NCLEX practice questions Hematologic – Flashcards
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The nurse is admitting a 24-year-old African American female client with a diagnosis of rule-out anemia. The client has a history of gastric bypass surgery for obesity four (4) years ago. Current assessment findings include height 5′5′′; weight 75 kg; P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of anemia would the nurse suspect the client has developed? 1. Vitamin B12 deficiency. 2. Folic acid deficiency. 3. Iron deficiency. 4. Sickle cell anemia.
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1. Vitamin B12 deficiency.
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The client diagnosed with menorrhagia complains to the nurse of feeling listless and tired all the time. Which scientific rationale would explain why these symptoms occur? 1. The pain associated with the menorrhagia does not allow the client to rest. 2. The client's symptoms are unrelated to the diagnosis of menorrhagia. 3. The client probably has been exposed to a virus that causes chronic fatigue. 4. Menorrhagia has caused the client to have decreased levels of hemoglobin.
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4. Menorrhagia has caused the client to have decreased levels of hemoglobin.
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The nurse writes a diagnosis of altered tissue perfusion for a client diagnosed with anemia. Which interventions should be included in the plan of care? Select all that apply. 1. Monitor the client's hemoglobin and hematocrit. 2. Move the client to a room near the nurse's desk. 3. Limit the client's dietary intake of green vegetables. 4. Assess the client for numbness and tingling. 5. Allow for rest periods during the day for the client.
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1,2,4,5
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The client diagnosed with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client? 1. Take Imodium, an antidiarrheal, OTC for diarrhea. 2. Limit exercise for several weeks until a tolerance is achieved. 3. The stools may be very dark, and this can mask blood. 4. Eat only red meats and organ meats for protein.
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3. The stools may be very dark, and this can mask blood.
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The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical unit. Which task should the nurse delegate to the UAP? 1. Check on the bowel movements of a client diagnosed with melena. 2. Take the vital signs of a client who received blood the day before. 3. Evaluate the dietary intake of a client who has been noncompliant with eating. 4. Shave the client diagnosed with severe hemolytic anemia.
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2. Take the vital signs of a client who received blood the day before.
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The client is diagnosed with congestive heart failure and anemia. The HCP ordered a transfusion of two (2) units of packed red blood cells. The unit has 250 mL of red blood cells plus 45 mL of additive. At what rate should the nurse set the IV pump to infuse each unit of packed red blood cells? ____________
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74ml/hr Pumps are set at an hourly rate. The client in congestive heart failure should receive blood at the slowest possible rate to prevent the client from further complications of fluid volume overload. Each unit of blood must be infused within four (4) hours of initiation of the infusion. 250 mL + 45 mL = 295 mL 295 mL ÷ 4 = 73 3 /4 mL/hr, which rounded is 74 mL/hr
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The client is being admitted with folic acid deficiency anemia. Which would be the most appropriate referral? 1. Alcoholics Anonymous. 2. Leukemia Society of America. 3. A hematologist. 4. A social worker.
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1. Alcoholics Anonymous. Most clients diagnosed with folic acid deficiency anemia have developed the anemia from chronic alcohol abuse. Alcohol consumption increases the use of folates, and the alcoholic diet is usually deficient in folic acid. A referral to Alcoholics Anonymous would be appropriate
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The charge nurse is making assignments on a medical floor. Which client should be assigned to the most experienced nurse? 1. The client diagnosed with iron-deficiency anemia who is prescribed iron supplements. 2. The client diagnosed with pernicious anemia who is receiving vitamin B12 intramuscularly. 3. The client diagnosed with aplastic anemia who has developed pancytopenia. 4. The client diagnosed with renal disease who has a deficiency of erythropoietin
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3. The client diagnosed with aplastic anemia who has developed pancytopenia.
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The client diagnosed with anemia begins to complain of dyspnea when ambulating in the hall. Which intervention should the nurse implement first? 1. Apply oxygen via nasal cannula. 2. Get a wheelchair for the client. 3. Assess the client's lung fields. 4. Assist the client when ambulating in the hall.
