chapter 33- assessment and management of patients with hematologic

Page 9Page 1Chapter 33- Assessment and Management of Patients With Hematologic1.The nurse informs a patient who asks where the body forms blood cells responds that blood cells are formed in the:A) Spleen B) Kidneys C) Bone marrow D) LiverAns:CDifficulty:Easy2.A patient complains of a heavy menstrual flow. Because red blood cell production increases during menstruation, the nurse is aware that the patient may need to increase her daily intake of:A) Vitamin C B) Vitamin D C) Iron D) MagnesiumAns:CDifficulty:Moderate3.A patient receives an injury to the skin that causes minor blood loss. Primary hemostasis is activated, during which:A)Severed blood vessels constrict.C)Prothrombin is converted to thrombin.B)Thromboplastin is released.D)Fibrin is lysed.Ans:ADifficulty:Moderate4.A patient is diagnosed with a hypoproliferative anemia. The nurse is aware that this type of anemia is due to:A)Lack of production of RBCsC)Injury to the RBCs in circulationB)Loss of RBCsD)Abnormality of RBCsAns:ADifficulty:Easy5.A patient reports symptoms of fatigue and pica. Laboratory findings reveal a low serum iron level and a low ferritin level. Upon evaluation of this assessment and laboratory data, the nurse suspects that the patient will be diagnosed with:A)Iron deficient anemiaC)Sickle cell anemiaB)Pernicious anemiaD)Hemolytic anemiaAns:ADifficulty:Moderate6.A patient is admitted with sickle cell anemia. The nurse is aware that the care of this patient often requires:A)Chronic transfusions with RBCsC)Vitamin B12 replacementB)Platelet transfusionsD)PhlebotomyAns:ADifficulty:Moderate7.To prevent abuse of analgesics in a patient with sickle cell anemia, the nurse encourages the patient to:A)Seek care from a variety of sources for pain relief.B)Seek care from a single provider for pain relief.C)Accept chronic pain being continually present as a fact of the disease.D)Limit the reporting of emergency department visits to the primary health care provider.Ans:BDifficulty:Easy8.A patient with iron-deficiency anemia states that she has minimal energy and finds it difficult to manage the household and work. The most appropriate intervention for the nurse to take to manage the fatigue is to:A)Encourage the patient to stop working.B)Encourage the patient to do minimal to no physical activity.C)Assist the patient to prioritize activities and establish an activity/rest schedule.D)Instruct the patient to perform activities only in the evening.Ans:CDifficulty:Moderate9.When assessing a patient with anemia, the nurse notes that the patient has developed peripheral numbness and poor coordination. The patient's family states that the patient appears to be confused at times at home. Neurologic symptoms most often accompany which type of anemia?A)Iron deficiency anemiaC)Pernicious anemiaB)Folic acid deficiencyD)Thalassemia majorAns:CDifficulty:Moderate10.The nurse expects the patient diagnosed with polycythemia vera to display which of the following manifestations of the disease?A)Elevated red blood cells and splenomegalyB)Lowered hematocrit and splenomegalyC)Lowered hematocrit and jaundiceD)Elevated red blood cells and jaundiceAns:ADifficulty:Difficult11.A nurse is explaining to a patient the common feature of leukemia, which is:A)Unregulated proliferation of white blood cellsB)Unregulated proliferation of red blood cell.C)Decrease in production of white blood cellsD)Decrease in production of red blood cellsAns:ADifficulty:Moderate12.A patient has been diagnosed with acute myeloid leukemia (AML). The nurse anticipates that the plan of care for this patient will most likely include:A)Aggressive chemotherapy treatmentC)Treatment with vancomycinB)Chronic albumin transfusionD)Interferon injectionsAns:ADifficulty:Moderate13.A 70-year-old patient is diagnosed with chronic lymphocytic leukemia (CLL). The nurse assesses the patient for which condition that may be associated with CLL?A)ConfusionC)Enlargement of lymph nodesB)Renal colicD)Hyperplasia of the gumsAns:CDifficulty:Moderate14.When caring for a patient with acute myeloid leukemia (AML) who is neutropenic, the nurse is aware that, if possible, the patient should not be given which of the following medications?A) Aspirin B) Acetaminophen C) Furosemide D) Oral laxativesAns:ADifficulty:Moderate15.When caring for a patient with acute leukemia, the nurse should monitor which of the following laboratory results to assess the risk for infection:A)Creatinine levelsC)Electrolyte levelsB)Hepatic function testsD)WBC countAns:DDifficulty:Easy16.A nurse is caring for a patient who is being