81 Hematology

Exams For Nursing NCLEX Nursing Exams - Hematologic Disorders Written by Administrator Sunday, 03 April 2011 19:11 -

MULTIPLE CHOICE

1. The nurse nurse assesses assesses the abnormal abnormal blood blood value value for a young woman woman as: 1. platelets, 200,000//mm³. 2. hemoglobin, 14 g/dL. 3. red blood cells, 2,000,000/mm³. 4. iron, 68 µg/dL.

ANS: 3 The RBCs are low. The normal value for RBCs is 4,500,000/mm³. The values for the other blood components are normal.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 571 OBJ: 3 TOP: Normal Laboratory Values KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The nurse nurse explai explains ns that that a normal normal hematocr hematocrit it value value is appro approxima ximately tely:: 1. three times the hemoglobin value. 2. the same as the t he hemoglobin value. 3. four times lower than the red blood cell count. 4. the same as the red blood cell count.

ANS: 1 Hematocrit is approximately three times the hemoglobin value.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 571

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OBJ: 3 TOP: Normal Laboratory Values KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. The nurse calls calls to the the attention attention of the charge charge nurse the PT/INR of a patient patient on Coumadin. The value that needs attention is: 1. control, 35; patient, 41; INR, 1.5. 2. control, 35; patient, 52; INR, 1.8. 3. control, 35; patient, 70; INR, 2.0. 4. control, 35; patient, 85; INR, 2.5.

ANS: 3 The therapeutic range of the PT/INR is 1.5 to 2 times the control with an INR of 1.5 to 2.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 578 OBJ: 3 TOP: Laboratory Values KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

4. The nurse caring caring for a patient receiving receiving a transfusion transfusion assesses that that the patient patient is wheezing and is complaining of back pain. After the nurse stops the transfusion, the nurse should: 1. discontinue the IV. 2. notify the charge nurse. 3. administer heparin. 4. raise the patient’s head.

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ANS: 2 The charge nurse should be notified immediately after the transfusion is stopped. The charge nurse will notify the physician and the lab or blood bank. The head of the bed should be raised to aid in respiration and O2 should be administered in high doses. The blood tubing and the bag should not be discarded because the blood bank will want it to check the accuracy of the typing.

PTS: 1 DIF: Cognitive Level: Application REF: 581 OBJ: 4 TOP: Blood Transfusion Reactions KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

5. The patient receiving Epogen Epogen asks how how soon there there will be an increase in his red blood cell count. The nurse’s best reply is that the initial increase in red cells should be seen in: 1. 2 days. 2. 1 weeks. 3. 10 days. 4. 2 weeks.

ANS: 3 Epoetin alfa (Epogen) stimulates the bone marrow to produce more red blood cells in about 2 days.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 581 OBJ: 6 TOP: Colony-Stimulating Medication KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

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6. The nurse explains explains that that sickle cell cell crisis occurs when the sickle-shaped sickle-shaped red blood cells: 1. rupture. 2. produce hemoglobin S. 3. interfere with blood production. 4. obstruct major arteries.

ANS: 4 Circulatory obstruction causes severe pain in sickle cell anemia, which is the major symptom in sickle cell crisis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 584 OBJ: 5 TOP: Sickle Cell Anemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

7. The information information that the nurse recognizes recognizes as pertinent patient patient self-care self-care for a patient with sickle cell anemia is: 1. exercise 3 to 4 hours a day. 2. consume a daily high-fat diet. 3. drink 4 to 6 L of fluid daily. 4. rest 10 to 12 hours each day.

ANS: 3 It is important for the patient to consume adequate fluids daily to keep the circulating volume adequate. This hydration is beneficial in preventing sickle cell crisis.

PTS: 1 DIF: Cognitive Level: Application REF: 586 OBJ: 5 TOP: Sickle Cell Anemia KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

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8. In preparing preparing discharge plans for a patient recently diagnosed diagnosed with with pernicious pernicious anemia, it is most important for the nurse to include information regarding: 1. adding daily high-fat, low-fiber supplements. 2. the need to add a rigorous daily workout. 3. avoidance of prolonged exposure to direct sunlight. 4. sufficient rest periods throughout the day.

ANS: 4 Fatigue and weakness are seen in all anemias.

