Lewis Chapter 33: Hematological Conditions

Question 1

In a severely anemic client, what would the nurse expect to find?

a. Dyspnea at rest and tachycardia

b. Cyanosis and pulmonary edema

c. Cardiomegaly and pulmonary fibrosis

d. Ventricular dysrhythmias and wheezing

Answer 1

A.

Question 2

When obtaining assessment data from a client with a microcytic, hypochromic anemia, what would the nurse question the client about?

a. Folic acid intake

b. Dietary intake of iron

c. History of gastric surgery

d. History of sickle cell anemia

Answer 2

B.

Question 3

Nursing interventions for a client with severe anemia related to peptic ulcer disease include which of the following? (Select all that apply.)

a. Giving instructions in high-iron diet

b. Taking vital signs every 8 hours

c. Monitoring stools for occult blood

d. Teaching self-injection of erythropoietin

e. Administering cobalamin (vitamin B12) injections

Answer 3

A, C.

Question 4

Which nursing management actions apply for a client in sickle cell crisis? (Select all that apply.)

a. Monitoring CBC

b. Providing optimal pain management and O2 therapy

c. Administering blood transfusions if required and iron chelation

d. Recommending rest as needed and deep-vein thrombosis (DVT) prophylaxis

e. Administering IV iron and a diet high in iron content

Answer 4

A.

Question 5

Which is a complication of the hyperviscosity of polycythemia?

a. Thrombosis

b. Cardiomyopathy

c. Pulmonary edema

d. Disseminated intravascular coagulation (DIC)

Answer 5

A.

Question 6

When caring for a client with thrombocytopenia, the patient teaching should include which instruction?

a. To wipe their nose gently instead of blowing

b. To be careful when shaving with a safety razor

c. To continue with physical activities to stimulate thrombopoiesis

d. To avoid acetylsalicylic acid because it may mask the fever that occurs with thrombocytopenia

Answer 6

A.

Question 7

The nurse would anticipate that a client with von Willebrand disease who is undergoing surgery would be treated with administration of von Willebrand factor (vWF) and which of the following?

a. Thrombin

b. Factor VI

c. Factor VII

d. Factor VIII

Answer 7

D.

Question 8

What physiological process occurs in a person with DIC?

a. The coagulation pathway is genetically altered, leading to thrombus formation in all major blood vessels.

b. An underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic episodes and infarcts.

c. A disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage.

d. An inherited predisposition causes a deficiency of clotting factors that leads to overstimulation of coagulation processes in the vasculature.

Answer 8

C.

Question 9

Which of the following is (are) a priority nursing action when caring for a hospitalized client with a new-onset temperature of 39°C and severe neutropenia? (Select all that apply.)

a. Administering the prescribed antibiotic STAT

b. Drawing peripheral and central line blood cultures

c. Ensuring ongoing monitoring of the client’s vital signs for septic shock

d. Taking a full set of vital signs and notifying the health care provider immediately

e. Administering transfusions of WBCs to decrease immunogenicity

Answer 9

A, B, C, D.

Question 10

Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow, which laboratory results would the nurse expect to find?

a. An excess of T cells

b. An excess of platelets

c. A deficiency of granulocytes

d. A deficiency of all cellular blood components

Answer 10

D.

Question 11

Which is the most common type of leukemia in older persons?

a. Acute myelocytic leukemia

b. Acute lymphocytic leukemia

c. Chronic myelocytic leukemia

d. Chronic lymphocytic leukemia

Answer 11

D.

Question 12

Why are multiple medications often used in combinations to treat leukemia and lymphoma?

a. There are fewer toxic and adverse effects.

b. The chance that one medication will be effective is increased.

c. The medications are more effective and cause fewer adverse effects.

d. The medications work by different mechanisms to maximize killing of cancerous cells.

Answer 12

D.

Question 13

What is the major difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma?

a. Hodgkin’s lymphoma occurs only in young adults.

b. Hodgkin’s lymphoma is considered potentially curable.

c. Non-Hodgkin’s lymphoma can manifest in multiple organs.

d. Non-Hodgkin’s lymphoma is treated only with radiation therapy.

Answer 13

C.

Question 14

A patient with multiple myeloma becomes confused and lethargic. What indications would the nurse expect from the diagnostic results?

a. Hyperkalemia

b. Hyperuricemia

c. Hypercalcemia

d. CNS myeloma

Answer 14

C.

Question 15

What would the nurse expect to find when reviewing a client’s hematological laboratory values after a splenectomy?

a. Deceased WBC count

b. RBC abnormalities

c. Decreased hemoglobin

d. Increased platelet count

Answer 15

D.

Question 16

Which complications of transfusions can be decreased by the use of leukocyte depletion or reduction of red blood cell transfusion?

a. Chills and hemolysis

b. Leukostasis and neutrophilia

c. Fluid overload and pulmonary edema

d. Transmission of cytomegalovirus and fever

Answer 16

D.

Question 17

Which classification system is the most accurate means of identifying anemias?

A. Morphological system

B. Etiological classification

C. NYHA classification system

D. ABO system

Answer 17

A. Morphological system

The morphological system is the most accurate means of classifying anemias. However, it is easier to discuss patient care by focusing on the cause or etiology of the anemia.

Question 18

Which sign is a potential gastrointestinal system sign of anemia?

A. Cheilitis

B. Sore throat

C. Diarrhea

D. Glossitis

Answer 18

D. Glossitis

Glossitis, which is a swollen, smooth, red tongue, is a gastrointestinal sign of anemia.

Question 19

Which statement about anemia in older adults is accurate?

A. A slight decrease in HB occurs in healthy women between ages 70 and 88.

B. Cytokine dysregulation is the most common cause of anemia in the older adults.

C. Anemia is common in older adults.

D. Anemia prevalence decreases after age 65.

Answer 19

A. A slight decrease in HB occurs in healthy women between ages 70 and 88.

A slight decrease in HB that occurs in healthy woman between ages 70 and 88 is a normal finding. Men of the same age have a decrease of about 10 g/L.