discharged after treatment for acute leukemia. To manage mucositis and painful mucous membranes, the nurse should instruct the patient to eat:A)Soft-textured food, such as meatloafB)Raw fruits, such as applesC)Raw vegetables, such as eggplantD)Foods with vitamin C, such as grapefruitsAns:ADifficulty:Moderate17.When caring for a patient with terminal acute myeloid leukemia (AML) receiving supportive care at home, the home care nurse should ensure that the family:A)Avoids grieving while the patient is livingB)Is informed about complications of infection and bleedingC)Provides all levels of care all the timeD)Encourages the patient to seek other treatmentsAns:BDifficulty:Moderate18.When caring for a patient with multiple myeloma who is experiencing bone destruction, the nurse should assess for signs of:A)HypercalcemiaC)Elevated serum viscosityB)Hyperproteinemia.D)Elevated RBC countAns:ADifficulty:Moderate19.A patient is diagnosed with thrombocytopenia. The nurse should explain to the patient that with this condition, there could be:A)An attack on the platelets by the antibodiesB)Decreased production of plateletsC)Elevated platelet productionD)Decreased white blood cell productionAns:BDifficulty:Moderate20.When caring for a patient with hemophilia, the nurse notes that the patient has developed joint pain in the left knee. Which of the following is an appropriate nursing intervention for the joint pain?A)Apply heat to the joint.B)Apply a cold compress to the joint.C)Encourage the patient to exercise the joint.D)Administer aspirin for pain.Ans:BDifficulty:Moderate21.A patient with autoimmune hemolytic anemia is not responding to conservative treatments. His condition is now becoming life threatening. The nurse is aware that a treatment option in this case may include:A)Hepatectomy.C)Platelet transfusionB)Vitamin K administrationD)SplenectomyAns:DDifficulty:Moderate22.Fifteen minutes after the infusion of packed red blood cells (RBCs) has begun, the patient complains of difficulty breathing and chest tightness. The most appropriate initial action for the nurse to take is:A)Notify the patient's physician.B)Stop the transfusion immediately.C)Remove the patient's intravenous access.D)Assess the patient's chest sounds and vital signs.Ans:BDifficulty:Moderate23.The nurse is preparing to administer a unit of blood to a patient diagnosed with anemia. After removing the blood from the refrigerator, the nurse should administer the blood within:A) 1 hour B) 2 hours C) 4 hours D) 6 hoursAns:CDifficulty:Moderate24.A patient is undergoing diagnostic testing for multiple myeloma. Diagnostic test findings indicative of multiple myeloma include:A)A decreased serum creatinine levelC)Bence-Jones protein in the urineB)HypocalcemiaD)A low serum protein levelAns:CDifficulty:Easy25.The nurse assessing a patient with multiple myeloma should keep in mind that patients with multiple myeloma are at risk for:A)Chronic liver failureC)Pathologic bone fracturesB)Acute heart failureD)HypoxemiaAns:CDifficulty:Moderate26.A patient is receiving chemotherapy for cancer. The nurse reviews the laboratory data and notes that he has thrombocytopenia. Which nursing diagnosis should be given the highest priority?A)Activity intoleranceB)Impaired tissue integrityC)Impaired oral mucous membranesD)Ineffective tissue perfusion (cerebral, cardiopulmonary, GI)Ans:DDifficulty:Moderate27.While monitoring a patient for the development of disseminated intravascular coagulation (DIC), the nurse should take note of what assessment parameters?A)Platelet count, prothrombin time (PT), and partial thromboplastin time (PTT)B)Platelet count, blood glucose level, and white blood cell (WBC) countC)Thrombin time, calcium level, and potassium levelD)Fibrinogen level, WBC count, and platelet countAns:ADifficulty:Difficult28.When teaching safety precautions to a patient with thrombocytopenia, the nurse should include which of the following directives?A)Eat foods high in iron.B)Avoid products that contain aspirin.C)Avoid people with respiratory tract infections.D)Eat only cooked vegetables.Ans:BDifficulty:Moderate29.A 50-year-old male with a diagnosis of leukemia is responding poorly to treatment. He's tearful and trying to express his feelings, but he's having difficulty. The nurse's first action should be to:A)Tell him that she'll leave for now but she'll be back.B)Offer to call pastoral care.C)Ask if he would like her to sit with him while he collects his thoughts.D)Tell him that she can understand how he's feeling.Ans:CDifficulty:Moderate30.A patient with renal failure has decreased erythropoietin production. Upon