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WorksheetsLewis Ch 29- Hematologic System
Total questions: 118
Worksheet time: 59mins
1. The nurse is caring for a patient who is being discharged after an emergency splenectomy following an automobile accident. Which instructions should the nurse include in the discharge teaching?
Watch for excess
bruising.
Check for swollen
lymph nodes.
Take iron supplements
to prevent anemia.
Wash hands and avoid
persons who are ill.
2. The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?
“Do you take
salicylates?”
“Are you taking any
oral contraceptives?”
“Have you been
prescribed antiseizure drugs?”
“How long have you
taken antihypertensive drugs?”
3. A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding?
Hematocrit of 35%
Hemoglobin of 11.8
g/dL
Platelet count of
400,000/µL
White blood cell (WBC)
count of 2800/µL
4. A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?
Elevate the head of
the bed to 45 degrees.
Apply a sterile 2-inch
gauze dressing to the site.
Use a half-inch
sterile gauze to pack the wound.
Have the patient lie
on the left side for 1 hour.
5. The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?
Yellow-tinged sclerae
Shiny, smooth tongue
Numbness of the
extremities
Gum bleeding and
tenderness
6. A patient’s complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?
“Have you had a recent
weight loss?”
“Do you have any
history of lung disease?”
“Have you noticed any
dark or bloody stools?”
“What is your dietary
intake of meats and protein?”
7. The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?
Aspirin
Heparin
Warfarin
Erythropoietin
8. When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered?
Platelet count
Neutrophil count
White blood cell count
Hemoglobin (Hgb) level
9. The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse?
A 2-cm nontender
supraclavicular node
A 1-cm mobile and
nontender axillary node
An inability to
palpate any superficial lymph nodes
Firm inguinal nodes in
a patient with an infected foot
10. A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory result would the nurse expect to find?
Hematocrit of 46%
Hemoglobin of 13.8
g/dL
Elevated reticulocyte
count
Decreased white blood
cell (WBC) count
11. The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?
Avoid intramuscular
injections.
Encourage increased
oral fluids.
Check temperature
every 4 hours.
Increase intake of
iron-rich foods.
12. The health care provider’s progress note for a patient states that the complete blood count (CBC) shows a “shift to the left.” Which assessment finding will the nurse expect?
Cool extremities
Pallor and weakness
Elevated temperature
Low oxygen saturation
13. The health care provider orders a liver/spleen scan for a patient who has been in a motor vehicle accident. Which action should the nurse take before this procedure?
Check for any iodine
allergy.
Insert a large-bore IV
catheter.
Place the patient on
NPO status.
Assist the patient to
a flat position.
14. A patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse will provide a consent form to sign for which test?
ABO blood typing
Bone marrow biopsy
Abdominal ultrasound
Complete blood count
(CBC)
15. The nurse reviews the complete blood count (CBC) and white blood cell (WBC) differential of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider?
Monocytes 4%
Hemoglobin 13.6 g/dL
Platelet count
168,000/µL
White blood cells
(WBCs) 15,500/µL
16. Which information shown in the accompanying figure about a patient who has just arrived in the emergency department is most urgent for the nurse to communicate to the health care pr
Platelet count
White blood cell count
History of abdominal
pain
Blood pressure and
heart rate
1. A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient’s laboratory findings to include
a hematocrit (Hct) of
38%.
an RBC count of
4,500,000/mL.
normal red blood cell
(RBC) indices.
a hemoglobin (Hgb) of
8.6 g/dL (86 g/L).
2. Which menu choice indicates that the patient understands the nurse’s teaching about best dietary choices for iron-deficiency anemia?
Omelet and whole wheat
toast
Cantaloupe and cottage
cheese
Strawberry and banana
fruit plate
Cornmeal muffin and
orange juice
3. A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of
iron.
folic acid.
cobalamin (vitamin B12).
ascorbic acid (vitamin
C).
4. A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, “I
need to start eating
more red meat and liver.”
will stop having a
glass of wine with dinner.”
could choose nasal
spray rather than injections of vitamin B12.”
will need to take a
proton pump inhibitor like omeprazole (Prilosec).”
