HEMO: Lewis Ch 30 Hematologic Problems

Question 1

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)

Answer 1

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

The patient’s symptoms indicate moderate anemia, which is consistent with a Hgb of 6 to 10 g/dL. The other values are all within the range of normal.

Question 2

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

Answer 2

a. Omelet and whole wheat toast

Eggs and whole grain breads are high in iron. The other choices are appropriate for other nutritional deficiencies but are not the best choice for a patient with iron-deficiency anemia.

Question 3

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)

Answer 3

b. Folic acid

Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia.

Question 4

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).”

Answer 4

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

Because pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitamin.

Question 5

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.

Answer 5

c. Encourage alternating rest and activity.

Nursing care for patients with anemia should alternate periods of rest and activity to avoid
undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in
vitamin K or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia.

Question 6

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.”

Answer 6

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

It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the health care provider about this. The other patient statements are correct.

Question 7

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

Answer 7

b. Infection

Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema.

Question 8

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

Answer 8

b. Evaluating the effectiveness of opioid analgesics

Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not emphasized.

Question 9

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.”

Answer 9

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

Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis, patients do not receive these therapies to prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises.

Question 10

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.

Answer 10

b. Avoid exposure to crowds when possible.

Exposure to crowds increases the patient’s risk for infection, the most common cause of sickle cell crisis. There is no restriction on caffeine use. Iron supplementation is generally not recommended. A high-fluid intake is recommended.

Question 11

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

Answer 11

b. Bilirubin level

Jaundice is caused by the elevation of bilirubin level associated with red blood cell hemolysis. Other tests would not be helpful in monitoring hemolytic anemia.

Question 12

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

Answer 12

b. Discontinue the heparin infusion.

All heparin is discontinued when 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.

Question 13

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.

Answer 13

d. Monitor fluid intake and output.

Monitoring hydration status is important during an acute exacerbation because the patient is at risk for fluid overload or underhydration. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis. Iron is contraindicated in patients with polycythemia vera.

Question 14

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.

Answer 14

b. Avoid intramuscular (IM) injections.

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.

Question 15

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

Answer 15

d. Activated partial thromboplastin time

Platelet aggregation in HIT causes neutralization of heparin, so 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.

Question 16

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.

Answer 16

b. Immobilize the knee joint.

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.

Question 17

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

Answer 17

b. Bleeding time

The bleeding time is affected by von Willebrand disease. Platelet count, prothrombin time, and thrombin time are normal in von Willebrand disease.

Question 18

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

Answer 18

b. Bone marrow biopsy

Bone marrow biopsy is needed to make the diagnosis and determine the specific type of myelodysplastic syndrome. The other treatments may be necessary later if there is progression of the myelodysplastic syndrome, but the initial action for this asymptomatic patient will be a bone marrow biopsy.

Question 19

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.

Answer 19

b. Check temperature every 4 hours.

The earliest sign of infection in a neutropenic patient is an elevation in temperature. While unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a “no visitors” policy is not needed.

Question 20

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

Answer 20

d. Absolute neutrophil count

Filgrastim increases the neutrophil count and function in neutropenic patients. Although total lymphocyte, platelet, and reticulocyte counts are also important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim.

Question 21

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.”

Answer 21

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

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.

Question 22

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.

Answer 22

b. Transfuse leukocyte-reduced PRBCs.

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.

Question 23

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.

Answer 23

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

Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and 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.

Question 24

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.

Answer 24

a. Monitor fluid intake and output.

A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient’s calcium level and are not used.

Question 25

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.

Answer 25

a. Test all stools for occult blood.

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.

Question 26

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.

Answer 26

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

The patient may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count <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.

Question 27

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

Answer 27

b. The patient is difficult to arouse.

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.

Question 28

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.

Answer 28

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

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.

Question 29

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.

Answer 29

b. Administer PRN acetaminophen (Tylenol).

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 is used for allergic reactions. This type of reaction does not indicate incorrect crossmatching.

Question 30

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.

Answer 30

d. Disconnect the transfusion and infuse normal saline.

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.

