Ch. 33 Management of Nonmalignant Hematologic Disorders

Question 1

The nurse is caring for a client with external bleeding. What is the nurse’s priority intervention?

a. Application of a tourniquet
b. Elevation of the extremity
c. Direct pressure
d. Pressure point control

Answer 1

c. Direct pressure

Question 2

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?

a. Platelet count, blood glucose levels, and white blood cell (WBC) count
b. Fibrinogen level, WBC, and platelet count
c. Thrombin time, calcium levels, and potassium levels
d. Platelet count, prothrombin time, and partial thromboplastin time

Answer 2

d. Platelet count, prothrombin time, and partial thromboplastin time

Question 3

A young female client has pale nailbeds. Her hemoglobin count is 10.2 gm/dL and her hematocrit count is 30%. She reports fatigue and states, “I’m tired all the time.” The client also reports excessive menstrual flow. The nurse assesses further and determines the client’s diet is balanced and provides adequate calories. The client is prescribed supplemental iron therapy. The highest nursing diagnosis is

a. Deficient knowledge related to new information with no previous experience
b. Altered nutrition: less than body requirements, related to inadequate intake of nutrients
c. Fatigue related to diminished oxygen–carrying capacity of the blood
d. Altered tissue perfusion related to diminished oxygen–carrying capacity of the blood

Answer 3

d. Altered tissue perfusion related to diminished oxygen–carrying capacity of the blood

Question 4

The nurse is screening donors for blood donation. Which client is an acceptable donor for blood?

a. Reports having a cold 1 month ago that resolved quickly
b. Has a history of viral hepatitis as a teenager 10 years ago
c. Had a dental extraction 2 days ago for caries in a tooth
d. Received a blood transfusion within 1 year

Answer 4

a. Reports having a cold 1 month ago that resolved quickly

Question 5

A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate?

a. Severity of the disease
b. Neurologic involvement
c. Insufficient intake of dietary nutrients
d. Loss of vibratory and position senses

Answer 5

b. Neurologic involvement

Question 6

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?

a. Iron may cause indigestion and should be taken with an antacid such as Mylanta.
b. Dilute the liquid preparation with another liquid such as juice and drink with a straw.
c. Discontinue the use of iron if your stool turns black.
d. Do not take medication with orange juice because it will delay absorption of the iron.

Answer 6

b. Dilute the liquid preparation with another liquid such as juice and drink with a straw.

Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption. Expect iron to color stool dark green or black.

Question 7

A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client?

a. Vaso-occlusive crisis
b. Acute chest syndrome
c. Pneumocystis pneumonia
d. Acute muscular strain

Answer 7

b. Acute chest syndrome

One of the unique manifestations of sickle cell disease is “acute chest syndrome,” a type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs. Acute chest syndrome is characterized by respiratory symptoms, such as coughing, wheezing, tachypnea, and chest pain. Vaso-occlusive crisis causes decrease in tissue perfusion and predisposes the client to pneumonia but is not the present problem with this client. Pneumocystis pneumonia is present in the client with HIV/AIDS or other immunocompromised clients. The client’s symptoms do not correlate with a diagnosis of acute muscular strain.

Question 8

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding?

a. Low ferritin level concentration
b. Elevated hematocrit concentration
c. Enlarged mean corpuscular volume (MCV)
d. Elevated red blood cell (RBC) count

Answer 8

a. Low ferritin level concentration

Question 9

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn’s disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?

a. The onset of a bacterial infection
b. Bleeding
c. Abdominal pain
d. Diarrhea

Answer 9

a. The onset of a bacterial infection

Question 10

A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this?

a. Women rarely manifest the gene expression
b. Women have lower hemoglobin levels
c. Women require grater folic acid supplementation
d. Women lose iron through menstrual cycles

Answer 10

d. Women lose iron through menstrual cycles

Hemochromatosis is a genetic condition where excess iron is absorbed in the GI tract and deposited in various organs, making them dysfunctional. Women are often less affected than men because women lose excess iron through their menstrual cycles.

