NCLEX: Hematology – Flashcards
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In a severely anemic patient, the nurse would expect to find: a. dyspnea and tachycardia b. cyanosis and pulmonary edema c. cardiomegaly and pulmonary fibrosis d. ventricular dysrhythmias and wheezing
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A - Patients with severe anemia (hemoglobin level, less than 6 g/dL) exhibit the following cardiovascular and pulmonary manifestations: tachycardia, increased pulse pressure, systolic murmurs, intermittent claudication, angina, heart failure, myocardial infarction, tachypnea, orthopnea, and dyspnea at rest.
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When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would question the patient about: a. folic acid intake b. dietary intake of iron c. a history of gastric surgery d. a history of sickle cell anemia
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B - Iron-deficiency anemia is a microcytic, hypochromic anemia.
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Nursing interventions for a patient with severe anemia related to peptic ulcer disease include (select all that apply): a. monitoring stools for guaiac b. instructions for high-iron diet c. taking vital signs every 8 hours d. teaching self-injection of erythropoietin e. administration of cobalamin (vitamin B12) injections
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A, B - Stool guaiac test is performed to determine the cause of iron-deficiency anemia that is related to gastrointestinal bleeding. Iron is increased in the diet. Teach the patient which foods are good sources of iron. If nutrition is already adequate, increasing iron intake by dietary means may not be practical. The patient with iron deficiency related to acute blood loss may require a transfusion of packed red blood cells (RBCs).
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The nursing management of a patient in sickle cell crisis incudes (select all that apply): a. monitoring CBC b. optimal pain management and O2 therapy c. blood transfusions if required and iron chelation d. rest as needed and deep vein thrombosis prophylaxis e. administration of IV iron and diet high in iron content
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A, B, C, D - Complete blood count (CBC) is monitored. Infections are common with elevated white blood cell counts, and anemia may occur with low hemoglobin levels and low RBC counts. Oxygen may be administered to treat hypoxia and control sickling. Rest may be instituted to reduce metabolic requirements, and prophylaxis for deep vein thrombosis (with anticoagulants) is prescribed. Transfusion therapy is indicated when an aplastic crisis occurs. Patients may require iron chelation therapy to reduce transfusion-produced iron overload. Pain occurring during an acute crisis is usually undertreated; patients should have optimal pain control with opioid analgesics, nonsteroidal antiinflammatory agents, antineuropathic pain medications, local anesthetics, or nerve blocks.
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A complication of the hyperviscosity of polycythemia is: a. thrombosis b. cardiomyopathy c. pulmonary edema d. disseminated intravascular coagulation (DIC)
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A - The patient with polycythemia may experience angina, heart failure, intermittent claudication, and thrombophlebitis, which may be complicated by embolization. These manifestations are caused by blood vessel distention, impaired blood flow, circulatory stasis, thrombosis, and tissue hypoxia, caused by the hypervolemia and hyperviscosity. The most common serious acute complication is stroke, caused by thrombosis.
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When caring for a patient with thrombocytopenia, the nurse instructs the patient to: a. dab his or her nose instead of blowing b. be careful when shaving with a safety razor c. continue with physical activities to stimulate thrombopoiesis d. avoid Aspirin (ASA) because it may mask the fever that occurs with thrombocytopenia
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A - Patients with thrombocytopenia should avoid aspirin because it reduces platelet adhesiveness, which contributes to bleeding. Patients should not perform vigorous exercise or lift weights. If a patient is weak and at risk for falling, supervise the patient when he or she is out of bed. Blowing the nose forcefully should be avoided. The patient should gently pat the nose with a tissue if needed. Instruct patients not to shave with a blade; an electric razor should be used.
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The nurse would anticipate that a patient with von Willebrand disease undergoing surgery would be treated with administration of vWF and: a. thrombin b. factor VI c. factor VII d. factor VIII
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D - von Willebrand disease involves deficiency of the von Willebrand coagulation protein, variable factor VIII deficiencies, and platelet dysfunction. Treatment includes administration of von Willebrand factor and factor VIII.
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DIC is a disorder in which: a. the coagulation pathway is genetically altered, leading to thrombus formation in all major blood vessels b. an underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic episodes and infarcts c. a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage d. an inherited predisposition causes a deficiency of clotting factors that leads to overstimulation of coagulation processes in the vasculature
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C - In disseminated intravascular coagulation (DIC), the coagulation process is stimulated, with resultant thrombosis and depletion of clotting factors, which leads to diffuse clotting and hemorrhage. The paradox of this condition is characterized by the profuse bleeding that results from the depletion of platelets and clotting factors.
