Question 1

Which of the following nursing actions should the nurse include in the plan of care for a client admitted with multiple myeloma?
A)Monitor fluid intake and output.
B)Administer calcium supplements.
C)Assess lymph nodes for enlargement.
D)Limit weight bearing and ambulation.

Accepted Answer

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 client's calcium level and are not used.

Question 2

The nurse is caring for a client receiving a transfusion of packed red blood cells who develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, which of the following actions is priority?
A)Draw blood for a new crossmatch
B)Send a urine specimen to the laboratory
C)Give the PRN diphenhydramine
D)Administer the PRN acetaminophen

Accepted Answer

The client'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 3

The nurse is caring for a client with immune thrombo-cytopenic purpura (ITP) who has a prescription for a platelet transfusion. Which of the following client information indicates that the nurse should consult with the health care provider before administering platelets?
A)The platelet count is 42 * 109/L.
B)Blood pressure is 94/56 mm Hg.
C)Blood is oozing from the venipuncture site.
D)Petechiae are present on the chest and back.

Accepted Answer

Platelet transfusions are not usually indicated until the platelet count is below 10 * 109/L unless the client is actively bleeding, so 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 indicate that the platelet transfusion is appropriate.

Question 4

The nurse is caring for a client who has a history of a transfusion-related acute lung injury (TRALI) and is to receive a transfusion of packed red blood cells (PRBCs). Which of the following actions should the nurse take to decrease the risk for TRALIforthis client?
A)Infuse the PRBCs slowly over 4 hours.
B)Transfuse only leukocyte-reduced PRBCs.
C)Administer the scheduled oral diuretic before the transfusion.
D)Give the PRN dose of antihistamine before starting the transfusion.

Accepted Answer

TRALI is caused by a reaction between the donor and the client 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 5

The nurse is caring for a client with non-Hodgkin's lymphoma who develops a platelet count of 38 * 109/L during chemotherapy. Which of the following actions should the nurse implement based on this finding?
A)Provide oral hygiene every 2 hours.
B)Check all stools for occult blood.
C)Assess temperature every 4 hours.
D)Encourage fluids to 3 000 mL/day.

Accepted Answer

Because the client 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 6

The nurse is caring for a client with acute myelogenous leukemia (AML) who is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT). Which of the following actions is best for the nurse to implement to assist the clientwith treatment decisions?
A)Emphasize the positive outcomes of a bone marrow transplant.
B)Discuss the need for adequate insurance to cover post-HSCT care.
C)Ask the client whether there are any questions or concerns about HSCT.
D)Explain that a cure is not possible with any other treatment except HSCT.

Accepted Answer

Offering the client an opportunity to ask questions or discuss concerns about HSCT will encourage the client to voice concerns about this treatment and also will allow the nurse to assess whether the client needs more information about the procedure. Treatment of AML using chemotherapy is another option for the client. It is not appropriate for the nurse to ask the client to consider insurance needs in making this decision.

Question 7

Fifteen minutes after a transfusion of packed red blood cells is started, a client has symptoms of back pain and dyspnea and a pulse rate of 124 beats/minute. Which of the following actions should the nurse implement initially?
A)Administer oxygen therapy at a high flow rate.
B)Obtain a urine specimen to send to the laboratory.
C)Notify the health care provider about the symptoms.
D)Disconnect the transfusion and infuse normal saline.

Accepted Answer

The client'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 8

When a febrile episode occurs in a client with neutropenia, at what time should antibiotic therapy be initiated?
A)Within 1 hour
B)After the causative agent is identified from the culture
C)Once the fever drops below 38°C (100.4°F)
D)For long-term therapy over 3 months

Accepted Answer

When a febrile episode occurs in a client with neutropenia, antibiotic therapy must be initiated immediately (within 1 hour), even before the determination by culture of a specific causative organism. Treatment does not wait until the fever drops. Long-term therapy over 3 months is not required at this time.

Question 9

After receiving change-of-shift report for the following four clients with neutropenia, which client should the nurse assess first?
A)66-year-old who has white pharyngeal lesions
B)35-year-old who has a fever of 38.2°C (100.8°F)
C)56-year-old who has frequent explosive diarrhea
D)23-year old who is complaining of severe fatigue

Accepted Answer

Any fever in a neutropenic client 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 clients also need to be assessed but do not exhibit symptoms of potentially life-threatening problems.

