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WorksheetsNUR425 Exam 2 review (hematology and renal)
Total questions: 75
Worksheet time: 6hrs 20mins
When a patient with vitamin B12 deficiency is counseled about diet, what statement by the patient indicates an understanding of the cause of the anemia?
“I know I need to eat more fruits and vegetables.”
“I have cut out all fried foods in my diet.”
“I have been eating more organic foods.”
“I have been having beef or fish at least once a day.”
Which patient is at greatest risk for developing IDA?
A 6-year-old African American boy with no health problems
A 15-year-old African American pregnant female
A 52-year-old Mexican American female with hypertension
A 72-year-old Caucasian male with cardiac disease
the nurse understands that it is essential for the patient to have which blood test before initiating folic acid supplementation?
vit B12 level
pregnancy test
CBC
liver enzymes
Which activity should be avoided in a patient with sickle cell anemia?
driving to the beach 3 hrs away
going to a concert
running a 5K race
carpentry work
Which nursing action is indicated for the patient with thrombocytopenia?
avoid IM injections
encourage patient to drink plenty of fluids
place the patient on isolation precautions
encourage frequent rest periods
The nurse correlates which diagnostic result as increasing the risk for infection in the patient wit leukemia?
WBC 11
ANC 0.5
Hgb 8.6
Plt 112,000
A patient with lymphoma is beginning the induction chemo regimen. Which info is MOST ESSENTIAL for the nurse to include in treatment plan?
advanced directive
bleeding precautions
importance of frequent rest periods
neutropenic precaution
Which term should the nurse use when documenting a decreased red blood cell (RBC) count?
Anemia
Neutropenia
Polycythemia
Thrombocytopenia
The nurse is reviewing the complete blood cell (CBC) count for a patient recently admitted to the medsurg unit. The CBC count is as follows: platelet 180,000/mm; hemoglobin 15 g/dL; red blood cells – 4.4 x 10^12 cells/L; white blood cells – 6,000/mm3 . Which conclusion by the nurse is appropriate?
The patient is anemic.
The patient has leukopenia
The patient has thrombocytopenia
The patient’s laboratory values are within normal limits.
Which laboratory test should the nurse anticipate when providing care to a patient with a clotting disorder caused by the intrinsic pathway?
Prothrombin time (PT)
Basic metabolic panel (BMP)
Complete blood cell (CBC) count
Partial thromboplastin time (PTT)
Which food should the nurse recommend for a patient who is experiencing anemia caused by a deficiency in folic acid?
Fish
Poultry
Citrus fruits
Green leafy vegetables
The nurse suspects that a patient with severe shortness of breath in the absence of cyanosis is experiencing anemia. Which laboratory tests should the nurse review to confirm anemia? Select all that apply.
Glucose
Hematocrit
Hemoglobin
Cardiac enzymes
Serum electrolytes
The home healthcare nurse is preparing a care plan for a patient with severe anemia. The patient currently lives alone and states, “I can’t even walk to the kitchen without getting winded.” What would be the priority nursing diagnosis for this patient?
1) Hopelessness
Activity Intolerance
Altered Nutrition, Less than Body Requirements
Anxiety
A nurse is providing discharge instructions to a patient with iron-deficiency anemia who is experiencing glossitis. Which patient statement indicates the need for further education?
“I will monitor my lips and tongue daily.”
“I will use an alcohol-based mouthwash twice per day.”
“I will apply a petroleum-based lubricating ointment to my lips.”
“I will use a soft toothbrush when brushing my teeth each day.”
A nurse is planning care for a patient with leukemia. The nurse chooses Risk for Bleeding as the nursing diagnosis. Which intervention supports this nursing diagnosis?
Educate patient in use of soft toothbrush for oral care
Limit parenteral injections
Apply pressure to arterial puncture sites for five minutes
Encourage patient to deep breathe and huff cough
A patient in sickle cell crisis reports taking a recent skiing trip that caused a respiratory infection from the cold weather. Which nursing diagnosis is a priority for this patient?