5. An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to
provide a diet high in
vitamin K.
alternate periods of
rest and activity.
teach the patient how
to avoid injury.
place the patient on
protective isolation.
6. Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate?
“I will call my health
care provider if my stools turn black.”
“I will take a stool
softener if I feel constipated occasionally.”
“I should take the
iron with orange juice about an hour before eating.”
“I should increase my
fluid and fiber intake while I am taking iron tablets.”
7. Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia?
Potential
complication: seizures
Potential
complication: infection
Potential
complication: neurogenic shock
Potential
complication: pulmonary edema
8. It is important for the nurse providing care for a patient with sickle cell crisis to
limit the patient’s
intake of oral and IV fluids.
evaluate the
effectiveness of opioid analgesics.
encourage the patient
to ambulate as much as tolerated.
teach the patient
about high-protein, high-calorie foods.
9. Which statement by a patient indicates good understanding of the nurse’s teaching about prevention of sickle cell crisis?
“Home oxygen therapy
is frequently used to decrease sickling.”
“There are no
effective medications that can help prevent sickling.”
“Routine continuous
dosage narcotics are prescribed to prevent a crisis.”
“Risk for a crisis is
decreased by having an annual influenza vaccination.”
10. Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis?
Take a daily
multivitamin with iron.
Limit fluids to 2 to 3
quarts per day.
Avoid exposure to
crowds when possible.
Drink only two
caffeinated beverages daily.
11. The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the
Schilling test.
bilirubin level.
stool occult blood
test.
gastric analysis
testing.
12. A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care?
Use
low-molecular-weight heparin (LMWH) only.
Administer the
warfarin (Coumadin) at the scheduled time.
Teach the patient
about the purpose of platelet transfusions.
Discontinue heparin
and flush intermittent IV lines using normal saline.
13. A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia vera is to
place the patient on
bed rest.
administer iron
supplements.
avoid use of aspirin
products.
monitor fluid intake
and output.
14. Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)?
Assign the patient to
a private room.
Avoid intramuscular
(IM) injections.
Use rinses rather than
a soft toothbrush for oral care.
Restrict activity to
passive and active range of motion.
15. Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)?
Prothrombin time
Erythrocyte count
Fibrinogen degradation
products
Activated partial
thromboplastin time
16. The nurse caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee will
immobilize the joint.
apply heat to the
knee.
assist the patient
with light weight bearing.
perform passive range
of motion to the knee.
17. A 28-year-old man with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the
platelet count.
bleeding time.
thrombin time.
prothrombin time.
18. A routine complete blood count indicates that an active 80-year-old man may have myelodysplastic syndrome. The nurse will plan to teach the patient about
blood transfusion
bone marrow biopsy.
filgrastim (Neupogen)
administration.
erythropoietin
(Epogen) administration.
19. Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic?
Avoid any injections.
Check temperature
every 4 hours.
Omit fruits or
vegetables from the diet.
Place a “No Visitors”
sign on the door.
20. Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy?
Platelet count
Reticulocyte count
Total lymphocyte count
Absolute neutrophil
count
21. A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate?
“If you do not want to
have chemotherapy, other treatment options include stem cell
transplantation.”
“The side effects of
chemotherapy are difficult, but AML frequently goes into remission with
chemotherapy.”
“The decision about
treatment is one that you and the doctor need to make rather than asking what
I would do.”
“You don’t need to
make a decision about treatment right now because leukemias in adults tend to
progress quite slowly.”
22. A patient with a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient?
Infuse the PRBCs
slowly over 4 hours.
Transfuse only
leukocyte-reduced PRBCs.
Administer the
scheduled diuretic before the transfusion.
Give the PRN dose of
antihistamine before the transfusion.
23. A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision is to
emphasize the positive
outcomes of a bone marrow transplant.
discuss the need for
adequate insurance to cover post-HSCT care.
ask the patient
whether there are any questions or concerns about HSCT.
explain that a cure is
not possible with any other treatment except HSCT.
24. Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma?
Monitor fluid intake
and output.
Administer calcium
supplements.
Assess lymph nodes for
enlargement.
Limit weight bearing
and ambulation.
