1.
The nurse is assisting with a bone marrow aspiration and biopsy. In which order, from fi rst to last, should the nurse complete the following tasks?2. Clean the skin with an antiseptic solution.
3. Verify the client has signed an informed consent.
4. Apply ice to the biopsy site.
1. Position the client in a side-lying position.
2.
A client with iron defi ciency anemia is refusing to take the prescribed oral iron medication because the medication is causing nausea. The nurse should do which of the following? Select all that apply.■ 1. Suggest that the client use ginger when taking the medication.
■ 2. Ask the client what she thinks is causing the nausea.
■ 3. Tell the client to use stool softeners to mini- mize constipation.
■ 4. Offer to administer the medication by an intramuscular injection.
■ 5. Suggest that the client take the iron with orange juice.
3.
A client had a mastectomy followed by chemotherapy 6 months ago. She reports that she is now “unable to concentrate at her card game” and“it seems harder and harder to fi nish her errands because of exhaustion.” Based on this information, the nurse should suggest that the client do which of the following?
■ 1. Take frequent naps.
■ 2. Limit activities.
■ 3. Increase fl uid intake.
■ 4. Avoid contact with others.
4.
A client is to have a transfusion of packed red blood cells from a designated donor. The client asks if any diseases can be transmitted by this donor. The nurse should inform the client that which of the fol- lowing diseases can be transmitted by a designated donor? Select all that apply.■ 1. Epstein-Barr virus.
■ 2. Human immunodefi ciency virus (HIV).
■ 3. Cytomegalovirus (CMV).
■ 4. Hepatitis A.
■ 5. Malaria.
5.
A client has been admitted with active rectal bleeding. He has been typed and cross-matched for 2 units of packed red blood cells (RBCs). Within 10 minutes of admission the client faints when getting up to go to the bedside commode. The nurse noti- fi es the health care provider, who orders a unit of blood immediately. The nurse should expect which type of packed RBCs will be used for immediate transfusion?■ 1. A negative.
■ 2. B negative.
■ 3. AB negative.
■ 4. O negative.
■ The Client with Red Blood Cell Disorders
■ The Client with Platelet Disorders
■ The Client with White Blood Cell Disorders
■ The Client with Lymphoma
■ The Client Who Is in Shock
■ Managing Care Quality and Safety
■ Answers, Rationales, and Test Taking Strategies
The Client with Hematologic Health Problems
3
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6.
The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the following foods should be included in the diet?■ 1. Eggs.
■ 2. Lettuce.
■ 3. Citrus fruits.
■ 4. Cheese.
7.
The nurse should instruct the client to eat which of the following foods to obtain the best supply of vitamin B12?■ 1. Whole grains.
■ 2. Green leafy vegetables.
■ 3. Meats and dairy products.
■ 4. Broccoli and brussels sprouts.
8.
The nurse has just admitted a 35-year-old female client who has a serum vitamin B12 concen- tration of 800 pg/mL. Which of the following labora- tory fi ndings should cue the nurse to focus the client history assessment on specifi c drug or alcohol use?■ 1. Total bilirubin, 0.3 mg/dL.
■ 2. Serum creatinine, 0.5 mg/dL.
■ 3. Hemoglobin, 16 g/dL.
■ 4. Folate, 1.5 ng/mL.
9.
Which of the following lab values should the nurse report to the health care provider when the client has anemia?■ 1. Schilling test result, elevated.
■ 2. Intrinsic factor, absent.
■ 3. Sedimentation rate, 16 mm per hour.
■ 4. Red blood cells (RBCs) within normal range.
10.
The nurse devises a teaching plan for the client with aplastic anemia. Which of the following is the most important concept to teach for health promotion and maintenance?■ 1. Eat animal protein and dark green, leafy vegetables every day.
■ 2. Avoid exposure to others with acute infec- tions.
■ 3. Practice yoga and meditation to decrease stress and anxiety.
■ 4. Get 8 hours of sleep at night and take naps during the day.
11.
A client comes to the health clinic 3 years after undergoing a resection of the terminal ileum and tells the nurse that he has weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teach- ing?■ 1. “I have been drinking plenty of fl uids.”■ 2. “I have been gargling with warm salt water for my sore tongue.”
■ 3. “I have three to four loose stools per day.”