analysis of the patient's complete blood count, the nurse will expect which of the following complete blood count results?A)Increased hemoglobin and hematocritC)Decreased MCV and MCHB)Decreased hemoglobin and hematocritD)Increased MCV and MCHAns:BDifficulty:Difficult31.Which of the following values will be decreased in a patient with disseminated intravascular coagulation (DIC)?A)Platelet count and fibrinogenB)Prothrombin time and partial thromboplastin timeC)Thrombin time and fibrinogenD)D-dimer and fibrin degradation productsAns:ADifficulty:Difficult32.A patient with iron deficiency anemia has been prescribed iron supplements. When providing information to the patient on iron administration, which of the following statements will the nurse include in her teaching?A)Take the iron with dairy products to enhance absorption.B)Increase the intake of vitamin E to enhance absorption.C)Iron will cause the stools to darken in color.D)Limit foods high in fiber due to the risk for diarrhea.Ans:CDifficulty:Moderate33.A patient with acute myeloid leukemia requires neutropenic precautions. Upon inspection of his dinner tray, the nurse determines that which of the following foods should be removed from the tray due to the neutropenic precautions?A)Mashed potatoesC)Lettuce and tomato saladB)Baked chickenD)Jell-O with whipped creamAns:CDifficulty:Moderate34.While administering a packed red blood cell transfusion, the patient becomes restless, febrile, and complains of nausea. The nurse's initial response to these symptoms is to:A)Stop the transfusionB)Notify the physicianC)Decrease the drip rate of the blood transfusionD)Obtain the patient's vital signsAns:ADifficulty:Difficult35.Plasminogen is a component necessary in the clotting cascade. Plasminogen is present in:A)Myocardial muscle tissueC)Cerebral tissueB)All body fluidsD)Renal tissueAns:BDifficulty:Easy36.Upon assessment, the nurse observes the patient's tongue to be red and smooth. The patient complains that the tongue is sore. Based upon assessment findings, the nurse is aware that he is demonstrating symptoms associated with:A)Sickle cell anemiaC)Megaloblastic anemiaB)Hemolytic anemiaD)Aplastic anemiaAns:CDifficulty:Moderate37.A patient with symptoms related to secondary polycythemia caused by renal cell carcinoma is not a surgical candidate and has elected not to start chemotherapy or radiation therapy due to the low success rates of these treatment modalities. The nurse recognizes that management of the symptoms of secondary polycythemia will likely require:A)A transfusion of packed red blood cellsB)Therapeutic phlebotomyC)High-dose vitamin and iron therapyD)Administration of corticosteroid therapyAns:BDifficulty:Difficult38.A patient with acute myeloid leukemia is preparing to undergo induction therapy. In preparing a care plan for this patient, the nurse will assign the highest priority to which of the following nursing diagnoses?A)Activity intoleranceC)Disturbed processesB)Risk for infectionD)Risk for spiritual distressAns:BDifficulty:Moderate39.The nurse is preparing to administer oral care to a patient with mucositis. Which of the following supplies will she gather?A)Sponge-tipped applicatorC)Medium-bristled toothbrushB)Antibacterial mouthwashD)Lemon-glycerin swabsAns:ADifficulty:Difficult40.While performing a physical assessment on a patient diagnosed with agnogenic myeloid metaplasia, the nurse will anticipate palpating enlargement of which organ(s)?A) Heart B) Liver C) Kidneys D) SpleenAns:DDifficulty:Moderate41.An oncology nurse is aware that which of the following individuals is at the greatest risk for the development of Hodgkin's disease?A)The spouse of a patient with Hodgkin's diseaseB)A patient with a liver transplant on immunosuppressive therapyC)A patient with heart failure on diuretic therapyD)A patient who works on a fishing boatAns:BDifficulty:Moderate42.What classic presenting symptom associated with multiple myeloma would the nurse assess for?A) Liver dysfunction B) Bone pain C) Serum hypocalcemia D) NauseaAns:BDifficulty:Moderate43.Upon analysis of laboratory data of a patient with multiple myeloma, the nurse expects to observe which of the following findings?A)Serum hypokalemiaC)Serum hyponatremiaB)Serum hypercalcemiaD)Serum hypermagnesemiaAns:BDifficulty:Easy44.During a teaching session with a patient diagnosed with primary thrombocythemia, the nurse correctly instructs the patient to:A)Decrease cardiac risks by drinking a glass of red wine nightlyB)Take Coumadin dailyC)Administer interferon-alfa-2b subcutaneouslyD)Take NSAIDs at the earliest sign of painAns:CDifficulty:Moderate