Fluid Volume Excess
Risk for Self-Mutilation
Knowledge Deficit
Acute Pain
A patient is admitted to the ED in a sickle cell crisis. The nurse assesses the patient and documents the ff clinical findings: temp 102°F, O2 sat 89%, and complaints of severe abdominal pain. Based on the assessment findings, which intervention is the greatest priority?
Apply oxygen per nasal cannula at 3 L/minute.
Assess and document peripheral pulses.
Administer morphine sulfate 10 mg IM.
Administer Tylenol 650 mg by mouth.
An emergency department nurse is caring for a child in a sickle cell crisis. The nurse suspects the etiology of the crisis as being thrombotic in nature due to which clinical manifestations?
The patient has profound pallor and fatigue.
The patient is in extreme pain.
The patient has profound hypotension and shock.
The patient’s chest CT reveals a pulmonary infarct
A child diagnosed with aplastic anemia is admitted to the hospital. The parents ask the nurse what aplastic anemia is. Which response by the nurse is accurate?
“Aplastic anemia causes a proliferation of white blood cells.”
“Aplastic anemia is characterized by abnormally shaped red blood cells.”
“Aplastic anemia is caused by the bone marrow producing inadequate cells.”
“Aplastic anemia is a disorder that occurs after a viral illness.”
Which is the priority nursing diagnosis for the child diagnosed with idiopathic thrombocytopenic purpura (ITP)?
Ineffective Breathing Pattern
Nausea
Fluid Volume Deficit
Risk for Injury
Which is the priority teaching point for the nurse to include in the discharge instructions for the parents of a child who was admitted to the hospital in a sickle cell crisis?
Rapid weaning of pain medications
A diet high in protein
Adequate hydration
Restriction of activities
The health-care provider prescribes laboratory tests following the initiation of treatment for a child who is diagnosed with iron-deficiency anemia. Which laboratory result should the nurse share with the child’s family as an indication of improvement?
Low hemoglobin
Normal platelet count
High reticulocyte count
Low hematocrit
A patient complaining of mouth soreness had gastric bypass surgery one year ago. During the assessment, the nurse notes the patient’s tongue is beefy, red, and smooth and the patient’s skin appears yellowish. Which additional information is most likely needed before diagnosing this patient?
Vitamin B6 levels
Vitamin B12 levels
Potassium levels
Iron levels
A patient experiencing fatigue, pallor, and dyspnea on exertion has a complete blood count drawn. Which red blood cell disorder should the nurse anticipate the patient is experiencing?
Polycythemia
Erythropoiesis
Herpes simplex
Anemia
An older adult patient with renal failure is diagnosed with anemia. Based on this data, which cause of anemia will the nurse plan for when providing care?
Loss of the kidney hormone erythropoietin
A loss of appetite related to elevated blood urea nitrogen (BUN) and creatinine levels
The renal dialysis used to treat the chronic renal failure
Loss of blood through the urine because the failing kidney does not function properly
Parents of a newborn infant are concerned that their baby may have sickle cell disease. The nurse reviews the medical record and finds that both parents have the sickle cell trait. Which is the best response for the nurse to give the parents?
“Since neither of you actually has sickle cell disease, your baby is not at risk.”
“Your baby has the disease, as you both carry the trait.”
“As you both have the sickle cell trait, your baby will be tested for the disease.”
“Have you talked to a genetic counselor about your concerns?”
A patient with a history of anemia has started a vegan diet. Which addition to meals should the nurse recommend to help ensure that this patient has adequate amounts of iron in the diet? Select all that apply.
Legumes
OJ
Brewer's yeast
Okra
Peas
An adult patient reports to the nurse an inability to tolerate usual exercise and the feeling of fatigue. The patient states that these symptoms have been gradual over time. Which physical assessment findings, along with the patient’s verbal reports, would indicate chronic lymphocytic leukemia (CML)? Select all that apply.
