Liver, B. Spleen, D. Bone marrow

Question 23

Which of the following correctly represents the sequence of events in hemostasis?

A. Platelet plug formation → Vascular injury and subendothelial exposure → Fibrin clot development → Clot retraction and dissolution

B. Vascular injury and subendothelial exposure → Platelet plug formation → Fibrin clot development → Clot retraction and dissolution

C. Fibrin clot development → Platelet plug formation → Vascular injury and subendothelial exposure → Clot retraction and dissolution

D. Clot retraction and dissolution → Fibrin clot development → Platelet plug formation → Vascular injury and subendothelial exposure

Answer 23

✅ Correct Answer: B

Explanation:
Hemostasis begins with vascular injury and exposure of the subendothelial layer, which triggers platelet plug formation (adhesion, activation, and aggregation). Next, a fibrin clot develops to stabilize the plug, followed by clot retraction and eventual dissolution to restore normal blood flow.

Question 24

Which statement accurately describes the coagulation and anticoagulation process?

A. Coagulation is achieved through antithrombin activity.
B. Clotting is encouraged through anticoagulants.
C. Anticoagulants including heparin and protein C support clot dissolution.
D. Antithrombin encourages the blood clot to remain stable and intact.

Answer 24

✅ Correct Answer: C. Anticoagulants including heparin and protein C support clot dissolution.

Explanation:

Anticoagulants, like heparin and activated protein C, help prevent further clotting and promote clot breakdown (fibrinolysis).

Antithrombin is a natural anticoagulant that inhibits thrombin and other clotting factors, thereby reducing clot formation, not stabilizing it.

So A, B, and D are incorrect in how they describe the roles of these substances.

Question 25

Which anatomical location of the abdomen houses the spleen? A. Upper left quadrant B. Upper right quadrant C. Lower left quadrant D. Lower right quadrant

Answer 25

✅ Correct Answer: A. Upper left quadrant Explanation: The spleen is located in the upper left quadrant of the abdomen, just beneath the rib cage and behind the stomach. It plays key roles in filtering blood, immune response, and recycling old red blood cells.

Question 26

❓ Which component is part of the lymph system? Select all that apply. One, some, or all responses may be correct. A. Fluid B. Digits C. Capillaries D. Ducts E. Nodes

Answer 26

✅ Correct Answers: A. Fluid, C. Capillaries, D. Ducts, E. Nodes ❌ B. Digits — definitely not part of the lymphatic system!

Question 27

Which body organ involves hematopoiesis? A. Spleen B. Bone marrow C. Lymph nodes D. Gallbladder

Answer 27

✅ Correct Answer: B. Bone marrow Explanation: Hematopoiesis is the process of forming new blood cells, and it primarily takes place in the bone marrow, particularly in red bone marrow found in flat and irregular bones like the pelvis, sternum, and vertebrae.

Question 28

Which primary role do neutrophils serve? A. Phagocytosis B. Coagulation C. Oxygen transport D. Allergic response

Answer 28

✅ Correct Answer: A. Phagocytosis Explanation: Neutrophils are the most abundant type of white blood cells and play a crucial role in the innate immune system. Their primary job is phagocytosis—engulfing and destroying bacteria, fungi, and cellular debris.

Question 29

Which cell type is a granulocyte? Select all that apply. One, some, or all responses may be correct. A. Erythrocytes B. Lymphocytes C. Basophils D. Neutrophils E. Thrombocytes

Answer 29

✅ Correct Answers: C. Basophils, D. Neutrophils

Question 30

Which finding is associated with a “shift to the left”? A. Active infection or inflammation B. Iron deficiency C. Bleeding disorder D. Nausea and vomiting

Answer 30

✅ Correct Answer: A. Active infection or inflammation Explanation: A "shift to the left" refers to an increased number of immature neutrophils (bands) in the blood, which typically indicates the body is mounting a rapid immune response — often due to an acute bacterial infection or significant inflammation.

Question 31

Which thrombocytopenia is the most common type of acquired thrombocytopenia? A. Heparin-induced thrombocytopenia and thrombosis syndrome B. Heparin-induced thrombocytopenia C. Immune thrombocytopenic purpura (ITP) D. Thrombotic thrombocytopenic purpura

Answer 31

✅ Correct Answer: C. Immune thrombocytopenic purpura (ITP) Explanation: Immune thrombocytopenic purpura (ITP) is the most common acquired thrombocytopenia, characterized by an autoimmune destruction of platelets.

