Hematology NCLEX questions – Flashcards
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What intervention most effectively protects a client with thrombocytopenia? A. Avoiding the use of dentures B. Encouraging the use of an electric shaver C. Taking rectal temperatures D. Using warm compresses on trauma sites
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Correct answer B The client should be advised to use an electric shaver instead of a razor. Any small cuts or nicks can cause problems because of the prolonged clotting time.
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A client with leukemia is being discharged from the hospital. After hearing a nurse's instructions to keep regularly scheduled follow-up provider appointments, the client says, "I don't have transportation." How does the nurse respond? A. "A pharmaceutical company might be able to help." B. "I might be able to take you." C. "The local American Cancer Society may be able to help." D. "You can take the bus."
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Correct answer C Many local units of the American Cancer Society offer free transportation to clients with cancer, including those with leukemia.
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Which client statement indicates that stem cell transplantation that is scheduled to take place in his home is not a viable option? A. "I don't feel strong enough, but my wife said she would help." B. "I was a nurse, so I can take care of myself." C. "I will have lots of medicine to take." D. "We live 5 miles from the hospital."
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Correct answer B Stem cell transplantation in the home setting requires support, assistance, and coordination from others. The client cannot manage this type of care on his own. The client must be emotionally stable to be a candidate for this type of care.
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A client who has been newly diagnosed with leukemia is admitted to the hospital. Avoiding which potential problem takes priority in the client's nursing care plan? A. Fluid overload (overhydration) B. Hemorrhage C. Hypoxia D. Infection
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Correct answer D The main objective in caring for a newly diagnosed client with leukemia is protection from infection.
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A client with thrombocytopenia is being discharged. What information does the nurse incorporate into the teaching plan for this client? A. "Avoid large crowds." B. "Drink at least 2 liters of fluid per day." C. "Elevate your lower extremities when sitting." D. "Use a soft-bristled toothbrush."
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Correct answer D Using a soft-bristled toothbrush reduces the risk for bleeding in the client with thrombocytopenia.
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A distant family member arrives to visit a female client recently diagnosed with leukemia. The family member asks, "What should I say to her?" Which responses does the nurse suggest? Select all that apply. A. "Ask her how she is feeling." B. "Ask her if she needs anything." C. "Tell her to be brave and to not cry." D. "Talk to her as you normally would when you haven't seen her for a long time." E. "Tell her what you know about leukemia."
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Correct answers A,B,D A. This is a broad general opening and would be nonthreatening to the client. B. This is a therapeutic communication of offering self and would be considered to be therapeutic and helpful to the client. D. There is no need to act differently with the client. If she wants to offer her feelings, keeping a normal atmosphere facilitates that option. Acting as if things are "different" because she has cancer takes the control of the situation from the client.
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A nurse is teaching a client about induction therapy for acute leukemia. Which client statement indicates a need for additional education? A. "After this therapy, I will not need to have any more." B. "I will need to avoid people with a cold or flu." C. "I will probably lose my hair during this therapy." D. "The goal of this therapy is to put me in remission."
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Correct answer A Induction therapy is not a cure for leukemia, it is a treatment.
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A client with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this client's problem? A. "Ask your doctor to prescribe more medication." B. "It is too soon for additional medication to be given." C. "I'll turn on some soothing classical music for you." D. "Would you like to try some relaxation techniques?"
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Correct answer D Because most clients with multiple myeloma have local or generalized bone pain, analgesics and alternative approaches for pain management, such as relaxation techniques, are used for pain relief. This also offers the client a choice.
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What are the risk factors for the development of leukemia? Select all that apply. A. Bone marrow hypoplasia B. Chemical exposure C. Down syndrome D. Ionizing radiation E. Multiple blood transfusions F. Prematurity at birth
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Correct answers A,B,C,D A. Reduced production of blood cells in the bone marrow is one of the risk factors for developing leukemia. B. Exposure to chemicals through medical need or by environmental events contributes to the development of leukemia. C. Certain genetic factors contribute to the development of leukemia. Down syndrome is one such condition. D. Radiation therapy for cancer or other exposure to radiation, perhaps through the environment, contributes to the development of leukemia.
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A nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out? A. Coughing and deep breathing B. Evidence of pus C. Fever of 102 F or higher D. Wheezes or crackles
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Correct answer D Wheezes or crackles in the neutropenic client may be the first symptom of infection in the lungs.
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A nurse is caring for a client with neutropenia who has a suspected infection. Which intervention does the nurse implement first? A. Hydrates the client with 1000 mL of IV normal saline B. Initiates the administration of prescribed antibiotics C. Obtains requested cultures D. Places the client on Bleeding Precautions
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Correct answer C Obtaining cultures to identify the infectious agent correctly is the priority for this client.
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A nurse is assessing a newly admitted client with thrombocytopenia. Which factor needs immediate intervention? A. A nosebleed B. Reports of pain C. Decreased urine output D. Increased temperature
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Correct answer A The client with thrombocytopenia has a high risk for bleeding. The nosebleed should be attended to immediately.
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A nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant (HSCT). What procedure does the nurse follow? A. Administers intravenous (IV) corticosteroids before starting the transfusion B. Allows the platelets to stabilize at the client's bedside for 30 minutes C. Infuses the transfusion over a 15- to 30-minute period D. Sets up the infusion with the standard transfusion "Y" tubing.
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Correct answer C The volume of platelets-200 or 300 mL (standard amount)-needs to be infused rapidly-over a 15- to 30-minute period.
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The client is a 56-year-old man admitted with a diagnosis of acute myelogenous leukemia (AML). He is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this therapy? A. Bone marrow suppression B. Liver toxicity C. Nausea D. Stomatitis
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Correct answer A This is a commonly prescribed course of aggressive chemotherapy, and bone marrow suppression is a major side effect. The client is even more at risk for infection than before treatment was begun.
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The client is a 56-year-old man admitted with a diagnosis of acute myelogenous leukemia (AML). He is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. He develops an infection. What knowledge does the nurse use to determine that the appropriate antibiotic has been prescribed for this client? A. Evaluating the client's liver function tests (LFTs) and serum creatinine levels B. Evaluating the client's white blood cell (WBC) count level C. Checking the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection D. Recognizing that vancomycin (Vancocin) is the drug of choice used to treat all infections in clients with AML
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Correct answer C Drug therapy is the main defense against infections that develop in clients undergoing therapy for AML. Agents used depend on the client's sensitivity to various antibiotics for the organism causing the infection.
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A 56-year-old man is admitted with a diagnosis of acute myelogenous leukemia (AML). He is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. He is started on an antiviral agent. What are serious side effects of antiviral agents? Select all that apply. A. Cardiomyopathy B. Nephrotoxicity C. Ototoxicity D. Stroke
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Correct answers B,C Antiviral agents, although helpful in combating severe infection, have serious side effects, especially nephrotoxicity and ototoxicity.