Question 20

Which etiology is a cause of iron-deficiency anemia? Select all that apply. One, some, or all responses may be correct.

A. Blood loss

B. Folic acid deficiency

C. Inadequate dietary intake

D. Malabsorption

E. Vitamin B12 deficiency

F. Hemolysis

Answer 20

A, C, D, F.

Blood loss is a common cause of iron-deficiency anemia in adults. GI bleed is a major cause of blood loss.
Inadequate dietary intake may be the cause of iron deficiency anemia in some individuals who have higher than average intake needs.
Malabsorption is a cause of iron-deficiency anemia for people who have had certain types of GI surgeries or syndromes.
Hemolysis is a potential cause of iron-deficiency anemia.

Question 21

Which recommendation to the patient maximizes absorption of oral iron supplements?

A. “Take your iron tablets in the morning with a glass of milk at least 30 minutes before breakfast.”

B. “Take your iron tablets in the morning with a glass of orange juice about an hour before breakfast.”

C. “Take your iron tablets first thing in the morning with a glass of milk.”

D. “Take your iron tablets in the morning with a glass of orange juice about an hour after breakfast.”

Answer 21

B. “Take your iron tablets in the morning with a glass of orange juice about an hour before breakfast.”

Iron is best absorbed in an acidic environment. It should be taken about an hour before meals when the duodenal mucosa is most acidic. Taking iron with vitamin C (ascorbic acid) or orange juice enhances iron absorption.

Question 22

Which treatment is the only cure for thalassemia major?

A. Chelation therapy

B. Blood transfusion

C. Intravenous deferoxamine

D. Stem cell transplant

Answer 22

D. Stem cell transplant

Hematopoietic stem cell transplantation (HSCT) is the only cure for thalassemia major, but it is a reasonable option for only a small number of patients. Obstacles to transplant include access, donor availability, and the procedural risk.

Question 23

Match the classification of megaloblastic anemia to its related cause.

Gastric bypass, pernicious anemia, intrinsic factor deficiency
-Cobalamin deficiency

Celiac disease, Crohn’s disease, poor diet
-Folic acid deficiency

Defective folate metabolism, defective transport of cobalamin
=Inborn errors

Alkylating agents, folate antagonists, metabolic inhibitors
-Medication-induced DNA suppression

Question 24

Which type of anemia is characterized by normocytic, normochromic, hypoproliferative RBCs?

A. Iron deficiency anemia

B. Anemia of chronic disease

C. Pernicious anemia

D. Sickle cell anemia

Answer 24

B. Anemia of chronic disease

In anemia of chronic disease, RBCs are normal in size and colour, but are under produced. Conditions such as cancer, autoimmune disorders, and infection are some of the causes.

Question 25

Which treatment is priority for anemia caused by chronic blood loss? A. Identify source and stop the bleed B. Identify source and administer packed RBCs C. Administer vitamin B12 supplements D. Apply pressure to the source to stop the bleed

Answer 25

A. Identify source and stop the bleed Identifying source and stopping the bleed is the appropriate treatment for anemia caused by chronic blood loss.

Question 26

Which clinical manifestation may be observed in patients with sickle cell anemia? Select all that apply. One, some, or all responses may be correct. A. Pain that ranges from mild to extreme B. Renal failure C. Development of autosplenectomy D. Acute chest syndrome E. Occurrence of priapism F. Cyanosis related to hemolysis

Answer 26

A, B, C, D, E. Pain episodes can affect any area of the body or several sites simultaneously, with the most-commonly affected areas being the back, chest, extremities, and abdomen. Kidneys may be injured from the increased blood viscosity and the lack of O2, which can lead to renal failure. The spleen becomes smaller due to repeated scarring that occurs during sickle cell episodes. Acute chest syndrome is a term used to describe acute pulmonary complications that include pneumonia, tissue infarction, and fat embolism. Priapism (persistent penile erection) may occur if penile veins become occluded.

Question 27

Which factor contributes to the physical destruction of RBCs in acquired hemolytic anemia? Select all that apply. One, some, or all responses may be correct. A. Oxidative medication B. Hemodialysis C. Extracorporeal circulation D. Prosthetic heart valves E. Isoimmune reactions F. Passage through radiated blood vessels

Answer 27

B, C, D, F. Hemodialysis causes disruption of the RBC membrane, which results in hemolysis. Extracorporeal circulation used in cardiopulmonary bypass causes disruption of the RBC membrane, leading to hemolysis. Prosthetic heart valves cause disruption of the RBC membrane, which leads to hemolysis. The high amount of force needed to push blood through radiated blood vessels can cause fragmentation, destroying RBCs.

Question 28

Which responsibility does the nurse have when caring for a patient in an acute exacerbation of polycythemia vera (PV)? A. Support NPO order B. Monitoring fluid intake and output C. Encourage complete bed rest D. Promote decreased food intake

Answer 28

B. Monitoring fluid intake and output Fluid intake and output must be evaluated during hydration therapy to avoid fluid overload and underhydration. Fluid overload further complicates the circulatory congestion while underhydration can cause the blood to become even more viscous.

Question 29

Which manifestation of anemia occurs with severe anemia? A. Heart palpitations B. Fatigue C. Sensitivity to cold D. Exertional dyspnea

Answer 29

C. Sensitivity to cold Sensitivity to cold occurs in the severe level of anemia when hemoglobin is at 60 g/L or less.

Question 30

Which finding during the assessment may trigger concerns about pernicious anemia? A. Patient has a history of recent gastric bypass surgery and reports excessive fatigue. B. Patient reports episodes of hematuria over the past week. C. Patient has a complete blood count (CBC) showing pancytopenia. D. Patient reports frequent episodes of epistaxis.

Answer 30

A. Patient has a history of recent gastric bypass surgery and reports excessive fatigue. Gastric bypass surgery diverts digestion away from the stomach, which also impairs intrinsic factor production and absorption. This results in pernicious anemia.