25. An appropriate nursing intervention for a patient with non-Hodgkin’s lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to
check all stools for
occult blood.
encourage fluids to
3000 mL/day.
provide oral hygiene
every 2 hours.
check the temperature
every 4 hours.
26. A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate?
Discuss the need for
hospital admission to treat the neutropenia.
Teach the patient to
administer filgrastim (Neupogen) injections.
Plan to discontinue
the chemotherapy until the neutropenia resolves.
Order a
high-efficiency particulate air (HEPA) filter for the patient’s home.
27. Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider?
The platelet count is
52,000/µL.
The patient is
difficult to arouse.
There are purpura on
the oral mucosa.
There are large
bruises on the patient’s back.
28. The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)?
Verify the patient
identification (ID) according to hospital policy.
Obtain the
temperature, blood pressure, and pulse before the transfusion.
Double-check the
product numbers on the PRBCs with the patient ID band.
Monitor the patient
for shortness of breath or chest pain during the transfusion.
29. A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take?
Draw blood for a new
crossmatch.
Send a urine specimen
to the laboratory.
Administer PRN
acetaminophen (Tylenol).
Give the PRN
diphenhydramine (Benadryl).
30. A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse’s first action should be to
administer oxygen
therapy at a high flow rate.
obtain a urine
specimen to send to the laboratory.
notify the health care
provider about the symptoms.
disconnect the
transfusion and infuse normal saline.
31. Which patient should the nurse assign as the roommate for a patient who has aplastic anemia?
A patient with chronic
heart failure
A patient who has
viral pneumonia
A patient who has
right leg cellulitis
A patient with
multiple abdominal drains
32. Which patient requires the most rapid assessment and care by the emergency department nurse?
The patient with
hemochromatosis who reports abdominal pain
The patient with
neutropenia who has a temperature of 101.8° F
The patient with
sickle cell anemia who has had nausea and diarrhea for 24 hours
The patient with
sickle cell anemia who has had nausea and diarrhea for 24 hours
33. A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets?
The platelet count is
42,000/mL.
Petechiae are present
on the chest.
Blood pressure (BP) is
94/56 mm Hg.
Blood is oozing from
the venipuncture site.
34. Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the physician?
Leg bruises
Tarry stools
Skin abrasions
Bleeding gums
35. A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take?
Avoid venipunctures.
Notify the patient’s
physician.
Apply sterile
dressings to the sites.
Give prescribed
proton-pump inhibitors.
36. A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature 102° F (38.9° C), and severe back pain. Which physician order will the nurse implement first?
Administer morphine
sulfate 4 mg IV.
Give acetaminophen
(Tylenol) 650 mg.
Infuse normal saline
500 mL over 30 minutes.
Schedule complete
blood count and coagulation studies.
37. Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)?
Assessing the patient
for signs and symptoms of infection
Teaching the patient
the purpose of neutropenic precautions
Administering
subcutaneous filgrastim (Neupogen) injection
Developing a discharge
teaching plan for the patient and family
38. Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?
44-year-old with
sickle cell anemia who says “my eyes always look sort of yellow”
23-year-old with no
previous health problems who has a nontender lump in the axilla
50-year-old with
early-stage chronic lymphocytic leukemia who reports chronic fatigue
19-year-old with
hemophilia who wants to learn to self-administer factor VII replacement
39. After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first?
56-year-old with
frequent explosive diarrhea
33-year-old with a
fever of 100.8° F (38.2° C)
66-year-old who has
white pharyngeal lesions
23-year old who is
complaining of severe fatigue
40. Which action will the nurse include in the plan of care for a patient who has thalassemia major?
Teach the patient to
use iron supplements.
Avoid the use of
intramuscular injections.
Administer iron
chelation therapy as needed.
Notify health care
provider of hemoglobin 11g/dL.
41. Which patient information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis?
Skin color
Hematocrit
Liver function
Serum iron level
42. Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider?
Hematocrit 55%
Presence of plethora
Calf swelling and pain
Platelet count
450,000/mL
43. Following successful treatment of Hodgkin’s lymphoma for a 55-year-old woman, which topic will the nurse include in patient teaching?
