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Unit 1 Hematology
| Question | Answer |
|---|---|
| 1. An adult male with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. Which laboratory data would the nurse identify as consistent with these symptoms? a. RBC count of 4,500,000/L b. Hematocrit (Hct) value of 38% c. | D |
| 2. Which menu choice indicates that the patient understands the nurse’s recommendations about dietary choices for iron-deficiency anemia? a. Omelet and whole wheat toast b. Cantaloupe and cottage cheese c. Strawberry and banana fruit plate d. Cornmeal muf | A |
| 3. A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. Which nutrient supplement should the nurse plan to explain to the patient? a. Iron b. Folic acid c. Cobalamin (vitamin B12) d. Ascorbic acid (vitam | B |
| 4. Which patient statement to the nurse indicates that the patient understands self-care for pernicious anemia? a. “I need to start eating more red meat and liver.” b. “I will stop having a glass of wine with dinner.” c. “I could choose nasal spray rather | C |
| 5. Which is an appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia? a. Provide a diet high in vitamin K. b. Teach the patient how to avoid injury. c. Encourage alternating rest and activity. d. Place the patient on pro | C |
| 6. Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate? a. “I could take a stool softener if I feel constipated.” b. “I can take the iron with orange juice before eating.” c. “I should notify | C |
| 7. Which potential complication should the nurse identify as a high risk for a patient admitted to the hospital with idiopathic aplastic anemia? a. Seizures b. Infection c. Neurogenic d. Pulmonary edema | B |
| 8. Which nursing intervention is important when providing care for a patient with sickle cell crisis? a. Limiting the patient’s intake of oral and IV fluids b. Evaluating the effectiveness of opioid analgesics c. Encouraging the patient to ambulate as muc | B |
| 9. Which statement by a patient indicates good understanding of the nurse’s teaching about preventing sickle cell crisis?NURSINGTB.COM a. “Home oxygen therapy is frequently used to decrease sickling.” b. “There are no effective medications that can help p | D |
| 10. Which instruction will the nurse plan to include in discharge teaching for a patient admitted with a sickle cell crisis? a. Limit fluids to 2 to 3 quarts per day. b. Avoid exposure to crowds when possible. c. Take a daily multivitamin supplement with | B |
| 11. The nurse observes scleral jaundice in a patient being admitted with hemolytic anemia. Which laboratory result the nurse should check? a. Schilling test b. Bilirubin level c. Stool occult blood d. Gastric acid analysis | B |
| 12. A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when the platelet level drops to 110,000/μL. Which action will the nurse includ | B |
| 13. What action is expected by the nurse caring for a patient who has an acute exacerbation of polycythemia vera? a. Place the patient on bed rest. b. Administer iron supplements. c. Avoid use of aspirin products. d. Monitor fluid intake and output. | D |
| 14. Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura? a. Assign the patient to a private room. b. Avoid intramuscular (IM) injections. c. Use rinses rather than a soft toothbrush for oral care | B |
| 15. Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? a. Prothrombin time b. Erythrocyte count c. Fibrinogen degradation products d. Activated partial thromboplastin time | D |
| 16. The nurse is caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee. Which action should the nurse take? a. Apply heat to the knee. b. Immobilize the knee joint. c. Assist the patient | B |
| 17. A young adult who has von Willebrand disease is admitted to the hospital for minor knee surgery. Which laboratory value should the nurse monitor? a. Platelet count b. Bleeding time c. Thrombin time d. Prothrombin time | B |
| 18. A routine complete blood count for an active older man indicates possible myelodysplastic syndrome. What should the nurse plan to explain to the patient? a. Blood transfusion b. Bone marrow biopsy c. Filgrastim administration d. Erythropoietin adminis | B |
| 19. Which action will the admitting nurse include in the care plan for a patient who has neutropenia? a. Avoid intramuscular injections. b. Check temperature every 4 hours. c. Place a “No Visitors” sign on the door. d. Omit fruits and vegetables from the | B |
| 20. Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute | D |
| 21. A patient who has acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. “If you do not want to have chemotherapy, other treatment options include stem | B |
| 22. A patient who has a history of a transfusion-related acute lung injury (TRALI) is to receive a USNT O transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient? a. Infuse PRBCs slowly ov | B |