Joint pain
Pallor
Spleenomegaly
Edema
abnormal bleeding
A nurse educator is teaching a group of parents how to prevent a crisis in the child with sickle cell disease. What should the nurse instruct about the precipitating factors that could contribute to a sickle cell crisis? Select all that apply.
Increased fluid intake
Altitude
Fever
Vomiting
Regular Exercise
Which parental statements regarding precipitating factors for sickle cell disease indicate correct understanding of the discharge information presented by the nurse? Select all that apply.
“My child should avoid regular exercise.”
“We should provide acetaminophen or ibuprofen to treat fever.”
“Our child needs to drink lots of fluid to avoid dehydration when playing sports.”
“High altitudes can cause exacerbation and should be avoided.”
“Fluid restriction is necessary to avoid exacerbations from occurring.”
The nurse is providing care to a patient at a local clinic. The nurse suspects that the patient is experiencing a urinary tract infection. Which urinalysis result supports the nurse’s suspicions?
pH 5.2
Negative glucose
WBC 10-15
Specific gravity 1.012
The nurse is caring for an older adult patient with a history of urinary tract infections (UTIs). Which action by the nurse would decrease the risk of the patient experiencing future UTIs?
Instruct the patient to completely empty the bladder.
Tell the patient to increase sugar in the diet.
Encourage the patient to take bubble baths.
Remind the patient to wipe from back to front.
The nurse is providing care to a patient with less than 100 mL of urine output in a 24-hour period. Which term should the nurse use when documenting this occurrence?
Anuria
Dysuria
Enuresis
Hematuria
The nurse is providing care to a patient who is experiencing painful urination. Which term should the nurse use when documenting this occurrence?
Anuria
Dysuria
Enuresis
Hematuria
The nurse is providing care to a patient who is experiencing involuntary urination at night. Which term should the nurse use when documenting this occurrence?
Anuria
Dysuria
Enuresis
Hematuria
The nurse is providing care to a patient with blood in the urine. Which term should the nurse use when documenting this occurrence?
Anuria
Dysuria
Enuresis
Hematuria
The nurse is providing care to a patient who states, “My doctor says I am experiencing nocturia. What does that mean?” Which response by the nurse is most appropriate?
“It means you have pain radiating to your groin.”
“It means you have the sudden urge to void immediately.”
“It means you are getting up frequently at night to urinate.”
“It means you are unable to completely empty your bladder.”
The nurse is providing care to a patient who states, “My doctor says I am experiencing renal colic. What does that mean?” Which response by the nurse is most appropriate?
“It means you have pain radiating to your groin.”
“It means you have the sudden urge to void immediately.”
“It means you are getting up frequently at night to urinate.”
“It means you are unable to completely empty your bladder.”
The nurse is caring for a patient admitted with a diagnosis of acute kidney injury. The patient asks the nurse, “Are my kidneys failing? Will I need a kidney transplant?” Which response by the nurse is the most appropriate?
“No, don't think that. You're going to be fine.”
“Your condition can be reversed with prompt treatment and usually will not destroy the kidney.”
“Kidney transplantation is likely, and it would be a good idea to start talking to family members.”
“When the doctor comes to see you, we can talk about whether you will need a transplant.”
The nurse is planning care for the patient with acute kidney injury. The nurse plans the patient’s care based on the nursing diagnosis of Excess Fluid Volume. Which assessment data supports this nursing diagnosis?
Pitting edema in the lower extremities
Bowel sounds positive in four quadrants
Wheezing in the lungs
Generalized weakness
The nurse is assessing the laboratory reports of four patients. Which patient’s reports indicate renal failure?
Patient A
Patient B
Patient C
Patient D
A patient reports anorexia along with cloudy and foul-smelling urine. Which condition should the nurse suspect?
Renal cancer
Renal trauma
Infection
Glomerulonephritis
Which assessment findings does the nurse associate with iron deficiency anemia (IDA)? Select all that apply.