■ 4. “I take a vitamin B12 tablet every day.”
12.
A client who follows a vegetarian diet was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling?The client:
■ 1. Adds dried fruit to cereal and baked goods.
■ 2. Cooks tomato-based foods in iron pots.
■ 3. Drinks coffee or tea with meals.
■ 4. Adds vitamin C to all meals.
13.
A client was admitted to the hospital with iron defi ciency anemia and blood-streaked emesis.Which question is most appropriate for the nurse to ask in determining the extent of the client’s activity intolerance?
■ 1. “What daily activities were you able to do 6 months ago compared with the present?”
■ 2. “How long have you had this problem?”
■ 3. “Have you been able to keep up with all your usual activities?”
■ 4. “Are you more tired now than you used to be?”
14.
A physician orders vitamin B12 for a client with pernicious anemia. Which site is appropriate for the nurse to administer vitamin B12? Select all that apply.■ 1. Median cutaneous.
■ 2. Greater femur trochanter.
■ 3. Acromion muscle.
■ 4. Ventrogluteal.
■ 5. Upper back.
■ 6. Dorsogluteal.
15.
Which position would most help to decrease a client’s discomfort when the client’s spouse injects vitamin B12 using the ventrogluteal site?■ 1. Lying on the side with legs extended.
■ 2. Lying on the abdomen with toes pointed inward.
■ 3. Leaning over the edge of a low table with hips fl exed.
■ 4. Standing upright with the feet one shoulder- width apart.
16.
A client is admitted from the emergency department after falling down a fl ight of stairs at home. Her vital signs are stable and her history states that she had a gastric stapling 2 years ago and takes neomycin for acne. The client jokes about how she is clumsy lately and trips over things. The nurse should ask the client which of the following ques- tions? Select all that apply.■ 1. “Are you experiencing numbness in your extremities?”
■ 2. “How much vitamin B12 are you getting?”
■ 3. “Are you feeling depressed?”
■ 4. “Do you feel safe at home?”
■ 5. “Are you getting suffi cient iron in your diet?”
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17.
A client returned home from an overseas tour of duty and tells the nurse he is always tired.He has a temperature of 99.5° F (37.5° C). His skin is dark bronze, and his urine has a dark color. His hemoglobin level is 9 g/dL; his hematocrit is 49, and red blood cells are 2.75 million/μL. What should the nurse do fi rst?
■ 1. Initiate an intake and output record.
■ 2. Place the client on bed rest.
■ 3. Place the client on contact isolation.
■ 4. Keep the client out of sunlight.
18.
When a client is receiving a cephalosporin, the nurse must monitor the client for which of the following?■ 1. Drug-induced hemolytic anemia.
■ 2. Purpura.
■ 3. Infectious emboli.
■ 4. Ecchymosis.
19.
A client is to have a Schilling test? The nurse should:■ 1. Administer methylcellulose (Citrucel).
■ 2. Start a 24- to 48-hour urine specimen collec- tion.
■ 3. Maintain nothing-by-mouth (NPO) status.
■ 4. Start a 72-hour stool specimen collection.
20.
A client from a Mediterranean country is admitted with thalassemia, jaundice, splenomegaly, and hepatomegaly. Which of the following should be the primary focus of nursing care for this client?■ 1. Providing activities of daily living on the time schedule of the client’s homeland.
■ 2. Offering foods that the client enjoys in order to increase the intake of calories.
■ 3. Decreasing cardiac demands by promoting rest.
■ 4. Listening to concerns about the hospitaliza- tion.
21.
A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. Which is the nurse’s best response?■ 1. “The reason for your vitamin defi ciency is an inability to absorb the vitamin because the stomach is not producing suffi cient acid.”
■ 2. “The reason for your vitamin defi ciency is an inability to absorb the vitamin because the stomach is not producing suffi cient intrinsic factor.”
■ 3. “The reason for your vitamin defi ciency is an excessive excretion of the vitamin because of kidney dysfunction.”
■ 4. “The reason for your vitamin defi ciency is an increased requirement for the vitamin because of rapid red blood cell production.”
22.
An African-American woman had experienced severe palpitations, weakness, and shortness of breath after taking bacitracin (Bactrim). As a part of the discharge planning, the nurse should evaluate the client’s knowledge about:■ 1. Increased folic acid needs.