Question 11

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?

a. A hemolytic reaction to Rh-incompatible blood
b. A hemolytic allergic reaction caused by an antigen reaction
c. A hemolytic reaction caused by bacterial contamination of donor blood
d. A hemolytic reaction to mismatched blood

Answer 11

b. A hemolytic allergic reaction caused by an antigen reaction

Question 12

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?

a. Eliminate direct contact with others who are infectious
b. Implement neutropenic precautions
c. Apply prolonged pressure to needle sites or other sources of external bleeding
d. Monitor temperature at least once per shif

Answer 12

c. Apply prolonged pressure to needle sites or other sources of external bleeding

Question 13

A client with sickle cell anemia has a

a. high hematocrit.
b. normal blood smear.
c. low hematocrit.
d. normal hematocrit.

Answer 13

c. low hematocrit.

Question 14

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide?

a. Observe stools for blood.
b. Observe the gums for bleeding after the client brushes teeth.
c. Observe the sputum for signs of blood.
d. Observe client for facial droop.

Answer 14

a. Observe stools for blood.

Question 15

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

a. Erythrocytes that are microcytic and hypochromic
b. Erythrocytes that are macrocytic and hyperchromic
c. An increased number of erythrocytes
d. Clustering of platelets with sickled red blood cells

Answer 15

a. Erythrocytes that are microcytic and hypochromic

Question 16

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?

a. Inform the client that she will feel better after receiving a bath and clean sheets.
b. Inform the client that the position must be changed, and then you will give her pain medication and omit the bath.
c. Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration.
d. Obtain the pain medication and delay the bath and position change until the medication reaches its peak.

Answer 16

d. Obtain the pain medication and delay the bath and position change until the medication reaches its peak.

Question 17

Which medication is the antidote to warfarin?

a. Clopidogrel
b. Protamine sulfate
c. Vitamin K
d. Aspirin

Answer 17

c. Vitamin K

Question 18

A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention?

a. Monitoring the client’s breathing and reviewing the client’s arterial blood gases
b. Monitoring the client’s temperature and reviewing the client’s complete blood count (CBC) with differential
c. Monitoring the client’s blood pressure and reviewing the client’s hematocrit
d. Monitoring the client’s heart rate and reviewing the client’s hemoglobin

Answer 18

b. Monitoring the client’s temperature and reviewing the client’s complete blood count (CBC) with differential

Question 19

A nurse cares for several clients with anemia and notes that all the clients have different types of anemia. What is the nurse’s best understanding of how anemias are classified, based on the deficiency of erythrocytes? Select all that apply.

a. Defective production of erythrocytes
b. Destruction of erythrocytes
c. Shape of erythrocytes
d. Quantity of erythrocytes
e. Loss of erythrocytes

Answer 19

a. Defective production of erythrocytes
b. Destruction of erythrocytes
e. Loss of erythrocytes

A physiologic approach classifies anemia according to whether the deficiency in erythrocytes is caused by a defect in their production (i.e., hypoproliferative anemia), by their destruction (i.e., hemolytic anemia), or by their loss (i.e., bleeding). Shape and quantity of erythrocytes are not categories of classifications of anemia.

Question 20

Hemophilia A is the most common of the three types of hemophilia. What is diminished in the less serious form of hemophilia A, known as von Willebrand’s disease?

a. quality of factor VIII
b. quality of factor XI
c. amount and quality of factor IX
d. amount and
quality of factor VIII

Answer 20

d. amount and

quality of factor VIII

Question 21

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have?

a. Sickle cell anemia
b. Iron deficiency anemia
c. Aplastic anemia
d. Megaloblastic anemia

Answer 21

b. Iron deficiency anemia

Question 22

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia?

a. Magnesium level of 2.5 mg/dL
b. Creatinine level of 6 mg/100 mL
c. Calcium level of 9.4 mg/dL
d. Potassium level of 5.2 mEq/L

Answer 22

b. Creatinine level of 6 mg/100 mL

Question 23

The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions?

a. Encouraging early and frequent activities.
b. Assisting in prioritizing activities.
c. Determining what days to be active.
d. Keeping long activity periods to build client stamina.