PTS: 1 DIF: Cognitive Level: Application REF: 583 OBJ: 6 TOP: Pernicious Anemia KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

9. The ration rationale ale for for administ administerin ering g injectio injections ns of vitami vitamin n B12 to patie patients nts with with pernici pernicious ous anemia is that: 1. the patient’s body does not normally manufacture enough vitamin B12. 2. the patient may lack intrinsic factor necessary for vitamin B12 absorption. 3. vitamin B12 is found in very small quantities in the patient’s body. 4. vitamin B12 is a mineral necessary to aid in the formation of strong bones.

ANS: 2 The patient with pernicious anemia lacks intrinsic factor, found in the stomach, which is essential for vitamin B12 absorption.

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PTS: 1 DIF: Cognitive Level: Analysis REF: 583 OBJ: 5 TOP: Pernicious Anemia KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

10. The foods that the nurse nurse would include include in a nutrition nutrition teaching plan for an an iron-deficiency anemia patient are : 1. beans and dried fruit. 2. apples and white rice. 3. yogurt and cooked carrots. 4. yellow squash and tortillas.

ANS: 1 Iron-rich foods include beans, dried fruit, liver, red meat, fish, and whole-grain breads.

PTS: 1 DIF: Cognitive Level: Application REF: 583 OBJ: 6 TOP: Iron-Deficiency Anemia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

11. Based on the the nursing assessment, an an appropriate appropriate nursing diagnosis for for a patient patient with hemophilia would be: 1. acute pain related to bleeding in closed spaces. 2. impaired gas exchange related to decreased oxygen to the cells. 3. excess fluid volume related to increased fluid within the cells. 4. hypothermia related to inability to produce heat.

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ANS: 1 Patients with hemophilia have severe pain due to bleeding into the joints.

PTS: 1 DIF: Cognitive Level: Analysis REF: 587 OBJ: 4 TOP: Hemophilia KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Physiological Integrity

12. A child with with sickle cell anemia is placed on the drug hydroxyurea. The nurse explains that this drug will: 1. increase energy. 2. decrease cardiomegaly. 3. clean out obstructed vessels. 4. produce a hemoglobin that resists sickling.

ANS: 4 Hydroxyurea produces a hemoglobin that resists sickling.

PTS: 1 DIF: Cognitive Level: Analysis REF: 584 OBJ: 3 TOP: Hydroxyurea KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

13. A newborn infant infant has developed marked marked jaundice jaundice and has a positive Coombs’ Coombs’ test

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result from high levels of bilirubin. The nurse has assessed the symptoms as being indicative of: 1. aplastic anemia. 2. hemophilia. 3. hemolytic anemia. 4. sickle cell anemia.

ANS: 3 Newborns can develop hemolytic anemias resulting from blood incompatibility to their mother. These are typical signs of hemolytic anemia in i n the newborn.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 583 OBJ: 5 TOP: Hemolytic Anemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

14. A 3-year-old 3-year-old African-American African-American child is diagnosed with sickle sickle cell anemia. The The parents know that sickle cell anemia is hereditary but do not understand why their child has the disease, because neither of them has it. The nurse explains that: 1. at least one of the parents has to have the disease. 2. only one parent has to have the disease or the trait. 3. someone in previous generations had the disease. 4. both parents were carriers of the sickle cell trait.

ANS: 4 Sickle cell anemia is a genetic disease carried by the recessive genes of both parents, who will not have any symptoms of the disease at all.

PTS: 1 DIF: Cognitive Level: Analysis REF: 583-584 OBJ: 5 TOP: Anemia KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

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15. When the patient patient with a platelet count of 20,000/mm3 20,000/mm3 receives receives 1 unit unit of platelets, platelets, the platelet count should rise to: 1. 25,000 to 30,000/mm3. 2. 35,000 to 40,000/mm3. 3. 45,000 to 50,000/mm3. 4. 55,000 to 100,000/mm3.

ANS: 1 Platelet transfusions are given when the platelet count falls below 20,000/mm3. One unit is expected to raise the count by 5000 to 10,000/mm3.

PTS: 1 DIF: Cognitive Level: Application REF: 580 OBJ: 3 TOP: Platelet Transfusion KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

16. When the nurse nurse prepares to give ferrous ferrous sulfate sulfate (Feosol) to a home health health patient, patient, the nurse will: 1. mix the drug with a high-protein milk shake. 2. give undiluted with a small snack. 3. mix with coffee or cola to disguise the bitter taste. t aste. 4. dilute and offer through a straw and a few crackers.

ANS: 4 Patients should avoid taking iron with milk or caffeine because it inhibits drug absorption. The drug is offered with food in a diluted form through t hrough a straw to prevent staining of the teeth.