| 23. A patient who has acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). What is the best approach for the nurse to assist the patient with this treatment decision? a. Discuss the need for insurance | B |
| 24. Which action will the nurse include in the plan of care for a patient admitted with multiple myeloma? a. Monitor fluid intake and output. b. Administer calcium supplements. c. Assess lymph nodes for enlargement. d. Limit weight bearing and ambulation. | A |
| 25. Which nursing intervention is appropriate for a patient with non-Hodgkin’s lymphoma whose platelet count drops to 18,000/μL during chemotherapy? a. Test all stools for occult blood. b. Encourage fluids to 3000 mL/day. c. Provide oral hygiene every 2 h | A |
| 26. A patient receiving outpatient chemotherapy for myelogenous leukemia develops an absolute neutrophil count of 850/μL. Which collaborative action should the outpatient clinic nurse anticipate?? a. Discuss the need for hospital admission to treat the ne | B |
| 27. Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the health care provider? a. Bruises on the patient’s back. b. The patient is difficult to arouse. c. Purpura on the patient’s oral mucosa. | B |
| 28. The nurse is planning to admNinisRter aItraGnsfuBs.ioCn ofMpacked red blood cells (PRBCs) to a USNT O patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)? a. Verify the | B |
| 29. 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? a. Send a urine spe | B |
| 30. A patient in the emergency department reports back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. What should the nurse’s first action be? a. Administer oxygen therapy at a high flowrate. b. Obtain a | D |
| 31. Which patient should the nurNse aRssigIn asGtheBr.ooCmmMate for a patient who has aplastic anemia? USNT O a. A patient with chronic heart failure b. A patient who has viral pneumonia c. A patient who has right leg cellulitis d. A patient with multiple | A |
| 32. Which patient requires the most rapid assessment and care by the emergency department nurse? a. The patient with hemochromatosis who reports abdominal pain. b. The patient with neutropenia who has a temperature of 101.8° F. c. The patient with thrombo | B |
| 33. A patient 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? a. Platelet count is 42 | A |
| 34. Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the health care provider? a. Leg bruises b. Tarry stools c. Skin abrasions d. Bleeding gums | B |
| 35. 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? a. Avoid other venipunctures. b. Apply dressings to the sites. c. Notify the health care provi | C |
| 36. A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature of 102° F (38.9° C), and severe back pain. Which prescribed action will the nurse implement first? a. Admini | C |
| 37. Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/VN)? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of | C |
| 38. 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? a. A 44-yr-old with sickle cell anemia who says his eyes always look yellow b. A 23-yr-old with n | B |
| 39. After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? a. A 23-yr-old who reports severe fatigue b. A 56-yr-old with frequent explosive diarrhea c. A 33-yr-old with a fever of 100.8° | C |
| 40. Which action will the nurse include in the plan of care for a patient who thalassemia major a. Administer chelation therapy as needed. b. Teach the patient to use iron supplements. c. Avoid the use of intramuscular injections. d. Notify health care p | A |
| 41. Which information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis? a. Skin color b. Hematocrit c. Liver function d. Serum iron level | D |
| 42. Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider? a. Hematocrit 55% b. Presence of plethora c. Calf swelling and pain d. Platelet count 450,000/L | C |
| 43. Following successful treatment of Hodgkin’s lymphoma for a 55-yr-old woman, which topic will the nurse include in patient teaching? a. Potential impact of chemNotheRrapIy treGatmBe.ntCon Mfertility USNT O b. Application of soothing lotions to treat re | D |
| 44. A patient who has non-Hodgkin’s lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse? a. Anorexia b. Vomiting c. Oral ulcers d. Lip swelling | D |
| 45. Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider? a. Patient reports severe back pain. b. Serum calcium level is 15 mg/dL. c. Patient reports no stool fo | B |
| 46. When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care? a. Recommend ibuprofen for left upper quadrant pain. b. Schedule immunization wNithRtheIpneGumoBc.ocCcalMvaccine. USNT | B |
| 2. A patient with a hemoglobin (Hgb) level of 7.8 g/dL (78 g/L) has cardiac palpitations, a heart rate of 102 bpm, and an increased reticulocyte count. Considering the severity of anemia, what other manifestation would the nurse expect the patient to exhi | B |