Answer 23

b. Assisting in prioritizing activities.

Question 24

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them:

a. to the bedside commode.
b. to the bathroom.
c. to a standing position so he can urinate.
d. onto the bedpan.

Answer 24

d. onto the bedpan.

Question 25

A client’s family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

a. “DIC is caused when hemolytic processes destroy erythrocytes.”
b. “DIC occurs when the immune system attacks platelets and causes massive bleeding.”
c. “DIC is a complication of an autoimmune disease that attacks the body’s own cells.”
d. “DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs.”

Answer 25

d. “DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs.”

Question 26

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

a. Hypertension
b. Truncal obesity
c. Osteoporosis
d. Muscle wasting

Answer 26

c. Osteoporosis

Question 27

Which nursing instructions help parents of a child with hemophilia provide a safe home environment for their child?

a. “Establish a written emergency plan including what to do in specific situations and the names and phone numbers of emergency contacts.”
b. “Talk with your child about home safety and have him problem-solve hypothetical situations about his health.”
c. “Pad the corners of coffee tables when your child is a toddler and provide kneepads for sports when the child is older.”
d. “Be a role model to your child by wearing a helmet when riding a bike so your child will, too.”

Answer 27

a. “Establish a written emergency plan including what to do in specific situations and the names and phone numbers of emergency contacts.”

Question 28

Which of the following is the most common hematologic condition affecting elderly patients

a. Thrombocytopenia
b. Leukopenia
c. Bandemia
d. Anemia

Answer 28

d. Anemia

Question 29

The registered nurse (RN) and licensed practical nurse (LPN) are preparing an educational program for clients who may be at risk for the development of iron-deficiency anemia. Which clients would receive the greatest benefit from this program? Select all that apply.

a. A client who is a vegetarian
b. A young female client with bulimia nervosa
c. A client who lives in a nursing home
d. An older adult client on a fixed income
e. A client with Crohn’s disease

Answer 29

b. A young female client with bulimia nervosa
d. An older adult client on a fixed income
e. A client with Crohn’s disease

Question 30

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication?

a. Prednisone
b. Amoxicillin
c. Aluminum hydroxide
d. Tegretol

Answer 30

c. Aluminum hydroxide

Question 31

A nurse caring for a client who has hemophilia is getting ready to take the client’s vital signs. What should the nurse do before taking a blood pressure?

a. Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.
b. Ask if taking a blood pressure has ever produced pain in the upper arm.
c. Ask if taking a blood pressure has ever caused bruising in the hand and wrist.
d. Ask if taking a blood pressure has ever produced the need for medication.

Answer 31

a. Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

Question 32

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?

a. hemoglobin A
b. hemoglobin S
c. hemoglobin M
d. hemoglobin F

Answer 32

b. hemoglobin S

Hemoglobin A (HbA) normally replaces fetal hemoglobin (HbF) about 6 months after birth. In people with sickle cell anemia, however, an abnormal form of hemoglobin, hemoglobin S (HbS), replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions.

Question 33

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply.

a. Inadequate formed white blood cells
b. Destruction of normally formed red blood cells
c. Infection
d. Blood loss
e. Abnormal erythrocyte production

Answer 33

b. Destruction of normally formed red
d. Blood loss
e. Abnormal erythrocyte production

Question 34

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn’s disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?

a. Diarrhea
b. The onset of a bacterial infection
c. Abdominal pain
d. Bleeding

Answer 34

b. The onset of a bacterial infection

Question 35

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order?

a. Oral
b. I.M.
c. Subcutaneous (subQ)
d. I.V.

