CHAPTER 33 Flashcards
1
Q
- The nurse is caring for a client with anemia who is experiencing increased fatigue and
occasional palpitations at rest. Which of the following laboratory findings should the nurse
expect?
a. Normal red blood cell (RBC) indices
b. Hematocrit (Hct) of 38%
c. Hemoglobin (Hb) of 86 g/L
d. RBC count of 4.5 ´ 1012/L
A
C
2
Q
- Which of the following menu choices indicate that the client understands the nurse’s
teaching about best dietary choices for iron-deficiency anemia?
a. Omelette and whole wheat toast
b. Cantaloupe and cottage cheese
c. Strawberry and banana fruit plate
d. Cornmeal muffin and orange juice
A
A
3
Q
- The nurse is caring for a client who is receiving methotrexate and develops a
megaloblastic anemia. Which of the following nutrients should the nurse include in the
teaching plan?
a. Iron
b. Folic acid
c. Cobalamin (vitamin B12)
d. Ascorbic acid (vitamin C)
A
B
4
Q
- The nurse is teaching a client with a new diagnosis of pernicious anemia about the
disorder. Which of the following client statements indicates that the teaching has been
effective?
a. “I need to start eating more red meat or liver.”
b. “I will stop having a glass of wine with dinner.”
c. “I will need to take a proton pump inhibitor like omeprazole.”
d. “I would rather use the nasal spray than have to get injections of vitamin B12.”
A
D
5
Q
- The nurse is caring for a client who is hospitalized for treatment of severe hemolytic
anemia. Which of the following actions should the nurse implement?
a. Provide a diet high in vitamin K.
b. Place the client on protective isolation.
c. Alternate periods of rest and activity.
A
C
6
Q
- The nurse has finished teaching a client about taking oral ferrous sulphate. Which of the
following client statements indicates that additional instruction is needed?
a. “I will call the doctor if my stools start to turn black.”
b. “I will take a stool softener if I feel constipated occasionally.”
c. “I should take the iron with orange juice about an hour before eating.”
d. “I should increase my fluid and fibre intake while I am taking the iron tablets.”
A
A
7
Q
- The nurse is caring for a client with idiopathic aplastic anemia. Which of the following
collaborative problems should the nurse include when developing the care plan?
a. Potential complication: seizures
b. Potential complication: infection
c. Potential complication: neurogenic shock
d. Potential complication: pulmonary edema
A
B
8
Q
- The nurse is caring for a client with a sickle cell crisis. While caring for the client during
the crisis, which of the following actions is priority?
a. Limit the client’s intake of oral and IV fluids.
b. Evaluate the effectiveness of opioid analgesics.
c. Encourage the client to ambulate as much as tolerated.
d. Teach the client about high-protein, high-calorie foods.
A
B
9
Q
- Which of the following statements by a client with sickle cell anemia indicates good
understanding of the nurse’s teaching about prevention of 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 narcotics are prescribed to prevent a crisis.”
d. “Risk for a crisis can be lowered by having an annual influenza vaccination.”
A
D
10
Q
- The nurse is planning discharge teaching for a client who was admitted with neutropenia. Which of the following instructions should the nurse include?
a. Limit fluids to 2–3 litres a day.
b. Include eggs and fish in the diet.
c. Avoid exposure to crowds as much as possible.
d. Drink only one or two caffeinated beverages daily.
A
C
11
Q
- The nurse is admitting a client with hemolytic anemia and notes jaundice of the sclerae.
Which of the following laboratory results should the nurse assess?
a. Schilling test
b. Bilirubin level
c. Stool occult blood test
d. Gastric analysis testing
A
B
12
Q
- The nurse is caring for a client who has been receiving a heparin infusion and warfarin for a deep vein thrombosis (DVT) with a diagnosis of heparin-induced thrombo-cytopenia
(HIT). Which of the following actions should the nurse include in the plan of care?
a. Use low-molecular-weight heparin (LMWH) only.
b. Flush all intermittent IV lines using normal saline.
c. Administer the warfarin at the scheduled time.
d. Teach the client about the purpose of platelet transfusions.
A
B
13
Q
- The nurse is caring for a client with an acute exacerbation of polycythemia vera. Which of the following actions should the nurse implement during treatment?
a. Place the client on bed rest.
b. Administer iron supplements.
c. Avoid use of Aspirin products.
d. Monitor fluid intake and output.