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PTS: 1 DIF: Cognitive Level: Application REF: 582, Box 32-1 OBJ: 6 TOP: Administration of Feosol KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

17. A 35-year-old 35-year-old man is seen in an urgent care clinic. He He presents with symptoms symptoms of polycythemia vera. The laboratory value that would confirm the possible diagnosis is an extremely: 1. high hemoglobin level. 2. low white cell count. 3. low platelet count. 4. high iron level.

ANS: 1 The symptoms of polycythemia vera are extremely high hemoglobin and hematocrit levels due to the excessive production of red blood cells. These persons have 1 pint of blood taken from them until the blood values become more normal. The blood is collected as for a blood donation but cannot be used for transfusion purposes.

PTS: 1 DIF: Cognitive Level: Analysis REF: 582 OBJ: 5 TOP: Polycythemia Vera KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

18. A 52-year-old 52-year-old man has a diagnosis of aplastic aplastic anemia. The information information that the nurse recognizes as being pertinent to this diagnosis is that the man: 1. has a long family history of cancer.

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2. is a regular blood donor. 3. is a 25-year employee in a chemical plant. 4. has gained 5 pounds in the last 2 years.

ANS: 3 Exposure to toxic chemicals can cause aplastic anemia.

PTS: 1 DIF: Cognitive Level: Analysis REF: 582-583 OBJ: 5 TOP: Aplastic Anemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

19. A nurse is completing an initial initial assessment on a new patient patient being being seen in the the hospital clinic. The female patient presents with vague symptoms of tiredness and large areas of ecchymosis. The question that would be most important to ask is: 1. “Are you allergic to anything?” 2. “Do your gums bleed easily?” 3. “How many hours do you sleep?” 4. “How frequent are your periods?”

ANS: 2 Bleeding gums are indicative of general bleeding tendencies. Sleep and frequency of periods are not significant, but the heaviness of the period is significant. History can reveal information pertinent to assisting the physician in making a diagnosis.

PTS: 1 DIF: Cognitive Level: Analysis REF: 573 OBJ: 2 TOP: Assessment of Patients with Hematologic Disorders KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

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20. At the end of a shift, shift, a nurse documents the effectiveness effectiveness of parent parent teaching concerning the transmission of hemophilia. Which of the following statements by the mother would best indicate an accurate parental perception? 1. “Hemophilia is a genetic disorder and I am a carrier, even though I do not have the disease.” 2. “My son developed hemophilia because I had measles while I was pregnant.” 3. “Since my husband isn’t affected by the disease, our daughter will not be a carrier.” 4. “I know it is not necessary to have my two daughters tested for the disease.”

ANS: 1 Women carry the trait and pass it on to their sons.

PTS: 1 DIF: Cognitive Level: Analysis REF: 587 OBJ: 5 TOP: Hemophilia KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

21. When assessing assessing the patient with thrombocytopenia thrombocytopenia,, the nurse nurse observes observes for: 1. distended neck veins and skin discoloration. 2. discoloration of the nails and sclera. 3. petechiae on the skin and bleeding gums. 4. enlarged thyroid gland and excitability.

ANS: 3 Symptoms of thrombocytopenia include petechiae, purpura, bleeding gums, and epistaxis.

PTS: 1 DIF: Cognitive Level: Analysis REF: 587 OBJ: 5 TOP: Thrombocytopenia

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KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

22. The nurse uses a common nursing diagnosis diagnosis for patients with disorders disorders of the hematologic system, which is: 1. Impaired Tissue Integrity. 2. Disturbed Body Image. 3. Ineffective Tissue Perfusion. 4. Activity Intolerance.

ANS: 4 Fatigue and activity intolerance are common complaints of patients with hematologic disorders.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 573 OBJ: 6 TOP: Hematologic Nursing Diagnosis KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Physiological Integrity

23. The nurse assessing a patient 20 minutes after after a bone marrow biopsy biopsy is concerned concerned when the patient says: 1. “There is fresh blood on my dressing.” 2. “I am thirsty.” 3. “My hip feels bruised where they stuck the needle.” 4. “I had a sharp pain in my leg when they pulled the needle out.”

ANS: 1 Fresh blood on the pressure dressing 20 minutes after the aspiration needs to be addressed.

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Usually, redressing with a pressure dressing and an ice pack are sufficient. Feelings of bruising and pain on extraction are to be expected. Thirst is of no clinical significance.

