Question 1

A 45-year-old woman with chronic myelogenous leukemia is considering the possibility of treatment with a bone marrow transplant from a human leukocyte antigen-matched sibling.To assist the patient with treatment decisions,what is the best approach for the nurse to use?

Accepted Answer

The nurse should ensure that the patient understands the risks of treatment-related death or treatment failure. While emphasizing the positive outcomes and discussing the potential for a cure is important, it is crucial for the patient to fully understand the risks and potential complications of the procedure. The nurse should also provide information about alternative treatments and encourage the patient to ask her physician any questions related to new, experimental treatments.

Question 2

The nurse identifies a nursing diagnosis of risk for injury related to medical interventions for a patient with immune thrombocytopenic purpura.What is an appropriate nursing intervention that addresses the etiology of this nursing diagnosis?

Accepted Answer

Limiting the number of venipunctures by using an intermittent-infusion device helps to reduce the risk of injury related to medical interventions for a patient with immune thrombocytopenic purpura by minimizing the number of potential sites for bleeding. The other options address other nursing interventions related to the care of a patient with immune thrombocytopenic purpura, but do not directly address the etiology of the nursing diagnosis of risk for injury.

Question 3

A patient's family member asks the nurse what caused the patient to develop disseminated intravascular coagulation (DIC).What does the nurse tell the family member about DIC?

Accepted Answer

DIC is caused by abnormal activation of clotting, which can be triggered by various factors such as sepsis, trauma, cancer, or obstetric complications. This leads to widespread formation of blood clots throughout the body, which can obstruct blood flow and cause tissue damage. As clotting factors are used up in the process, bleeding can also occur, leading to a complex and potentially life-threatening condition.

Question 4

During treatment of the patient who has sepsis-induced DIC with moderate bleeding,on what would the nurse expect the initial collaborative care will focus?

Accepted Answer

Treatment of the underlying cause, such as an infectious process, is crucial in managing sepsis-induced DIC. IV antibiotics are essential to control the infection that triggered the DIC.

Question 5

What is the most appropriate nursing intervention to assess for the presence of infection in a patient with neutropenia?

Accepted Answer

Monitoring temperature every 4 hours is important in patients with neutropenia because they have a decreased ability to fight off infections, putting them at increased risk for fevers. Fever is often the first sign of infection in neutropenic patients and should be promptly addressed. Monitoring WBCs, skin temperature and diaphoresis, and mouth/perianal areas for signs of infection are also important interventions, but monitoring temperature is the priority intervention.

Question 6

A patient with type A hemophilia has been admitted to the hospital with severe pain and swelling in his right knee.To prevent joint deformity during the initial care of the patient,what should the nurse do?

Accepted Answer

Immobilizing the knee will prevent further damage to the joint and reduce the risk of joint deformity in the initial care of the patient with type A hemophilia. Elevating the right lower limb on pillows and performing passive range of motion or isometric exercises may exacerbate the bleeding and swelling in the knee joint, leading to further joint damage and deformity.

Question 7

A patient with non-Hodgkin's lymphoma develops a platelet count of 10,000 cells/microlitre during chemotherapy.Based on this finding,what is an appropriate nursing intervention for the patient?

Accepted Answer

Checking all stools for occult blood is an appropriate nursing intervention for a patient with a very low platelet count, such as 10,000 cells/microlitre, due to the increased risk of bleeding, including gastrointestinal bleeding.

Question 8

During care of the patient with multiple myeloma,what is an important nursing intervention?

Accepted Answer

Maintaining a fluid intake of 3 to 4 L/day is an important nursing intervention for patients with multiple myeloma because it helps to dilute the calcium load and prevents renal damage. Hypercalcemia is a common complication of multiple myeloma, and increasing fluids can help prevent this complication. Limiting activity may also be necessary to prevent pathological fractures, but this is not the most important intervention. Assessing for changes in lymph nodes is more relevant in lymphoma, another type of cancer. Administering narcotic analgesics may be necessary to control bone pain, but it is not the most important intervention.

Question 9

A patient with myelodysplastic syndrome has laboratory values that indicate total bone marrow suppression.The nurse identifies a nursing diagnosis of risk for infection based on which of the following findings?