Fatigue
Bradycardia
Glossitis
Koilonychias
Pica
The nurse is caring for a patient with iron deficiency anemia. Which food should the nurse teach the patient to include in his or her daily diet to improve iron absorption?
white meat
citrus fruits
green leafy veggies
iron-fortified breakfast cereals
Which individuals are likely to develop vitamin B12 anemia. Select all that apply.
older adult patient
premenopausal patient
patient w/ recent GI resection
patient who is long-term vegetarian
patient with blood loss following an accident
Which is true regarding pernicious anemia?
It is caused by lack of vitamin B12
It is an autoimmune disease
It is overcome by increasing dietary sources of animal proteins
It stimulates the production of intrinsic factor in the stomach.
Which assessment finding is correlated with vitamin B12 deficiency? Select all that apply.
Pain in the joints
Impaired sens of balance
Neural tube defects
Numbness and tingling in the hands and feet
Sensation of electric shock produced by beck flexion
Which phase of an acute kidney injury involves an increase in the creatinine levels?
Oliguric phase
Diuretic phase
Initiating phase
Recovery phase
The nurse is caring for a patient who is diagnosed with acute kidney injury. When reviewing the patient’s laboratory data, which finding indicates that a patient has met the expected outcomes?
Decreasing serum creatinine
Decreasing neutrophil count
Decreasing lymphocyte count
Decreasing erythrocyte count
The nurse is providing education to a patient who is diagnosed with renal carcinoma. The patient states, “My doctor says I am a stage I. What does that mean?” Which response by the nurse is most appropriate?
“Your cancer is limited to the renal capsule.”
“Your cancer involves the perirenal fat but is confined to fascia with metastasis to the adrenal gland.”
“Your cancer involves the regional lymph node, renal vein, and vena cava.”
“Your cancer involves metastases to other sites in the body.”
A patient agrees to receive long-term hemodialysis to treat chronic kidney disease. For which surgical procedure should the nurse instruct this patient?
Insertion of a double-lumen catheter into the subclavian artery
Placement of a peritoneal catheter
Insertion of a subarachnoid-peritoneal shunt
Placement of an arteriovenous fistula
The nurse is caring for a patient with chronic kidney disease who is pale and experiencing fatigue. The nurse attributes these symptoms to anemia secondary to chronic kidney disease. The patient’s spouse asks why the patient is anemic. Which response by the nurse is the most appropriate?
“Your spouse has a genetic tendency for the development of anemia.”
The increased metabolic waste products in the body depress the bone marrow and cause anemia.”
“There is a decreased production by the kidneys of the hormone erythropoietin, which is the cause of anemia.”
“The patient is not eating enough iron-rich foods, which is causing anemia.”
The nurse is caring for a patient from another country who was admitted with hypertension and chronic kidney disease. The patient is receiving hemodialysis three times a week. The nurse is assessing the client’s diet, and the patient reports the use of salt substitutes. When teaching the patient to avoid salt substitute, which rationale supports this teaching point?
They will increase the risk of AV fistula infection.
They will cause the patient to retain fluid.
They will interact with the client’s antihypertensive medications.
They can potentiate hyperkalemia.
The nurse is caring for an older adult patient diagnosed with chronic kidney disease. The patient reports no bowel movement in the past two days. Based on this data, which condition is the patient at an increased risk for developing?
Metabolic acidosis
Hypocalcemia
Increased serum creatinine levels
Hyperkalemia
Which assessments should be performed to prevent intrarenal damage from postrenal causes in patients with acute kidney injuries?
examination of prostate
measurement of blood volume
measurement of cardiac output
identification of nephrotoxins
During a home visit, the nurse is concerned that an older adult patient is developing chronic kidney disease. The patient has no history of cardiovascular disease. Which data in the patient’s assessment caused the nurse to have this concern?