Answer 35

b. IM

A client with a platelet count of 22,000/μl bleeds easily. The nurse should avoid using the I.M. route because the area is highly vascular. The client may bleed readily when penetrated by a needle, and it may be difficult for the nurse to stop the bleeding. The client’s existing I.V. access would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subQ routes are preferred over I.M., but they’re less effective for acute pain management than I.V.

Question 36

An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200–900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client?

a. Ingest a diet higher in vitamin B12 sources.
b. Supplement the diet with vitamin B12.
c. Continue with the diet but include more sources of iron.
d. Change the vegetarian diet and begin to eat red meat.

Answer 36

b. Supplement the diet with vitamin B12.

Question 37

A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client’s condition?

a. Takes over–the–counter iron supplements
b. Eliminates use of alcohol
c. Takes 60 grams of protein each day
d. Takes a daily multiple vitamin pill

Answer 37

a. Takes over–the–counter iron supplements

When a client receives multiple transfusions and takes iron supplements, there may be a problem with iron overload. It is recommended that clients who are experiencing anemia either avoid or limit alcohol due to interference of alcohol with utilization of essential nutrients. The typical U.S. diet includes 60 grams of protein daily. Clients may be prescribed multivitamins.

Question 38

The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse

a. Places the client in isolation and allows no visitors
b. Changes the water in the humidifier for oxygen therapy every 48 hours
c. Assigns the client to a private room
d. Allows unlicensed assistive personnel who reports having a sore throat to provide care

Answer 38

c. Assigns the client to a private room

Question 39

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take?

a. Monitor partial thromboplastin (PTT) time.
b. Have the client limit physical activity.
c. Encourage a diet high in vitamin K.
d. Administer the prescribed enoxaparin (Lovenox).

Answer 39

d. Administer the prescribed enoxaparin (Lovenox).

Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.

Question 40

Which of the following is considered an antidote to heparin?

a. Ipecac
b. Protamine sulfate
c. Narcan
d. Vitamin K

Answer 40

b. Protamine sulfate

Question 41

A nurse cares for a client with anemia requiring nutritional supplementation. Which nursing intervention best promotes client adherence with the prescribed therapy?

a. Develop a therapeutic regimen based on the client’s understanding of the medication.
b. Assist the client to incorporate the therapeutic regimen into daily activities.
c. Develop a therapeutic regimen recommendation for the client.
d. Assist the client to use a medication reminder system for the therapeutic regimen.

Answer 41

b. Assist the client to incorporate the therapeutic regimen into daily activities.

The best way for the nurse to promote adherence to the therapeutic regimen is to assist the client to incorporate the therapeutic regimen into daily activities. This action is the only answer choice that is a collaborative effort with the client and is the reason it is correct.

Question 42

A client is receiving chemotherapy for cancer. The nurse reviews the client’s laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority?

a. Impaired tissue integrity
b. Impaired oral mucous membranes
c. Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI
d. Activity intolerance

Answer 42

c. Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

These are all appropriate nursing diagnoses for the client with thrombocytopenia. However, the risk of cerebral and GI hemorrhage and hypotension pose the greatest risk to the physiological integrity of the client.

Question 43

A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client?

a. Describes the importance of staying cool
b. Reports joint pain less than 3 on a scale of 0 to 10
c. Takes hydroxyurea during her pregnancy
d. Exhibits a temperature more than 100.3°F

Answer 43

b. Reports joint pain less than 3 on a scale of 0 to 10

An expected outcome for a client experiencing a sickle-cell crisis is control and reduction of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm not cool.

