Chapter 33 Med Surge

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Chapter: Chapter ((: $ssessment and &anagement of Patients )ith #ematologic Disorders
&ultiple Choice
*+ ,ou are caring for a patient with a hematologic disorder+ -he patient as.s you where the !ody
forms !lood cells+ )here would you tell the patient that !lood cells are formed/
$0 In the spleen
B0 In the .idneys
C0 In the !one marrow
D0 In the liver
$ns: C
Chapter: ((
Client Needs: D1*
Cognitive Level: Comprehension
Difficulty: %asy
Integrated Process: Nursing Process
!"ective: *
Page and #eader: 2345 $natomic and Physiologic verview
Feed!ac.: Bone marrow is the primary site for hematopoiesis+ -he liver and spleen may !e
involved during em!ryonic development or when marrow is destroyed+ -he .idneys release
erythropoietin5 which stimulates the marrow to increase production of 6BCs+ Blood cells are not
formed in the spleen5 .idneys5 or liver+
7+ $n elderly man trips over his dog and receives an in"ury to the s.in5 which causes minor
!lood loss+ Primary hemostasis is activated in this patient+ )hat occurs in primary hemostasis/
$0 Severed !lood vessels constrict+
B0 -hrom!oplastin is released+
C0 Prothrom!in is converted to throm!in+
D0 Fi!rin is lysed+
$ns: $
Chapter: ((
Client Needs: D14
Difficulty: &oderate
!"ective: 7
Feed!ac.: Primary hemostasis involves the severed vessel constricting and platelets collecting at
the in"ury site+ Secondary hemostasis occurs when throm!oplastin is released5 prothrom!in
converts to throm!in5 and fi!rin is lysed+
(+ $ patient has come to the B9:,N clinic with complaints of a heavy menstrual flow+ -he
nurse .nows that red !lood cell production will !e increased in the patient;s !ody+ Because of
this5 the nurse is aware that the patient may need to increase her daily inta.e of what/
$0 <itamin C
B0 <itamin D
C0 Iron
D0 &agnesium
$ns: C
Chapter: ((
Client Needs: D14
Cognitive Level: $pplication
!"ective: 7
Page and #eader: 23=5 $natomic and Physiologic verview
Feed!ac.: -o replace !lood loss5 the rate of red cell production increases+ Iron is incorporated
into hemoglo!in+ <itamins C and D and magnesium do not need to !e increased when red !lood
cell production is increased+
4+ ,ou are caring for a patient with a diagnosis of hypoproliferative anemia+ ,ou are aware that
this type of anemia is due to what/
$0 Lac. of production of 6BCs
B0 Loss of 6BCs
C0 In"ury to the 6BCs in circulation
D0 $!normality of 6BCs
$ns: $
Chapter: ((
Client Needs: D14
Difficulty: %asy
!"ective: (
Page and #eader: 2*35 $nemia
Feed!ac.: #ypoproliferative anemia is usually a result of inade>uate num!ers of 6BCs !eing
produced !y the !one marrow+ Loss of 6BCs is usually a result of !lood loss+ #emolytic anemia
can !e a result of in"ury to the 6BCs in circulation5 possi!ly due to heart valve hemolysis+
$!normality of 6BCs can occur in sic.le cell anemia+
=+ $ nurse is caring for a *?1year1old who has sic.le cell anemia+ -he nurse is concerned a!out
su!stance a!use in this patient+ )hat would the nurse encourage the patient to do to prevent
su!stance a!use of analgesics in this patient/
$0 See. care from a variety of sources for pain relief+
B0 See. care from a single provider for pain relief+
C0 $ccept chronic pain !eing continually present as a fact of the disease+
D0 Limit the reporting of emergency department visits to the primary health care provider+
$ns: B
Chapter: ((
Client Needs: D1(
Difficulty: %asy
Integrated Process: -eaching9Learning
!"ective: 4
Page and #eader: 2745 #emolytic $nemias
Feed!ac.: -he patient should !e encouraged to use a single primary health care provider to
address health care concerns+ %mergency department visits should !e reported to the primary
health care provider to achieve optimal management of the disease+
?+ $ *71year1old on the oncology unit at children;s hospital tells the nurse that they have
discovered there are different .inds of leu.emia+ -he child as.s the nurse to e@plain what ma.es
them all Aleu.emia+B )hat would the nurse reply
$0 -he different leu.emias all have unregulated proliferation of white !lood cells+
B0 -he different leu.emias all have unregulated proliferation of red !lood cells+
C0 -he different leu.emias all have a decrease in production of white !lood cells+
D0 -he different leu.emias all have a decrease in production of red !lood cells+
$ns: $
Chapter: ((
Client Needs: D14
!"ective: =
Page and #eader: 2(75 Leu.emia
Feed!ac.: Leu.emia commonly involves unregulated proliferation of white !lood cells+
Decreased production of red !lood cells is associated with anemias+ Decreased production of
white !lood cells is associated with leu.openia+
C+ ,ou are the nurse caring for a patient with acute leu.emia+ )hat would you do to assess the
ris. for infection/
$0 &onitor creatinine levels
B0 &onitor hepatic function tests
C0 &onitor electrolyte levels
D0 &onitor )BC count
$ns: D
Chapter: ((
Client Needs: D1(
Difficulty: %asy
!"ective: ?