Question 31

Which patient would be unlikely to benefit from iron supplements? A. Patient experiencing acute blood loss B. Patient in second trimester of pregnancy C. Patient with hereditary hemochromatosis D. Patient with limited access to healthy foods

Answer 31

C. Patient with hereditary hemochromatosis A patient with hereditary hemochromatosis has excessive amounts of iron in the body. Iron supplements would increase the iron load and cause harm to the patient.

Question 32

Which nutrient is necessary for erythropoiesis? Select all that apply. One, some, or all responses may be correct. A. Folic acid B. Fat C. Cobalamin D. Amino acids E. Pyridoxine F. Vitamin A

Answer 32

A, C, D, E. Folic acid is necessary for the synthesis of DNA and RNA as an essential function in erythropoiesis. Another function is maturation of RBCs. Foods rich in folic acid include leafy green vegetable, okra, liver, meat, fish, legumes, whole grains, and orange juice. Cobalamin (Vitamin B12) plays a role in erythropoiesis. It is essential for DNA synthesis, RBC maturation, and folate metabolism. Cobalamin is found in red meats, eggs, enriched grain products, dairy products, fish, and soy beverages. Amino acids play a role in erythropoiesis. It is necessary for hemoglobin and plasma membrane synthesis and structure. It is found in foods such as eggs, milk, poultry, fish, legumes, nuts, and soy Pyridoxine (Vitamin B6) is necessary for hemoglobin synthesis as a part of erythropoiesis. It is found in foods like meats, wheat germ, legumes, potatoes, cornmeal, bananas, nuts, and fish.

Question 33

Which anemia is caused by impaired DNA synthesis and characterized by macrocytic RBCs? Select all that apply. One, some, or all responses may be correct. A. Sickle cell disease B. Iron deficiency anemia C. Cobalamin deficiency anemia D. Thalassemia E. Folic acid deficiency anemia F. Erythroleukemia

Answer 33

C, E, F. Megaloblastic anemias are a group of disorders caused by impaired DNA synthesis and characterized by the presence of large RBCs. Iron deficiency, Folic acid deficiency is a cause of megaloblastic anemia. Erythroleukemia is a malignant blood disorder characterized by a proliferation of erythropoietic cells in bone marrow.

Question 34

Which comment from the nurse demonstrates an understanding of aplastic anemia? A. “It is the most common type of anemia.” B. “It can only be caused by certain medications and toxins.” C. “It is a disease in which the patient has pancytopenia and hypercellular bone marrow.” D. “It is most often due to autoimmune activity by cytotoxic T cells that destroy hematopoietic stem cells.”

Answer 34

D. “It is most often due to autoimmune activity by cytotoxic T cells that destroy hematopoietic stem cells.” About 70% of aplastic anemias are due to autoimmune activity by autoreactive T lymphocytes. These cytotoxic T cells target and destroy the patient’s own hematopoietic stem cells.

Question 35

Which organ is adversely affected in hemolytic anemia? Select all that apply. One, some or all responses may be correct. A. Spleen B. Bladder C. Liver D. Kidneys E. Small intestine F. Lungs

Answer 35

A, C, D. The spleen and the liver may enlarge because of their hyperactivity related to macrophage phagocytosis of the defective erythrocytes. The spleen and the liver may enlarge because of their hyperactivity related to macrophage phagocytosis of the defective erythrocytes. Jaundice is likely due to increased levels of bilirubin. When an RBC is hemolyzed, the Hb molecule is released and filtered by the kidneys. The accumulation of Hb molecules can obstruct the renal tubules and lead to acute tubular necrosis. A major focus of treatment of hemolysis, no matter its cause, is to maintain renal function.

Question 36

Which statement made by the nurse indicates an understanding of the clinical manifestations of anemia from acute blood loss? A. “The patient lost a lot of blood through trauma; she will need to be on a high iron diet.” B. “The patient reports feeling lightheaded, and blood pressure dropped when standing. Hemoglobin and hematocrit are normal, but we need to prepare for transfusion of PRBCs.” C. “The patient’s RBC, hemoglobin, and hematocrit levels are normal. She has recovered from yesterday’s blood loss in surgery.” D. “The patient received lactated Ringer’s solution to replace the volume of blood lost during trauma. We’ve prevented the onset of anemia symptoms.”

Answer 36

B. “The patient reports feeling lightheaded, and blood pressure dropped when standing. Hemoglobin and hematocrit are normal, but we need to prepare for transfusion of PRBCs.” Loss of RBCs is not reflected in laboratory data immediately during acute blood loss. Values may seem normal or high for 2 to 3 days. Once the plasma is replaced, the RBC mass is less concentrated and the RBC, Hb, and Hct levels are low, reflecting the actual blood loss. Orthostatic hypotension and lightheadedness are signs and a blood transfusion may be indicated.

Question 37

Which sickle cell disorder causes the most severe symptoms? A. Sickle cell anemia B. Sickle cell–thalassemia C. Sickle cell–HbC disease D. Sickle cell trait

Answer 37

A. Sickle cell anemia Sickle cell anemia, the most severe of the SCD syndromes, occurs when a person is homozygous for HbS (HbSS). The person has inherited HbS from both parents.

Question 38

Which patient exhibits signs and symptoms of hemochromatosis? A. A 47-year-old male with fatigue, weight loss, bronzing, and elevated total iron binding capacity (TIBC) B. A 25-year-old female with fatigue, swollen tongue, and tachycardia C. A 35-year-old male vegan with fatigue, constipation, and pallor D. An 8-month-old female with delayed growth, jaundice, and dark-coloured urine

Answer 38

A. A 47-year-old male with fatigue, weight loss, bronzing, and elevated total iron binding capacity (TIBC) Fatigue, weight loss, bronzing, and elevated TIBC are indicative of hemochromatosis. Arthralgia, erectile dysfunction, and abdominal pain are also early signs. Blood chemistry will show elevates serum iron and serum ferritin.

