Question 1

The nurse is caring for a client with an acute exacerbation of polycythemia vera. Which of the following actions should the nurse implement during treatment?

Accepted Answer

A) Place the client on bed rest. 
B) Administer iron supplements. 
C) Avoid use of Aspirin products. 
D) Monitor fluid intake and output.

Question 2

Which of the following laboratory tests should the nurse use to determine whether the prescribed filgrastim is effective in the treatment of a client who is receiving chemotherapy for acute lymphocytic leukemia?

Accepted Answer

A) Platelet count 
B) Reticulocyte count 
C) Total lymphocyte count 
D) Absolute neutrophil count

Question 3

Which of the following statements by a client with sickle cell anemia indicates good understanding of the nurse's teaching about prevention of sickle cell crisis?

Accepted Answer

A) "Home oxygen therapy is frequently used to decrease sickling." 
B) "There are no effective medications that can help prevent sickling." 
C) "Routine continuous dosage narcotics are prescribed to prevent a crisis." 
D) "Risk for a crisis can be lowered by having an annual influenza vaccination."

Question 4

The nurse is caring for a client with acute myelogenous leukemia (AML) who is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT). Which of the following actions is best for the nurse to implement to assist the clientwith treatment decisions?

Accepted Answer

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

Question 5

The nurse is caring for a client who has been receiving a heparin infusion and warfarin for a deep vein thrombosis (DVT) with a diagnosis of heparin-induced thrombo-cytopenia (HIT). Which of the following actions should the nurse include in the plan ofcare?

Accepted Answer

A) Use low-molecular-weight heparin (LMWH) only. 
B) Flush all intermittent IV lines using normal saline. 
C) Administer the warfarin at the scheduled time. 
D) Teach the client about the purpose of platelet transfusions.

Question 6

Which of the following nursing actions should the nurse include in the plan of care for a client admitted with multiple myeloma?

Accepted Answer

A) Monitor fluid intake and output. 
B) Administer calcium supplements. 
C) Assess lymph nodes for enlargement. 
D) Limit weight bearing and ambulation.

Question 7

The nurse is caring for a client with anemia who is experiencing increased fatigue and occasional palpitations at rest. Which of the following laboratory findings should the nurse expect?

Accepted Answer

A)  Normal red blood cell (RB
C)  indices 
B)  Hematocrit (Hct) of 38% 
C)  Hemoglobin (Hb) of 86 g/L 
D)  RBC count of 4.5 * 10¹²/L

Question 8

Which of the following nursing interventions should be included in the care plan for a client with immune thrombo-cytopenic purpura (ITP)?

Accepted Answer

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

Question 9

The nurse is caring for a client with von Willebrand disease who is admitted to the hospital for minor knee surgery. Which of the following laboratory information should the nurse assess?

Accepted Answer

A) Platelet count 
B) Bleeding time 
C) Thrombin time 
D) Prothrombin time

Question 10

After receiving change-of-shift report for the following four clients with neutropenia, which client should the nurse assess first?

Accepted Answer

A) 66-year-old who has white pharyngeal lesions 
B) 35-year-old who has a fever of 38.2°C (100.8°F) 
C) 56-year-old who has frequent explosive diarrhea 
D) 23-year old who is complaining of severe fatigue

Question 11

Which of the following actions should the nurse include in the care plan for a hospitalized client who is neutropenic?

Accepted Answer

A) Avoid any IM or subcutaneous injections. 
B) Check the oral temperature every 4 hours. 
C) Omit all fruits or vegetables from the diet. 
D) Place a "No Visitors" sign on the client door.

Question 12

The nurse is caring for a client with myelodysplastic syndrome who has 20% blasts in marrow and the health care provider has prescribed high-intensity treatment. Which of the following treatments should the nurse prepare the client to receive?

Accepted Answer

A) Antibiotics 
B) Antifungals 
C) Chemotherapy 
D) A blood transfusion

Question 13

Fifteen minutes after a transfusion of packed red blood cells is started, a client has symptoms of back pain and dyspnea and a pulse rate of 124 beats/minute. Which of the following actions should the nurse implement initially?

Accepted Answer

A) Administer oxygen therapy at a high flow rate. 
B) Obtain a urine specimen to send to the laboratory. 
C) Notify the health care provider about the symptoms. 
D) Disconnect the transfusion and infuse normal saline.

Question 14

The nurse is caring for a client with septicemia who develops prolonged bleeding from venipuncture sites and blood in the stools. Which of the following actions is most important for the nurse to take?

Accepted Answer

A) Notify the client's health care provider. 
B) Avoid unnecessary venipunctures. 
C) Apply sterile dressings to the sites. 
D) Give prescribed proton-pump inhibitors.

Question 15

A routine complete blood count indicates that a client may have myelodysplastic syndrome. At this time, which of the following information should the nurse include in the teaching plan?

Accepted Answer

A) Packed red blood cells (PRBCs) transfusion 
B) Bone marrow biopsy 
C) Filgrastim administration 
D) Erythropoietin administration

Question 16

The nurse is planning discharge teaching for a client who was admitted with neutropenia. Which of the following instructions should the nurse include?

Accepted Answer

A) Limit fluids to 2-3 litres a day. 
B) Include eggs and fish in the diet. 
C) Avoid exposure to crowds as much as possible. 
D) Drink only one or two caffeinated beverages daily.

Question 17

The nurse is caring for a client with non-Hodgkin's lymphoma who develops a platelet count of 38 * 109/L during chemotherapy. Which of the following actions should the nurse implement based on this finding?

Accepted Answer

A) Provide oral hygiene every 2 hours. 
B) Check all stools for occult blood. 
C) Assess temperature every 4 hours. 
D) Encourage fluids to 3 000 mL/day.

Question 18

The nurse is caring for a client who has a history of a transfusion-related acute lung injury (TRALI) and is to receive a transfusion of packed red blood cells (PRBCs). Which of the following actions should the nurse take to decrease the risk for TRALIforthis client?

Accepted Answer

A) Infuse the PRBCs slowly over 4 hours. 
B) Transfuse only leukocyte-reduced PRBCs. 
C) Administer the scheduled oral diuretic before the transfusion. 
D) Give the PRN dose of antihistamine before starting the transfusion.

Question 19

The nurse is caring for a client who is receiving methotrexate and develops a megaloblastic anemia. Which of the following nutrients should the nurse include in the teaching plan?

Accepted Answer

A) Iron 
B) Folic acid 
C) Cobalamin (vitamin B12) 
D) Ascorbic acid (vitamin 
C)

Exam 33: Nursing Management Hematological Problems