Page and #eader: 2(C5 Chronic Lymphocytic Leu.emia
Feed!ac.: -o monitor the ris. of infection5 the nurse should chec. the )BC count to assess the
ris. for infection+ -herefore options $5 B5 and C are incorrect+
8+ -he nursing instructor is tal.ing with the students a!out the care of a patient with multiple
myeloma who is e@periencing !one destruction+ )hat would the instructor tell the students the
patient should !e assessed for signs of/
$0 #ypercalcemia
B0 #yperproteinemia
C0 %levated serum viscosity
D0 %levated 6BC count
$ns: $
Chapter: ((
Client Needs: D14
!"ective: C
Page and #eader: 24=5 &ultiple &yeloma
Feed!ac.: #ypercalcemia may occur when !one destruction occurs due to the disease process+
%levated serum viscosity occurs !ecause plasma cells e@crete e@cess immunoglo!ulin+ 6BC
count will !e decreased+ #yperproteinemia would not !e present+
2+ $ patient newly diagnosed with throm!ocytopenia is admitted to your unit+ $fter the
admission assessment5 the patient as.s you to e@plain the disease to her+ )hat would you e@plain
to the patient a!out this condition/
$0 -here could !e an attac. on the platelets !y the anti!odies+
B0 -here could !e decreased production of platelets+
C0 -here could !e elevated platelet production+
D0 -here could !e decreased white !lood cell production+
$ns: B
Chapter: ((
Client Needs: D14
!"ective: 8
Page and #eader: 2425 -hrom!ocytopenia
Feed!ac.: -hrom!ocytopenia can result from a decreased platelet production5 increased platelet
destruction5 or increased consumption of platelets+ Increased production of platelets is associated
with throm!ocythemia5 and decreased white !lood cell production is associated with leu.openia+
*3+ $ critical care nurse is caring for a patient with autoimmune hemolytic anemia+ -he patient
is not responding to conservative treatments5 and his condition is now !ecoming life threatening+
-he nurse is aware that a treatment option in this case may include what/
$0 #epatectomy
B0 <itamin ' administration
C0 Platelet transfusion
D0 Splenectomy
$ns: D
Chapter: ((
Client Needs: D14
!"ective: 2
Page and #eader: 27?5 #emolytic $nemias
Feed!ac.: $ splenectomy may !e the course of treatment if autoimmune hemolytic anemia does
not respond to conservative treatment+ <itamin ' administration is treatment for vitamin '
deficiency+ Platelet transfusion may !e the course of treatment for some !leeding disorders+
#epatectomy would not help the patient+
**+ -he nurse caring for a patient receiving a transfusion notes that *= minutes after the infusion
of pac.ed red !lood cells D6BCs0 has !egun5 the patient is having difficulty !reathing and chest
tightness+ )hat is the most appropriate initial action for the nurse to ta.e/