Question 39

Match the type of leukemia to the age of onset. Increased incidence with age; peak incidence between 60 and 70 yr of age -Acute myelogenous leukemia Peak prevalence between ages 2 and 5 yr and after 50 yr -Acute lymphocytic leukemia Increased incidence with advancing age; median age at diagnosis of 67 yr -Chronic myelogenous leukemia Onset between 50–70 yr of age; rare below 30 yr of age -Chronic lymphocytic leukemia

Question 40

Which rationale explains the use of multi-drug therapy in treating leukemia? A. Using multi-drug therapy is experimental and has show improved results over single drug therapy. B. Using multiple generic drugs is less expensive that using one name-brand drug. C. Multiple drug therapy is more effective and less toxic than single drug therapy. D. Multi-drug therapy eliminates the need for radiation therapy.

Answer 40

C. Multiple drug therapy is more effective and less toxic than single drug therapy. The three purposes for using multiple drugs are to decrease drug resistance, minimize the drug toxicity to the patient by using multiple drugs with varying toxicities, interrupt cell growth at multiple points in the cell cycle.

Question 41

Which intervention is appropriate for the long-term survivor of leukemia? A. Enroll the patient at a local gym to regain strength B. Assure the patient that, once a long-term care plan is established, the patient can manage leukemia on their own C. Support the patient’s mindset about regaining health and learning how to cope with fear of relapse D. Encourage patient to enjoy time and activities alone until they can make new friends

Answer 41

C. Support the patient’s mindset about regaining health and learning how to cope with fear of relapse The patient and the family must learn to regain attitudes of health and life while facing the real fear of relapse of disease. Survivor networks and support groups may help the patient adapt to living after a life-threatening illness.

Question 42

Which statement by the nurse demonstrates an understanding of the progression of Hodgkin’s disease? A. “Hodgkin’s disease typically begins in the cervical lymph nodes and can remain there before progressing.” B. “Hodgkin’s disease that begins in abdominal lymph nodes rarely spreads further.” C. “Hodgkin’s disease relapse is typically confined to a few lymph nodes and does not infiltrate other organs.” D. “Hodgkin’s disease begins in the spleen and quickly moves into the adjacent lymph nodes.”

Answer 42

A. “Hodgkin’s disease typically begins in the cervical lymph nodes and can remain there before progressing.” The disease starts in a single location and then spreads along adjacent lymphatics. It starts in the cervical lymph nodes in 60–70% of patients. When the disease begins above the diaphragm, it remains confined to lymph nodes for a variable time.

Question 43

Which treatment plan will the nurse anticipate for the patient diagnosed with Hodgkin’s lymphoma Stage I B? A. Initiation of treatment with radiation therapy B. Four to six cycles of chemotherapy C. Two to four cycles of chemotherapy D. Six to eight cycles of chemotherapy

Answer 43

B. Four to six cycles of chemotherapy Patients with early-stage but unfavourable prognostic features (e.g., the presence of B symptoms) or intermediate-stage disease will receive four to six cycles of chemotherapy.

Question 44

Which intervention will the nurse perform when caring for a patient with non-Hodgkin’s lymphoma (NHL)? Select all that apply. One, some, or all responses may be correct. A. Enforcing bed rest orders B. Educating on radioactive antibody therapy C. Providing pain management D. Administering blood transfusions E. Advocating for aggressive treatment of indolent NHL

Answer 44

B, C. The nurse would educate the NHL patient on monoclonal antibody ibritumomab tiuxetan (Zevalin) therapy. The medication contains a radioactive particle than can kill cancer cells. Adverse effects of the medication include pancytopenia. Nurses must be aware of the precautions to take in caring for these patients and must educate patients about safety issues to minimize the risk of radiation exposure to staff and others. The nursing care for NHL is similar to that for Hodgkin’s lymphoma. It is largely focused on managing conditions related to the disease, pancytopenia, and other adverse effects of therapy (e.g., pain caused by the tumour, spinal cord compression, tumour lysis syndrome).

Question 45

Which symptom is the major manifestation in patients with multiple myeloma (MM)? A. Serum hyperviscosity syndrome B. Polyuria C. Skeletal pain D. Renal impairment

Answer 45

C. Skeletal pain Multiple myeloma develops slowly and insidiously. The patient often does not manifest symptoms until the disease is advanced, at which time skeletal pain is the major manifestation.

Question 46

Which intervention will the nurse employ to manage pain in a patient with multiple myeloma (MM)? Select all that apply. One, some, or all responses may be correct. A. Administering opioids B. Administering allopurinol C. Applying braces to patient D. Exercising caution when moving or ambulating the patient E. Ensuring proper hydration F. Administering acetaminophen

Answer 46

C, D, F. Braces, especially for the spine, may help control pain for patients with MM. Because of the potential for pathological fractures, the nurse must be careful when moving and ambulating the patient with MM. A slight twist or strain in the wrong area may be sufficient to cause a fracture. Analgesics, such as nonsteroidal anti-inflammatory medications, acetaminophen, or an acetaminophen–opioid combination, may be more effective than opioids alone in diminishing bone pain for patients with MM.

Question 47

Which electrolyte is important to monitor in the patient receiving a blood transfusion? Select all that apply. One, some, or all responses may be correct. A. Phosphorus B. Sodium C. Potassium D. Calcium E. Chloride F. Magnesium

Answer 47

C, D. Hyperkalemia results when potassium leaks from RBCs in stored blood. Mild to severe signs and symptoms can occur, including flaccid paralysis of the cardiac or respiratory muscles and cardiac arrest. Potassium must be monitored closely due to the potential for causing cardiac arrythmia and death. Patients receiving blood are at increased risk for hypocalcemia because citrate (a preservative added to the blood) can bind to the patient’s calcium, inactivating calcium, and causing hypocalcemia. Hypocalcemia symptoms manifest as muscle tremors and ECG changes that indicate abnormal cardiac rhythms. Calcium must be monitored closely due to the potential for causing cardiac arrythmia and death.