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Priority nursing actions when caring for a hospitalized patient with a new onset temperature of 102.2 F and severe neutropenia include (select all that apply): a. administering the prescribed antibiotic STAT b. drawing peripheral and central line blood cultures c. ongoing monitoring of the patient's vital signs for septic shock d. taking a full set of vital signs and notifying the physician immediately e. administering transfusions of WBCs treated to decrease immunogenicity
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A, B, C, D - Early identification of an infective organism is a priority, and cultures should be obtained from various sites. Serial blood cultures (at least two) or one from a peripheral site and one from a venous access device should be obtained promptly. In a febrile neutropenic patient, antibiotics should be started immediately (within 1 hour). Cultures of the nose, throat, sputum, urine, stool, obvious lesions, and blood may be indicated. Ongoing febrile episodes or a change in the patient's assessment findings (or vital signs) necessitates a call to the physician for additional cultures, diagnostic tests, addition of antimicrobial therapies, or a combination of these.
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Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow, laboratory results the nurse would expect to find include a(n): a. excess of T cells b. excess of platelets c. deficiency of granulocytes d. deficiency of all cellular blood components
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D - Myelodysplastic syndrome (MDS) commonly manifests as infection and bleeding. It is caused by inadequate numbers of ineffective functioning circulating granulocytes or platelets.
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The most common type of leukemia in older adults is: a. acute myelocytic leukemia b. acute lymphocytic leukemia c. chronic myelocytic leukemia d. chronic lymphocytic leukemia
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D - Chronic lymphocytic leukemia is a disease primarily of older adults.
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Multiple drugs are often used in combinations to treat leukemia and lymphoma because: a. there are fewer toxic side effects b. the chance that one drug will be effective is increased c. the drugs are more effective without causing side effects d. the drugs work by different mechanisms to maximize killing of malignant cells
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D - Combination therapy is the mainstay of treatment for leukemia. The three purposes for using multiple drugs are to (1) decrease drug resistance, (2) minimize the drug toxicity to the patient by using multiple drugs with varying toxic effects, and (3) interrupt cell growth at multiple points in the cell cycle.
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The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that: a. Hodgkin's lymphoma occurs only in young adults b. Hodgkin's lymphoma is considered potentially curable c. non-Hodgkin's lymphoma can manifest in multiple organs d. non-Hodgkin's lymphoma is treated only with radiation therapy
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C - Non-Hodgkin's lymphoma can originate outside the lymph nodes, the method of spread can be unpredictable, and most affected patients have widely disseminated disease.
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A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate: a. hyperkalemia b. hyperuricemia c. hypercalcemia d. CNS myeloma
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C - Bone degeneration in multiple myeloma causes calcium to be lost from bones, which eventually results in hypercalcemia. Hypercalcemia may cause renal, gastrointestinal, or neurologic manifestations, such as polyuria, anorexia, or confusion, and may ultimately cause seizures, coma, and cardiac problems.
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When reviewing the patient's hematologic laboratory values after a splenectomy, the nurse would expect to find: a. leukopenia b. RBC abnormalities c. decreased hemoglobin d. increased platelet count
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D - Splenectomy can have a dramatic effect in increasing peripheral RBC, white blood cell, and platelet counts.
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Complications of transfusions that can be decreased by the use of leukocyte depletion or reduction of RBC transfusion are: a. chills and hemolysis b. leukostasis and neutrophilia c. fluid overload and pulmonary edema d. transmission of cytomegalovirus and fever
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D - Infectious viruses, such as human immunodeficiency virus (HIV), human herpesvirus, hepatitis B and C type 6 (HCV-6), Epstein-Barr virus (EBV), human T-cell leukemia virus type 1 (HTLV-1), and cytomegalovirus (CMV), and other agents, such as the agent that causes malaria, can be transmitted by blood transfusion. Leukocyte-reduced blood products drastically reduce the risk for viral infections associated with blood transfusions, including CMV.
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An individual who lives at high altitudes may normally have an increased RBC count because: a. high altitudes cause vascular fluid loss, leading to hemoconcentration b. hypoxia caused by decreased atmospheric oxygen stimulates erythropoiesis c. the function of the spleen in removing old RBCs is impaired at high altitudes d. impaired production of leukocytes and platelets leads to proportionally higher red cell counts
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B - Normal physiologic increases in the red blood cell count occur at high altitudes. At high altitudes, less atmospheric weight pushes air into the lungs; the partial pressure of oxygen is thereby decreased, which causes hypoxia. Erythropoiesis is stimulated by hypoxia and controlled by erythropoietin, a glycoprotein growth factor synthesized and released by the kidneys. Erythropoietin stimulates the bone marrow to increase erythrocyte production.