Question 10

The hemophilia clinic nurse receives a call from a client with hemophilia to discuss all of these problems. Which of the following problems is most important to communicate to the health care provider?
A)Skin abrasions
B)Bleeding gums
C)Multiple bruises
D)Dark tarry stools

Accepted Answer

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 client teaching about how to avoid injury, but are not indicators of possible serious blood loss.

Question 11

All of these clients call the outpatient clinic and ask to make an appointment as soon as possible. Which of the following clients should the nurse schedule to be seen first?
A)19-year-old with no previous health problems who has a nontender lump in the axilla
B)46-year-old with sickle cell anemia who says "that my eyes always look sort of yellow"
C)21-year-old with hemophilia who wants to learn how to self-administer factor VII replacement
D)50-year-old with early-stage chronic lymphocytic leukemia who has complaints of chronic fatigue

Accepted Answer

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

Question 12

The nurse is caring for a client with septicemia who develops prolonged bleeding from venipuncture sites and blood in the stools. Which of the following actions is most important for the nurse to take?
A)Notify the client's health care provider.
B)Avoid unnecessary venipunctures.
C)Apply sterile dressings to the sites.
D)Give prescribed proton-pump inhibitors.

Accepted Answer

The client's new onset of bleeding and diagnosis of sepsis suggest that disseminated intravascular coagulation (DIC) may have developed, which will require collaborative actions such as diagnostic testing, blood product administration, and heparin administration. The other actions also are appropriate, but the most important action should be to notify the physician so that DIC treatment can be initiated rapidly.

Question 13

The nurse is caring for a client with neutropenia who is started on a cephalosporin. Which of the following common adverse effects should the nurse observe for in the client? (Select all that apply.)
A)Nephrotoxicity
B)Rash
C)Ototoxicity
D)Fever
E)Pruritus

Accepted Answer

Adverse effects common to cephalosporins include rashes, fever, and pruritus. Adverse effects common to aminoglycosides include nephrotoxicity and ototoxicity.

Question 14

Which of the following assessment data obtained by the nurse when caring for a client with thrombo-cytopenia should be immediately communicated to the health care provider?
A)The platelet count is 52 * 109/L.
B)The client is difficult to arouse.
C)There are large bruises on the back.
D)There are purpura on the oral mucosa.

Accepted Answer

Difficulty in arousing the client 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 client with thrombo-cytopenia.

Question 15

The nurse is caring for a client with acute myelogenous leukemia (AML) who has induction therapy prescribed and the client asks the nurse whether the planned chemotherapy will be worth undergoing. Which of the following responses by the nurse is best?
A)"If you do not want to have chemotherapy, there are other options for treatment such as stem cell transplantation."
B)"The decision about chemotherapy is one that you and the doctor need to make rather than asking what I would do."
C)"You don't need to make a decision about treatment right now since leukemias in adults tend to progress quite slowly."
D)"The adverse effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy."

Accepted Answer

This response uses therapeutic communication by addressing the client's question and giving accurate information. The other responses either give inaccurate information or fail to address the client's question, which will discourage the client from asking the nurse for information.

Question 16

Which of the following newly admitted clients should the nurse assign as a roommate for a client who has aplastic anemia?
A)A client with severe heart failure
B)A client who has viral pneumonia
C)A client who has right leg cellulitis
D)A client with multiple abdominal drains

Accepted Answer

Clients 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 17

All of these clients are waiting to be admitted by the emergency department nurse. Which one of the following requires the most rapid assessment and care by the nurse?
A)The client with hemochromatosis who has symptoms of abdominal pain
B)The client with thrombo-cytopenia who has blood oozing after having a tooth extracted
C)The client with chemotherapy-induced neutropenia who has a temperature of 38.2°C (100.8°F)
D)The client with a history of sickle cell anemia who has had nausea and diarrhea for 24 hours

Accepted Answer

A neutropenic client 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 clients also require rapid assessment and care but not as urgently as the neutropenic client.