Accepted Answer

The correct answer is D) White blood cell (WBC) count 2.8 x 10^9/L (2800 cells/microlitre). A low WBC count (leukopenia) increases the risk of infection, which is a concern in patients with total bone marrow suppression, such as those with myelodysplastic syndrome.

Question 10

A patient with chemotherapy-induced neutropenia is placed in a private room,and protective isolation is instituted.The care plan the nurse develops with the patient is based on the knowledge that which of the following sources of infection is the most common in patients with neutropenia?

Accepted Answer

The most common source of infection in patients with neutropenia, particularly those undergoing chemotherapy, is the patient's own flora. Neutropenia reduces the body's ability to fight off infections, making even normally nonpathogenic microorganisms potentially harmful.

Question 11

When caring for a patient with hemophilia,the nurse teaches the patient to seek immediate medical attention on experiencing which of the following signs?

Accepted Answer

Dark, tarry stools (melena) indicate gastrointestinal bleeding, which can be a serious complication for a patient with hemophilia and requires immediate medical attention.

Question 12

A patient with neutropenia has a nursing diagnosis of risk for infection.What is the most important nursing intervention in the prevention of transmission of harmful pathogens to the patient?

Accepted Answer

Strict and frequent handwashing is the most effective and important measure to prevent the transmission of pathogens to patients, especially those with compromised immune systems like those with neutropenia.

Question 13

Laboratory studies related to coagulation are performed on a patient with a bleeding disorder.The nurse explains to the patient that von Willebrand's disease can be differentiated from other types of hemophilia by evaluating which of the following laboratory results?

Accepted Answer

Bleeding time is the most accurate test to diagnose von Willebrand's disease. In this condition, the bleeding time is prolonged due to the defect in the platelet function. Platelet count, prothrombin time, and partial thromboplastin time are not specific tests for von Willebrand's disease.

Question 14

When preparing a patient for a blood transfusion,the nurse will prepare the blood.Which IV solution would the nurse prepare to administer in a Y-type tubing adjacent to the blood?

Accepted Answer

The IV solution that would be prepared to administer in a Y-type tubing adjacent to the blood during a blood transfusion is Normal saline. Normal saline is the most commonly used solution for blood transfusions as it does not affect the pH balance of the blood and is isotonic, meaning it has the same concentration of dissolved particles as the blood. Dextrose solutions and lactated Ringer's are not typically used for blood transfusions as they can potentially alter the blood's pH and electrolyte balance.

Question 15

A 64-year-old patient with newly diagnosed acute myelogenous leukemia (AML)is undergoing induction therapy with chemotherapeutic agents.He tells the nurse that he is so sick from the induction therapy that he wonders if it is worth it.What is the best response to this patient?

Accepted Answer

The best response is to acknowledge the patient's difficulty, but also emphasize the importance of the treatment and its role in achieving disease control. Option A may give false hope and not address the patient's concerns. Option B may be dismissive of the severity of the current symptoms. Option C may not be applicable to this specific patient or may create undue pressure.

Question 16

A patient receiving chemotherapy for acute lymphocytic leukemia has pancytopenia,and filgrastim (Neupogen)is prescribed.The nurse teaches the patient that the reason for the use of the medication is which of the following?

Accepted Answer

Filgrastim (Neupogen) is a medication that stimulates the production of neutrophils in the bone marrow, improving the number and function of these white blood cells. It is commonly used to prevent infections in patients with neutropenia, which is a common side effect of chemotherapy.

Question 17

A 26-year-old patient with stage II Hodgkin's disease asks the nurse how long he probably has to live.What is the best response to the patient?

Accepted Answer

Hodgkin's disease, especially in its early stages (such as stage II), has a high success rate with treatment. Most patients with stage II Hodgkin's disease can be treated successfully, making this the most accurate and hopeful response.

Question 18

Which nutrient plays a role in helping mature RBCs in erythropoiesis?

Accepted Answer

The answer of Which nutrient plays a role in helping...

Quiz 33: Nursing Management: Hematological Problems