Chapter 30/31 - Hematologic System Flashcards
- A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein
thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level
drops to 110,000/μL. Which action will the nurse include in the plan of care?
a. Use low-molecular-weight heparin (LMWH) only.
b. Administer the warfarin (Coumadin) at the scheduled time.
c. Teach the patient about the purpose of platelet transfusions.
d. Discontinue heparin and flush intermittent IV lines using normal saline.
ANS: D
All heparin is discontinued when the HIT is diagnosed. The patient should be
instructed to never receive heparin or LMWH. Warfarin is usually not given until
the platelet count has returned to 150,000/μL. The platelet count does not drop
low enough in HIT for a platelet transfusion, and platelet transfusions increase
the risk for thrombosis.
13. A
- Which intervention will be included in the nursing care plan for a patient
with immune thrombocytopenic purpura (ITP)?
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.
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 thromboplastin time
ANS: D
Platelet aggregation in HIT causes neutralization of heparin, so
that the activated partial thromboplastin 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 caring for a patient with type A hemophilia being admitted to the
hospital with severe pain and swelling in the right knee will
a. immobilize the joint.
b. apply heat to the knee.
c. assist the patient with light weight bearing.
d. perform passive range of motion to the knee.
ANS: A
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 28-year-old man with von Willebrand disease is admitted to the hospital for minor
knee surgery. The nurse will review the coagulation survey to check the
a. platelet count.
b. bleeding time.
c. thrombin time.
d. prothrombin time
ANS: B
The bleeding time is affected by von Willebrand
disease. Platelet count, prothrombin time, and
thrombin time are normal in von Willebrand disease
A 19-year-old woman 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. The platelet count is 42,000/L.
b. Petechiae are present on the chest.
c. Blood pressure (BP) is 94/56 mm Hg.
d. Blood is oozing from the venipuncture site.
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 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
ANS: D
Filgrastim increases the neutrophil count and function in neutropenic
patients. Although total lymphocyte, platelet, and reticulocyte counts
also are important to monitor in this patient, the absolute neutrophil
count is used to evaluate the effects of filgrastim.
- A 68-year-old woman with 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 frequently 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 quite slowly.”
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 with 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 the PRBCs slowly over 4 hours.
b. Transfuse only leukocyte-reduced PRBCs.
c. Administer the scheduled diuretic before the transfusion.
d. Give the PRN dose of antihistamine before the transfusion
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 54-year-old woman with acute myelogenous leukemia (AML) is considering
treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the
nurse to assist the patient with a treatment decision is to
a. emphasize the positive outcomes of a bone marrow transplant.
b. discuss the need for adequate insurance to cover post-HSCT care.
c. ask the patient whether there are any questions or concerns about HSCT.
d. explain that a cure is not possible with any other treatment except HSCT
ANS: C
Offering the patient an opportunity to ask questions or discuss concerns about HSCT will
encourage the patient to voice concerns about this treatment and also will allow the nurse
to assess whether the patient needs more information about the procedure. Treatment of
AML using chemotherapy is another option for the patient. It is not appropriate for the
nurse to ask the patient to consider insurance needs in making this decision
- An appropriate nursing intervention for a patient with non-Hodgkin’s
lymphoma whose platelet count drops to 18,000/μL during chemotherapy is to
a. check 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
ANS: A
Because the patient is at risk for spontaneous bleeding, the nurse should check
stools for occult blood. A low platelet count does not require an increased
fluid intake. Oral hygiene is important, but it is not necessary to provide oral
care every 2 hours. The low platelet count does not increase risk for infection,
so frequent temperature monitoring is not indicated.
- A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil
count of 850/μL while receiving outpatient chemotherapy. Which action by the outpatient
clinic nurse is most appropriate?
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.
ANS: B
The patient may be taught to self-administer filgrastim injections. Although chemotherapy
may be stopped with severe neutropenia (neutrophil count less than 500/μL),
administration of filgrastim usually allows the chemotherapy to continue. Patients with
neutropenia are at higher risk for infection when exposed to other patients in the hospital.
HEPA filters are expensive and are used in the hospital, where the number of pathogens is
much higher than in the patient’s home environment.