Question 48

Which patient does the nurse anticipate will benefit from autologous donation for blood transfusion? A. The patient who will require substantial blood product support during a major surgical procedure B. The patient scheduled for a minor surgery not expected to require any blood product support C. The patient with a rare blood type D. The patient requiring surgery for massive trauma

Answer 48

C. The patient with a rare blood type The patient with a rare blood type would benefit from autologous donation as matching the patient’s specific needs would be difficult. A non-matched transfusion could lead to significant complications.

Question 49

Which statement about leukemia demonstrates the nurse’s knowledge? A. “Leukemia is more common in women.” B. “Leukemia is characterized by the replacement of bone marrow with leukocyte precursors.” C. “Leukemia is a terminal disease.” D. “Leukemia is a specific type of cancer.”

Answer 49

B. “Leukemia is characterized by the replacement of bone marrow with leukocyte precursors.” Leukemia is characterized by diffuse replacement of bone marrow with proliferating leukocyte precursors. Loss of regulation in cell division results in accumulation of dysfunctional cells.

Question 50

Which description defines leukostasis? A. Bone marrow failure due to overcrowding of the marrow by abnormal cells. B. Solid masses can result from collections of leukemic cells. C. Accumulation of abnormal WBC in the patient’s organs. D. High leukemia WBC count in the peripheral blood can cause the blood to thicken.

Answer 50

D. High leukemia WBC count in the peripheral blood can cause the blood to thicken. High leukemia WBC count in the peripheral blood can cause the blood to thicken and potentially block circulatory pathways. This is called leukostasis and can be life-threatening.

Question 51

Which intervention by the nurse is part of caring for a patient with leukemia? Select all that apply. One, some, or all responses may be correct. A. Give the patient and family handouts and websites about coping with leukemia. B. Provide education on the prognosis, treatment plan, and treatment goals. C. Assume that the oncology team has addressed all of the patient’s concerns. D. Provide complete physical and psychological care to the patient. E. Perform astute ongoing assessments.

Answer 51

B, E. Provide education on the prognosis, treatment plan, and treatment goals. Making astute assessments and plan care to help the patient manage the severe adverse effects of chemotherapy is a primary nursing responsibility when caring for a patient with leukemia.

Question 52

Which form of lymphoma commonly includes fever, night sweats, and weight loss as symptoms? A. Burkitt lymphoma B. Non-Hodgkin’s lymphoma (NHL) C. Hodgkin’s disease D. Mantle cell lymphoma (MCL)

Answer 52

C. Hodgkin’s disease B symptoms (fever, night sweats, and weight loss) are common in Hodgkin’s disease.

Question 53

Which patient would be classified as having Hodgkin’s disease stage II B? A. A patient with lymphoma in two or more lymph nodes above the diaphragm with B symptoms present. B. A patient with lymph node involvement above and below the diaphragm and no B symptoms. C. A patient with lymph nodes involved on both sides of the diaphragm and in the liver, with no B symptoms. D. A patient with a single lymph node involved and experiencing B symptoms.

Answer 53

A. A patient with lymphoma in two or more lymph nodes above the diaphragm with B symptoms present. Stage II involves two or more lymph nodes on one side of diaphragm. “B” indicates that B symptoms are present.

Question 54

Which factor is known to have a role in the development of non-Hodgkin’s lymphoma (NHL)? Select all that apply. One, some, or all responses may be correct. A. Chromosomal translocations B. H. pylori C. Obesity D. Pesticides E. Herbicides F. COVID-19

Answer 54

A, B, D, E. Chromosomal translocations have a key role in the pathogenesis of many NHLs. Some viruses and bacteria are implicated in the pathogenesis of NHL, including HTLV1, EBV, human herpesvirus 8, hepatitis B and C, H. pylori, Chlamydophila psittaci, Campylobacter jejuni, and Borrelia burgdorferi. Environmental factors linked to the development of NHL include chemicals such as pesticides, herbicides, solvents, organic chemicals, and wood preservatives.

Question 55

Which explanation provides accurate education to patients about multiple myeloma (MM)? A. MM is the most common cancer diagnosed in women. B. MM tumours produce monoclonal antibodies that override healthy antibody cells. C. Multiple myeloma starts in the lymph system. D. Chronic cough is often the first symptom.

Answer 55

B. MM tumours produce monoclonal antibodies that override healthy antibody cells. In multiple myeloma, instead of a variety of plasma cells producing antibodies to fight different infections, myeloma tumours produce monoclonal antibodies. These cells are ineffective and even harmful as they do not fight infections, but infiltrate the bone marrow.

Question 56

Which finding is associated with multiple myeloma (MM)? Select all that apply. One, some, or all responses maybe correct. A. Elevated levels of calcium in the blood B. Presence of destroyed bone and thinning of bone tissue C. Absence of Bence Jones protein in urine D. M protein present in blood and urine E. Abnormally low serum creatinine F. High levels of β2microglobulin and low levels of albumin in the blood

Answer 56

A, B, D, F. Hypercalcemia may be present in MM, as bone tissue is broken down. Presence of destroyed bone and thinning of bone tissue in MRI, PET, or CT scans is indicative of multiple myeloma. M protein present in blood and urine is associated with multiple myeloma. High levels of β2microglobulin and low levels of albumin in the blood are associated with multiple myeloma and indicative of poorer prognosis.

Question 57

Which treatments are used in managing multiple myeloma (MM)? A. Complete bed rest B. Fluid restrictions C. Bisphosphonate administration D. Routine plasmapheresis

Answer 57

C. Bisphosphonate administration Bisphosphonates inhibit bone breakdown and is used for the treatment of skeletal pain and hypercalcemia, inhibits bone resorption without inhibiting bone formation and mineralization. Recommended for all patients with symptomatic multiple myeloma.

