Question 1

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

Accepted Answer

During a sickle cell crisis,the tissue distal to the occlusion has decreased blood flow and ischemia,leading to pain.Due to decreased blood flow,the client's legs will be cool or cold.The UAP can attempt to keep the client's legs warm.Ice and elevation will further decrease perfusion.Elastic bandage wraps are not indicated and may constrict perfusion in the legs.

Question 2

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

Accepted Answer

This client has manifestations of heparin-induced thrombocytopenia.Enoxaparin,salicylates,and warfarin do not cause this condition.

Question 3

A student nurse is helping a registered nurse with a blood transfusion.Which actions by the student are most appropriate? (Select all that apply.)

Accepted Answer

Correct actions prior to beginning a blood transfusion include hanging the product with saline and the correct filtered blood tubing,taking a full set of vital signs prior to starting,and using gloves.Someone stays with the client for the first 15 to 30 minutes of the transfusion.Two registered nurses must verify the client's identity and blood compatibility.

Question 4

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

Accepted Answer

The client should be taught to apply ice to areas of minor trauma.Flossing is not recommended.Hard foods should be avoided.The client should wear well-fitting shoes when ambulating.

Question 5

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

Accepted Answer

Several factors cause red blood cells to sickle in SCD,including dehydration,extreme stress,high altitudes,and pregnancy.Strenuous exercise can also cause sickling,but not unless it is very vigorous.

Question 6

A student nurse is learning about blood transfusion compatibilities.What information does this include? (Select all that apply.)

Accepted Answer

Blood type A can be donated to people who have blood types A or AB.Blood type O can be given to anyone.Blood type B can be donated to people who have blood types B or AB.Blood type AB can only go to recipients with blood type AB.

Question 7

A client has received a bone marrow transplant and is waiting for engraftment.What actions by the nurse are most appropriate? (Select all that apply.)

Accepted Answer

The client waiting for engraftment after bone marrow transplant has no white cells to protect him or her against infection.The client is on protective precautions and visitors are taught hand hygiene.No fresh flowers or plants are allowed due to the standing water in the vase or container that may harbor organisms.Limiting protein is not a healthy option and will not promote engraftment.

Question 8

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

Accepted Answer

While all options are reasonable choices,the best option is to help the client make sick day plans,as that is more comprehensive and inclusive than the other options,which focus on a single item.

Question 9

A client has heparin-induced thrombocytopenia (HIT).The student nurse asks how this is treated.About what drugs does the nurse instructor teach? (Select all that apply.)

Accepted Answer

The standard drugs used to treat HIT are argatroban,bivalirudin,and lepirudin.The other drugs are not used.Clopidogrel is an antiplatelet agent used to reduce the likelihood of stroke or myocardial infarction.Methylprednisolone is a steroid used to reduce inflammation.

Question 10

A nurse is preparing to administer a blood transfusion to an older adult.Understanding age-related changes,what alterations in the usual protocol are necessary for the nurse to implement? (Select all that apply.)

Accepted Answer

The older adult needs vital signs monitored as often as every 15 minutes for the duration of the transfusion because changes may be the only indication of a transfusion-related problem.To prevent fluid overload,the nurse obtains a prescription to hold other running IV fluids during the transfusion.The other options are not warranted.

Question 11

The nurse assesses a client's oral cavity and makes the discovery shown in the photo below:

What action by the nurse is most appropriate?

Accepted Answer

This condition is known as glossitis,and is characteristic of B₁₂ anemia.If the anemia is a pernicious anemia,it is treated with cobalamin.Genetic testing is not a priority for this condition.The client does not need high-fiber foods or protective precautions.

Question 12

A client with chronic anemia has had many blood transfusions.What medications does the nurse anticipate teaching the client about adding to the regimen? (Select all that apply.)

Accepted Answer

Darbepoetin alfa and epoetin alfa are both red blood cell colony-stimulating factors that will help increase the production of red blood cells.Azacitidine and decitabine are used for myelodysplastic syndromes.Methylprednisolone is a steroid and would not be used for this problem.

Question 13

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

Accepted Answer

The client who had two bloody diarrhea stools that morning may be hemorrhaging in the gastrointestinal (GI)tract and should be assessed first.The client with the change in respiratory rate may have an infection or worsening anemia and should be seen next.The other two clients are not a priority at this time.

Question 14

A client has a platelet count of 25,000/mm³.What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

Accepted Answer

This client has thrombocytopenia and requires bleeding precautions.These include oral hygiene with a soft-bristled toothbrush or swabs,avoiding rectal trauma,eating soft foods,shaving with an electric razor,and using a lift sheet to re-position the client.

Question 15

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

Accepted Answer

The best response is for the nurse to offer self,a therapeutic communication technique that uses presence.Attempting to assign blame to both parents will not help the client feel better.There is genetic testing available,so it is inaccurate to state there is no way to know who will have the disease.Stating that good treatments exist belittles the client's feelings.

Question 16

A client has Hodgkin's lymphoma,Ann Arbor stage Ib.For what manifestations should the nurse assess the client? (Select all that apply.)

Accepted Answer

In this stage,the disease is located in a single lymph node region or a single non-lymph node site.The client displays night sweats,persistent fever,and weight loss.Headache and urinary problems are not related.

Question 17

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

Accepted Answer

Chemical and ionizing radiation exposure and viral infections are known risk factors for developing leukemia.Eating genetically modified food and receiving vaccinations are not known risk factors.

Question 18

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

Accepted Answer

Although individuals with SCD often have elevated white blood cell (WBC)counts,this extreme elevation could indicate leukemia,a complication of taking hydroxyurea.The nurse should report this finding immediately.Alternatively,it could indicate infection,a serious problem for clients with SCD.Hematocrit and hemoglobin levels are normally low in people with SCD.The potassium level,while slightly low,is not as worrisome as the WBCs.

Quiz 40: Care of Patients with Hematologic Problems

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