Nursing Care for Anemia and Related Blood Disorders, Exams of Nursing

Download Nursing Care for Anemia and Related Blood Disorders and more Exams Nursing in PDF only on Docsity! Chapter 30 Hematologic Problems Exam Questions with Answers Latest Update An adult male with chronic anemia is experiencing increased fatigue and occasional Palpitations at rest. Which laboratory data would the nurse identify as consistent with these symptoms? a. RBC count of 4,500,000/L b. Hematocrit (Hct) value of 38% c. Normal red blood cell (RBC) indices d. Hemoglobin (Hgb) of 8.6 g/dL (86 g/L) - Correct answer ANS: D The patient's symptoms indicate moderate anemia, which is consistent with a Hgb of 6 to 10 g/dL. The other values are all within the range of normal. Which menu choice indicates that the patient understands the nurse's recommendations about dietary choices for iron-deficiency anemia? a. Omelet and whole wheat toast b. Cantaloupe and cottage cheese c. Strawberry and banana fruit plate d. Cornmeal muffin and orange juice - Correct answer ANS: A Eggs and whole grain breads are high in iron. The other choices are appropriate for other nutritional deficiencies but are not the best choice for a patient with iron-deficiency anemia. A patient who is receiving methotrexate for severe rheumatoid arthritis develops a Megaloblastic anemia. Which nutrient supplement should the nurse plan to explain to the patient? a. Iron b. Folic acid c. Coalmine (vitamin B12) d. Ascorbic acid (vitamin C) - Correct answer ANS: B Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements are the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia. Which patient statement to the nurse indicates that the patient understands self-care for pernicious anemia? a. "I need to start eating more red meat and liver." b. "I will stop having a glass of wine with dinner." c. "I could choose nasal spray rather than injections of vitamin B12." d. "I will need to take a proton pump inhibitor such as omeprazole (Prilosec)." - Correct answer ANS: C Because pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of coalman. Alcohol use does not cause coalman deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitamin Which is an appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia? a. Provide a diet high in vitamin K. b. Teach the patient how to avoid injury. c. Encourage alternating rest and activity. d. Place the patient on protective isolation. - Correct answer ANS: C Nursing care for patients with anemia should alternate periods of rest and activity to avoid undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in vitamin K or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia. Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate? a. "I could take a stool softener if I feel constipated." b. "I can take the iron with orange juice before eating." c. "I should notify my health care provider if my stools turn black." d. "I will increase my fluid and fiber intake while I am taking iron." - Correct answer ANS: C It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the health care provider about this. The other patient statements are correct. Which potential complication should the nurse identify as a high risk for a patient admitted to the hospital with idiopathic aplastic anemia? a. Seizures b. Infection c. Neurogenic shock d. Pulmonary edema - Correct answer ANS: B Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purport? a. Assign the patient to a private room. b. Avoid intramuscular (IM) injections. c. Use rinses rather than a soft toothbrush for oral care. d. Restrict activity to passive and active range of motion. - Correct answer ANS: B IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room. Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? a. Prothrombin time b. Erythrocyte count c. Fibrinogen degradation products d. Activated partial thromboplastic time - Correct answer ANS: D Platelet aggregation in HIT causes neutralization of heparin, so the activated partial thromboplastic time will be shorter, and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT. The nurse is caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee. Which action should the nurse take? a. Apply heat to the knee. b. Immobilize the knee joint. c. Assist the patient with light weight bearing. d. Perform passive range of motion to the knee. - Correct answer ANS: B The initial action should be total rest of the knee to minimize bleeding. Ice packs are used to decrease bleeding. Range of motion (ROM) and weight-bearing exercise are contraindicated initially, but after the bleeding stops, ROM and physical therapy are started. A young adult who has von Will brand disease is admitted to the hospital for minor knee surgery. Which laboratory value should the nurse monitor? a. Platelet count b. Bleeding time c. Thrombin time d. Prothrombin time - Correct answer ANS: B The bleeding time is affected by von Will brand disease. Platelet count, prothrombin time, and thrombin time is normal in von Will brand disease A routine complete blood count for an active older man indicates possible myelodysplastic syndrome. What should the nurse plan to explain to the patient? a. Blood transfusion b. Bone marrow biopsy c. Filgrastim administration d. Erythropoietin administration - Correct answer ANS: B Bone marrow biopsy is needed to make the diagnosis and determine the specific type of myelodysplastic syndrome. The other treatments may be necessary later if there is progression of the myelodysplastic syndrome, but the initial action for this asymptomatic patient will be a bone marrow biopsy. Which action will the admitting nurse include in the care plan for a patient who has neutropenia? a. Avoid intramuscular injections. b. Check temperature every 4 hours. c. Place a "No Visitors" sign on the door. d. Omit fruits and vegetables from the diet. - Correct answer ANS: B The earliest sign of infection in a neutropenia patient is an elevation in temperature. While unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neurogenic). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a "no visitors" policy is not needed. Which laboratory test will the nurse use to determine whether filgrastim (Neurogenic) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count - Correct answer ANS: D Filgrastim increases the neutrophil count and function in neutropenia patients. Although total lymphocyte, platelet, and reticulocyte counts are also important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim. A patient who has acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. "If you do not want to have chemotherapy, other treatment options include stem cell transplantation." b. "The side effects of chemotherapy are difficult, but AML often goes into remission with chemotherapy." c. "The decision about treatment is one that you and the doctor need to make rather than asking what I would do." d. "You don't need to make a decision about treatment right now because leukemia’s in adults tend to progress slowly." - Correct answer ANS: B This response uses therapeutic communication by addressing the patient's question and giving accurate information. The other responses either give inaccurate information or fail to address the patient's question, which will discourage the patient from asking the nurse for information. A patient who has a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient? a. Infuse PRBCs slowly over 4 hours. b. Transfuse leukocyte-reduced PRBCs. c. Administer the prescribed diuretic before the transfusion. d. Give the PRN dose of antihistamine before the transfusion. - Correct answer ANS: B TRALI is caused by a reaction between the donor and the patient leukocytes that causes pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory problems caused by circulatory overload or by allergic reactions, but they will not prevent TRALI. A patient who has acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). What is the best approach for the nurse to assist the patient with this treatment decision? a. Discuss the need for insurance to cover post-HSCT care. b. Inquire whether there are questions or concerns about HSCT. c. Emphasize the positive outcomes of a bone marrow transplant. d. Explain that a cure is not possible with any treatment except HSCT. - Correct answer ANS: B Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and will allow the nurse to assess The patient's clinical manifestations are consistent with a febrile, no hemolytic transfusion reaction. The transfusion should be stopped, and antipyretics administered for the fever as ordered. A urine specimen is needed if an acute hemolytic reaction is suspected. Diphenhydramine is used for allergic reactions. This type of reaction does not indicate incorrect crosshatching. A patient in the emergency department reports back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. What should the nurse's first action be? 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. - Correct answer ANS: D The patient's symptoms indicate a possible acute hemolytic reaction caused by the transfusion. The first action should be to disconnect the transfusion and infuse normal saline. The other actions also are needed but are not the highest priority. Which patient should the nurse assign as the roommate for a patient who has aplastic anemia? a. A patient with chronic heart failure b. A patient who has viral pneumonia c. A patient who has right leg cellulitis d. A patient with multiple abdominal drains - Correct answer ANS: A Patients with aplastic anemia are at risk for infection because of the low white blood cell production associated with this type of anemia, so the nurse should avoid assigning a roommate with any possible infectious process. Which patient requires the most rapid assessment and care by the emergency department nurse? a. The patient with hemochromatosis who reports abdominal pain. b. The patient with neutropenia who has a temperature of 101.8° F. c. The patient with thrombocytopenia who has oozing gums after a tooth extraction. d. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours. - Correct answer ANS: B A neutropenia patient with a fever is assumed to have an infection and is at risk for rapidly developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed. The other patients also require rapid assessment and care but not as urgently as the neutropenia patient. A patient with immune thrombocytopenic purport (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets? a. Platelet count is 42,000/L. b. Blood pressure is 94/56 mm Hg. c. Petechial are present on the chest. d. Blood is oozing from the venipuncture site. - Correct answer ANS: A Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/L unless the patient is actively bleeding. Therefore, the nurse should clarify the order with the health care provider before giving the transfusion. The other data all indicate that bleeding caused by ITP may be occurring and that the platelet transfusion is appropriate. Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the health care provider? a. Leg bruises b. Tarry stools c. Skin abrasions d. Bleeding gums - Correct answer ANS: B Melena is a sign of gastrointestinal bleeding and requires collaborative actions such as checking hemoglobin and hematocrit and administration of coagulation factors. The other problems indicate a need for patient teaching about how to avoid injury but are not indicators of possible serious blood loss. A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take? a. Avoid other venipunctures. b. Apply dressings to the sites. c. Notify the health care provider. d. Give prescribed proton-pump inhibitors. - Correct answer ANS: C The patient's new onset of bleeding and diagnosis of sepsis suggest that disseminated intravascular coagulation (DIC) may have developed, which will require collaborative actions such as diagnostic testing, blood product administration, and heparin administration. The other actions are also appropriate, but the most important action should be to notify the health care provider so that DIC treatment can be initiated rapidly. A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature of 102° F (38.9° C), and severe back pain. Which prescribed action will the nurse implement first? a. Administer morphine sulfate 4 mg IV. b. Give acetaminophen (Tylenol) 650 mg. c. Infuse normal saline 500 mL over 30 minutes. d. Schedule complete blood count and coagulation studies. - Correct answer ANS: C The patient's blood pressure indicates hypovolemic caused by blood loss and should be addressed immediately to improve perfusion to vital organs. The other actions are also appropriate and should be rapidly implemented, but improving perfusion is the priority for this patient. Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/VN)? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of neutropenia precautions c. Administering subcutaneous filgrastim (Neurogenic) injection d. Developing a discharge teaching plan for the patient and family - Correct answer ANS: C Administration of subcutaneous medications is included in LPN/VN education and scope of practice. Patient teaching, assessment, and developing the plan of care require RN level education and scope of practice. Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first? a. A 44-yr-old with sickle cell anemia who says his eyes always look yellow b. A 23-yr-old with no previous health problems that has a contender axillary lump c. A 50-yr-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue d. A 19-yr-old with hemophilia who wants to learn to self-administer factor VII replacement - Correct answer ANS: B The patient's age and presence of a contender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment? The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently. After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first?