Potential impact of
chemotherapy treatment on fertility
Application of
soothing lotions to treat residual pruritus
Use of maintenance
chemotherapy to maintain remission
Need for follow-up
appointments to screen for malignancy
44. A patient who has non-Hodgkin’s lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse?
Anorexia
Vomiting
Oral ulcers
Lip swelling
45. Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider?
Serum calcium level is
15 mg/dL.
Patient reports no
stool for 5 days.
Urine sample has
Bence-Jones protein.
Patient is complaining
of severe back pain.
46. When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care?
Discourage deep
breathing to reduce risk for splenic rupture.
Teach the patient to
use ibuprofen (Advil) for left upper quadrant pain.
Schedule immunization
with the pneumococcal vaccine (Pneumovax).
Avoid the use of
acetaminophen (Tylenol) for 2 weeks prior to surgery.
47. The nurse has obtained the health history, physical assessment data, and laboratory results shown in the accompanying figure for a patient admitted with aplastic anemia. Which information is most important to communicate to the health care provider?
Neutropenia
Increasing fatigue
Thrombocytopenia
Frequent constipation
1. A patient is to receive an infusion of 250 mL of platelets over 2 hours through tubing that is labeled: 1 mL equals 10 drops. How many drops per minute will the nurse infuse?
42
21
18
27
1. When doing discharge teaching for a patient who has had an emergency splenectomy following an automobile accident, the nurse will teach the patient about the increased risk for
infection.
lymphedema.
chronic anemia.
prolonged bleeding.
2. While obtaining a health history from a patient with numerous petechiae on the skin, the nurse asks the patient specifically about the patient’s use of
salicylates.
contraceptives.
antiseizure drugs.
antihypertensives.
3. The nurse who is reviewing laboratory data for an 86-year-old patient will be most concerned about
a white blood cell
(WBC) count of 3500/mL.
a hematocrit of 37%.
a platelet count of
400,000/mL.
a hemoglobin of 11.8
g/dL.
4. The health care provider performs a bone marrow aspiration from the left posterior iliac crest on a patient with pancytopenia. Following the procedure, the nurse should
elevate the head of
the bed to 45 degrees.
apply a sterile
Band-Aid at the aspiration site.
use half-inch sterile
gauze to pack the wound.
have the patient lie
on the left side for an hour.
5. When caring for a patient with a chronic iron deficiency anemia, the nurse will assess for
yellow-tinged sclerae.
shiny, smooth tongue.
numbness of the
extremities.
gum bleeding and
tenderness.
6. A patient’s complete blood count shows a hemoglobin of 20 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?
“Has there been any
recent weight loss?”
“Do you have any
history of lung disease?”
“What is your intake
of fruits and vegetables?”
“Have you noticed any
dark or bloody stools?”
7. When caring for a patient who is receiving heparin, the nurse will monitor
prothrombin time (PT).
fibrin degradation
products (FDP).
international
normalized ratio (INR).
activated partial
thromboplastin time (aPTT).
8. When evaluating the red cell indices of a patient, the nurse knows that a low mean corpuscular volume (MCV) indicates
hypochromic red blood
cells (RBCs).
inadequate numbers of
RBCs.
low hemoglobin in the
RBCs.
small size of the RBCs
9. While examining the lymph nodes during physical assessment, the nurse would be most concerned about
a 2-cm nontender
supraclavicular node.
a 1-cm mobile and
nontender axillary node.
an inability to
palpate any superficial lymph nodes.
firm inguinal nodes in
a patient with an infected foot.
10. In the patient who had an intraoperative hemorrhage 12 hours ago, the nurse would expect to find hematology results indicating
a hematocrit of 45%.
a hemoglobin of 13.2
g/dL.
a decreased white
blood cell (WBC) count.
an elevated
reticulocyte count.
11. The complete blood count (CBC) and differential indicate that a patient is neutropenic. Which action should the nurse include in the plan of care?
Avoid intramuscular
injections.
Encourage increased oral
fluids.
Check temperature
every 4 hours.
Increase intake of
iron-rich foods.
12. The history and physical for a newly admitted patient states that the complete blood count (CBC) shows a “shift to the left.” The nurse will plan to monitor the patient for
cool extremities.
pallor and weakness.
elevated temperature.
low oxygen saturation.