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Malignant disorders that arise from granulocytic cells in the bone marrow will have the primary effect of causing: a. risk for hemorrhage b. altered oxygenation c. decreased production of antibodies d. decreased phagocytosis of bacteria
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D - The primary function of granulocytes is phagocytosis, a process by which white blood cells (WBCs) ingest or engulf any unwanted organism, such as bacteria, and then digest and kill it. In malignant disorders, these phagocytic cells are often reduced in number and function.
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An anticoagulant such as warfarin (Coumadin) that interferes with prothrombin production will alter the clotting mechanisms during: a. platelet aggregation b. activation of thrombin c. the release of tissue thromboplastin d. stimulation of factor activation complex
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B - Warfarin inhibits the effective synthesis of vitamin K-dependent clotting factors: II (prothrombin), VII (stable factor), IX (Christmas factor), and X (Stuart-Prower factor) in the extrinsic pathway. Thrombin is not activated, and coagulation is interrupted in the final common pathway of the clotting cascade. Without thrombin activation, fibrinogen is not converted to fibrin, and blood clotting does not occur.
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When reviewing laboratory results of an 83 year old patient with an infection, the nurse would expect to find: a. minimal leukocytosis b. decreased platelet count c. increased hemoglobin and hematocrit levels d. decreased erythrocyte sedimentation rate (ESR)
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A - During an infection, an older adult may have only a minimal elevation in the total WBC count. This laboratory finding suggests a diminished bone marrow reserve of granulocytes in older adults and reflects possible impaired stimulation of hematopoiesis.
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Significant information obtained from the patient's health history that relates to the hematologic system includes: a. jaundice b. bladder surgery c. early menopause d. multiple pregnancies
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A - Jaundice is a common symptom that occurs with hematologic abnormalities. Jaundice is related to an accumulation of bile pigment that is caused by rapid or excessive hemolysis or liver damage.
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While assessing the lymph nodes, the nurse should: a. apply gentle, firm pressure to deep lymph nodes b. palpate the deep cervical and supraclavicular nodes last c. lightly palpate superficial lymph nodes with the pads of the fingers d. use the tips of the second, third and fourth fingers to apply deep palpation
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C - To assess superficial lymph nodes, the nurse should lightly palpate the nodes, using the pads of the fingers. Then the nurse gently rolls the skin over the area and concentrates on feeling for possible lymph node enlargement.
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If a lymph node is palpated, what is a normal finding? a. hard, fixed nodes b. firm, mobile nodes c. enlarged, tender nodes d. hard, non tender nodes
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B - Ordinarily, lymph nodes are not palpable in adults. If a node is palpable, it should be small (0.5 to 1 cm), mobile, firm, and nontender to be considered a normal finding.
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Nursing care for a patient immediately after a bone marrow biopsy and aspiration includes (select all that apply): a. administering analgesics as necessary b. preparing to administer a blood transfusion c. instructing on need to lie still with a sterile pressure dressing intact d. monitoring vital signs and assessing the site for excess drainage or bleeding e. instructing on the need for preprocedure and post procedure antibiotic medications
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A, C, D - The needle aspiration or biopsy site is covered with a sterile pressure dressing. Monitor the patient's vital signs until stable, and assess the site for excess drainage or bleeding. If bleeding is detected, advise the patient to lie on the side for 30 to 60 minutes to maintain pressure on the site. If the bed is too soft, have the patient lie on a rolled towel to provide additional pressure. Analgesics for post procedure pain may be administered. Soreness over the puncture site for 3 to 4 days after the procedure is normal.
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You are taking care of a male patient who has the following laboratory values from his CBC: WBC 6.5x10(3)/uL, Hgb 13.4 g/dL, Hct 40%, platelets 50x10(3)/uL. What are you most concerned about? a. your patient is neutropenic b. your patient has an infection c. your patient is at risk for bleeding d. your patient is at fall risk due to his anemia
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C - The patient complete blood cell count (CBC) has normal parameters except for the platelet count, which is below normal.
