Deck 42: Care of Patients With Hematologic Problems

Question 1

The nurse is teaching a client who has iron deficiency anemia.Which food choice indicates that the client correctly understands the teaching?

A) Chicken
B) Oranges
C) Steak
D) Tomatoes

Answer 1

Steak

Question 2

The nurse is preparing a client for surgery.The client states,"I am concerned I might be given blood products during surgery and this would be against my religious beliefs." How does the nurse respond?

A) "We can use other means to replace blood loss besides blood products."
B) "Your chance of needing a blood transfusion is small."
C) "The operating team will do what is necessary to save your life."
D) "You could have family members donate blood for you."

Answer 2

"We can use other means to replace blood loss besides blood products."

Question 3

The nurse is planning discharge teaching for a client who has acute myelogenous leukemia (AML).Which instruction does the nurse include in this client's discharge plan?

A) Avoid contact sports.
B) Refrain from intercourse.
C) Apply heat to any bruised areas.
D) Use aspirin for headaches.

Answer 3

Avoid contact sports.

Question 4

The registered nurse is assigning a practical nurse to care for a client who has leukemia.Which instruction does the registered nurse provide to the practical nurse when delegating this client's care?

A) Evaluate the amount of protein the client eats.
B) Assess the client's roommate for symptoms of infection.
C) Perform effective hand hygiene frequently.
D) Wear a mask when entering the room.

Question 5

The nurse is teaching a client who has sickle cell disease and was admitted for splenomegaly and abdominal pain.Which instruction does the nurse include in the client's discharge teaching?

A) "Avoid drinking large amounts of fluids."
B) "Eat six small meals daily instead of large meals."
C) "Engage in aerobic exercise 3 days a week."
D) "Receive a yearly influenza vaccination."

Question 6

The nurse is caring for a client during a sickle cell crisis.Which intervention does the nurse implement for the client?

A) Administer acetaminophen (Tylenol) as needed.
B) Administer intravenous fluids to keep the vein open.
C) Keep the room temperature at 80° F.
D) Transfuse red blood cells (RBCs).

Question 7

The nurse is assessing a client who has a factor VIII deficiency.Which clinical manifestation does the nurse expect to assess in this client?

A) Excessive bleeding from a cut
B) Chronic lower back pain
C) Nausea and vomiting
D) Temperature of 101° F

Question 8

The nurse is transfusing red blood cells to a client who has sickle cell disease.Which laboratory result indicates that the nurse should discontinue the transfusion?

A) Hematocrit level (Hct), 32%
B) Hemoglobin S, 88%
C) Serum iron level, 300 mcg/dL
D) Total white blood cell count, 12,000/mm³

Question 9

The nurse is caring for a 20-year-old man who has Hodgkin's lymphoma in the abdominal and pelvic regions.The client is scheduled for radiation therapy and states,"I want to have children someday,and this procedure will destroy my chances." How does the nurse respond?

A) "Adoption is always an option."
B) "Infertility is not seen with this type of radiation therapy."
C) "Sperm production will be permanently disrupted."
D) "You have the option to store sperm in a sperm bank."

Question 10

The nurse is assessing a client with anemia.Which clinical manifestation does the nurse expect to see in this client?

A) Dyspnea with activity
B) Hypertension
C) Bradycardia
D) Warm, flushed skin

Question 11

The nurse is planning care for a client who has leukemia.Which intervention does the nurse include in the plan of care to prevent fatigue?

A) Arrange for a family member to stay with the client.
B) Plan care for times when the client has the most energy.
C) Schedule for daily physicals and occupational therapy.
D) Plan all activities to occur in the morning to allow for afternoon naps.

Question 12

The nurse is teaching a client who is being discharged to home after bone marrow transplantation.The client asks,"Why is it so important to protect myself from injury?" How does the nurse respond?

A) "Injuries put you at high risk for infection."
B) "Platelet recovery is slow, which makes you at risk for bleeding."
C) "Severe trauma could result in rejection of the transplant."
D) "The medications you are taking will make you bruise easily."

Question 13

The nurse assesses that a client has a smooth,beefy red tongue.Which intervention does the nurse implement for this client?

A) Administer prescribed oral iron supplements.
B) Monitor the daily white blood cell count.
C) Provide a diet high in green leafy vegetables.
D) Perform more frequent mouth care.

Question 14

The nurse is providing health promotion education to a client who has a family history of leukemia.Which factor does the nurse teach this client to avoid?

A) Alcohol consumption
B) Exposure to ionizing radiation
C) High-cholesterol diet
D) Smoking cigarettes

Question 15

The nurse is preparing a client with leukemia for a peripheral stem cell transfusion.Which information does the nurse provide the client?

A) "Nausea and vomiting are common after the transfusion."
B) "The transfusion will take about 6 hours."
C) "You may have numbness in your fingers and toes."
D) "Your urine may be red for a short time."

Question 16

The nurse prepares to administer a blood transfusion to a client.Which means of identification does the nurse use to ensure that the blood is administered to the correct client?