$0 Notify the patient;s physician+
B0 Stop the transfusion immediately+
C0 6emove the patient;s intravenous access+
D0 $ssess the patient;s chest sounds and vital signs+
$ns: B
Chapter: ((
Client Needs: D1(
!"ective: 2
Page and #eader: 2?25 -ransfusion
Feed!ac.: <ascular collapse5 !ronchospasm5 laryngeal edema5 shoc.5 fever5 chills5 and "ugular
vein distension are severe reactions+ -he nurse should discontinue the transfusion immediately5
monitor the patient;s vital signs5 and notify the physician+ -he !lood container and tu!ing should
!e sent to the !lood !an.+ $ !lood and urine specimen may !e needed if a transfusion reaction or
a !acterial infection is suspected+ ,ou do not remove the patient;s I< access+
*7+ ,ou are the nurse assessing a patient with multiple myeloma+ )hat should you .eep in mind
that patients with multiple myeloma are at ris. for/
$0 Chronic liver failure+
B0 $cute heart failure+
C0 Pathologic !one fractures+
D0 #ypo@emia+
$ns: C
Chapter: ((
Client Needs: D14
Cognitive Level: $nalysis
!"ective: C
Page and #eader: 24=5 &ultiple &yeloma
Feed!ac.: Clients with multiple myeloma are at ris. for pathologic !one fractures secondary to
diffuse osteoporosis and osteolytic lesions+ $lso5 clients are at ris. for renal failure secondary to
myeloma proteins !y causing renal tu!ular o!struction+ Liver failure and heart failure are not
usually se>uelae of multiple myeloma+ #ypo@emia is not usually related to multiple myeloma+
*(+ $ student nurse is caring for a patient who is receiving chemotherapy for cancer+ -he student
nurse reviews the la!oratory data with his preceptor and notes that the patient has
throm!ocytopenia+ )hich nursing diagnosis should the nurse give the highest priority/
$0 $ctivity intolerance
B0 Impaired tissue integrity
C0 Impaired oral mucous mem!ranes
D0 Ineffective tissue perfusion Dcere!ral5 cardiopulmonary5 :I0
$ns: D
Chapter: ((
Client Needs: D1(
!"ective: 8
Page and #eader: 2=85 Disseminated Intravascular Coagulation
Feed!ac.: -hese are all appropriate nursing diagnoses for the client with throm!ocytopenia
Dreduced platelet count0+ #owever5 the ris. of cere!ral and :I hemorrhage and hypotension pose
the greatest ris. to the client;s physiologic integrity+
*4+ $ patient with advanced leu.emia is responding poorly to treatment+ ,ou find the patient
tearful and trying to e@press his feelings5 !ut he is having difficulty+ )hat would !e your first
nursing action/
$0 -ell him that you;ll leave for now !ut you;ll !e !ac.+
B0 ffer to call pastoral care+
C0 $s. if he would li.e you to sit with him while he collects his thoughts+
D0 -ell him that you can understand how he;s feeling+
$ns: C
Chapter: ((
Client Needs: C
Integrated Process: Caring
!"ective: ?
