NCLEX - HEMATOLOGY Day1

The nurse is caring for clients who are receiving chemotherapy. Which client should the nurse assess first?

• Client with a hemoglobin of 8 g/dL (80 g/L)
• Client with alopecia and oral mucositis noted during the previous shift
• Client with new-onset back pain and weakness in the legs
• Client with persistent vomiting and a potassium of 3.4 mEq/L (3.4 mmol/L)
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The nurse has been made aware of laboratory test results for assigned clients. Which of the following test results would require immediate follow-up?

• a decrease in platelet count from 175,000/mm3 to 86,000/mm3 for a client receiving a heparin infusion
• a BUN of 24 mg/dL for a client with dehydration
• a WBC count of 2000/mm3 for a client with myelodysplastic syndrome
• a decrease in hemoglobin from 8.1 g/dL to 7.9 g/dL for a client with sickle cell disease
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The nurse is screening clients for those at risk for developing oral cancer. Which of the following factors would increase a client's risk for developing oral cancer? Select all that apply.

• tobacco use
• chronic gingivitis
• impetigo infection
• persistent mucosal irritation
• consumption of high-fat foods

The nurse is screening clients for those at risk for developing cervical cancer. The nurse should recognize the client at highest risk for developing cervical cancer is the client who

• gave birth to her first child at age 16 and has multiple sexual partners
• has had 1 spontaneous abortion and has been treated for chlamydia
• takes immunosuppressants and uses a diaphragm for birth control
• took oral contraceptives for 7 years and has never been pregnant
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The nurse is caring for a client with sickle cell disease who is experiencing an episode of acute pain and is receiving IV morphine every 4 hours. The client states, "The morphine has not helped my pain at all. I need stronger medication." Which of the following actions should the nurse take?

• Give the client ice packs to apply to painful areas.
• Provide the client with resources for substance use rehabilitation.
• Request a prescription for patient-controlled analgesia for the client.
• Recommend changing the client's prescription from morphine to meperidine.
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The nurse is teaching a client who had a total knee replacement and has a new prescription for enoxaparin. Which of the following information should the nurse include?

• Take over-the-counter medications such as ibuprofen to relieve mild discomfort
• Black stools are a common, harmless side effect of the medication.
• Eliminate green, leafy, vitamin K-rich vegetables from your diet.
• Mild bruising or redness may occur at the injection site.
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The nurse is assessing a 5-year-old client with sickle cell disease who is experiencing an episode of acute pain. The client has shortness of breath, nausea with vomiting, and generalized body and joint pain. Which finding requires immediate intervention?

• enlarged spleen on palpation
• hemoglobin level of 9.0 g/dL (90 g/L)
• pain rated as 8 on the Wong-Baker FACES Scale
• bilateral swelling of the hands and feet
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A 6-month-old infant is brought to the emergency department after experiencing vomiting and diarrhea for 4 days. Which prescription from the health care provider is the priority?

• 0.9% sodium chloride 20ml/kg IV bolus over 1 hour
• Acetaminophen 80 mg IV every 6 hours
• Ampicillin 240 mg IV every 12 hours
• Ondansetron 2 mg IV every 8 hours
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The nurse in the emergency department is reviewing new prescriptions for an 8-year-old client with hemophilia A who sustained a head injury on the school playground. The client has vomited once and reports a headache. The nurse should first implement the prescription to

• administer IV factor VIII
• administer IV ondansetron
• obtain a specimen to check the hematocrit
• prepare the client for surgery
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The nurse is preparing to administer a scheduled vaccine to a pediatric client with hemophilia. Which of the following actions should the nurse take? Select all that apply.

• Administer ibuprofen for pain relief.
• Apply a warm compress to the injection site.
• Hold firm pressure to the injection site for 5 minutes.
• Massage the injection site to disperse the medication.
• Use the smallest bore and shortest needle length indicated.