| 3. Priority Decision: A 76-year-old woman has an Hgb of 7.3 g/dL (73 g/L) and is experiencing ataxia, confusion, weakness, and fatigue on admission to the hospital. What is the priority nursing intervention for this patient? a. Provide a darkened, quiet r | C |
| 4. During the physical assessment of the patient with severe anemia, which finding is of the most concern to the nurse? a. Anorexia b. Bone pain c. Hepatomegaly d. Dyspnea at rest | D |
| 5. Which anemia is manifested with pancytopenia? a. Thalassemia b. Aplastic anemia c. Megaloblastic anemia d. Anemia of chronic disease | B |
| 6. Which descriptions are characteristic of iron-deficiency anemia (select all that apply)? a. Lack of intrinsic factor b. Autoimmune-related disease c. Most common type of anemia d. Associated with chronic blood loss e. May occur with removal of the stom | CDF |
| 7. A 20-year-old female patient is in the emergency department for anorexia and fatigue. She takes phenytoin (Dilantin) for a seizure disorder and oral contraceptives. For which type of anemia is this patient most at risk? a. Aplastic anemia b. Hemolytic | D |
| 9. When teaching the patient about a new prescription for oral iron supplements, what does the nurse teach the patient to do? a. Increase fluid and dietary fiber intake. b. Take the iron preparations with meals. c. Use enteric-coated preparations taken wi | A |
| 10. In teaching the patient with pernicious anemia about the disease, the nurse explains that it results from a lack of a. folic acid. b. intrinsic factor. c. extrinsic factor. d. cobalamin intake. | B |
| 11. During the assessment of a patient with cobalamin deficiency, what manifestation would the nurse expect to find in the patient? a. Icteric sclera b. Hepatomegaly c. Paresthesia of the hands and feet d. Intermittent heartburn with acid reflux | C |
| 12. The nurse determines that teaching about pernicious anemia has been effective when the patient says, a. “This condition can kill me unless I take injections of the vitamin for the rest of my life.” b. “My symptoms can be completely reversed after I ta | A |
| 13. The strict vegetarian is at highest risk for the development of which anemia? a. Thalassemia b. Iron-deficiency anemia c. Folic acid deficiency anemia d. Cobalamin deficiency anemia | D |
| 14. A patient with aplastic anemia has impaired oral mucous membranes. This problem can be related to the effects of what deficiencies (select all that apply)? a. RBCs b. Ferritin c. Platelets d. Coagulation factor VIII e. White blood cells (WB | ACE |
| 15. Nursing interventions for the patient with aplastic anemia are directed toward the prevention of which complications? a. Fatigue and dyspnea b. Hemorrhage and infection c. Thromboemboli and gangrene d. Cardiac dysrhythmias and heart failure | B |
| 16. Which statements describe anemia related to blood loss (select all that apply)? a. A major concern is prevention of shock. b. This anemia is most frequently treated with increased dietary iron intake. c. In addition to the general symptoms of anemia, | ADE |
| 17. What causes the anemia of sickle cell disease? a. Intracellular hemolysis of sickled RBCs b. Accelerated breakdown of abnormal RBCs c. Autoimmune antibody destruction of RBCs d. Isoimmune antibody-antigen reactions with RBCs | B |
| 18. A patient with sickle cell anemia asks the nurse why the sickling crisis does not stop when oxygen therapy is started. Which explanation should the nurse give to the patient? a. Sickling occurs in response to decreased blood viscosity, which is not af | B |
| 19. What is a nursing intervention that is indicated for the patient during a sickle cell crisis? a. Frequent ambulation b. Application of antiembolism hose c. Restriction of sodium and oral fluids d. Administration of large doses of continuous opioid ana | D |
| 20. During discharge teaching of a patient with newly diagnosed sickle cell disease, what should the nurse teach the patient to do? a. Limit fluid intake. b. Avoid humid weather. c. Eliminate exercise from the lifestyle. d. Seek early medical interventio | D |
| 21. Which statements accurately describe thrombocytopenia (select all that apply)? a. Patients with platelet deficiencies can have internal or external hemorrhage. b. The most common acquired thrombocytopenia is thrombotic thrombocytopenic purpura (TTP). | ACD |
| 22. A 45-year-old patient has symptoms including arthralgia, impotence, weight loss, and liver enlargement. His laboratory results include an elevated serum iron, total iron binding capacity (TIBC), and serum ferritin levels. Which disorder does this desc | B |
| 23. In providing care for a patient hospitalized with an acute exacerbation of polycythemia vera, the nurse gives priority to which activity? a. Maintaining protective isolation b. Promoting leg exercises and ambulation c. Protecting the patient from inju | B |
