Question 1

The nurse suspects the development of heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) when a patient receiving heparin

Accepted Answer

A)   develops a pancytopenia.
B)   has a platelet count of 200,000/ml.
C)   develops a spiking temperature and chills.
D)   has decreasing activated partial thromboplastin times. D

Question 2

Which nursing intervention will be included in the care plan for a patient with ITP?

Accepted Answer

A)   Use rinses rather than a toothbrush for oral care.
B)   Restrict activity to passive and active range of motion.
C)   Place patient in a private room.
D)   Avoid intramuscular (IM)  and subcutaneous injections. D

Question 3

Fifteen minutes after a transfusion of packed red cells is started, a patient develops tachycardia and tachypnea and complains of back pain and feeling warm. The nurse first action should be to

Accepted Answer

A)   disconnect the transfusion and infuse normal saline.
B)   obtain a urine specimen to send to the laboratory.
C)   administer oxygen therapy at a high flow rate.
D)   notify the health care provider about the transfusion reaction. A

Question 4

A patient with von Willebrand's disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the

Accepted Answer

A)   bleeding time.
B)   platelet count.
C)   prothrombin time.
D)   thrombin time.

Question 5

A patient with chronic lymphocytic leukemia is hospitalized for treatment of severe hemolytic anemia. An appropriate nursing intervention for the patient is to

Accepted Answer

A)   provide a diet high in vitamin K.
B)   isolate the patient from visitors.
C)   plan care to alternate periods of rest and activity.
D)   encourage increased intake of fluid and fiber in the diet.

Question 6

A patient receiving a whole-blood transfusion develops chills and fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, the nurse will plan to

Accepted Answer

A)   send a urine specimen to the laboratory.
B)   administer acetaminophen (Tylenol) .
C)   give diphenhydramine (Benadryl) .
D)   draw blood for a new cross-match.

Question 7

A patient is admitted to the hospital with idiopathic aplastic anemia. An appropriate collaborative problem for the nurse to identify for the patient is

Accepted Answer

A)   potential complication: hemorrhage.
B)   potential complication: neurogenic shock.
C)   potential complication: pulmonary edema.
D)   potential complication: seizures.

Question 8

A patient with newly diagnosed leukemia is receiving chemotherapy. Which intervention will the nurse include in the plan of care?

Accepted Answer

A)   Avoid the intake of fresh fruits and vegetables.
B)   Administer oral prophylactic antibiotics.
C)   Teach visitors hand washing techniques.
D)   Place the patient in a laminar airflow room.

Question 9

During treatment of the patient with an acute exacerbation of polycythemia vera, a critical action by the nurse is to

Accepted Answer

A)   check oxygen saturation q4hr.
B)   monitor fluid intake and output.
C)   place the patient on bed rest.
D)   administer iron supplements.

Question 10

A patient with sickle cell anemia is admitted to the hospital with a sickle cell crisis. While caring for the patient during the crisis, it is important for the nurse to

Accepted Answer

A)   limit the patient's intake of oral and IV fluids.
B)   evaluate the effectiveness of opioid analgesics.
C)   encourage the patient to ambulate as much as tolerated.
D)   teach the patient about high-protein, high-calorie foods.

Question 11

After teaching the patient about taking oral iron preparations for a moderate iron-deficiency anemia, the nurse determines that additional instruction is needed when the patient says,

Accepted Answer

A)   "I will call the doctor if my stools start to turn black."
B)   "I will take a stool softener if I feel constipated occasionally."
C)   "I will increase my fluid and fiber intake while I am taking the iron tablets."
D)   "I should take the iron with orange juice about an hour before eating."

Question 12

Which of these assessment data obtained by the nurse when caring for a patient with thrombocytopenia should be immediately communicated to the health care provider?

Accepted Answer

A)   Platelet count is 52,000/ml.
B)   There are bullae on the oral mucosa.
C)   The patient is difficult to arouse.
D)   There are large bruises on the back.

Question 13

The nurse is caring for a patient ITP who has an order for a platelet transfusion. Which patient information indicates that the nurse should consult with the health care provider before administering platelets?

Accepted Answer

A)   Petechiae are present on the chest and back.
B)   Blood pressure (BP)  is 94/56 mm Hg.
C)   Platelet count is 42,000/ml.
D)   Blood is oozing from the venipuncture site.

Question 14

A patient with a history of iron-deficiency anemia who has not taken iron supplements for several years is experiencing increased fatigue and occasional palpitations. The nurse would expect the patient's laboratory findings to include

Accepted Answer

A)   hematocrit (Hct)  38%.
B)   red blood cell count (RB
C)   4,500,000/ml.
C)   hemoglobin (Hb)  8.6 g/dl (86 g/L) .
D)   normal RBC indices.

Question 15

A 45-year-old patient with chronic myelogenous leukemia (CML) is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT) from an HLA-matched sibling. To assist the patient with treatment decisions, the best approach for the nurse to use is to

Accepted Answer

A)   emphasize the positive outcomes of a bone marrow transplant.
B)   ask the patient whether there are any questions or concerns about HSCT.
C)   explain that a cure is not possible with any other treatment except HSCT.
D)   discuss the need for adequate insurance to cover post-HSCT care.

Question 16

During the admission assessment of a patient who has an Hb of 7.6 g/dl (76 g/L), the nurse notes jaundice of the sclera. The nurse will plan to check the laboratory results for

Accepted Answer

A)   the stool occult blood test.
B)   the bilirubin level.
C)   the gastric analysis testing.
D)   the Schilling test.

Question 17

The most appropriate nursing intervention to include in the care plan for a patient with neutropenia is to

Accepted Answer

A)   omit fresh fruits or vegetables from the diet.
B)   check the temperature q4hr.
C)   avoid any IM or subcutaneous injections.
D)   assess all wounds for redness and drainage.

Question 18

When discussing appropriate food choices with a patient who has iron-deficiency anemia and follows a low-cholesterol diet, the nurse will encourage the patient to increase the dietary intake of

Accepted Answer

A)   eggs and muscle meats.
B)   nuts and cornmeal.
C)   milk and milk products.
D)   legumes and dried fruits.

Question 19

The nurse caring for a patient with hemophilia teaches the patient to seek immediate medical attention upon experiencing

Accepted Answer

A)   sore throat.
B)   skin abrasions.
C)   bleeding gums.
D)   dark tarry stools.

Question 20

A 22-year-old patient with acute myelogenous leukemia develops neutropenia after receiving outpatient chemotherapy. Which action by the nurse in the outpatient clinic is most appropriate?

Accepted Answer

A)   Plan to admit the patient to the hospital for treatment of the neutropenia.
B)   Schedule the patient to come into the hospital daily for filgrastim (Neupogen)  injections.
C)   Teach the patient or family how to administer filgrastim (Neupogen)  injections at home.
D)   Obtain a high-efficiency particulate-air (HEP
A)   filter for the patient to use at home.

Exam 31: Nursing Management: Hematologic Problems