13. The health care provider orders an ultrasound of the spleen for a patient who has been in a car accident. Which action should the nurse take before this procedure?
Check for any iodine
allergy.
Insert a large-bore IV
catheter.
Place the patient on
NPO status.
Assist the patient to
a flat position.
14. A confused patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse should contact the patient’s family member to sign a consent form before the
ABO blood typing.
bone marrow biopsy.
abdominal ultrasound.
complete blood count
(CBC).
15. When reviewing the complete blood count (CBC) for a patient admitted with abdominal pain, which information will be most important for the nurse to communicate to the health care provider?
Monocytes 4%
Hemoglobin 11.6 g/dL
Platelet count
145,000/µL
White blood cells
(WBCs) 13,500/µL
1. A patient with anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient’s laboratory findings to include
normal red blood cell
(RBC) indices.
a hematocrit (Hct) of
38%.
a hemoglobin (Hb) of
8.6 g/dL (86 g/L).
an RBC count of
4,500,000/mL.
2. Which menu choice indicates that the patient understands the nurse’s teaching about best dietary choices for iron-deficiency anemia?
Omelet and whole wheat
toast
Cantaloupe and cottage
cheese
Strawberry and banana
fruit plate
Cornmeal muffin and
orange juice
3. A patient who is receiving methotrexate develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of
iron.
folic acid.
cobalamin (vitamin B12).
ascorbic acid (vitamin
C).
4. A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious anemia, the nurse determines that the patient understands the disorder when the patient states,
“I need to start
eating more red meat or liver.”
“I will stop having a
glass of wine with dinner.”
“I will need to take a
proton pump inhibitor like omeprazole (Prilosec).”
“I would rather use
the nasal spray than have to get injections of vitamin B12.”
5. A patient is hospitalized for treatment of severe hemolytic anemia. An appropriate nursing action for the patient is to
provide a diet high in
vitamin K.
place the patient on
protective isolation.
alternate periods of
rest and activity.
teach the patient how
to avoid injury.
6. After the nurse has finished teaching a patient about taking oral ferrous sulfate, which patient statement indicates that additional instruction is needed?
“I will call the
doctor if my stools start to turn black.”
“I will take a stool
softener if I feel constipated occasionally.”
“I should take the
iron with orange juice about an hour before eating.”
“I should increase my
fluid and fiber intake while I am taking the iron tablets.”
7. A patient is admitted to the hospital with idiopathic aplastic anemia. Which of these collaborative problems will the nurse include when developing the care plan?
Potential
complication: seizures
Potential
complication: infection
Potential
complication: neurogenic shock
Potential
complication: pulmonary edema
8. A patient is admitted to the hospital with a sickle cell crisis. While caring for the patient during the crisis, it is important for the nurse to
limit the patient’s
intake of oral and IV fluids.
evaluate the
effectiveness of opioid analgesics.
encourage the patient
to ambulate as much as tolerated.
teach the patient
about high-protein, high-calorie foods.
9. Which statement by a patient with sickle cell anemia indicates good understanding of the nurse’s teaching about prevention of sickle cell crisis?
“Home oxygen therapy
is frequently used to decrease sickling.”
“There are no
effective medications that can help prevent sickling.”
“Routine continuous
dosage narcotics are prescribed to prevent a crisis.”
“Risk for a crisis can
be lowered by having an annual influenza vaccination.”
10. When planning discharge teaching for the patient who was admitted with a sickle cell crisis, which instruction will the nurse include?
Limit fluids to 2 to 3
quarts a day.
Take a daily
multivitamin with iron.
Avoid exposure to
crowds as much as possible.
Drink only one or two
caffeinated beverages daily.
11. During the admission assessment of a patient with hemolytic anemia, the nurse notes jaundice of the sclerae. The nurse will plan to check the laboratory results for
the Schilling test.
the bilirubin level.
the stool occult blood
test.
the gastric analysis
testing.
12. A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT). Which action will the nurse include in the plan of care?
Use
low-molecular-weight heparin (LMWH) only.
Flush all intermittent
IV lines using normal saline.
Administer the warfarin
(Coumadin) at the scheduled time.
Teach the patient
about the purpose of platelet transfusions.