Question 32

Which nursing diagnosis would be appropriate for a patient with thrombocytopenia? A. Potential for melena as evidenced by high dietary fibre intake B. Potential for excessive clotting as evidenced by inherent coagulopathy C. Potential for epistaxis as evidenced by decrease in platelets D. Potential for impaired oral mucous membrane integrity as evidenced by increased platelets

Answer 32

✅ Correct Answer: C. Potential for epistaxis as evidenced by decrease in platelets Explanation: Thrombocytopenia means low platelet count, which increases the risk of bleeding — including epistaxis (nosebleeds).

Question 33

Which response does the nurse provide when the patient asks why she has small, flat, red spots on her skin? A. “Those are scars caused by leaked white cells. They settle into the skin and result in scar tissue.” B. “Those are the start of fever blisters. They are caused by very high temperatures when your body is fighting an infection.” C. “Those are petechiae. They are very tiny hemorrhages that happen when your platelet count is low and red cells leak out of blood vessels and into skin.” D. “Those are normal signs of aging and nothing to worry about.”

Answer 33

✅ Correct Answer: C. “Those are petechiae. They are very tiny hemorrhages that happen when your platelet count is low and red cells leak out of blood vessels and into skin.” Explanation: Petechiae are small, pinpoint, flat red or purple spots that result from bleeding under the skin, often due to low platelet counts (thrombocytopenia).

Question 34

Which X-linked genetic disorder is caused by a deficiency in factor IX? A. Hepatitis C B. Hemophilia A C. Von Willebrand disease D. Hemophilia B

Answer 34

✅ Correct Answer: D. Hemophilia B Explanation: Hemophilia B, also known as Christmas disease, is an X-linked recessive disorder caused by a deficiency in clotting factor IX. Most prominent in men.

Question 35

Which treatment is used when hemophilia causes bleeding into a joint? Select all that apply. One, some, or all responses may be correct. A. Pack the joint in ice. B. Give acetaminophen for pain control. C. Give aspirin for pain control. D. Encourage mobilization of the affected area after bleeding stops. E. Implement weight-bearing movement immediately.

Answer 35

✅ Correct Answers: A. Pack the joint in ice – Reduces inflammation and slows bleeding. B. Give acetaminophen for pain control – Safe analgesic that does not increase bleeding risk. D. Encourage mobilization of the affected area after bleeding stops – Promotes joint function and prevents deformities, but only after active bleeding is controlled.

Question 36

Which education will the nurse provide to the patient with hemophilia? A. “Minor scrapes can be managed at home. If you have blood in your urine, cuts requiring stitches, or a head injury, you will need to seek medical attention immediately.” B. “Be sure to avoid dark leafy greens in your diet. These contain vitamin K, which will interfere with your heparin.” C. “You can play soccer and football as long as you wear the proper safety equipment.” D. “When performing dental hygiene, floss aggressively to prevent gum infections.”

Answer 36

✅ Correct Answer: A This statement correctly educates the patient on self-management of minor injuries and identifies serious symptoms that require immediate medical attention — which is essential for patients with hemophilia.

Question 37

Which description is the defining characterization of disseminated intravascular coagulation (DIC)? A. Powerful coagulation triggered by tissue factor release leading to enhanced platelet aggregation B. Profuse bleeding resulting from the depletion of platelets and clotting factors C. Stable clot formation at injury sites D. Rapid dehydration due to polyuria

Answer 37

✅ Correct Answer: B. Profuse bleeding resulting from the depletion of platelets and clotting factors Rationale: DIC is a serious disorder characterized by systemic activation of clotting mechanisms, which leads to the widespread formation of clots in small blood vessels. This consumes platelets and clotting factors, resulting in severe bleeding.

