Chapter 33- Assessment and Management of Patients With Hematologic

1. The nurse informs a patient who asks where the body forms blood cells responds that blood cells are formed in the: A) Spleen B) Kidneys C) Bone marrow D) Liver Ans: C Difficulty: Easy 2. A patient complains of a heavy menstrual flow. Because red blood cell production increases during menstruation, the nurse is aware that the patient may need to increase her daily intake of: A) Vitamin C B) Vitamin D C) Iron D) Magnesium Ans: C Difficulty: Moderate 3. A patient receives an injury to the skin that causes minor blood loss. Primary hemostasis is activated, during which: A) Severed blood vessels constrict. C) Prothrombin is converted to thrombin. B) Thromboplastin is released. D) Fibrin is lysed. Ans: A Difficulty: Moderate 4. A patient is diagnosed with a hypoproliferative anemia. The nurse is aware that this type of anemia is due to: A) Lack of production of RBCs C) Injury to the RBCs in circulation B) Loss of RBCs D) Abnormality of RBCs Ans: A Difficulty: Easy 5. A patient reports symptoms of fatigue and pica. Laboratory findings reveal a low serum iron level and a low ferritin level. Upon evaluation of this assessment and laboratory data, the nurse suspects that the patient will be diagnosed with: A) Iron deficient anemia C) Sickle cell anemia B) Pernicious anemia D) Hemolytic anemia Ans: A Difficulty: Moderate 6. A patient is admitted with sickle cell anemia. The nurse is aware that the care of this patient often requires: A) Chronic transfusions with RBCs C) Vitamin B12 replacement B) Platelet transfusions D) Phlebotomy Ans: A Difficulty: Moderate 7. To prevent abuse of analgesics in a patient with sickle cell anemia, the nurse encourages the patient to: A) Seek care from a variety of sources for pain relief.
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B) C) D)

Seek care from a single provider for pain relief. Accept chronic pain being continually present as a fact of the disease. Limit the reporting of emergency department visits to the primary health care provider. Ans: B Difficulty: Easy

8. A patient with iron-deficiency anemia states that she has minimal energy and finds it difficult to manage the household and work. The most appropriate intervention for the nurse to take to manage the fatigue is to: A) Encourage the patient to stop working. B) Encourage the patient to do minimal to no physical activity. C) Assist the patient to prioritize activities and establish an activity/rest schedule. D) Instruct the patient to perform activities only in the evening. Ans: C Difficulty: Moderate 9. When assessing a patient with anemia, the nurse notes that the patient has developed peripheral numbness and poor coordination. The patient's family states that the patient appears to be confused at times at home. Neurologic symptoms most often accompany which type of anemia? A) Iron deficiency anemia C) Pernicious anemia B) Folic acid deficiency D) Thalassemia major Ans: C Difficulty: Moderate 10. The nurse expects the patient diagnosed with polycythemia vera to display which of the following manifestations of the disease? A) Elevated red blood cells and splenomegaly B) Lowered hematocrit and splenomegaly C) Lowered hematocrit and jaundice D) Elevated red blood cells and jaundice Ans: A Difficulty: Difficult 11. A nurse is explaining to a patient the common feature of leukemia, which is: A) Unregulated proliferation of white blood cells B) Unregulated proliferation of red blood cell. C) Decrease in production of white blood cells D) Decrease in production of red blood cells Ans: A Difficulty: Moderate 12. A patient has been diagnosed with acute myeloid leukemia (AML). The nurse anticipates that the plan of care for this patient will most likely include: A) Aggressive chemotherapy treatment C) Treatment with vancomycin

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B)

Chronic albumin transfusion Ans: A Difficulty: Moderate

D)

Interferon injections

13. A 70-year-old patient is diagnosed with chronic lymphocytic leukemia (CLL). The nurse assesses the patient for which condition that may be associated with CLL? A) Confusion C) Enlargement of lymph nodes B) Renal colic D) Hyperplasia of the gums Ans: C Difficulty: Moderate 14. When caring for a patient with acute myeloid leukemia (AML) who is neutropenic, the nurse is aware that, if possible, the patient should not be given which of the following medications? A) Aspirin B) Acetaminophen C) Furosemide D) Oral laxatives Ans: A Difficulty: Moderate 15. When caring for a patient with acute leukemia, the nurse should monitor which of the following laboratory results to assess the risk for infection: A) Creatinine levels C) Electrolyte levels B) Hepatic function tests D) WBC count Ans: D Difficulty: Easy 16. A nurse is caring for a patient who is being discharged after treatment for acute leukemia. To manage mucositis and painful mucous membranes, the nurse should instruct the patient to eat: A) Soft-textured food, such as meatloaf B) Raw fruits, such as apples C) Raw vegetables, such as eggplant D) Foods with vitamin C, such as grapefruits Ans: A Difficulty: Moderate 17. When caring for a patient with terminal acute myeloid leukemia (AML) receiving supportive care at home, the home care nurse should ensure that the family: A) Avoids grieving while the patient is living B) Is informed about complications of infection and bleeding C) Provides all levels of care all the time D) Encourages the patient to seek other treatments Ans: B Difficulty: Moderate 18. When caring for a patient with multiple myeloma who is experiencing bone destruction, the nurse should assess for signs of:

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A) B)

Hypercalcemia Hyperproteinemia. Ans: A Difficulty: Moderate

C) D)

Elevated serum viscosity Elevated RBC count

19. A patient is diagnosed with thrombocytopenia. The nurse should explain to the patient that with this condition, there could be: A) An attack on the platelets by the antibodies B) Decreased production of platelets C) Elevated platelet production D) Decreased white blood cell production Ans: B Difficulty: Moderate 20. When caring for a patient with hemophilia, the nurse notes that the patient has developed joint pain in the left knee. Which of the following is an appropriate nursing intervention for the joint pain? A) Apply heat to the joint. B) Apply a cold compress to the joint. C) Encourage the patient to exercise the joint. D) Administer aspirin for pain. Ans: B Difficulty: Moderate 21. A patient with autoimmune hemolytic anemia is not responding to conservative treatments. His condition is now becoming life threatening. The nurse is aware that a treatment option in this case may include: A) Hepatectomy. C) Platelet transfusion B) Vitamin K administration D) Splenectomy Ans: D Difficulty: Moderate 22. Fifteen minutes after the infusion of packed red blood cells (RBCs) has begun, the patient complains of difficulty breathing and chest tightness. The most appropriate initial action for the nurse to take is: A) Notify the patient's physician. B) Stop the transfusion immediately. C) Remove the patient's intravenous access. D) Assess the patient's chest sounds and vital signs. Ans: B Difficulty: Moderate 23. The nurse is preparing to administer a unit of blood to a patient diagnosed with anemia. After removing the blood from the refrigerator, the nurse should administer the blood within: A) 1 hour B) 2 hours C) 4 hours D) 6 hours

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Ans: C Difficulty: Moderate 24. A patient is undergoing diagnostic testing for multiple myeloma. Diagnostic test findings indicative of multiple myeloma include: A) A decreased serum creatinine level C) Bence-Jones protein in the urine B) Hypocalcemia D) A low serum protein level Ans: C Difficulty: Easy 25. The nurse assessing a patient with multiple myeloma should keep in mind that patients with multiple myeloma are at risk for: A) Chronic liver failure C) Pathologic bone fractures B) Acute heart failure D) Hypoxemia Ans: C Difficulty: Moderate 26. A patient is receiving chemotherapy for cancer. The nurse reviews the laboratory data and notes that he has thrombocytopenia. Which nursing diagnosis should be given the highest priority? A) Activity intolerance B) Impaired tissue integrity C) Impaired oral mucous membranes D) Ineffective tissue perfusion (cerebral, cardiopulmonary, GI) Ans: D Difficulty: Moderate 27. While monitoring a patient for the development of disseminated intravascular coagulation (DIC), the nurse should take note of what assessment parameters? A) Platelet count, prothrombin time (PT), and partial thromboplastin time (PTT) B) Platelet count, blood glucose level, and white blood cell (WBC) count C) Thrombin time, calcium level, and potassium level D) Fibrinogen level, WBC count, and platelet count Ans: A Difficulty: Difficult 28. When teaching safety precautions to a patient with thrombocytopenia, the nurse should include which of the following directives? A) Eat foods high in iron. B) Avoid products that contain aspirin. C) Avoid people with respiratory tract infections. D) Eat only cooked vegetables. Ans: B Difficulty: Moderate 29. A 50-year-old male with a diagnosis of leukemia is responding poorly to treatment.