Progressive edema
Complaints of hip joint pain
Recent increase in hunger and thirst
Warm moist skin
While caring for a patient with chronic kidney disease, the nurse tracks the patient’s serum albumin level. For which nursing diagnosis is the action most indicated?
Excess Fluid Volume
Imbalanced Nutrition: Less Than Body Requirements
Risk for Ineffective Perfusion
Risk for Infection
The nurse is providing care to a patient who may have polycystic kidney disease. Which is the first symptom the nurse should assess this patient for?
Hypertension
Hematuria
Urinary frequency
Urinary calculi
A patient with frequent urinary tract infections is seen in the urology clinic and is at risk for acute kidney injury. The nurse reviews the patient’s medical history. Which item supports the patient’s being at risk for acute kidney injury? Select all that apply.
Dehydration
Renal calculi
Ineffective wound healing
Low serum albumin
Hypertension
The nurse is preparing to administer hemodialysis treatment for a patient with chronic kidney disease. Which laboratory values does the nurse anticipate prior to the patient’s treatment? Select all that apply.
Increased blood urea nitrogen (BUN)
Decreased potassium
Decreased phosphorus
Increased urine osmolality
Increased creatinine
Age-related changes that affect the hematological system include which findings? (Select all that apply.)
Iron binding decreases.
B. The number of stem cells in the marrow increases.
Lymphocyte function, especially cellular immunity, decreases.
Platelet adhesiveness decreases.
Hematocrit decreases.
The nurse is assigned to a patient with thrombocytopenia. What is the priority goal of nursing care?
Prevention of infection
Prevention of injury
Prevention of dehydration
Prevention of nutritional deficit
The nurse is asked to obtain a differential after the results of the CBC reveal an elevated WBC count. Which statement is true about a differential?
determines the percentage of platelets in the circulating blood
determines the proportion of each type of WBC in a blood sample
if the infection is bacterial then the neutrophil count will be decreased
if the basophils are elevated, then the patient has a viral infection
When completing an H/P examination on a patient with hematological disorder, which action is appropriate?
deeply palpate the spleen to determine the extent of splenomegaly.
perform a respiratory assessment after moderate exercise for accurate measurement of depth and rhythm.
inspect oral mucous membranes and the tongue for lesions, swelling, and pain
suggest a bone marrow biopsy if the patient reports energy levels.
What is a probable initial assessment finding for a patient with a low hemoglobin count?
increased and bounding peripheral pulses
hypertension
pallor and fatigue
moist mucus membranes
RBC values for men and women.
(write answers respectively, numbers only with comma, whole numbers accepted, per prof values accepted).
(a)
Hgb, Hct values for men and women
(learned in class per prof, write values (only) respectively with commas)
(a)
WBC and platelet values
(write values respectively, with commas, whole numbers accepted)
(a)
BUN and Cr values (not ratio)
(write values respectively, exact values only, with commas)
(a)
electrolyte values:
sodium
potassium
phosphate
calcium
(write values respectively, with commas, exact values only)
(a)
The nurse recognizes that genetic counseling is appropriate for which patient?
A child with frequent UTI
An adult with frequent UTI
An adult with PKD
An adult with metastatic renal cancer
The nurse correlates which clinical manifestations with the pathophysiology of acute pyelonephritis? Select all that apply.
N/V
hematuria
flank pain
fever
abd pain
Which is a prerenal cause of AKI?
Acute glomerulonephritis and neoplasms
Septic shock and nephrotoxic injury from medications
Pyelonephritis and calculi formation
Hypovolemia and myocardial infarction
The risk factor or factors most often associated with CKD include which of the following? Select all that apply.
HTN
DM
malnutrition
PVD
Somking
The nurse understands that CKD is characterized by which of the following?
A rapid decrease in urine output with CKD-elevated BUN
Progressive irreversible destruction to the kidneys
Abrupt increasing creatinine clearance w/ decrease in urinary output
Confusion and somnolence leading to coma and death