Question 31

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

Answer 31

a. A patient with chronic heart failure

Patients with aplastic anemia are at risk for infection because of the low white blood cell production associated with this type of anemia, so the nurse should avoid assigning a roommate with any possible infectious process.

Question 32

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.

Answer 32

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

A neutropenic patient with a fever is assumed to have an infection and is at risk for rapidly developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed. The other patients also require rapid assessment and care but not as urgently as the neutropenic patient.

Question 33

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.

Answer 33

a. Platelet count is 42,000/L.

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.

Question 34

hich 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

Answer 34

b. Tarry stools

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.

Question 35

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.

Answer 35

c. Notify the health care provider.

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 are also appropriate, but the most important action should be to notify the health care provider so that DIC treatment can be initiated rapidly.

Question 36

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.

Answer 36

c. Infuse normal saline 500 mL over 30 minutes.

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 are also appropriate and should be rapidly implemented, but improving perfusion is the priority for this patient.

Question 37

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

Answer 37

c. Administering subcutaneous filgrastim (Neupogen) injection

Administration of subcutaneous medications is included in LPN/VN education and scope of practice. Patient teaching, assessment, and developing the plan of care require RN level education and scope of practice.

Question 38

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

Answer 38

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

The patient’s age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment. The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently.

Question 39

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

Answer 39

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

Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are needed. The other patients also need to be assessed but do not have symptoms of potentially life-threatening problems.

Question 40

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.

Answer 40

a. Administer chelation therapy as needed.

The frequent transfusions used to treat thalassemia major lead to iron toxicity in patients unless iron chelation therapy is consistently used. Iron supplementation is avoided in patients with thalassemia. There is no need to avoid intramuscular injections. The goal for patients with thalassemia major is to maintain a hemoglobin of 10 g/dL or greater.

Question 41

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

Answer 41

d. Serum iron level

Because iron chelating agents are used to lower serum iron levels, the most useful information will be the patient’s iron level. The other parameters will also be monitored but are not the most important to monitor when determining the effectiveness of deferoxamine.

Question 42

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

Answer 42

c. Calf swelling and pain

The calf swelling and pain suggest that the patient may have developed a deep vein thrombosis, which will require diagnosis and treatment to avoid complications such as pulmonary embolus. The other findings will also be reported to the health care provider but are expected in a patient with this diagnosis.

Question 43

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

Answer 43

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

The chemotherapy used in treating Hodgkin’s lymphoma results in a high incidence of secondary malignancies; follow-up screening is needed. Chemotherapy will not impact the fertility of a 55-yr-old woman. Maintenance chemotherapy is not used for Hodgkin’s lymphoma. Pruritus is a clinical manifestation of lymphoma but should not be a concern after treatment.

Question 44

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

Answer 44

d. Lip swelling

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.

Question 45

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.

Answer 45

b. Serum calcium level is 15 mg/dL.

Hypercalcemia may lead to complications such as dysrhythmias or seizures and should be addressed quickly. The other patient findings will also be discussed with the health care provider but are not life threatening.

Question 46

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.

Answer 46

b. Schedule immunization with the pneumococcal vaccine

Asplenic patients are at high risk for infection with pneumococcal infections and immunization reduces this risk. There is no need to avoid acetaminophen use before surgery, but nonsteroidal antiinflammatory drugs (NSAIDs) may increase bleeding risk and should be avoided. The enlarged spleen may decrease respiratory depth, and the patient should be encouraged to take deep breaths.

Question 47

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

Answer 47

b. Neutropenia

The low white blood cell count indicates that the patient is at high risk for infection and needs immediate actions to diagnose and treat the cause of the leukopenia. The other information may require further assessment or treatment but does not place the patient at immediate risk for complications.

Question 48

A patient is to receive an infusion of 250 mL of platelets over 2 hours through tubing that is labeled: 1 mL equals 10 drops. How many drops per minute will the nurse infuse?

Answer 48

ANS: 21

To infuse 250 mL over 2 hours, the calculated drip rate is 20.8 drops/min or 21 drops/min.