Question 18

The nurse is caring for a client with acute myelogenous leukemia who is receiving outpatient chemotherapy and develops an absolute neutrophil count of 0.9 * 10⁹/L. Which of the following actions by the nurse in the outpatient clinic is best? A)Discuss the need for hospital admission to treat the neutropenia. B)Plan to discontinue the chemotherapy until the neutropenia resolves. C)Teach the client how to administer filgrastim injections at home. D)Obtain a high-efficiency particulate air (HEPA) filter for the client for home use.

Accepted Answer

The client may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count less than 0.5 * 10⁹/L), administration of filgrastim usually allows the chemotherapy to continue. Clients with neutropenia are at higher risk for infection when exposed to other clients in the hospital. HEPA filters are expensive and are used in the hospital, where the number of pathogens is much higher than in the client's home environment.

Question 19

The nurse is caring for a client with myelodysplastic syndrome who has 20% blasts in marrow and the health care provider has prescribed high-intensity treatment. Which of the following treatments should the nurse prepare the client to receive?
A)Antibiotics
B)Antifungals
C)Chemotherapy
D)A blood transfusion

Accepted Answer

Low-risk clients (<5% blasts in marrow) can often be treated with transfusions, antibiotics, antifungals, EPO, and hematopoietic growth factors. High-risk clients (>5% blasts in marrow) may be treated with single-agent chemotherapy (e.g., hydroxyurea) or intensive chemotherapy as in AML.

Quiz 33: Nursing Management Hematological Problems

Which of the following nursing actions should the nurse include in the plan of care for a client admitted with multiple myeloma?

The nurse is caring for a client receiving a transfusion of packed red blood cells who develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, which of the following actions is priority?

The nurse is caring for a client with immune thrombo-cytopenic purpura (ITP) who has a prescription for a platelet transfusion. Which of the following client information indicates that the nurse should consult with the health care provider before administering platelets?

The nurse is caring for a client who has a history of a transfusion-related acute lung injury (TRALI) and is to receive a transfusion of packed red blood cells (PRBCs) . Which of the following actions should the nurse take to decrease the risk for TRALIforthis client?

The nurse is caring for a client with non-Hodgkin's lymphoma who develops a platelet count of 38 * 109/L during chemotherapy. Which of the following actions should the nurse implement based on this finding?

The nurse is caring for a client with acute myelogenous leukemia (AML) who is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT) . Which of the following actions is best for the nurse to implement to assist the clientwith treatment decisions?

Fifteen minutes after a transfusion of packed red blood cells is started, a client has symptoms of back pain and dyspnea and a pulse rate of 124 beats/minute. Which of the following actions should the nurse implement initially?

When a febrile episode occurs in a client with neutropenia, at what time should antibiotic therapy be initiated?

After receiving change-of-shift report for the following four clients with neutropenia, which client should the nurse assess first?

The hemophilia clinic nurse receives a call from a client with hemophilia to discuss all of these problems. Which of the following problems is most important to communicate to the health care provider?

All of these clients call the outpatient clinic and ask to make an appointment as soon as possible. Which of the following clients should the nurse schedule to be seen first?

The nurse is caring for a client with septicemia who develops prolonged bleeding from venipuncture sites and blood in the stools. Which of the following actions is most important for the nurse to take?

The nurse is caring for a client with neutropenia who is started on a cephalosporin. Which of the following common adverse effects should the nurse observe for in the client? (Select all that apply.)

Which of the following assessment data obtained by the nurse when caring for a client with thrombo-cytopenia should be immediately communicated to the health care provider?

The nurse is caring for a client with acute myelogenous leukemia (AML) who has induction therapy prescribed and the client asks the nurse whether the planned chemotherapy will be worth undergoing. Which of the following responses by the nurse is best?

Which of the following newly admitted clients should the nurse assign as a roommate for a client who has aplastic anemia?

All of these clients are waiting to be admitted by the emergency department nurse. Which one of the following requires the most rapid assessment and care by the nurse?

The nurse is caring for a client with acute myelogenous leukemia who is receiving outpatient chemotherapy and develops an absolute neutrophil count of 0.9 * 10⁹/L. Which of the following actions by the nurse in the outpatient clinic is best?

The nurse is caring for a client with myelodysplastic syndrome who has 20% blasts in marrow and the health care provider has prescribed high-intensity treatment. Which of the following treatments should the nurse prepare the client to receive?