Question 38

Which action does the nurse take when caring for a patient with disseminated intravascular coagulation (DIC)? Select all that apply. One, some, or all responses may be correct. A. Administer blood products B. Assess for polyuria C. Assess for external bleeding D. Assess for signs of internal bleeding E. Provide prompt administration of prescribed therapies

Answer 38

✅ Correct Answers: A, C, D, E

Question 39

Which cause is the most common cause of neutropenia? A. Aplastic anemia B. Parasitic infection C. Hypersplenism D. Immunosuppressive therapy

Answer 39

✅ Correct Answer: D. Immunosuppressive therapy

Question 40

Which characterization describes myelodysplastic syndrome (MDS)? A. Patients with MDS have peripheral blood cytopenia and hypercellular bone marrow exhibiting dysplastic changes. B. Patients with MDS have peripheral blood cytopenia and hypocellular bone marrow exhibiting dysplastic changes. C. Patients with MDS typically have a genetic disorder affecting the quality of their bone marrow. D. MDS is the most common form of hematological disorder in Canada for all age groups.

Answer 40

✅ Correct Answer: A. Patients with MDS have peripheral blood cytopenia and hypercellular bone marrow exhibiting dysplastic changes. Rationale: MDS is characterized by ineffective hematopoiesis leading to cytopenias (low blood cell counts) in the peripheral blood despite a hypercellular bone marrow with abnormal (dysplastic) cell development. The bone marrow is typically not hypocellular in MDS (so B is incorrect). MDS is generally acquired, not a primary genetic disorder (C is incorrect). MDS is more common in older adults and is not the most common hematologic disorder in all age groups (D is incorrect).

Question 41

Which therapy is appropriate for low-risk patients with myelodysplastic syndrome (MDS)? A. Whole blood transfusions B. Radiation C. Myeloid growth factors D. High intensity chemotherapy

Answer 41

✅ Correct Answer: C. Myeloid growth factors

Question 42

Which scenario(s) may lead to the diagnosis of myelodysplastic syndrome (MDS) in a patient? Select all that apply. A. Irregular results on a routine CBC B. Found during chest X-ray for pneumonia C. Uncovered during evaluation of anemia symptoms D. Screening for folate deficiency E. Full-body MRI F. Discovered during treatment of infection and bleeding

Answer 42

✅ Correct Answers: A. Irregular results on a routine CBC C. Uncovered during evaluation of anemia symptoms F. Discovered during treatment of infection and bleeding

Question 43

Which lab result is indicative of thrombotic thrombocytopenic purpura (TTP)? A. Absence of megakaryocytes on bone marrow biopsy B. Platelet count below 10 x 10⁹/L with the presence of Reed-Sternberg cells C. Elevated D-dimer and decreased C-reactive protein (CRP) D. Platelet count below 10 x 10⁹/L with presence of spherocytes and schistocytes

Answer 43

Answer: D. Platelet count below 10 x 10⁹/L with presence of spherocytes and schistocytes

Question 44

For which therapy does the nurse prepare the patient with immune thrombocytopenic purpura (ITP)? A. Warfarin administration B. Plasmapheresis C. Discontinuation of heparin D. Platelet transfusion

Answer 44

D. Platelet transfusion

Question 45

Which clinical manifestations are caused by hemophilia? Select all that apply. A) Fever B) Prolonged bleeding from minor cut C) Hypercoagulation D) Hemarthrosis E) Uncontrollable hemorrhage post dental extraction F) Persistent epistaxis

Answer 45

B) Prolonged bleeding from minor cut D) Hemarthrosis (bleeding into joints) E) Uncontrollable hemorrhage post dental extraction F) Persistent epistaxis (nosebleeds)

Question 46

Which patient with a deficiency in clotting factors does the nurse recognize as experiencing internal hemorrhaging? A. A patient with slowed bleeding in response to the application of Gelfoam B. A patient with headache, fatigue, and muscle spasms after administration of desmopressin C. A patient with scab formation after application of thrombin D. A patient with pain and swelling in the forearm after a constrictive bandage is applied at the elbow

Answer 46

D Pain and swelling after a tight bandage can signal internal bleeding or compartment syndrome, which is an emergency.