- Which information obtained by the nurse caring for a patient with thrombocytopenia
should be immediately communicated to the health care provider?
a. The platelet count is 52,000/μL.
b. The patient is difficult to arouse.
c. There are purpura on the oral mucosa.
d. There are large bruises on the patient’s back.
ANS: B
Difficulty in arousing the patient may indicate a cerebral hemorrhage,
which is life threatening and requires immediate action. The other
information should be documented and reported but would not be
unusual in a patient with thrombocytopenia
- 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 temperature, blood pressure, and pulse 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.
ANS: B
UAP education includes measurement of vital signs. UAP would
report the vital signs to the registered nurse (RN). The other
actions require more education and a larger scope of practice
and should be done by licensed nursing staff members.
- 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. Draw blood for a new crossmatch.
b. Send a urine specimen to the laboratory.
c. Administer PRN acetaminophen (Tylenol).
d. Give the PRN diphenhydramine (Benadryl).
ANS: C
The patient’s clinical manifestations are consistent with a febrile, nonhemolytic 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 (Benadryl) is used for allergic reactions. This type of reaction does not
indicate incorrect crossmatching
- A patient in the emergency department complains of back pain and difficulty breathing
15 minutes after a transfusion of packed red blood cells is started. The nurse’s first action
should be to
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.
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
A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil
count of 850/μL while receiving outpatient chemotherapy. Which action by the outpatient
clinic nurse is most appropriate?
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
ANS: B
The patient may be taught to self-administer filgrastim injections. Although chemotherapy
may be stopped with severe neutropenia (neutrophil count less than 500/μL),
administration of filgrastim usually allows the chemotherapy to continue. Patients with
neutropenia are at higher risk for infection when exposed to other patients in the hospital.
HEPA filters are expensive and are used in the hospital, where the number of pathogens is
much higher than in the patient’s home environment
- A 19-year-old woman 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. The platelet count is 42,000/L.
b. Petechiae are present on the chest.
c. Blood pressure (BP) is 94/56 mm Hg.
d. Blood is oozing from the venipuncture site.
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 physician?
a. Leg bruises
b. Tarry stools
c. Skin abrasions
d. Bleeding gums
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 venipunctures.
b. Notify the patient’s physician.
c. Apply sterile dressings to the sites.
d. Give prescribed proton-pump inhibitors.
ANS: B
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 also are appropriate, but the most important action
should be to notify the physician 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 102° F (38.9° C), and
severe back pain. Which physician order 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
ANS: C
The patient’s blood pressure indicates hypovolemia caused by blood loss and
should be addressed immediately to improve perfusion to vital organs. The
other actions also are appropriate and should be rapidly implemented, but
improving perfusion is the priority for this patient.
- Following successful treatment of Hodgkin’s lymphoma for a 55-year-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
ANS: D
The chemotherapy used in treating Hodgkin’s lymphoma results in a high incidence of
secondary malignancies; follow-up screening is needed. The fertility of a 55-year-old
woman will not be impacted by chemotherapy. Maintenance chemotherapy is not used for
Hodgkin’s lymphoma. Pruritus is a clinical manifestation of lymphoma, but should not be a
concern after treatment.
- 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
ANS: D
Lip swelling in angioedema may indicate a hypersensitivity reaction to
the rituximab. The nurse should stop the infusion and further assess for
anaphylaxis. The other findings may occur with chemotherapy, but are
not immediately life threatening.
A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment
with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist
the patient with a treatment decision is to
a. emphasize the positive outcomes of a bone marrow transplant.
b. discuss the need for adequate insurance to cover post-HSCT care.
c. ask the patient whether there are any questions or concerns about HSCT.
d. explain that a cure is not possible with any other treatment except HSCT
ANS: C
Offering the patient an opportunity to ask questions or discuss concerns about HSCT will
encourage the patient to voice concerns about this treatment and also will allow the nurse
to assess whether the patient needs more information about the procedure. Treatment of
AML using chemotherapy is another option for the patient. It is not appropriate for the
nurse to ask the patient to consider insurance needs in making this decision.