Question 44

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse’s role during a transfusion?

a. To assess for enlargement and tenderness over the liver and spleen
b. To administer vitamin B12 injections
c. To instruct the client to rest immediately if chest pain develops
d. To closely monitor the rate of administration

Answer 44

d. To closely monitor the rate of administration

Question 45

A nurse cares for a client with a hematological disorder and malnutrition. What is the nurse’s best understanding of how the client’s nutritional status may worsen the client’s hematological condition?

a. Decreased fat stores lead to decreased ability for red blood cells
b. Decreased carbohydrates lead to decreased oxygen affinity of the hemoglobin
c. Decreased protein stores lead to decreased immune response
d. Decreased calories lead to decreased immune response

Answer 45

c. Decreased protein lead to decreased immune response

Question 46

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client’s discharge instructions?

a. Encourage frequent handwashing.
b. Avoid contact with family/friends who are sick.
c. Use a disposable razor when shaving.
d. Plan for frequent periods of rest.

Answer 46

c. Use a disposable razor when shaving.

Question 47

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms?

a. Folate
b. B12
c. Thiamine
d. Iron

Answer 47

b. B12

Question 48

Which is a symptom of hemochromatosis?

a. Inflammation of the tongue
b. Weight gain
c. Bronzing of the skin
d. Inflammation of the mouth

Answer 48

c. Bronzing of the skin

Question 49

For a client with Hodgkin disease who has developed neutropenia, what is an appropriate nursing intervention to include in the care plan?

a. Omitting fresh fruits and vegetables from the diet
b. Avoiding intramuscular (IM) injections
c. Positioning the client to increase lung expansion
d. Monitoring temperature every 4 hours

Answer 49

d. Monitoring temperature every 4 hours

Question 50

The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. What instruction should the nurse give to the parents?

a. Encourage the toddler to participate in playground activities with other toddlers
b. Administer over–the–counter preparations for a cold
c. Administer factor VIII intravenously at the first sign of bleeding
d. Use nasal packing for any nose bleeds

Answer 50

c. Administer factor VIII intravenously at the first sign of bleeding

Question 51

The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for?

a. Bone marrow aspiration
b. Magnetic resonance imaging (MRI) study
c. Schilling test
d. Bone marrow biopsy

Answer 51

c. Schilling test

Question 52

A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient’s lab work for which diagnostic indicator?

a. Leukocyte count of 11,500/mm3
b. Erythrocyte count of 6.5 m/?L
c. Hematocrit of 60%
d. Platelet value of 350,000/mm3

Answer 52

c. Hematocrit of 60%

Although all results are elevated, the diagnostic indicator is the elevated hematocrit (normal = 42% to 52% for a male). These results are used in combination with other indicators (e.g., splenomegaly) for a definitive diagnosis.

Question 53

A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse?

a. “Thalassemia is treated with iron supplements.”
b. “I’ll see a genetic counselor before starting a family.”
c. “If my fiancé was of Middle Eastern descent, I wouldn’t be worried about having children.”
d. “I need to learn how to give myself vitamin B12 injections.”

Answer 53

b. “I’ll see a genetic counselor before starting a family.”

Question 54

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving:

a. O-negative blood to an O-positive client.
b. A-positive blood to an A-negative client.
c. O-positive blood to an A-positive client.
d. B-positive blood to an AB-positive client.

Answer 54

b. A-positive blood to an A-negative client.

Question 55

The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse’s priority action?

a. Notify the physician
b. Ask someone to clean the bedpan
c. Stop the nosebleed
d. Put in an IV line

Answer 55

a. Notify the physician

Question 56

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?

a. Agranulocytosis
b. Iron-deficiency anemia
c. Pernicious anemia
d. Aplastic anemia

Answer 56

d. Aplastic anemia

Clients with a plastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client’s blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells.

Question 57

When a nurse is planning discharge teaching for a client admitted with sickle cell crisis, which information should the nurse include in the teaching?

a. Receive pneumococcal and annual influenza vaccinations
b. Limit fluids to 2 quarts a day
c. Take a daily multivitamin with iron
d. Drink only one caffeinated beverage daily

Answer 57

a. Receive pneumococcal and annual influenza vaccinations