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When assessing a patient's nutritional-metabolic pattern related to hematologic health, what should the nurse do? a. inspect the skin for petechiae. b. ask the patient about joint pain. c. assess for vitamin C deficiency. d. determine if the patient can perform ADLs
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A - Any changes in the skin's texture or color should be explored when assessing the patient's nutritional-metabolic pattern related to hematologic health. The presence of petechiae or ecchymotic areas could be indicative of hematologic deficiencies related to poor nutritional intake or related causes. The other options are not specific to the nutritional-metabolic pattern related to hematologic health.
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When assessing laboratory values on a patient admitted with septicemia, what should the nurse expect to find? a. increased platelets b. decreased red blood cells c. decreased erythrocyte sedimentation rate (ESR) d. increased bands in the white blood cell (WBC) differential (shift to the left)
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D - When infections are severe, such as in septicemia, more granulocytes are released from the bone marrow as a compensatory mechanism. To meet the increased demand, many young, immature polymorphonuclear neutrophils (bands) are released into circulation. WBCs are usually reported in order of maturity (initially with the less mature forms on the left side of a written report). Hence, the term "shift to the left" is used to denote an increase in the number of bands. Thrombocytosis occurs with inflammation and some malignant disorders. Decreased red blood cells indicate anemia. Decreased ESR is not indicative of septicemia.
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Results of a patient's most recent blood work indicate an elevated neutrophil level. The nurse should recognize that this diagnostic finding most likely suggests which problem? a. hypoxemia b. an infection c. a risk of hypocoagulation d. an acute thrombotic event
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B - An increase in the neutrophil count most commonly occurs in response to infection or inflammation. Hypoxemia and coagulation do not directly affect neutrophil production.
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A 30-year-old patient has undergone a splenectomy as a result of injuries suffered in a motor vehicle accident. Which phenomena are likely to result from the absence of the patient's spleen (select all that apply)? a. impaired fibrinolysis b. increased platelet levels c. increased eosinophil levels d. fatigue and cold intolerance e. impaired immunologic function
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B, E - Splenectomy can result in increased platelet levels and impaired immunologic function as a consequence of the loss of storage and immunologic functions of the spleen. Fibrinolysis, fatigue, and cold intolerance are less likely to result from the loss of the spleen since coagulation and oxygenation are not primary responsibilities of the spleen.
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The nurse is providing care for older adults on a subacute, geriatric medicine unit. What effect is aging likely to have on hematologic function of older adults? a. thrombocytosis b. decreased hemoglobin c. decreased WBC count d. decreased blood volume
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B - Older adults frequently experience decreased hemoglobin levels as a result of changes in erythropoiesis. Decreased blood volume, decreased WBCs, and alterations in platelet number are not considered to be normal, age-related hematologic changes.
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A blood type and cross-match has been ordered for a male patient who is experiencing an upper gastrointestinal bleed. The results of the blood work indicate that the patient has type A blood. Which description explains what this means? a. the patient can be transfused with type AB blood. b. the patient may only receive a type A transfusion. c. the patient has A antigens on his red blood cells (RBCs). d. antibodies are present on the surface of the patient's RBCs.
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C - An individual with type A blood has A antigens, not A antibodies, on his RBCs. An AB transfusion would result in agglutination, but he may be transfused with either type A or type O blood.
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The nurse is reviewing the objective data from a patient with suspected allergies. Which assessment finding does the nurse know indicates allergies? Tab 1 - Physical Examination Dry cough Pale skin Tab 2 - Laboratory Results Neutrophils: 60% Eosinophils: 10% Basophils: 1% Lymphocytes: 20% Monocytes: 6% Tab 3 - Medications Acetaminophen 1000 mg every 12 hours Levothyroxine (Synthroid) 125 mcg each day a. dry cough b. eosinophil result c. lymphocyte result d. acetaminophen use
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B - Eosinophils are granulocytes that phagocytize antigen-antibody complexes formed during an allergic response. The normal eosinophil count is 2% to 4% of all WBCs. The dry cough, lymphocyte result, and acetaminophen use do not indicate allergies.
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The patient has anemia and has had laboratory tests done to diagnose the cause. Which results should the nurse know indicates a lack of nutrients needed to produce new red blood cells (select all that apply)? a. increased homocysteine b. decreased reticulocyte count c. decreased cobalamin (vitamin B12) d. increased methylmalonic acid (MMA) e. elevated erythrocyte sedimentation rate (ESR)
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A, C, D - Increased homocysteine and MMA along with decreased cobalamin (vitamin B12) indicate cobalamin deficiency, which is a nutrient needed for RBC production. Decreased reticulocytes indicate low bone marrow activity in producing RBCs, not available nutrients. Elevated ESR is related to an increased inflammatory process, not anemia.