■ 2. Congenital enzyme defi ciency.
■ 3. Restricted activity in hot weather.
■ 4. Need for blood transfusions.
23.
The nurse is assessing a client’s activity tolerance by having the client walk on a treadmill for 5 minutes. Which of the following indicates an abnormal response?■ 1. Pulse rate increased by 20 beats per minute (bpm) immediately after the activity.
■ 2. Respiratory rate decreased by 5 breaths/min-
■ 3. Diastolic blood pressure increased by 7 mm Hg.ute.
■ 4. Pulse rate within 6 bpm of resting pulse after 3 minutes of rest.
24.
When comparing the hematocrit levels of a postoperative client, the nurse notes that the hema- tocrit decreased from 36% to 34% on the third day even though the RBC count and hemoglobin value remained stable at 4.5 million/μL and 11.9 g/dL, respectively. The nurse should next:■ 1. Check the dressing and drains for frank bleeding.
■ 2. Call the physician.
■ 3. Continue to monitor vital signs.
■ 4. Start oxygen at 2 L/minute per nasal cannula.
25.
The nurse is administering packed red blood cells (PRBCs) to a client. The nurse should fi rst:■ 1. Discontinue the I.V. catheter if a blood trans- fusion reaction occurs.
■ 2. Administer the PRBCs through a percutane- ously inserted central catheter line with a 20-gauge needle.
■ 3. Flush PRBCs with 5% dextrose and 0.45%
normal saline solution.
■ 4. Stay with the client during the fi rst 15 min- utes of infusion.
26.
The nurse should instruct a young female adult with sickle cell anemia to do which of the fol- lowing? Select all that apply.■ 1. Drink plenty of fl uids when outside in hot weather.
■ 2. Avoid travel to cities where the oxygen level is lower.
■ 3. Be aware that since she is homozygous for HbS, she carries the sickle cell trait.
■ 4. Know that pregnancy with sickle cell disease increases the risk of a crisis.
■ 5. Avoid fl ying on commercial airlines.
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31.
A client is to receive epoetin (Epogen) injec- tions. What laboratory value should the nurse assess before giving the injection?■ 1. Hematocrit.
■ 2. Partial thromboplastin time.
■ 3. Hemoglobin concentration.
■ 4. Prothrombin time.
32.
When beginning I.V. erythropoietin (Epogen, Procrit) therapy, the nurse should do which of the following? Select all that apply.■ 1. Checking the hemoglobin levels before administering subsequent doses.
■ 2. Shaking the vial thoroughly to mix the con- centrated white, milky solution.
■ 3. Keeping the multidose vial refrigerated between scheduled twice-a-day doses.
■ 4. Administering the medication through the I.V. line without other medications.
■ 5. Adjusting the initial doses according to the client’s changes in blood pressure.
■ 6. Educating the client to avoid driving and per- forming hazardous activity during the initial treatment.
33.
A client states that she is afraid of receiving vitamin B12 injections because of potential toxic reactions. Which is the nurse’s best response to relieve these fears?■ 1. “Vitamin B12 will cause ringing in the ears before a toxic level is reached.”
■ 2. “Vitamin B12 may cause a very mild rash ini- tially.”
■ 3. “Vitamin B12 cause mild nausea but nothing toxic.”
■ 4. “Vitamin B12 is generally free of toxicity because it is water-soluble.”
34.
A client with microcytic anemia is hav- ing trouble selecting food from the hospital menu.Which food is best for the nurse to suggest for satis- fying the client’s nutritional needs?
■ 1. Egg yolks.
■ 2. Brown rice.
■ 3. Vegetables.
■ 4. Tea.
35.
A client with macrocytic anemia has a burn on her foot and states that she had been watch- ing television while lying on a heating pad. Which action should be the nurse’s fi rst response?■ 1. Assess for potential abuse.
■ 2. Check for diminished sensations.
■ 3. Document the fi ndings.
■ 4. Clean and dress the area.
27.
The nurse is teaching a client and his family about the client’s new diagnosis of hemochromato- sis. Which of the following details should the nurse include?■ 1. Hemochromatosis is an autoimmune disorder that affects the HFE gene.