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2. Get a wheelchair for the client.
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The nurse is transcribing the HCP's order for an iron supplement on the MAR. At which time should the nurse schedule the daily dose? 1. 0900. 2. 1000. 3. 1200. 4. 1630.
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2. 1000.
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The nurse is discharging a client diagnosed with anemia. Which discharge instruction should the nurse teach? 1. Take the prescribed iron until it is completely gone. 2. Monitor pulse and blood pressure at a local pharmacy weekly. 3. Have a complete blood count checked at the HCP's office. 4. Perform isometric exercise three (3) times a week.
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3. Have a complete blood count checked at the HCP's office.
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The nurse writes a client problem of "activity intolerance" for a client diagnosed with anemia. Which intervention should the nurse implement? 1. Pace activities according to tolerance. 2. Provide supplements high in iron and vitamins. 3. Administer packed red blood cells. 4. Monitor vital signs every four (4) hours.
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1. Pace activities according to tolerance.
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The charge nurse in the intensive care unit is making client assignments. Which client should the charge nurse assign to the graduate nurse who has just finished the three (3)-month orientation? 1. The client with an abdominal peritoneal resection who has a colostomy. 2. The client diagnosed with pneumonia who has acute respiratory distress syndrome. 3. The client with a head injury developing disseminated intravascular coagulation. 4. The client admitted with a gunshot wound who has an H&H of 7 and 22.
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1. The client with an abdominal peritoneal resection who has a colostomy.
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Which client would be most at risk for developing disseminated intravascular coagulation (DIC)? 1. A 35-year-old pregnant client with placenta previa. 2. A 42-year-old client with a pulmonary embolus. 3. A 60-year-old client receiving hemodialysis 3 days a week. 4. A 78-year-old client diagnosed with septicemia.
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4. A 78-year-old client diagnosed with septicemia.
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The client admitted with full-thickness burns may be developing DIC. Which signs/symptoms would support the diagnosis of DIC? 1. Oozing blood from the IV catheter site. 2. Sudden onset of chest pain and frothy sputum. 3. Foul-smelling, concentrated urine. 4. A reddened, inflamed central line catheter site.
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1. Oozing blood from the IV catheter site.
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Which laboratory result would the nurse expect in the client diagnosed with DIC? 1. A decreased prothrombin time (PT). 2. A low fibrinogen level. 3. An increased platelet count. 4. An increased white blood cell count
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2. A low fibrinogen level.
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Which collaborative treatment would the nurse anticipate for the client diagnosed with DIC? 1. Administer oral anticoagulants. 2. Prepare for plasmapheresis. 3. Administer frozen plasma. 4. Calculate the intake and output.
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3. Administer frozen plasma.
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The unlicensed assistive personnel (UAP) asks the primary nurse, "How does someone get hemophilia A?" Which statement would be the primary nurse's best response? 1. "It is an inherited X-linked recessive disorder." 2. "There is a deficiency of the clotting factor VIII." 3. "The person is born with hemophilia A." 4. "The mother carries the gene and gives it to the son."
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4. "The mother carries the gene and gives it to the son."
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Which sign/symptom should the nurse expect to assess in the client diagnosed with hemophilia A? 1. Epistaxis. 2. Petechiae. 3. Subcutaneous emphysema. 4. Intermittent claudication.
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1. Epistaxis.
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Which situation might cause the nurse to think that the client has von Willebrand's disease? 1. The client has had unexplained episodes of hematemesis. 2. The client has microscopic blood in the urine. 3. The client has prolonged bleeding following surgery. 4. The female client developed abruptio placentae
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3. The client has prolonged bleeding following surgery.
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The client with hemophilia A is experiencing hemarthrosis. Which intervention should the nurse recommend to the client? 1. Alternate aspirin and acetaminophen to help with the pain. 2. Apply cold packs for 24 to 48 hours to the affected area. 3. Perform active range-of-motion exercise on the extremity. 4. Put the affected extremity in the dependent position.