Page and #eader: 2(25 Chronic Lymphocytic Leu.emia
Feed!ac.: Providing emotional support and discussing the uncertain future are crucial+ ption $
is incorrect !ecause leaving the patient doesn;t show acceptance of his feelings+ ption B is
incorrect !ecause offering to call pastoral care may !e helpful for some patients !ut should !e
done after the nurse has spent time with the patient+ ption D is incorrect !ecause telling the
patient that you understand how he;s feeling is inappropriate !ecause it doesn;t help him e@press
his feelings+
*=+ -he nurse is providing education to a patient with iron deficiency anemia who has !een
prescri!ed iron supplements+ )hat will the nurse include in her teaching/
$0 -a.e the iron with dairy products to enhance a!sorption+
B0 Increase the inta.e of vitamin % to enhance a!sorption+
C0 Iron will cause the stools to dar.en in color+
D0 Limit foods high in fi!er due to the ris. for diarrhea+
$ns: C
Chapter: ((
Client Needs: D17
!"ective: 4
Page and #eader: 2*=5 #ypoproloferative $nemias
Feed!ac.: -he nurse will inform the patient that iron will cause the stools to !ecome dar. in
color+ Iron should !e ta.en on an empty stomach5 as its a!sorption is affected !y food5 especially
dairy products+ Patients should !e instructed to increase their inta.e of vitamin C to enhance iron
a!sorption+ Foods high in fi!er should !e consumed to minimiEe pro!lems with constipation5 a
common side effect associated with iron therapy+
*?+ ,ou are assessing a new patient with complaints of a sore5 red5 and smooth tongue+ Based
upon your assessment findings5 you .now that the patient is demonstrating symptoms associated
with what/
$0 Sic.le cell anemia
B0 #emolytic anemia
C0 &egalo!lastic anemia
D0 $plastic anemia
$ns: C
Chapter: ((
Client Needs: D14
!"ective: (
Page and #eader: 2*C5 #ypoproloferative $nemias
Feed!ac.: $ red5 smooth5 sore tongue is a symptom associated with meaglo!lastic anemia+ Iron
deficiency anemia may !e characteriEed !y a smooth5 red tongue+ Sic.le cell and hemolytic
anemia do not have symptoms involving the tongue+
*C+ $ nursing student is caring for a patient with acute myeloid leu.emia who is preparing to
undergo induction therapy+ In preparing a plan of care for this patient5 the student should assign
the highest priority to which nursing diagnoses/
$0 $ctivity intolerance
B0 6is. for infection
C0 Distur!ed processes
D0 6is. for spiritual distress
$ns: B
Chapter: ((
Client Needs: D14
!"ective: =
Page and #eader: 2(45 $cute &yeloid Leu.emia
Feed!ac.: Induction therapy places the patient at ris. for infection5 and this is the priority
nursing diagnosis+ During the time of induction therapy5 the patient is very ill5 with !acterial5
fungal5 and occasional viral infectionsF !leeding and severe mucositis5 which causes diarrheaF
and mar.ed decline in the a!ility to maintain ade>uate nutrition+ Supportive care consists of
administering !lood products and promptly treating infections+ ptions $5 C5 and D are valid
nursing diagnosis for this patient !ut they are not the highest priority+
*8+ $ patient with renal failure has decreased erythropoietin production+ Gpon analysis of the
patient;s complete !lood count5 the nurse will e@pect which of the following complete !lood
count results/
$0 $n increased hemoglo!in and hematocrit
B0 $ decreased hemoglo!in and hematocrit
C0 $ decreased &C< and &C#
D0 $n increased &C< and &C#
$ns: B
Chapter: ((
Client Needs: D14
Difficulty: Difficult
!"ective: *
Feed!ac.: -he decreased production of erythropoietin will result in a decreased hemoglo!in and
hematocrit+ -he patient will have normal &C< and &C# values+ -his ma.es options $5 C5 and
D incorrect+
*2+ $ student as.s the physiology instructor a!out the clotting cascade+ -he instructor e@plains
that plasminogen is a component necessary in the clotting cascade+ )here in the !ody is
plasminogen present/
$0 &yocardial muscle tissue
B0 $ll !ody fluids
C0 Cere!ral tissue
D0 6enal tissue
$ns: B
Chapter: ((