PTS: 1 DIF: Cognitive Level: Analysis REF: 577, Table 32-1 OBJ: 3 TOP: Diagnostic Tests KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

24. The nurse caring for a patient with crushing crushing injuries injuries from an auto auto accident is horrified to find the patient bleeding profusely from the nose, mouth, and rectum, as well as from the injuries. The nurse assesses this emergency situation as: 1. hemophilia. 2. disseminated intravascular coagulation (DIC). 3. leukemia. 4. thrombocytopenia.

ANS: 2 DIC occurs in massive crushing injuries, burns, and allergic responses. The body’s clotting ability is exhausted because trying to repair so many areas with coagulation. When the platelet supply is gone, the clotting ability is lost and massive hemorrhaging occurs.

PTS: 1 DIF: Cognitive Level: Analysis REF: 587 OBJ: 4 TOP: DIC KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

25. At 10:00 AM, AM, the nurse nurse receives 2 units of blood for a patient to be transfused. transfused. The nurse should :

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1. set up 1 unit for the infusion i nfusion to start at 10:30 AM and send the other unit back until the first one has run. 2. set up both units to run at the same time for an infusion at 11:00 AM. 3. set up one unit for infusion and place the other in the refrigerator for the later infusion. 4. send both units back and ask for reissue of only 1 unit.

ANS: 1 Blood must be started within 30 minutes of its receipt after it has been checked by two licensed staff members. In many settings, LPNs do not start the blood, but can set the infusion up. The best option is to send the second unit back immediately, with an explanation that it will be called for later. A unit of blood usually takes about 2 to 4 hours to run.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 580, Box 32-5 OBJ: 1 TOP: Transfusion Protocol KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

MULTIPLE RESPONSE

1. The nurse nurse notes notes the the past past medical medical histor history y informat information ion that that is signif significan icantt to potenti potential al bleeding problems as (select all that apply): 1. drinks two glasses of wine a day. 2. eats red meat three times a week. 3. takes NSAIDs for arthritis four times a day. 4. has hepatitis B. 5. had a cardiac valve replaced r eplaced 6 months ago.

ANS: 3, 4, 5 NSAIDs and liver disorders enhance the probability of bleeding. The valve replacement of a few months ago suggests that the patient is using anticoagulant drugs.

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PTS: 1 DIF: Cognitive Level: Comprehension REF: 573 OBJ: 2 TOP: Factors Predisposing to Bleeding Tendency KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

2. The nurse giving giving iron dextran IM will use the the Z-track method because because this method method (select all that apply): 1. makes the injection less painful. 2. prevents staining of the skin. 3. prevents postinjection pain. 4. allows another injection to be given at the same location. 5. cleans the needle on withdrawal.

ANS: 3 All the Z-track method ensures is that there will be no iron staining the skin after injection. The amount of pain is the same and, after all IM injections, i njections, the needle is cleaned on withdrawal. Injections are never given at recent injection sites.

PTS: 1 DIF: Cognitive Level: Application REF: 582, Table 32-1 OBJ: 6 TOP: Z-Track Method KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

3. The nurse explains explains that that the major difference between fresh fresh frozen plasma plasma (FFP) and cryoprecipitate (CPP) is that FFP (select all that apply): 1. contains more albumin. 2. has a longer infusion time.

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3. contains no platelets. 4. has a very high probability of causing an allergic reaction. 5. can cause dangerous blood pressure elevation.

ANS: 3 FFP contains no platelets.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 579, Table 32-1 OBJ: 5 TOP: FFP versus CPP KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

OTHER

1. The nurse plans plans the intervention interventions s to prepare prepare a patient patient for a bone bone marrow aspiration aspiration (place the options in the correct sequence): 1. Assist the patient to abdomen and drape hip and lower limbs 2. Confirm the presence of laboratory personnel to stain the specimen. 3. Apply a pressure dressing and assist the patient to lie on his or her back. 4. Get the permission form signed. 5. Explain that the procedure will take about 30 minutes.

ANS: 5, 4, 1, 2, 3 The appropriate sequence is the following: explain the procedure; when the t he patient indicates understanding, get the permission form signed; assist the patient to abdomen and drape hip and lower extremities; confirm the presence of laboratory personnel to stain the specimen; apply a pressure dressing and assist the patient to lie on his or her back.

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PTS: 1 DIF: Cognitive Level: Analysis REF: 577, Table 32-2 OBJ: 3 TOP: Bone Marrow Aspiration Preparation KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

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81 Hematology

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