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2. Apply cold packs for 24 to 48 hours to the affected area.
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Which sign would the nurse expect to assess in the client diagnosed with idiopathic thrombocytopenic purpura (ITP)? 1. Petechiae on the anterior chest, arms, and neck. 2. Capillary refill of less than three (3) seconds. 3. An enlarged spleen. 4. Pulse oximeter reading of 95%.
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1. Petechiae on the anterior chest, arms, and neck.
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The nurse is caring for the following clients. Which client should the nurse assess first? 1. The client whose partial thromboplastin time (PTT) is 38 seconds. 2. The client whose hemoglobin is 14 g/dL and hematocrit is 45%. 3. The client whose platelet count is 75,000 per cubic millimeter of blood. 4. The client whose red blood cell count is 4.8 × 106/mm3.
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3. The client whose platelet count is 75,000 per cubic millimeter of blood. A platelet count of less than 100,000 per cubic millimeter of blood indicates thrombocytopenia.
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Which nursing interventions should the nurse implement when caring for a client diagnosed with hemophilia A? Select all that apply. 1. Instruct the client to use a razor blade to shave. 2. Avoid administering enemas to the client. 3. Encourage participation in noncontact sports. 4. Teach the client how to apply direct pressure if bleeding occurs. 5. Explain the importance of not flossing the gums
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2,3,4
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The client has a hematocrit of 22.3% and a hemoglobin of 7.7 g/dL. The HCP has ordered two (2) units of packed red blood cells to be transfused. Which interventions should the nurse implement? Select all that apply. 1. Obtain a signed consent. 2. Initiate a 22-gauge IV. 3. Assess the client's lungs. 4. Check for allergies. 5. Hang a keep-open IV of D5W
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1,3,4
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The client is admitted to the emergency department after a motor-vehicle accident. The nurse notes profuse bleeding from a right-sided abdominal injury. Which intervention should the nurse implement first? 1. Type and crossmatch for red blood cells immediately (STAT). 2. Initiate an IV with an 18-gauge needle and hang normal saline. 3. Have the client sign a consent for an exploratory laparotomy. 4. Notify the significant other of the client's admission.
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2. Initiate an IV with an 18-gauge needle and hang normal saline.
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The nurse is working in a blood bank facility procuring units of blood from donors. Which client would not be a candidate to donate blood? 1. The client who had wisdom teeth removed a week ago. 2. The nursing student who received a measles immunization two (2) months ago. 3. The mother with a six (6)-week-old newborn. 4. The client who developed an allergy to aspirin in childhood.
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3. The mother with a six (6)-week-old newborn.
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The client with O+ blood is in need of an emergency transfusion but the laboratory does not have any O+ blood available. Which potential unit of blood could be given to the client? 1. The O- unit. 2. The A+ unit. 3. The B+ unit. 4. Any Rh+ unit.
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1. The O- unit.
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The client is scheduled to have a total hip replacement in two (2) months and has chosen to prepare for autologous transfusions. Which medication would the nurse administer to prepare the client? 1. Prednisone, a glucocorticoid. 2. Zithromax, an antibiotic. 3. Ativan, a tranquilizer. 4. Epogen, a biologic response modifier
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4. Epogen, a biologic response modifier
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The client undergoing knee replacement surgery has a "cell saver" apparatus attached to the knee when he arrives in the post-anesthesia care unit (PACU). Which intervention should the nurse implement to care for this drainage system? 1. Infuse the drainage into the client when a prescribed amount fills the chamber. 2. Attach an hourly drainage collection bag to the unit and discard the drainage. 3. Replace the unit with a continuous passive motion unit and start it on low. 4. Have another nurse verify the unit number prior to reinfusing the blood.
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1. Infuse the drainage into the client when a prescribed amount fills the chamber.
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Which statement is the scientific rationale for infusing a unit of blood in less than four (4) hours? 1. The blood will coagulate if left out of the refrigerator for >four (4) hours. 2. The blood has the potential for bacterial growth if allowed to infuse longer. 3. The blood components begin to break down after four (4) hours. 4. The blood will not be affected; this is a laboratory procedure.