Client Needs: D14
Difficulty: %asy
!"ective: 7
Feed!ac.: Plasminogen5 which is present in all !ody fluids5 circulates with fi!rinogen+
Plasminogen is found in !ody fluids5 not tissue+
73+ $ patient comes to the clinic complaining of fatigue and pica+ La!oratory findings reveal a
low serum iron level and a low ferritin level+ )hat would the nurse suspect that the patient will
!e diagnosed with/
$0 Iron deficiency anemia
B0 Pernicious anemia
C0 Sic.le cell anemia
D0 #emolytic anemia
$ns: $
Chapter: ((
Client Needs: D14
!"ective: (
Page and #eader: 2*45 #ypoproloferative $nemias
Feed!ac.: $ low serum iron level5 a low ferritin level5 and symptoms of pica are associated with
iron deficiency anemia+ -IBC may also !e elevated+ None of the other anemias are associated
with pica+
7*+ ,ou are caring for a patient whose !one marrow has !een replaced !y scar tissue in many of
the areas that produce !lood cells for the !ody+ )hat organs can !ecome active in !lood cell
production !y the process of e@tramedullary hematopoiesis/
$0 Spleen and .idneys
B0 'idneys and pancreas
C0 Pancreas and liver
D0 Liver and spleen
$ns: D
Chapter: ((
Client Needs: $1*
!"ective: *
Feed!ac.: In adults with disease that causes marrow destruction5 fi!rosis5 or scarring5 the liver
and spleen can also resume production of !lood cells !y a process .nown as e@tramedullary
hematopoiesis+ -he .idneys and pancreas do not produce !lood cells for the !ody+
&ultiple Selection
77+ In the process of hematopoiesis stem cells differentiate into either myeloid or lymphoid stem
cells+ )hat do myeloid stem cells further differentiate into/ D&ar. all that apply+0
$0 Leu.ocytes
B0 &ast cells
C0 -hrom!ocytes
D0 Platelets
%0 %rythrocytes
$ns: $5 D5 %
Chapter: ((
Client Needs: $1*
!"ective: *
Feed!ac.: &yeloid stem cells differentiate into three !road cell types: erythrocytes5 leu.ocytes5
and platelets+
&ultiple Choice
7(+ )hen a human !ody receives an in"ury that causes !lood loss5 there are several processes
involved in maintaining hemostasis+ )hen a !lood clot is no longer needed5 what digests the
fi!rinogen and fi!rin/
$0 Plasminogen
B0 -hrom!in
C0 Prothrom!in
D0 Plasmin
$ns: D
Chapter: ((
Client Needs: B
!"ective: 7
Feed!ac.: -he su!stance plasminogen is re>uired to lyse D!rea. down0 the fi!rin+ Plasminogen5
which is present in all !ody fluids5 circulates with fi!rinogen and is therefore incorporated into
the fi!rin clot as it forms+ )hen the clot is no longer needed Deg5 after an in"ured !lood vessel has
healed05 the plasminogen is activated to form plasmin+ Plasmin digests the fi!rinogen and fi!rin+
Prothrom!in is converted to throm!in, which in turn catalyEes the conversion of fi!rinogen to
fi!rin so a clot can form+
74+ $ *?1year1old female comes into the clinic complaining of fatigue+ Blood wor. shows an
increased !iliru!in concentration and an increased reticulocyte count+ )hat would the nurse
suspect the patient has/
$0 $ hypoproliferative anemia
B0 $ leu.emia
C0 $ !leeding disorder
D0 $ hemolytic anemia
$ns: D
Chapter: ((
Client Needs: B
!"ective: (
Feed!ac.: In hemolytic anemias5 premature destruction of erythrocytes results in the li!eration
of hemoglo!in from the erythrocytes into the plasmaF the released hemoglo!in is converted in
large part to !iliru!in5 and therefore the !iliru!in concentration rises+ -he increased erythrocyte
destruction leads to tissue hypo@ia5 which in turn stimulates erythropoietin production+ -his
increased production is reflected in an increased reticulocyte count as the !one marrow responds
to the loss of erythrocytes+ ptions $5 B5 and C are incorrect+
7=+ -he nurse is caring for a patient with severe anemia+ -he patient is tachycardic and
complains of diEEiness and e@ertional dyspnea+ -he nurse .nows that in an effort to deliver more
!lood to hypo@ic tissue the wor.load on the heart is increased+ )hat signs and symptoms might
develop if this patient goes into heart failure/
$0 #epatomegaly
B0 $scites
C0 Fluid overload