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A) B) C) D)

He's tearful and trying to express his feelings, but he's having difficulty. The nurse's first action should be to: Tell him that she'll leave for now but she'll be back. Offer to call pastoral care. Ask if he would like her to sit with him while he collects his thoughts. Tell him that she can understand how he's feeling. Ans: C Difficulty: Moderate

30. A patient with renal failure has decreased erythropoietin production. Upon analysis of the patient's complete blood count, the nurse will expect which of the following complete blood count results? A) Increased hemoglobin and C) Decreased MCV and MCH hematocrit B) Decreased hemoglobin and D) Increased MCV and MCH hematocrit Ans: B Difficulty: Difficult 31. Which of the following values will be decreased in a patient with disseminated intravascular coagulation (DIC)? A) Platelet count and fibrinogen B) Prothrombin time and partial thromboplastin time C) Thrombin time and fibrinogen D) D-dimer and fibrin degradation products Ans: A Difficulty: Difficult 32. A patient with iron deficiency anemia has been prescribed iron supplements. When providing information to the patient on iron administration, which of the following statements will the nurse include in her teaching? A) Take the iron with dairy products to enhance absorption. B) Increase the intake of vitamin E to enhance absorption. C) Iron will cause the stools to darken in color. D) Limit foods high in fiber due to the risk for diarrhea. Ans: C Difficulty: Moderate 33. A patient with acute myeloid leukemia requires neutropenic precautions. Upon inspection of his dinner tray, the nurse determines that which of the following foods should be removed from the tray due to the neutropenic precautions? A) Mashed potatoes C) Lettuce and tomato salad B) Baked chicken D) Jell-O with whipped cream Ans: C Difficulty: Moderate

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34. While administering a packed red blood cell transfusion, the patient becomes restless, febrile, and complains of nausea. The nurse's initial response to these symptoms is to: A) Stop the transfusion B) Notify the physician C) Decrease the drip rate of the blood transfusion D) Obtain the patient's vital signs Ans: A Difficulty: Difficult 35. Plasminogen is a component necessary in the clotting cascade. Plasminogen is present in: A) Myocardial muscle tissue C) Cerebral tissue B) All body fluids D) Renal tissue Ans: B Difficulty: Easy 36. Upon assessment, the nurse observes the patient's tongue to be red and smooth. The patient complains that the tongue is sore. Based upon assessment findings, the nurse is aware that he is demonstrating symptoms associated with: A) Sickle cell anemia C) Megaloblastic anemia B) Hemolytic anemia D) Aplastic anemia Ans: C Difficulty: Moderate 37. A patient with symptoms related to secondary polycythemia caused by renal cell carcinoma is not a surgical candidate and has elected not to start chemotherapy or radiation therapy due to the low success rates of these treatment modalities. The nurse recognizes that management of the symptoms of secondary polycythemia will likely require: A) A transfusion of packed red blood cells B) Therapeutic phlebotomy C) High-dose vitamin and iron therapy D) Administration of corticosteroid therapy Ans: B Difficulty: Difficult 38. A patient with acute myeloid leukemia is preparing to undergo induction therapy. In preparing a care plan for this patient, the nurse will assign the highest priority to which of the following nursing diagnoses? A) Activity intolerance C) Disturbed processes B) Risk for infection D) Risk for spiritual distress Ans: B Difficulty: Moderate 39. The nurse is preparing to administer oral care to a patient with mucositis. Which of the following supplies will she gather?

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A) B)

Sponge-tipped applicator Antibacterial mouthwash Ans: A Difficulty: Difficult

C) D)

Medium-bristled toothbrush Lemon-glycerin swabs

40. While performing a physical assessment on a patient diagnosed with agnogenic myeloid metaplasia, the nurse will anticipate palpating enlargement of which organ(s)? A) Heart B) Liver C) Kidneys D) Spleen Ans: D Difficulty: Moderate 41. An oncology nurse is aware that which of the following individuals is at the greatest risk for the development of Hodgkin's disease? A) The spouse of a patient with Hodgkin's disease B) A patient with a liver transplant on immunosuppressive therapy C) A patient with heart failure on diuretic therapy D) A patient who works on a fishing boat Ans: B Difficulty: Moderate 42. What classic presenting symptom associated with multiple myeloma would the nurse assess for? A) Liver dysfunction B) Bone pain C) Serum hypocalcemia D) Nausea Ans: B Difficulty: Moderate 43. Upon analysis of laboratory data of a patient with multiple myeloma, the nurse expects to observe which of the following findings? A) Serum hypokalemia C) Serum hyponatremia B) Serum hypercalcemia D) Serum hypermagnesemia Ans: B Difficulty: Easy 44. During a teaching session with a patient diagnosed with primary thrombocythemia, the nurse correctly instructs the patient to: A) Decrease cardiac risks by drinking a glass of red wine nightly B) Take Coumadin daily C) Administer interferon-alfa-2b subcutaneously D) Take NSAIDs at the earliest sign of pain Ans: C Difficulty: Moderate

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