Chapter 30: Hematologic Problems

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)

d. Hemoglobin (Hgb) of 8.6 g/dL (86 g/L)

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

a. Omelet and whole wheat toast

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. Cobalamin (vitamin B12)

d. Ascorbic acid (vitamin C)

b. Folic acid

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)."

c. "I could choose nasal spray rather than injections of vitamin B12."

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.

c. Encourage alternating rest and activity.

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."

c. "I should notify my health care provider if my stools turn black."

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

b. Infection

Which nursing intervention is important when providing care for a patient with sickle cell crisis?

a. Limiting the patient's intake of oral and IV fluids

b. Evaluating the effectiveness of opioid analgesics

c. Encouraging the patient to ambulate as much as tolerated

d. Teaching the patient about high-protein, high-calorie foods

b. Evaluating the effectiveness of opioid analgesics

Which statement by a patient indicates good understanding of the nurse's teaching about preventing sickle cell crisis?

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 opioids are prescribed to prevent a crisis."

d. "Risk for a crisis is decreased by having an annual influenza vaccination."

d. "Risk for a crisis is decreased by having an annual influenza vaccination."

Which instruction will the nurse plan to include in discharge teaching for a patient admitted with a sickle cell crisis?

a. Limit fluids to 2 to 3 quarts per day.

b. Avoid exposure to crowds when possible.

c. Take a daily multivitamin supplement with iron.

d. Drink no more than two caffeinated beverages daily.

b. Avoid exposure to crowds when possible.

The nurse observes scleral jaundice in a patient being admitted with hemolytic anemia. Which laboratory result the nurse should check?

a. Schilling test

b. Bilirubin level

c. Stool occult blood

d. Gastric acid analysis

b. Bilirubin level

A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when the platelet level drops to 110,000/μL. Which action will the nurse include in the plan of care?

a. Prepare for platelet transfusion.

b. Discontinue the heparin infusion.

c. Administer prescribed warfarin (Coumadin).

d. Give low-molecular-weight heparin (LMWH).

b. Discontinue the heparin infusion.

What action is expected by the nurse caring for a patient who has an acute exacerbation of polycythemia vera?

a. Place the patient on bed rest.

b. Administer iron supplements.

c. Avoid use of aspirin products.

d. Monitor fluid intake and output.

d. Monitor fluid intake and output.

Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura?

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.

b. Avoid intramuscular (IM) injections.

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 thromboplastin time

d. Activated partial thromboplastin time

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.

b. Immobilize the knee joint.

A young adult who has von Willebrand 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

b. Bleeding time

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

b. 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.

b. Check temperature every 4 hours.

Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) 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

d. Absolute neutrophil count

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 leukemias

in adults tend to progress slowly."

b. "The side effects of chemotherapy are difficult, but AML often goes into remission

with chemotherapy."

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.

b. Transfuse leukocyte-reduced PRBCs.

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.

b. Inquire whether there are questions or concerns about HSCT.

Which action will the nurse include in the plan of care for a patient admitted with multiple myeloma?

a. Monitor fluid intake and output.

b. Administer calcium supplements.

c. Assess lymph nodes for enlargement.

d. Limit weight bearing and ambulation.

a. Monitor fluid intake and output.

Which nursing intervention is appropriate for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/μL during chemotherapy?

a. Test all stools for occult blood.

b. Encourage fluids to 3000 mL/day.

c. Provide oral hygiene every 2 hours.

d. Check the temperature every 4 hours.

a. Test all stools for occult blood.

A patient receiving outpatient chemotherapy for myelogenous leukemia develops an absolute neutrophil count of 850/μL. Which collaborative action should the outpatient clinic nurse anticipate??

a. Discuss the need for hospital admission to treat the neutropenia.

b. Teach the patient to administer filgrastim (Neupogen) injections.

c. Plan to discontinue the chemotherapy until the neutropenia resolves.

d. Order a high-efficiency particulate air (HEPA) filter for the patient's home.

b. Teach the patient to administer filgrastim (Neupogen) injections.

Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the health care provider?

a. Bruises on the patient's back.

b. The patient is difficult to arouse.

c. Purpura on the patient's oral mucosa.

d. The patient's platelet count is 52,000/μL.

b. The patient is difficult to arouse.

The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)?

a. Verify the patient identification (ID) according to hospital policy.

b. Obtain the patient's temperature and blood pressure before the transfusion.

c. Double-check the product numbers on the PRBCs with the patient ID band.

d. Monitor the patient for shortness of breath or chest pain during the transfusion.

b. Obtain the patient's temperature and blood pressure before the transfusion.

A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take?

a. Send a urine specimen to the laboratory.

b. Administer PRN acetaminophen (Tylenol).

c. Draw blood for a new type and crossmatch.

d. Give the prescribed PRN diphenhydramine.

b. Administer PRN acetaminophen (Tylenol).

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 flowrate.

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.

d. Disconnect the transfusion and infuse normal saline.

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

a. A patient with chronic heart failure

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.

b. The patient with neutropenia who has a temperature of 101.8° F.

A patient with immune thrombocytopenic purpura (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. Petechiae are present on the chest.

d. Blood is oozing from the venipuncture site.

a. Platelet count is 42,000/L.

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

b. Tarry stools

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.

c. Notify the health care provider.

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.

c. Infuse normal saline 500 mL over 30 minutes.

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 neutropenic precautions

c. Administering subcutaneous filgrastim (Neupogen) injection

d. Developing a discharge teaching plan for the patient and family

c. Administering subcutaneous filgrastim (Neupogen) injection

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 who has a nontender 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.

b. A 23-yr-old with no previous health problems who has a nontender axillary lump

After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first?

a. A 23-yr-old who reports severe fatigue

b. A 56-yr-old with frequent explosive diarrhea

c. A 33-yr-old with a fever of 100.8° F (38.2° C)

d. A 66-yr-old who has white pharyngeal lesions

c. A 33-yr-old with a fever of 100.8° F (38.2° C)

Which action will the nurse include in the plan of care for a patient who has thalassemia major?

a. Administer chelation therapy as needed.

b. Teach the patient to use iron supplements.

c. Avoid the use of intramuscular injections.

d. Notify health care provider of hemoglobin 11 g/dL.

a. Administer chelation therapy as needed.

Which information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis?

a. Skin color

b. Hematocrit

c. Liver function

d. Serum iron level

d. Serum iron level

Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider?

a. Hematocrit 55%

b. Presence of plethora

c. Calf swelling and pain

d. Platelet count 450,000/L

c. Calf swelling and pain

Following successful treatment of Hodgkin's lymphoma for a 55-yr-old woman, which topic

will the nurse include in patient teaching?

a. Potential impact of chemotherapy treatment on fertility

b. Application of soothing lotions to treat residual pruritus

c. Use of maintenance chemotherapy to maintain remission

d. Need for follow-up appointments to screen for malignancy

d. Need for follow-up appointments to screen for malignancy

A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse?

a. Anorexia

b. Vomiting

c. Oral ulcers

d. Lip swelling

d. Lip swelling

Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider?

a. Patient reports severe back pain.

b. Serum calcium level is 15 mg/dL.

c. Patient reports no stool for 5 days.

d. Urine sample has Bence-Jones protein.

b. Serum calcium level is 15 mg/dL.

When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care?

a. Recommend ibuprofen for left upper quadrant pain.

b. Schedule immunization with the pneumococcal vaccine.

c. Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery.

d. Discourage deep breathing and coughing to reduce risk for splenic rupture.

b. Schedule immunization with the pneumococcal vaccine.

The nurse has obtained the health history, physical assessment data, and laboratory results shown in the accompanying figure for a patient admitted with aplastic anemia. Which information is most important to communicate to the health care provider?

a. Bruising

b. Neutropenia

c. Increasing fatigue

d. Thrombocytopenia

b. Neutropenia