D0 Pulmonary edema
$ns: $
Chapter: ((
Client Needs: D14
!"ective: 4
Feed!ac.: Cardiac status should !e carefully assessed+ )hen the hemoglo!in level is low5 the
heart attempts to compensate !y pumping faster and harder in an effort to deliver more !lood to
hypo@ic tissue+ -his increased cardiac wor.load can result in such symptoms as tachycardia5
palpitations5 dyspnea5 diEEiness5 orthopnea5 and e@ertional dyspnea+ #eart failure may eventually
develop5 as evidenced !y an enlarged heart Dcardiomegaly0 and liver Dhepatomegaly0 and !y
peripheral edema+ -his patient would not e@hi!it ascites5 fluid overload5 or pulmonary edema+
7?+ $ patient is admitted to the hospital with pernicious anemia+ )hat possi!le complications
would the nurse caring for this patient .now to monitor for/
$0 Pulmonary edema
B0 Confusion
C0 Peripheral edema
D0 $scites
$ns: B
Chapter: ((
Client Needs: D1(
!"ective: 4
Page and #eader: 2*(5 $nemia
Feed!ac.: Based on the assessment data5 potential complications that may develop include heart
failure5 angina5 paresthesias5 and confusion+ Potential complications of the anemias generally do
not include pulmonary or peripheral edema or ascites+
7C+ $ ?C1year1old male is admitted to your unit with a suspected diagnosis of acute myeloid
leu.emia D$&L0+ -he patient as.s you how much time he has left+ )hat would you tell this
patient/
$0 A-he =1year survival rate for $&L is (=H+B
B0 ANo one can predict who lives and who dies+B
C0 A-he =1year survival rate for those older than ?= years of age is 4H+B
D0 A-hat is something I can;t answer for you+B
$ns: C
Chapter: ((
Client Needs: B
Integrated Process: Communication and Documentation
!"ective: =
Page and #eader: 2((5 $cute &yeloid Leu.emia
Feed!ac.: -he =1year survival rate for patients with $&L who are ?= years of age or younger is
(=HF it drops to 4H for those older than ?= years of age+ ptions B and D are incorrect !ecause
they avoid answering the patient;s >uestion+ ption $ is incorrect !ecause is not a complete
correct answer to the patient;s >uestion+
78+ $ (=1year1old male is admitted to the hospital complaining of severe headaches5 vomiting5
and testicular pain+ #is !lood wor. shows reduced num!ers of platelets5 leu.ocytes5 and
erythrocytes with a high proportion of immature cells+ -he nurse caring for this patient suspects a
diagnosis of what/
$0 $&L
B0 C&L
C0 &DS
D0 $LL
$ns: D
Chapter: ((
Client Needs: $1*
!"ective: =
Page and #eader: 2(?5 Chronic Lymphocytic Leu.emia
Feed!ac.: In acute lymphocytic leu.emia5 manifestations of leu.emic cell infiltration into other
organs are more common than with other forms of leu.emia5 and include pain from an enlarged
liver or spleen and !one pain+ -he central nervous system is fre>uently a site for leu.emic cellsF
thus5 patients may e@hi!it headache and vomiting !ecause of meningeal involvement+ ther
e@tranodal sites include the testes and !reasts+
72+ $ patient with leu.emia has developed stomatitis and is not eating+ $n oral anesthetic has
!een prescri!ed+ )hat would you warn the patient a!out/
$0 Chew with e@treme care to avoid inadvertently !iting the tongue+
B0 Gse the oral anesthetic * hour prior to meal time+
C0 Brush the teeth !efore and after eating+
D0 Swallow slowly+
$ns: $
Chapter: ((
Client Needs: D1(
!"ective: ?
Feed!ac.: If oral anesthetics are used5 the patient must !e warned to chew with e@treme care to
avoid inadvertently !iting the tongue or !uccal mucosa+ $n oral anesthetic would !e meta!oliEed
!y the time the patient eats if it is used * hour prior to meals+ ,ou would not warn the patient
a!out !rushing the teeth or swallowing slowly !ecause an oral anesthetic has !een used+
(3+ $ patient diagnosed with leu.emia has "ust !een admitted to the oncology unit+ ,ou are
helping to write this patient;s care plan+ ,ou .now that potential complications for patients with
leu.emia include what/
$0 Pancreatitis
B0 DIC
C0 Nutritional e@cess
D0 Liver dysfunction
$ns: B
Chapter: ((
Client Needs: D1(
!"ective: ?