13. During treatment of the patient with an acute exacerbation of polycythemia vera, a critical action by the nurse is to
place the patient on
bed rest.
administer iron supplements.
avoid use of aspirin
products.
monitor fluid intake
and output.
14. Which nursing intervention will be included in the care plan for a patient with immune thrombocytopenic purpura (ITP)?
Assign the patient to
a private room.
Avoid intramuscular
(IM) injections.
Use rinses rather than
a toothbrush for oral care.
Restrict activity to
passive and active range of motion.
15. Which laboratory information will the nurse monitor to detect heparin-induced thrombocytopenia (HIT) in a patient who is receiving a continuous heparin infusion?
Prothrombin time
Erythrocyte count
Fibrinogen degradation
products
Activated partial
thromboplastin time
16. A patient with type A hemophilia has been admitted to the hospital with severe pain and swelling in the right knee. During the initial care of the patient, the nurse should
immobilize the knee.
apply heat to the
joint.
assist the patient
with light weight bearing.
perform passive range
of motion to the knee.
17. A patient with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the
platelet count.
bleeding time.
thrombin time.
prothrombin time.
18. A routine complete blood count indicates that a patient may have myelodysplastic syndrome. At this time, the nurse will plan to teach the patient about
packed red blood cells
(PRBCs) transfusion.
bone marrow biopsy.
filgrastim (Neupogen)
administration.
erythropoietin
(Epogen) administration.
19. Which action will be included in the care plan for a hospitalized patient who is neutropenic?
Avoid any IM or
subcutaneous injections.
Check the oral
temperature every 4 hours.
Omit all fruits or
vegetables from the diet.
Place a “No Visitors”
sign on the patient door.
20. Which laboratory test will the nurse use to determine whether the prescribed filgrastim (Neupogen) is effective in the treatment of a patient who is receiving chemotherapy for acute lymphocytic leukemia?
Platelet count
Reticulocyte count
Total lymphocyte count
Absolute neutrophil count
21. A 64-year-old with acute myelogenous leukemia (AML) who has induction therapy prescribed asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate?
“If you do not want to
have chemotherapy, there are other options for treatment such as stem cell
transplantation.”
“The decision about
chemotherapy is one that you and the doctor need to make rather than asking
what I would do.”
“You don’t need to
make a decision about treatment right now since leukemias in adults tend to
progress quite slowly.”
“The side effects of the chemotherapy are difficult,
but AML frequently does go into remission with chemotherapy.”
22. A patient who has a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action will the nurse take to decrease the risk for TRALI for this patient?
Infuse the PRBCs
slowly over 4 hours.
Transfuse only
leukocyte-reduced PRBCs.
Administer the
scheduled oral diuretic before the transfusion.
Give the PRN dose of
antihistamine before starting the transfusion.
23. A 45-year-old patient with acute myelogenous leukemia (AML) is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT). To assist the patient with treatment decisions, the best approach for the nurse to use is to
emphasize the positive
outcomes of a bone marrow transplant.
discuss the need for
adequate insurance to cover post-HSCT care.
ask the patient
whether there are any questions or concerns about HSCT.
explain that a cure is
not possible with any other treatment except HSCT.
24. Which nursing action will be included in the plan of care for a patient admitted with multiple myeloma?
Monitor fluid intake
and output.
Administer calcium
supplements.
Assess lymph nodes for
enlargement.
Limit weight-bearing
and ambulation.
25. A patient with non-Hodgkin’s lymphoma develops a platelet count of 18,000/µl during chemotherapy. An appropriate nursing intervention for the patient based on this finding is to
provide oral hygiene
every 2 hours.
check all stools for
occult blood.
check the temperature
every 4 hours.
encourage fluids to
3000 mL/day.
26. A 22-year-old with acute myelogenous leukemia who is receiving outpatient chemotherapy develops an absolute neutrophil count of 900/µl. Which action by the nurse in the outpatient clinic is most appropriate?
Discuss the need for
hospital admission to treat the neutropenia.
Plan to discontinue
the chemotherapy until the neutropenia resolves.
Teach the patient how to administer filgrastim
(Neupogen) injections at home.