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2. The blood has the potential for bacterial growth if allowed to infuse longer.
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The HCP orders two (2) units of blood to be administered over eight (8) hours each for a client diagnosed with heart failure. Which intervention(s) should the nurse take? 1. Call the HCP to question the order because blood must infuse within four (4) hours. 2. Retrieve the blood from the laboratory and run each unit at an eight (8)-hour rate. 3. Notify the lab to split each unit into half-units and infuse each half for four (4) hours. 4. Infuse each unit for four (4) hours, the maximum rate for a unit of blood
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3. Notify the lab to split each unit into half-units and infuse each half for four (4) hours.
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The client receiving a unit of PRBCs begins to chill and develops hives. Which action should be the nurse's first response? 1. Notify the laboratory and health-care provider. 2. Administer the histamine-1 blocker, Benadryl, IV. 3. Assess the client for further complications. 4. Stop the transfusion and change the tubing at the hub.
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4. Stop the transfusion and change the tubing at the hub.
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The nurse and an unlicensed assistive personnel (UAP) are caring for clients on an oncology floor. Which nursing task would be delegated to the UAP? 1. Assess the urine output on a client who has had a blood transfusion reaction. 2. Take the first 15 minutes of vital signs on a client receiving a unit of PRBCs. 3. Auscultate the lung sounds of a client prior to a transfusion. 4. Assist a client who received 10 units of platelets in brushing the teeth.
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4. Assist a client who received 10 units of platelets in brushing the teeth.
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The nurse is caring for clients on a medical floor. After the shift report, which client should be assessed first? 1. The client who is two thirds of the way through a blood transfusion and has had no complaints of dyspnea or hives. 2. The client diagnosed with leukemia who has a hematocrit of 18% and petechiae covering the body. 3. The client with peptic ulcer disease who called over the intercom to say that he is vomiting blood. 4. The client diagnosed with Crohn's disease who is complaining of perineal discomfort.
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3. The client with peptic ulcer disease who called over the intercom to say that he is vomiting blood.
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The client received two (2) units of packed red blood cells of 250 mL with 63 mL of preservative each during the shift. There was 240 mL of saline remaining in the 500-mL bag when the nurse discarded the blood tubing. How many milliliters of fluid should be documented on the intake and output record? _____________
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886ml/hr 250 mL + 63 mL = 313 mL per unit 313 + 313 = 626 mL 500 mL of saline - 240 mL remaining = 260 mL infused. 626 mL + 260 mL = 886 mL of fluid infused
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The student nurse asks the nurse, "What is sickle cell anemia?" Which statement by the nurse would be the best answer to the student's question? 1. "There is some written material at the desk that will explain the disease." 2. "It is a congenital disease of the blood in which the blood does not clot." 3. "The client has decreased synovial fluid that causes joint pain." 4. "The blood becomes thick when the client is deprived of oxygen."
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4. "The blood becomes thick when the client is deprived of oxygen."
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The client's nephew has just been diagnosed with sickle cell anemia. The client asks the nurse, "How did my nephew get this disease?" Which statement would be the best response by the nurse? 1. "Sickle cell anemia is an inherited autosomal recessive disease." 2. "He was born with it and both his parents were carriers of the disease." 3. "At this time, the cause of sickle cell anemia is unknown." 4. "Your sister was exposed to a virus while she was pregnant."
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2. "He was born with it and both his parents were carriers of the disease."
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The client diagnosed with sickle cell anemia comes to the emergency department complaining of joint pain throughout the body. The oral temperature is 102.4˚F and the pulse oximeter reading is 91%. Which action should the emergency room nurse implement first? 1. Request arterial blood gases STAT. 2. Administer oxygen via nasal cannula. 3. Start an IV with an 18-gauge angiocath. 4. Prepare to administer analgesics as ordered.
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2. Administer oxygen via nasal cannula.