■ 2. Individuals who are heterozygous for hemo- chromatosis rarely develop the disease.
■ 3. Individuals who are homozygous for hemo- chromatosis are carriers of hemochromatosis.
■ 4. Men are at greater risk for hemochromatosis.
28.
A client is having a blood transfusion reac- tion. The nurse must do the following in what order of priority from fi rst to last?2. Complete the appropriate Transfusion Reaction Form(s).
3. Stop the transfusion.
4. Keep the I.V. open with normal saline infusion.
1. Notify the attending physician and blood bank.
29.
Which safety measures would be most impor- tant to implement when caring for a client who is receiving 2 units of packed red blood cells (PRBCs)?Select all that apply.
■ 1. Verify that the ABO and Rh of the 2 units are the same.
■ 2. Infuse a unit of PRBCs in less than 4 hours.
■ 3. Stop the transfusion if a reaction occurs, but keep the line open.
■ 4. Take vital signs every 15 minutes while the unit is transfusing.
■ 5. Inspect the blood bag for leaks, abnormal color, and clots.
■ 6. Use a 22-gauge catheter for optimal fl ow of a blood transfusion.
30.
A client who had received 25 mL of packed red blood cells (PRBCs) has low back pain and pru- ritus. After stopping the infusion, the nurse should take what action next?■ 1. Administer prescribed antihistamine and aspirin.
■ 2. Collect blood and urine samples and send to the lab.
■ 3. Administer prescribed diuretics.
■ 4. Administer prescribed vasopressors.
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41.
A client has a platelet count of 31,000/μL.The nurse should instruct the client to:
■ 1. Pad sharp surfaces to avoid minor trauma when walking.
■ 2. Assess for spontaneous petechiae in the extremities.
■ 3. Keep the room darkened.
■ 4. Check for blood in the urine.
42.
A client with a history of systemic lupus ery- thematosus was admitted with a severe viral respi- ratory tract infection and diffuse petechiae. Based on these data, it is most important that the nurse further evaluate the client’s recent:■ 1. Quality and quantity of food intake.
■ 2. Type and amount of fl uid intake.
■ 3. Weakness, fatigue, and ability to get around.
■ 4. Length and amount of menstrual fl ow.
43.
When a client with thrombocytopenia has of a severe headache, the nurse interprets that this may indicate which of the following?■ 1. Stress of the disease.
■ 2. Cerebral bleeding.
■ 3. Migraine headache.
■ 4. Sinus congestion.
44.
The nurse evaluates that the client correctly understands how to report signs and symptoms of bleeding when the client makes which of the follow- ing statements?■ 1. “Petechiae are large, red skin bruises.”
■ 2. “Ecchymoses are large, purple skin bruises.”
■ 3. “Purpura is an open cut on the skin.”
■ 4. “Abrasions are small pinpoint red dots on the skin.”
45.
The client states she does not understand what causes idiopathic thrombocytopenic purpura (ITP). The nurse provides which of the following explanations?■ 1. It is believed that the platelets are coated with antibodies and the spleen sees them as foreign bodies.
■ 2. It is believed that the liver identifi es the plate- lets as foreign bodies.
■ 3. It is now believed that the syndrome is related to an underactive immune system.
■ 4. The cause is unknown.
46.
The nurse should instruct the client with a platelet count of less than 150,000/μL to avoid which of the following activities?■ 1. Ambulation.
■ 2. Valsalva’s maneuver.
■ 3. Visiting with children.
■ 4. Semi-Fowler’s position.
36.
Which of the following is a late symptom of polycythemia vera?■ 1. Headache.
■ 2. Dizziness.
■ 3. Pruritus.
■ 4. Shortness of breath.
37.
The nurse is teaching a client with poly- cythemia vera about potential complications from this disease. Which manifestations should the nurse include in the client’s teaching plan? Select all that apply.■ 1. Hearing loss.
■ 2. Visual disturbance.
■ 3. Headache.
■ 4. Orthopnea.
■ 5. Gout.
■ 6. Weight loss.
38.
When a client is diagnosed with aplastic anemia, the nurse should assess the client for changes in which of the following physiologic functions?■ 1. Bleeding tendencies.
■ 2. Intake and output.
■ 3. Peripheral sensation.
■ 4. Bowel function.