Question 58

Which safety precaution will the nurse take when administering a blood transfusion? A. Warm blood products in the microwave to prevent patient chilling. B. Perform a dual check of the blood component with another licensed nurse. C. Use Y-tubing with the PRBCs on one limb and dextrose on the other limb to dilute the infusion. D. Check the patient’s vital signs prior to beginning the transfusion and then every 30 minutes for 4 hours.

Answer 58

B. Perform a dual check of the blood component with another licensed nurse. Improper product-to-patient identification causes 90% of hemolytic transfusion reactions. The nurse must follow the policy and procedures of the institution where care is being provided. Many institutions have implemented a dual checking system with two licensed individuals checking patient identification with the labelled blood component.

Question 59

Which intervention prevents a blood transfusion reaction? Select all that apply. One, some, or all responses may be correct. A. Application topical hydrocortisone B. Administration of antihistamines C. Infusion of 1L normal saline per unit of PBRC D. Infusion of 10% calcium gluconate E. Inject heparin into fresh-frozen plasma (FFP) prior to transfusing F. Warm blood prior to transfusion

Answer 59

B, D, F. Administration of antihistamines may help prevent allergic reactions. Epinephrine or corticosteroids may be used to treat a severe reaction. reactions result from the recipient’s sensitivity to plasma proteins of the donor’s blood. These reactions are more common in an individual with a history of allergies. Citrate toxicity can occur when large quantities of blood products are used. Calcium binds to the citrate meaning citrate toxicity is likely to develop when blood is transfused at a rate of 1 unit in 10 minutes. Hypocalcemia can be prevented or reversed by the infusion of 10% calcium gluconate. Hypothermia and cardiac dysrhythmias can result from rapid infusion of large quantities of cold blood. Blood-warming equipment prevents this problem.

Question 60

Which statement by the nurse demonstrates understanding of autotransfusion and autologous transfusion? A. “Autologous transfusion uses blood donated by the patient’s friends and family.” B. “Autotransfusion occurs during surgery when the patient’s blood is collected, filtered, and returned to the body.” C. “Autologous transfusion uses automation to decrease the likelihood of patient-to-product mismatches.” D. “Autotransfusion is the process of automatically transfusing all surgical patients who experience blood loss greater than 500 mL.”

Answer 60

B. “Autotransfusion occurs during surgery when the patient’s blood is collected, filtered, and returned to the body.” Autologous donation occurs when a person donates blood before a planned surgical procedure; the patient receives their own blood if a transfusion is needed. Autotransfusion is a method for replacing blood volume involves safely and aseptically collecting, filtering, and returning the patient’s own blood that is lost during a major surgical procedure or from a traumatic injury.

Question 61

Which thrombocytopenia is the most common type of acquired thrombocytopenia? A. Heparin-induced thrombocytopenia and thrombosis syndrome B. Heparin-induced thrombocytopenia C. Immune thrombocytopenic purpura (ITP) D. Thrombotic thrombocytopenic purpura

Answer 61

C. Immune thrombocytopenic purpura (ITP) The most common acquired thrombocytopenia is a syndrome of abnormal destruction of circulating platelets termed immune thrombocytopenic purpura (ITP).

Question 62

Which nursing diagnosis would be appropriate for a patient with thrombocytopenia? A. Potential for melena as evidenced by high dietary fibre intake B. Potential for excessive clotting as evidenced by inherent coagulopathy C. Potential for epistaxis as evidenced by decrease in platelets D. Potential for impaired oral mucous membrane integrity as evidenced by increased platelets

Answer 62

C. Potential for epistaxis as evidenced by decrease in platelets Potential for epistaxis as evidenced by decrease in platelets is an appropriate nursing diagnosis for a patient with thrombocytopenia. Impaired clotting leads to risk of increased bleeding.

Question 63

Which response does the nurse provide when the patient asks why she has small, flat, red spots on her skin? A. “Those are scars caused by leaked white cells. They settle into the skin and result in scar tissue.” B. “Those are the start of fever blisters. They are caused very high temperatures when your body is fighting an infection.” C. “Those are petechiae. They are very tiny hemorrhages that happen when your platelet count is low and red cells leak out of blood vessels and into skin.” D. “Those are normal signs of aging and nothing to worry about.”

Answer 63

C. “Those are petechiae. They are very tiny hemorrhages that happen when your platelet count is low and red cells leak out of blood vessels and into skin.” When the platelet count is low, RBCs may leak out of the blood vessels and into the skin to cause petechiae. This response demonstrates the nurse’s understanding.

Question 64

Which X-linked genetic disorder is caused by a deficiency in factor IX? A. Hepatitis C B. Hemophilia A C. Von Willebrand disease D. Hemophilia B

Answer 64

D. Hemophilia B Hemophilia B is an X-linked deficiency in factor IX. It occurs mostly in men, but women can be carriers of the trait.

Question 65

Which treatment is used when hemophilia causes bleeding into a joint? Select all that apply. One, some, or all responses may be correct. A. Pack the joint in ice. B. Give acetaminophen for pain control. C. Give aspirin for pain control. D. Encourage mobilization of the affected area. E. Implement weight-bearing movement immediately.

Answer 65

A, B, D. When hemophilia causes bleeding into a joint, packing the joint in ice helps reduce inflammation. Analgesics are given to reduce severe pain (e.g., acetaminophen [Tylenol], codeine) when hemophilia causes bleeding into a joint. Encourage mobilization of the affected area through range of-motion exercises and physical therapy when hemophilia causes bleeding into a joint.

Question 66

Which education will the nurse provide to the patient with hemophilia? A. “Minor scrapes can be managed at home. If you have blood in your urine, cuts requiring stitches, or a head injury, you will need to seek medical attention immediately.” B. “Be sure to avoid dark leafy greens in your diet. These contain vitamin K, which will interfere with your heparin.” C. “You can play soccer and football as long as you wear the proper safety equipment.” D. “When performing dental hygiene, floss aggressively to prevent gum infections.”