Question 47

Which clinical manifestations are present in disseminated intravascular coagulation (DIC)? Select all that apply. A. GI tract bleeding B. Hemoptysis C. Hematuria D. Cyanosis E. Acute kidney injury F. Pulmonary emboli

Answer 47

Answer: A, B, C, D, E, F

Question 48

Which patient statement indicates an understanding of neutropenia education? Select all that apply. A. “My absolute neutrophil count puts me at an increasing level of infection risk the lower the count is.” B. “My total WBC count may be above normal in neutropenia because the white blood cells are not working.” C. “The cause of my neutropenia is not important because it is treated the same regardless of the cause.” D. “Neutropenia puts me at increased risk of infection. Nothing can be done about that so I should stay home alone.” E. “Any infection can develop into sepsis or death.”

Answer 48

A,B,E

Question 49

Which education will the nurse provide to the patient with neutropenia about infection risk? Select all that apply. A. “Avoid activity. Your body needs rest and exercise may overtax it.” B. “Do not perform gardening or clean up after pets. Feeding and petting your pet is fine as long as you wash your hands well afterwards.” C. “Sushi is a healthy source of protein that your immune system needs to fight infection.” D. “Vaginal itching or abnormal discharge is common in patients with neutropenia. It is nothing to worry about.” E. “Bathe or shower daily. A moisturizer may be used to prevent skin from drying and cracking.” F. “Wash hands frequently and make sure those around you wash their hands frequently, particularly if they help with your care.”

Answer 49

Why: B is correct because avoiding exposure to soil and animal waste reduces infection risk, but petting and feeding are okay with good hand hygiene. E is correct — daily bathing and moisturizing prevent skin breaks, which can be entry points for infection. F is correct — hand hygiene is critical for infection prevention, especially for patients with neutropenia. A is wrong — moderate activity is usually encouraged unless contraindicated. C is wrong — raw fish like sushi is a risk for infection in immunocompromised patients. D is wrong — vaginal itching or abnormal discharge should be evaluated, as it could signal infection.

Question 51

Which statement about leukemia demonstrates the nurse’s knowledge? A. “Leukemia is more common in women.” B. “Leukemia is characterized by the replacement of bone marrow with leukocyte precursors.” C. “Leukemia is a terminal disease.” D. “Leukemia is a specific type of cancer.”

Answer 51

B. “Leukemia is characterized by the replacement of bone marrow with leukocyte precursors.” Leukemia leads to overcrowding of immature white cells in the bone marrow, which interferes with normal blood cell production.

Question 52

Which description defines leukostasis? A. Bone marrow failure due to overcrowding of the marrow by abnormal cells B. Solid masses can result from collections of leukemic cells C. Accumulation of abnormal WBC in the patient’s organs D. High leukemia WBC count in the peripheral blood can cause the blood to thicken

Answer 52

D. High leukemia WBC count in the peripheral blood can cause the blood to thicken Leukostasis is basically when there's a dangerously high WBC count, and the blood becomes viscous like syrup — yikes! This can lead to blocked blood vessels and is considered a medical emergency.

Question 53

Which intervention by the nurse is part of caring for a patient with leukemia? Select all that apply. One, some, or all responses may be correct. A. Give the patient and family handouts and websites about coping with leukemia. B. Provide education on the prognosis, treatment plan, and treatment goals. C. Assume that the oncology team has addressed all of the patient’s concerns. D. Provide complete physical and psychological care to the patient. E. Perform astute ongoing assessments.

Answer 53

✅ Correct answers: B and E B – Yes! Patient education is key so they understand the diagnosis and what to expect. E – Absolutely! Ongoing, thorough assessments help monitor complications and treatment response.

Question 54

Which form of lymphoma commonly includes fever, night sweats, and weight loss as symptoms? A. Burkitt lymphoma B. Non-Hodgkin’s lymphoma (NHL) C. Hodgkin’s disease D. Mantle cell lymphoma (MCL)

Answer 54

✅ Correct Answer: C. Hodgkin’s disease Why? Hodgkin’s disease is known for those hallmark B symptoms — fever, night sweats, and weight loss. They’re often used to stage the disease and assess prognosis. Burkitt lymphoma is aggressive and usually presents with abdominal masses or CNS involvement. NHL can include B symptoms but isn’t as consistently associated with them. MCL is a subtype of NHL and doesn't characteristically present with all three of those symptoms as prominently.