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The client diagnosed with sickle cell anemia is experiencing a vaso-occlusive sickle cell crisis secondary to an infection. Which medical treatment should the nurse anticipate the HCP ordering for the client? 1. Administer meperidine (Demerol) intravenously. 2. Admit the client to a private room and keep in reverse isolation. 3. Infuse D5W 0.33% NS at 150 mL/hr via pump. 4. Insert a 22-French Foley catheter with a urimeter.
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3. Infuse D5W 0.33% NS at 150 mL/hr via pump.
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The nurse is assessing an African American client diagnosed with sickle cell crisis. Which assessment datum is most pertinent when assessing for cyanosis in clients with dark skin? 1. Assess the client's oral mucosa. 2. Assess the client's metatarsals. 3. Assess the client's capillary refill time. 4. Assess the sclera of the client's eyes.
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1. Assess the client's oral mucosa.
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The client is diagnosed with sickle cell crisis. The nurse is calculating the client's intake and output (I & O) for the shift. The client had 20 ounces of water, eight (8) ounces of apple juice, three (3) cartons of milk with four (4) ounces each, 1,800 mL of IV fluids for the last 12 hours, and a urinary output of 1,200. What is the client's total intake for this shift? _____________
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3,000 mL. **The key is knowing that 1 ounce is equal to 30 mL. Then, 20 ounces (20 × 30) = 600 mL, 8 ounces (8 × 30) = 240 mL, and 4 ounces (4 × 30) = 120 × 3 cartons = 360 mL for a total of 600 + 240 + 360 = 1,200 mL of oral fluids. That, plus 1,800 mL of IV fluids, makes the total intake for this shift 3,000 mL.
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The nurse is caring for the female client recovering from a sickle cell crisis. The client tells the nurse her family is planning a trip this summer to Yellowstone National Park. Which response would be best for the nurse? 1. "That sounds like a wonderful trip to take this summer." 2. "Have you talked to your doctor about taking the trip?" 3. "You really should not take a trip to areas with high altitudes." 4. "Why do you want to go to Yellowstone National Park?"
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3. "You really should not take a trip to areas with high altitudes."
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Which is a potential complication that occurs specifically to a male client diagnosed with sickle cell anemia during a sickle cell crisis? 1. Chest syndrome. 2. Compartment syndrome. 3. Priapism. 4. Hypertensive crisis.
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3. Priapism.
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The nurse is completing discharge teaching for the client diagnosed with a sickle cell crisis. The nurse recommends the client getting the flu and pneumonia vaccines. The client asks, "Why should I take those shots? I hate shots." Which statement by the nurse is the best response? 1. "These vaccines promote health in clients with chronic illnesses." 2. "You are susceptible to infections. These shots may help prevent a crisis." 3. "The vaccines will help your blood from sickling secondary to viruses." 4. "The doctor wanted to make sure that I discussed the vaccines with you."
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2. "You are susceptible to infections. These shots may help prevent a crisis."
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The client diagnosed with sickle cell anemia asks the nurse, "Should I join the Sickle Cell Foundation? I received some information from the Sickle Cell Foundation. What kind of group is it?" Which statement is the best response by the nurse? 1. "It is a foundation that deals primarily with research for a cure for SCA." 2. "It provides information on the disease and on support groups in this area." 3. "I recommend joining any organization that will help deal with your disease." 4. "The foundation arranges for families that have children with sickle cell to meet."
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2. "It provides information on the disease and on support groups in this area."
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Which sign/symptom will the nurse expect to assess in the client diagnosed with a vaso-occlusive sickle cell crisis? 1. Lordosis. 2. Epistaxis. 3. Hematuria. 4. Petechiae.
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3. Hematuria.
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The male client with sickle cell anemia comes to the emergency room with a temperature of 101.4˚F and tells the nurse that he is having a sickle cell crisis. Which diagnostic test should the nurse anticipate the emergency room doctor ordering for the client? 1. Spinal tap. 2. Hemoglobin electrophoresis. 3. Sickle-turbidity test (Sickledex). 4. Blood cultures.
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4. Blood cultures.