A
D
14
Q
- Which of the following nursing interventions should be included in the care plan for a
client with immune thrombo-cytopenic purpura (ITP)?
a. Assign the client to a private room.
b. Avoid intramuscular (IM) injections.
c. Use rinses rather than a toothbrush for oral care.
d. Restrict activity to passive and active range of motion.
A
B
15
Q
- Which of the following laboratory information should the nurse monitor to detect
heparin-induced thrombo-cytopenia (HIT) in a client who is receiving a continuous
heparin infusion?
a. Prothrombin time
b. Erythrocyte count
c. Fibrinogen degradation products
d. Activated partial thromboplastin time
A
D
16
Q
- The nurse is admitting a client with type A hemophilia who has severe pain and swelling
in the right knee. Which of the following actions should the nurse implement initially?
a. Immobilize the knee
b. Apply heat to the joint
c. Assist the client with light weight bearing
d. Perform passive range of motion to the knee
A
A
17
Q
- The nurse is caring for a client with von Willebrand disease who is admitted to the hospital for minor knee surgery. Which of the following laboratory information should the nurse assess?
a. Platelet count
b. Bleeding time
c. Thrombin time
d. Prothrombin time
A
B
18
Q
- A routine complete blood count indicates that a client may have myelodysplastic
syndrome. At this time, which of the following information should the nurse include in the
teaching plan?
a. Packed red blood cells (PRBCs) transfusion
b. Bone marrow biopsy
c. Filgrastim administration
d. Erythropoietin administration
A
B
19
Q
- Which of the following actions should the nurse include in the care plan for a hospitalized client who is neutropenic?
a. Avoid any IM or subcutaneous injections.
b. Check the oral temperature every 4 hours.
c. Omit all fruits or vegetables from the diet.
d. Place a “No Visitors” sign on the client door.
A
B
20
Q
- Which of the following laboratory tests should the nurse use to determine whether the
prescribed filgrastim is effective in the treatment of a client who is receiving
chemotherapy for acute lymphocytic leukemia?
a. Platelet count
b. Reticulocyte count
c. Total lymphocyte count
d. Absolute neutrophil count
A
D
21
Q
- The nurse is caring for a client with acute myelogenous leukemia (AML) who has
induction therapy prescribed and the client asks the nurse whether the planned
chemotherapy will be worth undergoing. Which of the following responses by the nurse is
best?
a. “If you do not want to have chemotherapy, there are other options for treatment
such as stem cell transplantation.”
b. “The decision about chemotherapy is one that you and the doctor need to make
rather than asking what I would do.”
c. “You don’t need to make a decision about treatment right now since leukemias in
adults tend to progress quite slowly.”
d. “The adverse effects of the chemotherapy are difficult, but AML frequently does
go into remission with chemotherapy.”
A
D
22
Q
- The nurse is caring for a client who has a history of a transfusion-related acute lung injury (TRALI) and is to receive a transfusion of packed red blood cells (PRBCs). Which of the following actions should the nurse take to decrease the risk for TRALI for this client?
a. Infuse the PRBCs slowly over 4 hours.
b. Transfuse only leukocyte-reduced PRBCs.
c. Administer the scheduled oral diuretic before the transfusion.
d. Give the PRN dose of antihistamine before starting the transfusion.
A
B
23
Q
- The nurse is caring for a client with acute myelogenous leukemia (AML) who is
considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT).
Which of the following actions is best for the nurse to implement to assist the client with
treatment decisions?
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 client whether there are any questions or concerns about HSCT.
d. Explain that a cure is not possible with any other treatment except HSCT.
A
C
24
Q
- Which of the following nursing actions should the nurse include in the plan of care for a
client 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
A
25
Q
- The nurse is caring for a client with non-Hodgkin’s lymphoma who develops a platelet
count of 38 ´ 109/L during chemotherapy. Which of the following actions should the nurse
implement based on this finding?
a. Provide oral hygiene every 2 hours.
b. Check all stools for occult blood.
c. Assess temperature every 4 hours.
d. Encourage fluids to 3 000 mL/day.