Question 55

Which patient would be classified as having Hodgkin’s disease stage II B? A. A patient with lymphoma in two or more lymph nodes above the diaphragm with B symptoms present. B. A patient with lymph node involvement above and below the diaphragm and no B symptoms. C. A patient with lymph nodes involved on both sides of the diaphragm and in the liver, with no B symptoms. D. A patient with a single lymph node involved and experiencing B symptoms.

Answer 55

A. A patient with lymphoma in two or more lymph nodes above the diaphragm with B symptoms present. Breakdown: Stage II = Two or more lymph node regions on the same side of the diaphragm. "B" classification = Presence of B symptoms (fever, night sweats, weight loss). A single node with B symptoms? That would be Stage I B (D is out). Nodes above and below the diaphragm = Stage III (B and C are out).

Question 56

Which is a clinical manifestation of mild anemia? a. Glossitis b. Weight loss c. Dyspnea upon exertion d. Icteric Conjunctiva and Sclera

Answer 56

c. Dyspnea upon exertion Here's why: Mild anemia (Hgb 100–120 g/L) often presents with minimal symptoms. Some individuals may experience exertional dyspnea, palpitations, or fatigue, especially during activity. Glossitis (a) and icteric conjunctiva/sclera (d) are more common in moderate to severe anemia or specific types like pernicious or hemolytic anemia. Weight loss (b) is not a typical sign of mild anemia.

Question 57

Which amount of time would the nurse monitor their patient for when beginning a transfusion of packed red blood cells? a. 10 Minutes b. 15 Minutes c. 20 Minutes d. 25 Minutes

Answer 57

The correct answer is: b. 15 Minutes Explanation: When starting a transfusion of packed red blood cells (PRBCs), the first 15 minutes are critical. Most acute transfusion reactions—such as febrile, allergic, or hemolytic reactions—occur during this period. The nurse must stay with the patient and monitor vital signs and symptoms closely for the first 15 minutes. If no reaction occurs, the transfusion can usually proceed at the prescribed rate.

Question 58

What integumentary finding is indicative of anemia? a. Pallor b. Pruritis c. Jaundice d. Hyperpigmentation

Answer 58

a. Pallor Pallor (especially of the skin, mucous membranes, and nail beds) is a classic integumentary sign of anemia. It results from: Reduced hemoglobin levels Decreased blood flow to the skin

Question 59

Which intervention is included in the collaborative management of iron-deficiency anemia? a. Administration of enteric-coated iron supplmenet capsules b. Subcutaneous injection of iron in the case of malabsorption c. Taking an oral iron supplement with a dietary source of Vitamin C d. Inclusion of iron-rich foods in the diet like dairy products and seafood

Answer 59

c. Taking an oral iron supplement with a dietary source of Vitamin C Explanation: Vitamin C enhances iron absorption, especially non-heme iron from supplements or plant-based foods. A common teaching for patients with iron-deficiency anemia is to take oral iron with orange juice or other Vitamin C-rich foods. Why not the others? a. Enteric-coated iron supplements are not recommended because they bypass the duodenum, where iron is best absorbed. b. Iron injections (usually IM, not subcutaneous) are used in severe cases or malabsorption, but oral is first-line. d. While seafood can be iron-rich, dairy products inhibit iron absorption due to calcium, so this is not the best dietary advice.

Question 60

What term describes an abnormal condition characterized by increased red blood cells? a. Leukemia b. Thalassemia c. Polycythemia d. Hemochromatosis

Answer 60

Polycythemia is a condition characterized by increased red blood cell (RBC) mass. This leads to increased blood viscosity and volume, which can cause complications like thrombosis.

Question 61

Which breakfast choice is the most appropriate for a patient with iron-deficiency anemia? a. Cantaloupe and kiwi b. Peanut butter and banana c. Scrambled eggs and spinach d. Blueberry muffin and glass of milk

Answer 61

c. Scrambled eggs and spinach Iron-deficiency anemia requires foods high in iron and ideally vitamin C to enhance absorption. Scrambled eggs provide heme iron (from animal sources), which is more easily absorbed. Spinach provides non-heme iron and other nutrients.

Question 62

What is the primary symptoms associated with sickle cell crisis? a. Pain b. Fever c. Swelling d. Tachypnea

Answer 62

a. Pain 💥 Pain is the hallmark symptom of a sickle cell crisis. It's caused by ischemia due to sickled red blood cells blocking blood flow in small vessels. Pain can range from mild to excruciating and may affect various parts of the body—most commonly the back, chest, extremities, and abdomen.