Obtain a
high-efficiency particulate air (HEPA) filter for the patient for home use.
27. Which of the following assessment data obtained by the nurse when caring for a patient with thrombocytopenia should be immediately communicated to the health care provider?
The platelet count is
52,000/µl.
The patient is difficult to arouse.
There are large
bruises on the back.
There are purpura on
the oral mucosa.
28. Which nursing action should the nurse delegate to nursing assistive personnel (NAP) when administering a transfusion of packed red blood cells (PRBCs) to a patient with blood loss?
Verify the patient
identification (ID) according to hospital policy.
Obtain the
temperature, blood pressure, and pulse before the transfusion.
Double-check the
product numbers on the PRBCs with the patient ID band.
Monitor the patient
for shortness of breath or chest pain during the transfusion.
29. A patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, what is the first action that the nurse should take?
Draw blood for a new
crossmatch.
Send a urine specimen
to the laboratory.
Give the PRN diphenhydramine
(Benadryl).
Administer the PRN acetaminophen (Tylenol).
30. Fifteen minutes after a transfusion of packed red blood cells is started, a patient complains of back pain and dyspnea. The pulse rate is 124. The nurse’s first action should be to
administer oxygen
therapy at a high flow rate.
obtain a urine
specimen to send to the laboratory.
notify the health care
provider about the symptoms.
disconnect the transfusion and infuse normal saline.
31. Which newly admitted patient should the nurse assign as a roommate for a patient who has aplastic anemia?
A patient with severe
heart failure
A patient who has
viral pneumonia
A patient who has
right leg cellulitis
A patient with
multiple abdominal drains
32. All of the following patients are waiting to be admitted by the emergency department nurse. Which one requires the most rapid assessment and care by the nurse?
The patient with
hemochromatosis who is complaining of abdominal pain
The patient with
thrombocytopenia who has oozing after having a tooth extracted
The patient with
chemotherapy-induced neutropenia who has a temperature of 100.8° F
The patient with a history
of sickle cell anemia who has had nausea and diarrhea for 24 hours
33. The nurse is caring for a patient with immune thrombocytopenic purpura (ITP) who has an order for a platelet transfusion. Which patient information indicates that the nurse should consult with the health care provider before administering platelets?
The platelet count is
42,000/mL.
Blood pressure (BP) is
94/56 mm Hg.
Blood is oozing from
the venipuncture site.
Petechiae are present
on the chest and back.
34. A patient with hemophilia calls the nurse in the hemophilia clinic to discuss all of these problems. Which problem is most important to communicate to the physician?
Skin abrasions
Bleeding gums
Multiple bruises
Dark tarry stools
35. A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take?
Notify the patient’s physician.
Avoid unnecessary
venipunctures.
Apply sterile
dressings to the sites.
Give prescribed
proton-pump inhibitors.
36. A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature 102° F (38.9° C), and severe back pain. Which of these physician orders will the nurse implement first?
Administer morphine
sulfate 4 mg IV.
Infuse normal saline 500 mL over 30 minutes.
Draw blood for
complete blood count and coagulation studies.
Give acetaminophen
(Tylenol) 650 mg for temperature 102° F or higher.
37. Which of the following nursing actions included in the care plan for a patient with neutropenia is appropriate for the RN to delegate to an LPN/LVN who is assisting with patient care?
Assessing the patient
for signs and symptoms of infection
Teaching the patient
the purpose of neutropenic precautions
Developing a discharge
teaching plan for the patient and family
Administering the ordered subcutaneous filgrastim
(Neupogen) injection
38. All of these patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?
19-year-old with no previous health problems who has a
nontender lump in the axilla
46-year-old with
sickle cell anemia who says “that my eyes always look sort of yellow”
21-year-old with
hemophilia who wants to learn how to self-administer factor VII replacement
50-year-old with
early-stage chronic lymphocytic leukemia who has complaints of chronic
fatigue
39. After receiving change-of-shift report for the following four patients with neutropenia, which patient should the nurse assess first?
66-year-old who has
white pharyngeal lesions
35-year-old who has a fever of 100.8° F (38.2° C)
56-year-old who has
frequent explosive diarrhea
23-year old who is
complaining of severe fatigue