| 24. A patient has a platelet count of 50,000/μL and is diagnosed with ITP. What does the nurse anticipate that initial treatment will include? a. Splenectomy b. Corticosteroids c. Administration of platelets d. Immunosuppressive therapy | B |
| 25. Priority Decision: A patient is admitted to the hospital for evaluation and treatment of thrombocytopenia. Which action is most important for the nurse to implement? a. Taking the temperature every 4 hours to assess for fever b. Maintaining the patien | C |
| 27. In reviewing the laboratory results of a patient with hemophilia A, what would the nurse expect to find? a. An absence of factor IX b. A decreased platelet count c. A prolonged bleeding time d. A prolonged partial thromboplastin time (PTT) | D |
| 28. A patient with hemophilia comes to the clinic for treatment. What should the nurse anticipate that he or she will need to administer? a. Whole blood b. Thromboplastin c. Coagulation factor d. Fresh frozen plasma | C |
| 29. A patient with hemophilia is hospitalized with acute knee pain and swelling. What is an appropriate nursing intervention for the patient? a. Wrapping the knee with an elastic bandage b. Placing the patient on bed rest and applying ice to the joint c. | B |
| 30. Which bleeding disorder affects both genders, is autosomal dominant, and will have laboratory results showing prolonged bleeding time? a. Hemophilia A b. Hemophilia B c. Thrombocytopenia d. von Willebrand disease | D |
| 33. What is the most important method to identify the presence of infection in a neutropenic patient? a. Frequent temperature monitoring b. Routine blood and sputum cultures c. Assessing for redness and swelling d. Monitoring WBC count | A |
| 34. What is a major method of preventing infection in the patient with neutropenia? a. Prophylactic antibiotics b. A diet that eliminates fresh fruits and vegetables c. High-efficiency particulate air (HEPA) filtration d. Strict hand washing by all person | D |
| 36. Which leukemia is seen in 80% of adults with acute leukemia and exhibits proliferation of precursors of granulocytes? a. Hairy cell leukemia b. Biphenotypic leukemia c. Acute lymphocytic leukemia (ALL) d. Acute myelogenous leukemia (AML) | D |
| 37. Which statements accurately describe chronic lymphocytic leukemia (CLL) (select all that apply)? a. Most common leukemia of adults in Western countries b. Only cure is bone marrow transplant c. Neoplasm of activated B lymphocytes d. Increased incidenc | ACF |
| 38. What is the underlying cause of lymphadenopathy, splenomegaly, and hepatomegaly in leukemia? a. The development of infection at these sites b. Increased compensatory production of blood cells by these organs c. Infiltration of the organs by increased | C |
| 39. A patient with AML is considering a hematopoietic stem cell transplant and asks the nurse what is involved. What is the best response the nurse can give the patient? a. “Your bone marrow is destroyed by radiation, and new bone marrow cells from a mat | C |
| 41. What characteristics should the nurse be aware of in planning care for the patient with Hodgkin’s lymphoma? a. Staging of Hodgkin’s lymphoma is not important to predict prognosis. b. Management of the patient being treated for Hodgkin’s lymphoma inclu | B |
| 42. Following a splenectomy for the treatment of ITP, what laboratory test result would the nurse expect to find? a. Decreased RBCs b. Decreased WBCs c. Increased platelets d. Increased immunoglobulins | C |
| 43. Patient-Centered Care: A 60-year-old male farmer is diagnosed with multiple myeloma. He has pain in his ribs with movement and his diagnostic studies show hypercalcemia. What nursing interventions should be implemented for this patient as the interpro | CEF |
| 44. Priority Decision: While receiving a unit of packed RBCs, the patient develops chills and a temperature of 102.2° F (39° C). What is the priority action for the nurse to take? a. Stop the transfusion and instill normal saline. b. Notify the health car | A |
| 45. A patient with thrombocytopenia with active bleeding is to receive 2 units of platelets. To administer the platelets, what should the nurse do? a. Check for ABO compatibility. b. Agitate the bag periodically during the transfusion. c. Take vital signs | B |
| 46. Which type of transfusion reaction occurs with leukocyte or plasma protein incompatibility and may be avoided with leukocyte reduction filters? a. Allergic reaction b. Acute hemolytic reaction c. Febrile, nonhemolytic reaction d. Massive blood transfu | C |
| 47. Which characteristics are related to an acute hemolytic transfusion reaction (select all that apply)? a. ABO incompatibility b. Hypothermia common c. Destruction of donor RBCs d. Acute kidney injury occurs e. Hypocalcemia and hyperkalemia f. Epinephri | ACD |
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