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In assessing the patient, which abnormal finding should the nurse relate to hemostasis abnormalities? a. purpura b. pruritus c. weakness d. pale conjunctiva
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A - Purpura may occur when platelets or clotting factors are decreased and bleeding into the skin occurs. Pruritus is not related to hemostasis, but to hematologic cancers (e.g., lymphomas, leukemias) or increased bilirubin. Weakness and pale conjunctiva are not related to hemostasis unless a lot of bleeding leads to anemia with low Hgb level.
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During the admission assessment, the nurse discovers that the patient has used illicit drugs. Related to the hematologic system, what question should the nurse next ask the patient? a. "Do you have any blood in your stools?" b. "What agent and when did you last use it?" c. "Have you had any surgeries causing pain?" d. "Do you have shortness of breath with activity?"
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B - Although all these questions are appropriate related to the hematologic system, the only one related specifically to illicit drug use is asking about what agent and when it was last used. The route and frequency should also be assessed.
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The thrombocytopenic patient has had a bone marrow biopsy taken from the posterior iliac crest. What nursing care is the priority for this patient after this procedure? a. position the patient prone. b. apply a pressure dressing. c. administer analgesic for pain. d. return metal objects to the patient.
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B - The sterile pressure dressing is applied after a bone marrow biopsy to ensure hemostasis. If bleeding is present, the patient will lie on the site and may need a rolled towel for additional pressure, thus this patient will not be in the prone position. The analgesic should have been administered preprocedure. Metal objects would be removed for an MRI, not a bone marrow biopsy.
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When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What should the nurse place highest priority on initiating interventions to reduce? a. thirst b. fatigue c. headache d. abdominal pain
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B - The patient with a low hemoglobin and hematocrit is anemic and would be most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Thirst, headache, and abdominal pain are not related to anemia.
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The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? a. unit secretary b. a physician's assistant c. another registered nurse d. an unlicensed assistive personnel
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C - Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. The unit secretary, physician's assistant, or unlicensed assistive personnel should not be asked.
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Before starting a transfusion of packed red blood cells for an older anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion? a. 5 b. 15 c. 30 d. 60
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B - As part of standard procedure, the nurse remains with the patient for the first 15 minutes after starting a blood transfusion. Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing. Monitoring during the transfusion will be every 30 to 60 minutes.
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When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? a. lactated Ringer's b. 5% dextrose in water c. 0.9% sodium chloride d. 0.45% sodium chloride
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C - The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Dextrose and lactated Ringer's solutions cannot be used with blood as they will cause RBC hemolysis.
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The nurse notes a physician's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? a. 11:45 AM b. 12:00 noon c. 12:30 PM d. 3:30 PM
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B - The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank.
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The nurse receives a physician's order to transfuse fresh frozen plasma to a patient suffering from an acute blood loss. Which procedure is most appropriate for infusing this blood product? a. infuse the fresh frozen plasma as rapidly as the patient will tolerate. b. hang the fresh frozen plasma as a piggyback to the primary IV solution. c. infuse the fresh frozen plasma as a piggyback to a primary solution of normal saline. d. hang the fresh frozen plasma as a piggyback to a new bag of primary IV solution without KCl.
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A - The fresh frozen plasma should be administered as rapidly as possible and should be used within 24 hours of thawing to avoid a decrease in Factors V and VIII. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion.
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Before beginning a transfusion of RBCs, which action by the nurse would be of highest priority to avoid an error during this procedure? a. check the identifying information on the unit of blood against the patient's ID bracelet. b. select new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. c. remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction. d. add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow.
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A - The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer's because it will cause RBC hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started, as this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.
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The blood bank notifies the nurse that the two units of blood ordered for an anemic patient are ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? a. immediately pick up both units of blood from the blood bank. b. infuse the blood slowly for the first 15 minutes of the transfusion. c. regulate the flow rate so that each unit takes at least 4 hours to transfuse. d. set up the Y-tubing of the blood set with dextrose in water as the flush solution.
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B - Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging a unit of blood. Only one unit of blood can be picked up at a time, must be infused within 4 hours, and cannot be hung with dextrose.
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Which patient is most likely to experience anemia related to an increased destruction of red blood cells? a. A 59-year-old man whose alcoholism has precipitated folic acid deficiency b. A 23-year-old African American man who has a diagnosis of sickle cell disease c. A 30-year-old woman with a history of "heavy periods" accompanied by anemia d. A 3-year-old child whose impaired growth and development is attributable to thalassemi
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B - A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.
