Question 1

After receiving change-of-shift report for several patients with neutropenia,which patient should the nurse assess first?

Accepted Answer

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 exhibit symptoms of potentially life-threatening problems.

Question 2

Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma?

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 patient's calcium level and are not used.

Question 3

A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy.Which action by the outpatient clinic nurse is most appropriate?

Accepted Answer

The patient may be taught to self-administer filgrastim injections.Although chemotherapy may be stopped with severe neutropenia (neutrophil count less than 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 4

A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40,temperature 102° F (38.9° C),and severe back pain.Which physician order will the nurse implement first?

Accepted Answer

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

Question 5

A 68-year-old woman with acute myelogenous leukemia (AML)asks the nurse whether the planned chemotherapy will be worth undergoing.Which response by the nurse is appropriate?

Accepted Answer

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 6

Which patient should the nurse assign as the roommate for a patient who has aplastic anemia?

Accepted Answer

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 7

Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the physician?

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

Question 8

Which action will the nurse include in the plan of care for a patient who has thalassemia major?

Accepted Answer

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 9

A 54-year-old woman with acute myelogenous leukemia (AML)is considering treatment with a hematopoietic stem cell transplant (HSCT).The best approach for the nurse to assist the patient with a treatment decision is to

Accepted Answer

Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and also 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 10

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)?

Accepted Answer

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 11

A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started.The nurse's first action should be to

Accepted Answer

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 12

Which patient requires the most rapid assessment and care by the emergency department nurse?

Accepted Answer

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 13

An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to

Accepted Answer

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 14

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?

Accepted Answer

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 15

Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider?

Accepted Answer

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 16

Which action for a patient with neutropenia is appropriate for the registered nurse (RN)to delegate to a licensed practical/vocational nurse (LPN/LVN)?

Accepted Answer

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

Question 17

A patient with 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?

Accepted Answer

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 18

A 19-year-old woman 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?

Accepted Answer

Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/mL 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 19

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?

Accepted Answer

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

Question 20

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?

Accepted Answer

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

Quiz 31: Nursing Management: Hematologic Problems

After receiving change-of-shift report for several patients with neutropenia,which patient should the nurse assess first?

Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma?

A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy.Which action by the outpatient clinic nurse is most appropriate?

A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40,temperature 102° F (38.9° C) ,and severe back pain.Which physician order will the nurse implement first?

A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing.Which response by the nurse is appropriate?

Which patient should the nurse assign as the roommate for a patient who has aplastic anemia?

Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the physician?

Which action will the nurse include in the plan of care for a patient who has thalassemia major?

A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT) .The best approach for the nurse to assist the patient with a treatment decision is to

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) ?