A) Ask the client whether his or her name is the one on the blood product tag.
B) Ask the client's spouse if the client is supposed to have a transfusion.
C) Compare the name and ID number on the blood product tag with the name and ID number on the client's ID band.
D) Compare the unit and room number of the client with the unit and room number listed on the blood product tag.

Question 17

Which risk factor does the nurse assess for to determine a client's cause of anemia?

A) Antacid therapy
B) Chronic alcoholism
C) Congestive heart failure
D) Type 2 diabetes

Question 18

The nurse is caring for a client who has autoimmune thrombocytopenic purpura.Which intervention does the nurse implement for this client?

A) Avoid intramuscular injections.
B) Administer prescribed anticoagulants.
C) Infuse intravenous normal saline.
D) Monitor for an increase in temperature.

Question 19

The nurse is teaching a client who is being discharged after stem cell transplantation.Which instruction does the nurse include in this client's discharge teaching?

A) Eat a diet high in fruits and vegetables.
B) Ask your provider to administer a rubella vaccination.
C) Wash your hands frequently.
D) Participate in physical therapy every day.

Question 20

The nurse is teaching a client with vitamin B₁₂ deficiency anemia to eat a diet high in this vitamin.Which meal selected by the client indicates that the client correctly understands the prescribed diet?

A) Baked chicken breast, mashed potatoes, glass of milk
B) Eggplant parmesan, cottage cheese, iced tea
C) Fried liver and onions, orange juice, spinach salad
D) Fettuccine alfredo, green salad, glass of red wine

Question 21

The nurse is preparing to transfuse a third unit of red blood cells to a client.Which laboratory result is the nurse most concerned about?

A) Fibrinogen level less than 100 mg/dL
B) Hematocrit of 30%
C) Potassium level of 5.5 mg/dL
D) Serum ferritin level of 250 ng/mL

Question 22

A client who has sickle cell anemia is admitted to the hospital.The client reports severe pain.Which action does the nurse take first?

A) Administer one unit of packed red blood cells.
B) Administer prescribed hydroxyurea (Droxia).
C) Begin intravenous fluids at 250 mL/hr.
D) Prepare for bone marrow transplantation.

Question 23

A client who is receiving a unit of red blood cells begins to report chest and lower back pain.Which action does the nurse take first?

A) Administer morphine sulfate 1 mg IV.
B) Assess the level of the pain.
C) Stop the transfusion.
D) Reposition the client on the right side.

Question 24

The nurse is teaching a client who is scheduled to undergo allogeneic bone marrow transplantation.Which statements indicate that the client correctly understands the teaching?

A) "The surgeon will insert the marrow into my femur bone."
B) "Until the marrow transplant takes, I can have visitors."
C) "The transplant does not start working immediately."
D) "I will need chemotherapy before my transplant."
E) "Radiation treatments will begin 2 days after transplantation."

Question 25

The nurse observes that a client,whose blood type is AB-negative,is receiving a transfusion with type O-negative packed red blood cells.Which action does the nurse take first?

A) Report the problem to the blood bank.
B) Assess and record the client's vital signs.
C) Stop the transfusion and keep the IV open.
D) Administer prescribed diphenhydramine (Benadryl).

Question 26

The nurse is assessing a client with a history of heart failure who is receiving a unit of packed red blood cells.The client's respiratory rate is 33 breaths/min and blood pressure is 140/90 mm Hg.Which action does the nurse take first?

A) Administer prescribed diphenhydramine (Benadryl).
B) Continue to monitor the client's vital signs.
C) Stop the infusion of packed red blood cells.
D) Slow the infusion rate of the transfusion.

Question 27

The nurse is preparing to administer transfusion therapy to a client.Which interventions does the nurse implement before starting the infusion?

A) Confirm the client's room number with the blood tag.
B) Check the client's ABO and Rh types with the blood tag.
C) Place a 20-gauge needle or larger in the client's forearm.
D) Obtain the client's pulse oximetry reading.
E) Assess the client's temperature.

Question 28

The nurse is teaching a client who has myelodysplastic syndrome.Which instruction does the nurse include in this client's teaching?

A) "Rise slowly when getting out of bed."
B) "Drink at least 3 liters of liquids per day."
C) "Wear gloves and socks outdoors in cool weather."
D) "Use a soft-bristled toothbrush."

Question 29

The nurse is teaching a client who was recently diagnosed with thrombocytopenia.Which instruction does the nurse include in this client's discharge teaching?

A) "Drink at least 3 liters of fluid each day."
B) "Use a soft-bristled toothbrush."
C) "Avoid blowing your nose."
D) "Use only aspirin when having pain."

Question 30

A client is newly diagnosed with sickle cell anemia.Which information does the nurse include in the client's discharge instructions?

A) "Eat a diet high in iron."
B) "Take hydroxyurea (Droxia) every morning."
C) "Be aware of the early symptoms of crisis."
D) "Do not use any oral contraceptives."