Answer 66

A. “Minor scrapes can be managed at home. If you have blood in your urine, cuts requiring stitches, or a head injury, you will need to seek medical attention immediately.” The nurse should teach the patient to recognize disease-related symptoms and to know which symptoms can be resolved at home and which require hospitalization. Head injury, hematuria, melena, and skin wound needing sutures require prompt medical attention.

Question 67

Which description is the defining characterization of disseminated intravascular coagulation (DIC)? A. Powerful coagulation triggered by tissue factor release leading to enhanced platelet aggregation B. Profuse bleeding resulting from the depletion of platelets and clotting factors C. Stable clot formation at injury sites D. Rapid dehydration due to polyuria

Answer 67

B. Profuse bleeding resulting from the depletion of platelets and clotting factors Disseminated intravascular coagulation (DIC) is a serious bleeding and thrombotic disorder that results from abnormally initiated and accelerated clotting and anticlotting processes that occur in response to disease or injury. It is characterized by the profuse bleeding resulting from the depletion of platelets and clotting factors.

Question 68

Which action does the nurse take when caring for a patient with disseminated intravascular coagulation (DIC)? Select all that apply. One, some, or all responses may be correct. A. Adminster blood products. B. Assess for polyuria. C. Assess for external bleeding. D. Assess for signs of internal bleeding. E. Provide prompt administration of prescribed therapies.

Answer 68

A, C, D, E. Administration of blood products to replace lost volume, treat anemia, and otherwise support the cardiovascular system may be necessary when caring for a patient in DIC. Appropriate nursing interventions are essential to the survival of a patient in DIC, including assessing for external bleeding such as petechiae, leaks at IV or injection sites. Assessing for signs of internal bleeding such as increased heart rate, increasing abdominal girth, altered mental status are nursing interventions necessary when caring for a patient in DIC. Appropriate nursing interventions are essential to the survival of a patient in DIC, including providing prompt administration of prescribed therapies.

Question 69

Which cause is the most common cause of neutropenia? A. Aplastic anemia B. Parasitic infection C. Hypersplenism D. Immunosuppressive therapy

Answer 69

D. Immunosuppressive therapy The most common cause of neutropenia is iatrogenic resulting from widespread use of chemotherapeutic and immunosuppressive therapy in the treatment of cancer and autoimmune diseases.

Question 70

Which characterization describes myelodysplastic syndrome (MDS)? A. Patients with MDS have peripheral blood cytopenia and hypercellular bone marrow exhibiting dysplastic changes. B. Patients with MDS have peripheral blood cytopenia and hypocellular bone marrow exhibiting dysplastic changes. C. Patients with MDS typically have a genetic disorder affecting the quality of their bone marrow. D. MDS is the most common form of hematological disorder in Canada for all age groups.

Answer 70

A. Patients with MDS have peripheral blood cytopenia and hypercellular bone marrow exhibiting dysplastic changes. Myelodysplastic syndrome (MDS) is a group of related hematological disorders characterized by a change in the quantity and quality of bone marrow elements.

Question 71

Which therapy is appropriate for low-risk patients with MDS? A. Whole blood transfusions B. Radiation C. Myeloid growth factors D. High intensity chemotherapy

Answer 71

C. Myeloid growth factors Low-risk patients often can be treated with myeloid growth factors (e.g., G-CSF), in addition to EPO and immunomodulators, such as lenalidomide (Revlimid).

Question 72

Which scenario may lead to the diagnosis of myelodysplasia syndrome (MDS) in a patient? Select all that Apply. One, some, or all responses may be correct. A. Irregular results on a routine CBC B. Found during chest X-ray for pneumonia C. Uncovered during evaluation of anemia symptoms D. Screening for folate deficiency E. Full-body MRI F. Discovered during treatment of infection and bleeding

Answer 72

A, C, F. MDS is caused by inadequate numbers of ineffectively functioning circulating granulocytes or platelets. A complete blood count may show decreased levels of platelets. MDS is caused by inadequate numbers of ineffectively functioning circulating granulocytes or platelets. Blood loss may result in anemia-type symptoms, leading to the discovery of the disease. MDS commonly manifests as infection and bleeding caused by inadequate numbers of ineffectively functioning circulating granulocytes or platelets.

Question 73

Which factor leads the nurse to suspect the patient is experiencing thrombocytopenia? A. Patient’s prothrombin time is 12 seconds B. Patient has inherited an X-linked mutation C. Patient is prescribed ganciclovir (Cytovene) D. Patient’s platelet count is 250 x 109/L

Answer 73

C. Patient is prescribed ganciclovir (Cytovene) Medication-related thrombocytopenia is most often caused by accelerated platelet destruction caused by antibodies. Chemotherapeutic agents, such as ganciclovir (Cytovene), are commonly associated. The nurse understands that a patient taking ganciclovir or other chemotherapeutic medications are at high risk of developing thrombocytopenia.

Question 74

Which lab result does the nurse know to be indicative of thrombotic thrombocytopenic purpura (TTP)? A. Absence of megakaryocytes on bone marrow biopsy B. Platelet count below 10 x 109/L with the presence of Reed-Sternberg cells C. Elevated D-dimer and decreased C-reactive protein (CRP) D. Platelet count below 10 x 109/L with presence of spherocytes and schistocytes

Answer 74

D. Platelet count below 10 x 109/L with presence of spherocytes and schistocytes Decreased platelets with abnormal RBC morphology are indicative of thrombotic thrombocytopenic purpura.

Question 75

For which therapy does the nurse prepare the patient with immune thrombocytopenic purpura (ITP)? A. Warfarin administration B. Plasmapheresis C. Discontinuation of heparin D. Platelet transfusion

Answer 75

D. Platelet transfusion Platelet transfusion therapy may be used in life-threatening situations when the patient is diagnosed with ITP.