Feed!ac.: Based on the assessment data5 potential complications that may develop include
infection5 !leeding9DIC5 renal dysfunction5 tumor lysis syndrome5 nutritional depletion5
mucositis5 depression5 and an@iety+ Pancreatitis and liver dysfunction are generally not
complications of leu.emia+
(*+ ,ou are triaging patients in the wal.1in clinic+ $ CC1year1old man comes in complaining of
fatigue and !ac. pain+ )hat should !e closely evaluated in this patient/
$0 #odg.in;s disease
B0 Non1#odg.in;s lymphoma
C0 &ultiple myeloma
D0 $cute throm!ocythemia
$ns: C
Chapter: ((
Client Needs: D14
!"ective: C
Page and #eader: 24?5 &ultiple &yeloma
Feed!ac.: Bac. pain5 which is often a presenting symptom in multiple myeloma5 should !e
closely investigated in older patients+ -he lymphomas and !leeding disorders do not present with
the primary symptom of !ac. pain+
(7+ -he home health nurse is caring for a patient with multiple myeloma+ )hat does the nurse
.now is a priority issue to !e managed in a patient with multiple myeloma/
$0 Nutrition
B0 Stress
C0 Coping
D0 Pain
$ns: D
Chapter: ((
Client Needs: D14
!"ective: C
Page and #eader: 24?5 &ultiple &yeloma
Feed!ac.: Pain management is very important in patients with multiple myeloma+ Nutrition5
stress5 and coping may !e issues the home health nurse addresses5 !ut the priority management
issue is pain+
((+ ,ou are caring for a patient with #odg.in;s lymphoma at the oncology clinic+ )hile doing
patient teaching you .now you need to stress what/
$0 6is. of infection
B0 Need for nutritious diet
C0 Need for ade>uate sleep
D0 6is. of losing support networ.
$ns: $
Chapter: ((
Client Needs: D1(
!"ective: C
Page and #eader: 24(5 #odg.in Lymphoma
Feed!ac.: Patients need to !e taught to minimiEe the ris.s of infection5 to recogniEe signs of
possi!le infection5 and to contact their health care provider if such signs develop+ $ nutritious
diet and ade>uate sleep may !e included in the teaching !ut will not !e stressed li.e the ris. of
infection+ ption D is a distracter for this >uestion+
(4+ ,ou are doing patient teaching with a patient newly diagnosed with primary
throm!ocythemia+ )hile teaching the patient a!out the signs and symptoms of throm!osis5 what
neurologic manifestations would you include/
$0 %cchymosis
B0 <isual changes
C0 Pain
D0 Fatigue
$ns: B
Chapter: ((
Client Needs: D14
!"ective: 8
Feed!ac.: -he patient is informed a!out signs and symptoms of throm!osis5 particularly the
neurologic manifestations5 such as visual changes5 num!ness5 tingling5 and wea.ness+
Neurologic manifestations of throm!osis do not generally include ecchymosis5 pain5 or fatigue+
&ultiple Selection
(=+ $ nurse is admitting a patient with idiopathic throm!ocytopenic purpura to the unit+ In
completing the admission assessment5 the nurse must !e alert for what medications that alter
platelet function/ D&ar. all that apply+0
$0 $ntihypertensives
B0 Penicillins
C0 Sulfa1containing medications
D0 $spirin1!ased drugs
%0 NS$IDs
$ns: C5 D5 %
Chapter: ((
Client Needs: D17
!"ective: 8
Page and #eader: 2=*5 Idiopathic -hrom!ocytopenic Purpura
Feed!ac.: -he nurse must !e alert for sulfa1containing medications and others that alter platelet
function Deg5 aspirin1!ased or other NS$IDs0+ -he antihypertensive drugs and the penicillins do
not alter platelet function+
&ultiple Choice
(?+ $ patient5 7= years of age5 comes to the emergency department complaining of e@cessive
!leeding from a cut sustained when cleaning a .nife+ Blood wor. shows a prolonged P- !ut a
vitamin ' deficiency is ruled out+ )hen assessing the patient5 areas of ecchymosis are noted on
other areas of the !ody+ -he nurse caring for this patient suspects what/
$0 Lymphoma
B0 Leu.emia
C0 #emophilia
D0 #epatic dysfunction
$ns: D
Chapter: ((
Client Needs: B
!"ective: 2
Page and #eader: 2=45 Liver Disease
Feed!ac.: Prolongation of the P-5 unless it is caused !y vitamin ' deficiency5 may indicate