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What will caring for a patient with a diagnosis of polycythemia vera likely require the nurse to do? a. encourage deep breathing and coughing. b. assist with or perform phlebotomy at the bedside. c. teach the patient how to maintain a low-activity lifestyle. d. perform thorough and regularly scheduled neurologic assessments.
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B - Primary polycythemia vera often requires phlebotomy in order to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation. Deep breathing and coughing exercises do not directly address the etiology or common sequelae of polycythemia, and neurologic manifestations are not typical.
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What nursing intervention should be the priority in the care of a 30-year-old woman who has a diagnosis of immune thrombocytopenic purpura (ITP)? a. administration of packed red blood cells b. administration of oral or IV corticosteroids c. administration of clotting factors VIII and IX d. maintenance of reverse isolation and application of standard precautions
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B - Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients.
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A patient with a diagnosis of hemophilia had a fall down an escalator earlier in the day and is now experiencing bleeding in her left knee joint. What should be the emergency nurse's immediate response to this? a. immediate transfusion of platelets b. resting the patient's knee to prevent hemarthroses c. assistance with intracapsular injection of corticosteroids d. range-of-motion exercises to prevent thrombus formation
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C - In patients with hemophilia, joint bleeding requires resting of the joint in order to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.
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An older patient relates that she has increased fatigue and a headache. The nurse identifies pale skin and glossitis on assessment. In response to these findings, which teaching will be helpful to the patient if she has microcytic, hypochromic anemia? a. take enteric-coated iron with each meal. b. take cobalamin with green leafy vegetables. c. take the iron with orange juice one hour before meals. d. decrease the intake of the antiseizure medications to improve.
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C - With microcytic, hypochromic anemia, there may be an iron, B6, or copper deficiency, thalassemia, or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals as it is best absorbed in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help RBC maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider.
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The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? a. elevated D-dimers b. elevated fibrinogen c. reduced prothrombin time (PT) d. reduced fibrin degradation products (FDPs)
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A - The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.
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After the diagnosis of disseminated intravascular coagulation (DIC), what is the first priority of collaborative care? a. administer heparin. b. administer whole blood. c. treat the causative problem. d. administer fresh frozen plasma.
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C - Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.
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The patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about (select all that apply)? a. strict hand washing b. daily nasal swabs for culture c. monitor temperature every hour. d. daily skin care and oral hygiene e. encourage eating all foods to increase nutrients. f. private room with a high-efficiency particulate air (HEPA) filter
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A, D, F - Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora, other people, and uncooked meats, seafood, eggs, unwashed fruits and vegetables, and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4° F or more, but temperature is not monitored every hour.
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A 57-year-old patient has been diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what? a. leukapheresis b. attaining remission c. one chemotherapy agent d. waiting with active supportive care
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B - Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the WBC count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia (CLL), waiting may be done to attain remission, but not with AML.
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A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? a. prevent patient infection. b. avoid abnormal bleeding. c. give pneumococcal vaccine. d. provide companionship while isolated.
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A - After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done, but should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.
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A 22-year-old female patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? a. brentuximab vedotin (Adcetris) b. two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine c. four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine d. BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone
answer
B - The patient with stage favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.
question
The patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? a. skin care that will be needed b. method of obtaining the treatment c. gastrointestinal tract effects of treatment d. treatment type and expected side effects
answer
D - The patient with stage favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.
question
The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient? a. multiple myeloma b. thrombocytopenia c. megaloblastic anemia d. myelodysplastic syndrome
answer
A - Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.
question
A patient who has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient? a. start IV fluids. b. maintain oxygenation. c. maintain distal warmth. d. check peripheral pulses.
answer
B - Maintaining oxygenation is a priority as sickling episodes are frequently triggered by low oxygen tension in the blood which is commonly caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity will also be used, but oxygenation is the priority.
question
The nurse knows that hemolytic anemia can be caused by which extrinsic factors? a. trauma or splenic sequestration crisis b. abnormal hemoglobin or enzyme deficiency c. macroangiopathic or microangiopathic factors d. chronic diseases or medications and chemicals
answer
C - Macroangiopathic or microangiopathic extrinsic factors lead to acquired hemolytic anemias. Trauma or splenic sequestration crisis can lead to anemia from acute blood loss. Abnormal hemoglobin or enzyme deficiency are intrinsic factors that lead to hereditary hemolytic anemias. Chronic diseases or medications and chemicals can decrease the number of RBC precursors which reduce RBC production.