Question 76

Which clinical manifestation is caused by hemophilia? Select all that apply. One, some, or all responses may be correct. A. Fever B. Prolonged bleeding from minor cut C. Hypercoagulation D. Hemarthrosis E. Uncontrollable hemorrhage post dental extraction F. Persistent epistaxis

Answer 76

B, D, E , F. Prolonged bleeding from minor cut or minor trauma is a clinical manifestation of hemophilia. Due to a lack of certain clotting factors, bleeding is uncontrolled by the body. Hemarthrosis (bleeding into the joints) may lead to joint deformity severe enough to cause crippling, most commonly in knees, elbows, and ankles. Due to a lack of certain clotting factors, bleeding is uncontrolled by the body. Uncontrollable hemorrhage after dental extractions or irritation of the gingiva with a hard-bristle toothbrush are oral manifestations of hemophilia. Due to a lack of certain clotting factors, bleeding is uncontrolled by the body. Prolonged epistaxis, especially following a facial blow, is a clinical manifestation of hemophilia. Due to a lack of certain clotting factors, bleeding is uncontrolled by the body.

Question 77

Which statement by the nurse demonstrates understanding of prophylactic measures in hemophilia? A. “Apply pressure to the site with clean gauze. The patient should call the primary care provider.” B. “The patient should go to the emergency department if a head injury occurs.” C. “A diet rich in vitamin K helps prevent bleeding and is essential in maintaining proper levels of coagulants.” D. “Desmopressin acetate will be administered before surgery and repeated during the procedure if necessary.”

Answer 77

D. “Desmopressin acetate will be administered before surgery and repeated during the procedure if necessary.” For mild hemophilia A and certain subtypes of von Willebrand disease, desmopressin acetate (also known as DDAVP), a synthetic analogue of vasopressin, may be used to stimulate an increase in factor VIII and vWF. Beneficial effects of DDAVP when administered by IV are seen within 30 minutes and can last for more than 12 hours.

Question 78

Which patient with deficiency in clotting factors does the nurse recognize as experiencing internal hemorrhaging? A. A patient with a slowed bleeding in response to the application of Gelfoam B. A patient with a headache, fatigue, and muscle spasms after administration of desmopressin C. A patient with a scab formation after application of thrombin D. A patient with pain and swelling in the forearm after a constrictive bandage is applied at the elbow

Answer 78

D. A patient with pain and swelling in the forearm after a constrictive bandage is applied at the elbow Pain and swelling are signs of compartment syndrome caused by internal bleeding, especially in the setting of a constrictive or restrictive bandage or medical device. This patient requires immediate medical attention.

Question 79

Which clinical manifestations are present in disseminated intravascular coagulation (DIC)? Select all that apply. One, some, or all responses may be correct. A. GI tract bleeding B. Hemoptysis C. Hematuria D. Cyanosis E. Acute kidney injury F. Pulmonary emboli

Answer 79

A, B, C, D, E , F. DIC has both bleeding and thrombotic manifestations. GI tract bleeding is a possible sign. Hemoptysis (coughing blood) is a potential sign of DIC, which has both bleeding and thrombotic manifestations. DIC has both bleeding and thrombotic manifestations. Hematuria (blood in urine) is a possible sign. Cyanosis, caused by reduced oxygenation to tissues, is a potential sign of DIC, which has both bleeding and thrombotic manifestations. DIC has both bleeding and thrombotic manifestations. Acute kidney injury, caused by thrombus formation inside the kidneys, is a possible sign. Pulmonary emboli, caused by thrombi within the lungs, is a potential sign of DIC, which has both bleeding and thrombotic manifestations.

Question 80

Which patient statement indicates an understanding of neutropenia education? Select all that apply. One, some, or all responses may be correct. A. “My absolute neutrophil count puts me at an increasing level of infection risk the lower the count is.” B. “My absolute neutrophil count may be above normal in neutropenia because the white blood cells are not working.” C. “The cause of my neutropenia is not important because it is treated the same regardless of the cause.” D. “Neutropenia puts me at increased risk of infection. Nothing can be done about that so I should stay home alone.” E. “Any infection can develop into sepsis or death.”

Answer 80

A, B, E. An ANC of 0.5 to 1 ×109/L, places the patient at moderate risk for a bacterial infection. An ANC less than 0.5 to 1 × 109/L places the patient at severe risk. The lower the ANC count, the greater the risk for infection. Patients with acute leukemia who present with a high WBC may in fact have neutropenia, because the majority of the WBCs are ineffective leukemia blast cells. The immunocompromised, neutropenic patient has little or no ability to fight infection. Minor infections can lead rapidly to sepsis and death.

Question 81

Which education will the nurse provide to the patient with neutropenia about infection risk? Select all that apply. One, some, or all responses may be correct. A. “Avoid activity. Your body needs rest and exercise may overtax it.” B. “Do not perform gardening or clean up after pets. Feeding and petting your pet is fine as long as you wash your hands well afterwards.” C. “Sushi is a healthy source of protein that your immune system needs to fight infection.” D. “Vaginal itching or abnormal discharge is common in patients with neutropenia. It is nothing to worry about.” E. “Bathe or shower daily. A moisturizer may be used to prevent skin from drying and cracking.” F. “Wash hands frequently and make sure those around you wash their hands frequently, particularly if they help with your care.”

Answer 81

B, E, F. Exposure to potentially infectious agents in soil or animal feces poses a significant risk to patients with neutropenia. Proper hygiene and skin care protects the skin’s physical barrier against infection. Hand hygiene is the most effective method in preventing common infections.

Question 82

Which education by the nurse to the patient demonstrates an accurate understanding of myelodysplastic syndrome (MDS)? A. “MDS may transform into acute myelogenous leukemia.” B. “MDS cells cannot function normally.” C. “Aggressive treatment is necessary for MDS.” D. “MDS is the most common bone marrow disorder in children.”

Answer 82

A. “MDS may transform into acute myelogenous leukemia.” Depending on the subtype, MDS may progress to acute myelogenous leukemia. Treatment adjustments will be necessary if this occurs.