severe hepatic dysfunction+ ption C is incorrect as the ma"ority of hemophiliacs are diagnosed
as children+ -he scenario does not descri!e signs or symptoms of lymphoma or leu.emia+
(C+ $ patient is admitted to the ICG with a diagnosis of !leeding esophageal varices+ -he patient
has a comor!idity of cirrhosis+ $n attempt to stop the !leeding has !een only partially successful+
)hat would the critical care nurse e@pect to have ordered for this patient/
$0 Fresh froEen plasma
B0 <itamin '
C0 ral anticoagulants
D0 #eparin drip
$ns: $
Chapter: ((
Client Needs: D17
Difficulty: %asy
!"ective: 2
Page and #eader: 2=45 Liver Disease
Feed!ac.: Patients with liver dysfunction may also have life1threatening hemorrhage from
peptic ulcers or esophageal varices+ In these cases5 replacement with fresh froEen plasma5
P6BCs5 and platelets is usually re>uired+ ral drugs would not wor. fast enough for !leeding
esophageal variciesF !esides5 an anticoagulant would not !e ordered for this patient+ <itamin '
may !e ordered once the !leeding is stopped5 !ut that is not what is needed to stop the !leeding
of the varices+
(8+ $ patient undergoing a hip replacement has autologous !lood on stand!y if a transfusion is
needed+ )hat is the primary advantage of autologous transfusions/
$0 Safe transfusion for patients with a history of transfusion reactions
B0 Prevention of viral infections from another person;s !lood
C0 $voidance of complications in patients with alloanti!odies
D0 Prevention of alloimmuniEation
$ns: B
Chapter: ((
Client Needs: D17
!"ective: 2
Page and #eader: 2??5 Procuring Blood and Blood Products
Feed!ac.: -he primary advantage of autologous transfusions is the prevention of viral infections
from another person;s !lood+ ther advantages include safe transfusion for patients with a history
of transfusion reactions5 prevention of alloimmuniEation5 and avoidance of complications in
patients with alloanti!odies+
(2+ -he nurse on the pediatric unit is caring for a *31year1old !oy with a diagnosis of
hemophilia+ -he nurse .nows that a priority nursing diagnosis for a patient with hemophilia is
what/
$0 Infection
B0 Self1image
C0 Coping
D0 Nutrition
$ns: C
Chapter: ((
Client Needs: D14
!"ective: 8
Page and #eader: 2=(5 #emophilia
Feed!ac.: &ost patients with hemophilia are diagnosed as children+ -hey often re>uire
assistance in coping with the condition !ecause it is chronic5 places restrictions on their lives5
and is an inherited disorder that can !e passed to future generations+ From childhood5 patients are
helped to cope with the disease and to identify the positive aspects of their lives+ -hey are
encouraged to !e self1sufficient and to maintain independence !y preventing unnecessary trauma
that can cause acute !leeding episodes and temporarily interfere with normal activities+ $s they
wor. through their feelings a!out the condition and progress to accepting it5 they can assume
more and more responsi!ility for maintaining optimal health+ $ll of the other options need to !e
addressed with these patients5 !ut they are not all priorities+
43+ $ patient with non1#odg.in;s lymphoma is receiving information from the oncology nurse+
-he patient as.s the nurse why she should stop drin.ing and smo.ing and stay out of the sun+
)hat would !e the nurse;s !est response/
$0 A%veryone should do these things+B
B0 A,ou don;t want to develop a second cancer5 do you/B
C0 AIust to !e on the safe side+B
D0 A,ou need to reduce other factors that increase the ris. of developing second cancers+B
$ns: D
Chapter: ((
Client Needs: D14
Difficulty: %asy
!"ective: C
Page and #eader: 2445 Non1#odg.in Lymphomas
Feed!ac.: -he nurse should encourage patients to reduce other factors that increase the ris. of
developing second cancers5 such as use of to!acco and alcohol and e@posure to environmental
carcinogens and e@cessive sunlight+ ptions $5 B5 and C do not answer the patient;s >uestion5
and also ma.e light of the patient;s >uestion+

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