A
B
26
Q
- The nurse is caring for a client with acute myelogenous leukemia who is receiving
outpatient chemotherapy and develops an absolute neutrophil count of 0.9 ´ 109/L. Which
of the following actions by the nurse in the outpatient clinic is best?
a. Discuss the need for hospital admission to treat the neutropenia.
b. Plan to discontinue the chemotherapy until the neutropenia resolves.
c. Teach the client how to administer filgrastim injections at home.
d. Obtain a high-efficiency particulate air (HEPA) filter for the client for home use.
A
C
27
Q
- Which of the following assessment data obtained by the nurse when caring for a client
with thrombo-cytopenia should be immediately communicated to the health care provider?
a. The platelet count is 52 ´ 109/L.
b. The client is difficult to arouse.
c. There are large bruises on the back.
A
B
28
Q
- When a febrile episode occurs in a client with neutropenia, at what time should antibiotic therapy be initiated?
a. Within 1 hour
b. After the causative agent is identified from the culture
c. Once the fever drops below 38°C (100.4°F)
d. For long-term therapy over 3 months
A
A
29
Q
- The nurse is caring for a client receiving a transfusion of packed red blood cells who
develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started.
After stopping the transfusion, which of the following actions is priority?
a. Draw blood for a new crossmatch
b. Send a urine specimen to the laboratory
c. Give the PRN diphenhydramine
d. Administer the PRN acetaminophen
A
D
30
Q
- Fifteen minutes after a transfusion of packed red blood cells is started, a client has
symptoms of back pain and dyspnea and a pulse rate of 124 beats/minute. Which of the
following actions should the nurse implement initially?
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.
A
D
31
Q
- Which of the following newly admitted clients should the nurse assign as a roommate for a client who has aplastic anemia?
a. A client with severe heart failure
b. A client who has viral pneumonia
c. A client who has right leg cellulitis
d. A client with multiple abdominal drains
A
A
32
Q
- All of these clients are waiting to be admitted by the emergency department nurse. Which one of the following requires the most rapid assessment and care by the nurse?
a. The client with hemochromatosis who has symptoms of abdominal pain
b. The client with thrombo-cytopenia who has blood oozing after having a tooth
extracted
c. The client with chemotherapy-induced neutropenia who has a temperature of
38.2°C (100.8°F)
A
C
33
Q
- The nurse is caring for a client with immune thrombo-cytopenic purpura (ITP) who has a prescription for a platelet transfusion. Which of the following client information indicates that the nurse should consult with the health care provider before administering platelets?
a. The platelet count is 42 ´ 109/L.
b. Blood pressure is 94/56 mm Hg.
c. Blood is oozing from the venipuncture site.
d. Petechiae are present on the chest and back.
A
A
34
Q
- The hemophilia clinic nurse receives a call from a client with hemophilia to discuss all of these problems. Which of the following problems is most important to communicate to the health care provider?
a. Skin abrasions
b. Bleeding gums
c. Multiple bruises
d. Dark tarry stools
A
D
35
Q
- The nurse is caring for a client with septicemia who develops prolonged bleeding from
venipuncture sites and blood in the stools. Which of the following actions is most
important for the nurse to take?
a. Notify the client’s health care provider.
b. Avoid unnecessary venipunctures.
c. Apply sterile dressings to the sites.
d. Give prescribed proton-pump inhibitors.
A
A
36
Q
- After receiving change-of-shift report for the following four clients with neutropenia,
which client should the nurse assess first?
a. 66-year-old who has white pharyngeal lesions
b. 35-year-old who has a fever of 38.2°C (100.8°F)
c. 56-year-old who has frequent explosive diarrhea
d. 23-year old who is complaining of severe fatigue
A
B
37
Q
- The nurse is caring for a client with myelodysplastic syndrome who has 20% blasts in
marrow and the health care provider has prescribed high-intensity treatment. Which of the
following treatments should the nurse prepare the client to receive?
a. Antibiotics
b. Antifungals
c. Chemotherapy
d. A blood transfusion
A
C
38
Q
- All of these clients call the outpatient clinic and ask to make an appointment as soon as
possible. Which of the following clients should the nurse schedule to be seen first?
a. 19-year-old with no previous health problems who has a nontender lump in the
axilla
b. 46-year-old with sickle cell anemia who says “that my eyes always look sort of
yellow”
c. 21-year-old with hemophilia who wants to learn how to self-administer factor VII
replacement
d. 50-year-old with early-stage chronic lymphocytic leukemia who has complaints of
chronic fatigue
A
A
