Chapter 40

Question 1

A nurse caring for a client with sickle cell disease (SCD) reviews the client’s laboratory work. Which finding should the nurse report to the provider?

Answer 1

Creatinine: 2.9 mg/dL

Question 2

A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best?

Answer 2

Give the client pain medication if it is time for another dose.

Question 3

A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best?

Answer 3

0.45% normal saline

Question 4

A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority?

Answer 4

Administer oxygen.

Question 5

A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells. What action by the nurse is best?

Answer 5

Perform a Hemoccult test on the client’s stools.

Question 6

A client has Crohn’s disease. What type of anemia is this client most at risk for developing?

Answer 6

Folic acid deficiency

Question 7

A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client should the nurse see first?

Answer 7

Client who reports shortness of breath

Question 8

A nursing student is caring for a client with leukemia. The student asks why the client is still at risk for infection when the client’s white blood cell count (WBC) is high. What response by the registered nurse is best?

Answer 8

“Those WBCs are abnormal and don’t provide protection.”

Question 9

The family of a neutropenic client reports the client “is not acting right.” What action by the nurse is the priority?

Answer 9

Assess the client for infection.

Question 10

A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client cope with the long recovery period, what action by the nurse is best?

Answer 10

Help the client find things to hope for each day of recovery.

Question 11

A nursing student is struggling to understand the process of graft-versus-host disease. What explanation by the nurse instructor is best?

Answer 11

“The donor’s cells are actually attacking the client’s cells.”

Question 12

The nurse is caring for a client with leukemia who has the priority problem of fatigue. What action by the client best indicates that an important goal for this problem has been met?

Answer 12

Doing activities of daily living (ADLs) using rest periods

Question 13

A nurse is caring for a young male client with lymphoma who is to begin treatment. What teaching topic is a priority?

Answer 13

Sperm banking

Question 14

A client has been admitted after sustaining a humerus fracture that occurred when picking up the family cat. What test result would the nurse correlate to this condition?

Answer 14

Bence-Jones protein in urine

Question 15

A client with multiple myeloma demonstrates worsening bone density on diagnostic scans. About what drug does the nurse plan to teach this client?

Answer 15

Zoledronic acid (Zometa)

Question 16

A client with autoimmune idiopathic thrombocytopenic purpura (ITP) has had a splenectomy and returned to the surgical unit 2 hours ago. The nurse assesses the client and finds the abdominal dressing saturated with blood. What action is most important?

Answer 16

Taking a set of vital signs and notifying the surgeon

Question 17

A client has a platelet count of 9000/mm3. The nurse finds the client confused and mumbling. What action takes priority?

Answer 17

Calling the Rapid Response Team

Question 18

A nurse is preparing to administer a blood transfusion. What action is most important?

Answer 18

Ensuring informed consent is obtained if required

Question 19

A nurse is preparing to hang a blood transfusion. Which action is most important?

Answer 19

Putting on a pair of gloves

Question 20

A client receiving a blood transfusion develops anxiety and low back pain. After stopping the transfusion, what action by the nurse is most important?

Answer 20

Double-checking the client and blood product identification

Question 21

A client has thrombocytopenia. What client statement indicates the client understands self-management of this condition?

Answer 21

“I usually put ice on bumps or bruises.”

Question 22

A client has a sickle cell crisis with extreme lower extremity pain. What comfort measure does the nurse delegate to the unlicensed assistive personnel (UAP)?

Answer 22

Keep the lower extremities warm.

Question 23

A client admitted for sickle cell crisis is distraught after learning her child also has the disease. What response by the nurse is best?

Answer 23

“I can see you are upset. I can stay here with you a while if you like.”

Question 24

A client with sickle cell disease (SCD) takes hydroxyurea (Droxia). The client presents to the clinic reporting an increase in fatigue. What laboratory result should the nurse report immediately?

Answer 24

White blood cell count: 38,000/mm3

Question 25

A nurse is caring for four clients with leukemia. After hand-off report, which client should the nurse see first?

Answer 25

Client who had two bloody diarrhea stools this morning

Question 26

A client has frequent hospitalizations for leukemia and is worried about functioning as a parent to four small children. What action by the nurse would be most helpful?

Answer 26

Assist the client to make “sick day” plans for household responsibilities.

Question 27

A client has been treated for a deep vein thrombus and today presents to the clinic with petechiae. Laboratory results show a platelet count of 42,000/mm3. The nurse reviews the client’s medication list to determine if the client is taking which drug?

Answer 27

Unfractionated heparin

Question 28

The nurse assesses a client’s oral cavity and makes the discovery shown in the photo below:
What action by the nurse is most appropriate?

Answer 28

Teach the client about cobalamin therapy.

Question 29

A nurse working with clients with sickle cell disease (SCD) teaches about self-management to prevent exacerbations and sickle cell crises. What factors should clients be taught to avoid? (Select all that apply.)

a. Dehydration
b. Exercise
c. Extreme stress
d. High altitudes
e. Pregnancy

Answer 29

A,C,D,E

Question 30

A student studying leukemias learns the risk factors for developing this disorder. Which risk factors does this include? (Select all that apply.)

a. Chemical exposure
b. Genetically modified foods
c. Ionizing radiation exposure
d. Vaccinations
e. Viral infections

Answer 30

A,C,E