Question 1

A patient walks into the urgent care clinic,stating that he has hemophilia and that he is bleeding.The triage nurse does a quick assessment and sees no signs of active bleeding.Several patients are already in the waiting area.Which action by the nurse is most appropriate?

Accepted Answer

A)   Palpate the suspected area for tenderness and edema.
B)   Ask the patient to sit in the waiting room until his name is called.
C)   Place the patient in an examination room and tell the physician that the patient may be bleeding.
D)   Send the patient for routine x-rays according to clinic protocol to look for a source of bleeding, and then place him in an examination room. C

Question 2

The nurse is caring for a patient in sickle cell crisis.What is the rationale for providing warm compresses and blankets for this patient?

Accepted Answer

A)   Sickle cell crisis causes shivering and discomfort.
B)   Heat helps prevent the cells from becoming sickled.
C)   Heat speeds production of new healthy RBCs.
D)   Heat prevents vasoconstriction and impaired circulation. D

Question 3

A patient is diagnosed with anemia and asks the nurse what nutrients are important for RBC formation.The nurse bases an answer on the understanding that which nutrients are essential for production of healthy red cells?

Accepted Answer

A)   Iron, folic acid, and vitamin B12
B)   Vitamin C, vitamin D, and selenium
C)   Vitamin A, calcium, and phosphorus
D)   Aluminum, vitamin E, and beta carotene A

Question 4

A patient who has had a splenectomy complains of malaise.The nurse checks the patient's temperature and finds it is 102°F (39°C).Which action by the nurse should take priority?

Accepted Answer

A)   Notify the physician.
B)   Encourage fluids to reduce fever and prevent dehydration.
C)   Administer acetaminophen to reduce fever and relieve discomfort.
D)   Explain to the patient that low-grade fevers are common after splenectomy because the spleen is part of the immune system.

Question 5

A patient is being tested for possible leukemia.With which diagnostic test should the nurse anticipate assisting?

Accepted Answer

A)   Liver biopsy
B)   Thoracentesis
C)   Bone marrow biopsy
D)   Arterial blood gas analysis

Question 6

The nurse is collaborating on discharge teaching needed for a patient recovering from a splenectomy.What follow-up care is most important for the nurse to emphasize with this patient?

Accepted Answer

A)   Monthly coagulation studies
B)   Yearly influenza vaccination
C)   Oral analgesics for pain control
D)   Routine transfusion of packed RBCs to prevent anemia

Question 7

The nurse is identifying approaches to reduce the risk of infection in a patient with leukemia.Why is it important for the nurse to institute infection control measures for this patient?

Accepted Answer

A)   Infection can precipitate hemorrhage in the patient with leukemia.
B)   The drugs needed to fight infection have life-threatening side effects.
C)   Infection in the patient with leukemia can lead to permanent neurological damage.
D)   Leukemia seriously impairs the leukocytes and the body's ability to fight infection.

Question 8

A patient with multiple myeloma is at risk for hypercalcemia.Which nursing intervention is most important for the patient with hypercalcemia?

Accepted Answer

A)   Encourage fluids.
B)   Offer citrus juices and fruits.
C)   Place the patient on a low-sodium diet.
D)   Discourage intake of alcoholic beverages.

Question 9

A patient with terminal lymphoma says to the nurse,"I'm tired of being so fatigued all the time.Can't you just give me a big shot of morphine and help me end this suffering?" Which response by the nurse is most appropriate?

Accepted Answer

A)   "You sound frustrated. It must be difficult to feel so tired all the time."
B)   "Are you sure that is what you want me to do? Maybe you should think about it first."
C)   "That is really not appropriate to ask. Would you like a shot just to take away the pain?"
D)   "You have orders for morphine 10 to 15 mg. I don't think that's enough to end your suffering."

Question 10

The nurse is preparing to provide care to a patient recovering from surgery.What nursing action is the best way to prevent infection in a postoperative patient?

Accepted Answer

A)   Practice good hand washing.
B)   Encourage 2 L of fluid daily.
C)   Change wound dressings daily.
D)   Assess vital signs every 4 hours.

Question 11

A patient with hemophilia A is bleeding.Which treatment should the nurse anticipate being prescribed for this patient?

Accepted Answer

A)   IV infusion of factor IX
B)   IM injection of factor IX
C)   IV infusion of factor VIII
D)   IM injection of factor VIII

Question 12

The nurse is caring for a patient with a clotting disorder.Which blood product should the nurse anticipate being prescribed?

Accepted Answer

A)   Albumin
B)   Normal saline
C)   Cryoprecipitates
D)   Packed WBCs

Question 13

The nurse is caring for a patient scheduled for tests to confirm the diagnosis of lymphoma.For which diagnostic tests should the nurse prepare the patient? (Select all that apply.)

Accepted Answer

A)   CT scan
B)   Cerebral angiogram
C)   Lymph node biopsy
D)   Lymphangiography
E)   Complete blood count

Question 14

The nurse is providing education to an individual with sickle cell anemia.Which activities should the nurse instruct the patient to avoid? (Select all that apply.)

Accepted Answer

A)   Scuba diving
B)   Contact sports
C)   Sexual activity
D)   Long-distance driving
E)   Skiing in the mountainsF)  Standing for long periods

Question 15

The nurse is preparing to give an injection of iron (Imferon)to a patient with anemia.What is the rationale for using the Z-track method for injection?

Accepted Answer

A)   Prevent pain at the site
B)   Prevent tissue damage at the site
C)   Promote absorption of the medication
D)   Prevent discoloration of tissue at the site

Question 16

A patient with lymphoma wants to attend a family member's wedding but is extremely fatigued.The nurse develops a plan for Activity Intolerance related to symptoms of lymphoma.How will the nurse know if the plan has been effective?

Accepted Answer

A)   The patient is able to sleep 8 hours at night.
B)   The patient can list three ways to combat fatigue.
C)   The patient attends the family member's wedding.
D)   The patient verbalizes understanding of the importance of gradually increasing activity.

Question 17

A patient with thrombocytopenia is having pain.If each of the following medications is ordered,which should the nurse choose to administer?

Accepted Answer

A)   Morphine SQ
B)   Meperidine (Demerol)  IM
C)   Oxycodone with aspirin (Percodan)  PO
D)   Acetaminophen with codeine (Tylenol No. 3)  PO

Question 18

The nurse is caring for a patient with anemia.Which blood component is deficient in this patient?

Accepted Answer

A)   Plasma
B)   Platelets
C)   Red blood cells (RBCs) 
D)   White blood cells (WBCs)

Question 19

A patient with Hodgkin's disease has cervical lymph node enlargement.Which symptom should the nurse attend to first?

Accepted Answer

A)   Pain
B)   Fever
C)   Stridor
D)   Fatigue

Question 20

The nurse is assessing a patient with stage III Hodgkin's disease.Where should the nurse expect to find enlarged lymph nodes?

Accepted Answer

A)   In the neck only
B)   Above the diaphragm only
C)   Below the diaphragm only
D)   Generalized throughout the body

Exam 28: Nursing Care of Patients With Hematologic and Lymphatic Disorders