Question 63

Which measure will ensure maximum absorption of iron from tablets? Select all that apply. a. Take tablet with food b. Take tablet an hour before meals c. Take the tablet before exercise d. Take the tablet after exercise d. Take the tablet with orange juice

Answer 63

✅ b. Take tablet an hour before meals ✅ d. Take the tablet with orange juice

Question 64

Which time is the latest a nurse can hang a unit of PRBC if they are picked up from the blood bank at 1015h? a. 1030 b. 1045 c. 1100 d. 1115

Answer 64

Once you pick up the blood from the blood bank, you usually have 30 minutes to start the transfusion. If you pick it up at 10:15 AM, the latest you can hang it is 10:45 AM. So the answer is: b. 1045

Question 65

Which blood product would the nurse administer to a patient with hypovolemic shock? a. albumin b. platelets c. fresh-frozen plasma d. packed red blood cells

Answer 65

For hypovolemic shock (which is basically severe blood or fluid loss causing low blood volume), the main goal is to restore blood volume and improve oxygen delivery. The best blood product for that is: d. packed red blood cells (PRBCs)

Question 66

Which preliminary assessment would be performed to reduce side effects of Rituximab? Select all that apply. a. screening patient for history of hepatitis b. serial monitoring of patient's renal function c. monitoring patient for bone marrow suppression d. monitoring patient for hypersensitivity infusion reactions e. evaluating patient for history of seizures

Answer 66

The right picks for reducing side effects of rituximab are: a. Screening patient for history of hepatitis — because rituximab can reactivate hepatitis B. d. Monitoring patient for hypersensitivity infusion reactions — since rituximab often causes infusion-related reactions. The others (renal function, bone marrow suppression, seizures) are less directly relevant as preliminary assessments for rituximab. So, a and d are correct!

Question 67

Which extrinsic factors can cause hemolytic anemia? a. Trauma or splenic sequestration crisis b. Abnormal hemoglobin or enzyme deficiency c. Macroangiopathic or microangiopathic factors d. Chronic diseases or medications and chemicals

Answer 67

c. Macroangiopathic or microangiopathic factors Because extrinsic factors that physically damage RBCs—like mechanical trauma in macroangiopathic (large vessel) or microangiopathic (small vessel) hemolytic anemia—cause hemolysis from outside the cells.

Question 68

Which action would the nurse take when required to safely infuse one unit of fresh-frozen plasma before the patient's arrival to the operating room? a. Infuse the fresh-frozen plasma over 4 hours and then bring patient to OR b. Infuse fresh-frozen plasma as rapidly as the patient will tolerate c. Hang the fresh-frozen plasma as a piggyback to the primary IV solution d. Hang the fresh-frozen plasma as a piggyback to lactated Ringer's solution

Answer 68

b. Infuse fresh-frozen plasma as rapidly as the patient will tolerate Fresh-frozen plasma (FFP) should be infused promptly, typically over 30 to 60 minutes, but always monitoring the patient’s tolerance to avoid complications.

Question 69

Which erythrocyte characteristic would the nurse expect to see in the lab findings for a patient with acute blood loss after an accident? a. microcytic b. hypochrmoic c. normocytic d. megaloblastic

Answer 69

In acute blood loss, the initial erythrocyte characteristics typically show: Normocytic (normal size) and normochromic (normal color) red blood cells Why? Because the bone marrow hasn't had time yet to produce new cells that would change size or color. The immediate effect is just a reduced number of RBCs due to loss.

Question 70

Which assessment finding does the nurse recall to be a classic sign of pernicious anemia? a. Diarrhea b. Indigestion c. Flushed skin d. Red, beefy tongue (glossitis)

Answer 70

d. Red, beefy tongue (glossitis)

Question 71

Which priority intervention would the nurse perform when caring for a patient who is neutropenic and having a febrile episode? a. obtain blood cultures from two sites b. administer a broad-spectrum intravenous (IV) antibiotic c. administer an oral antibiotic d. obtain culture of the throat

Answer 71

The priority is b. administer a broad-spectrum intravenous (IV) antibiotic. In neutropenic patients, fever can signal a serious infection, so starting IV antibiotics ASAP is critical to prevent sepsis.

Question 72

Which statement by the patient indicates a need for further instruction about safety measures and thrombocytopenia? a. "I will avoid blowing my nose" b. "At the gym, I will not lift weights" c. "I will use an electric razor to shave" d. "I will take aspirin if I have a headache"

Answer 72

The statement that indicates a need for further instruction is: d. "I will take aspirin if I have a headache" Aspirin can increase bleeding risk by affecting platelet function, so patients with thrombocytopenia should avoid it unless prescribed by their doctor.

Question 73

The primary purpose of protective (reverse) isolation is to help prevent the spread of organisms by doing what? a. Using special techniques to destroy discharge from the patient's body b. Using special techniques to handle the patient's linen and personal items c. Preventing spread to patient from sources outside the patient's environment d. Preventing spread from patient to health care personnel, visitors, other patients

Answer 73

c. Preventing spread to patient from sources outside the patient's environment Protective (reverse) isolation is used to protect immunocompromised patients (like those with neutropenia or undergoing chemotherapy) from infections brought in from the outside—including from healthcare staff, visitors, and equipment.

Question 74

Which patient teaching would be priority for the treatment for non-hodgkin's lymphoma (NHL)? a. Skin care that will be needed b. Method of obtaining treatment c. Gestro tract effects of treatment d. Treatment type and expected side effects

Answer 74

d. Treatment type and expected side effects

Question 75

Which management intervention would the nurse teach the patient who has been experiencing fatigue when executing activities of daily living? a. Assist the patient in walking immediately after meals b. Ensure that all activities are completed in the morning c. Encourage visitors to visit the patient often d. Assist in assigning priority to activities

Answer 75

d. Assist in assigning priority to activities Fatigue is a major symptom in many conditions, especially anemia, cancer, chronic illness, etc. Teaching patients to prioritize their activities helps them conserve energy for what's most important to them (like hygiene, meals, medication routines) while resting between tasks.

Question 76

Which would the nurse place highest priority on reducing for a patient with metastatic cancer and a hemoglobin level of 87 mmol/L and hematocrit of 26% a. Thirst b. Fatigue c. Headache d. Abdominal pain

Answer 76

b. Fatigue A hemoglobin level of 87 mmol/L (or 87 g/L) and hematocrit of 26% indicate moderate anemia. One of the most common and debilitating symptoms of anemia is fatigue.

Question 77

Which description would the nurse give when a patient with acute lymphocytic leukemia (ALL) asks for clarification about the disease? a. Infectious in nature and characterized by increased white cells b. Malignant in nature and characterized by increase in circulating red cells c. Malignant in nature and characterized by proliferation of immature white cells d. Inflammatory in nature and characterized by solid tumour formation in the lymph nodes

Answer 77

✅ c. Malignant in nature and characterized by proliferation of immature white cells

Question 78

After diagnosis of disseminated intravascular coagulation (DIC), which is first prioritty of collaborative care? a. Administer heparin b. Administer whole blood c. Treat causative problem d. Administer fresh-frozen plasma

Answer 78

c. Treat causative problem Explanation: Disseminated intravascular coagulation (DIC) is a secondary complication of an underlying condition (such as sepsis, trauma, cancer, or obstetric complications). In DIC, the body forms small blood clots throughout the bloodstream, leading to clotting factor depletion and bleeding.

Question 79

Which assessment finding may be indicative of development of disseminated intravascular coagulation (DIC)? a. Scattered wheezes b. Increasing dyspnea c. Bradycardia and hypertension d. Blood oozing from venipuncture sites

Answer 79

D. Blood oozing from venipuncture sites DIC is a condition where the body uses up clotting factors and platelets due to widespread clotting, leading to severe bleeding. One of the early signs is bleeding from sites that are normally controlled, like IV or venipuncture sites, mucous membranes, or surgical wounds.

Question 80

What is nurse's priority for patient who has sickle cell disease and has developed cellulitis above the left ankle? a. start IV fluids b. maintain oxygenation c. maintain distal warmth d. check peripheral pulses

Answer 80

a. start IV fluids.