Question 1

The nurse is caring for a client with acute myelogenous leukemia who is receiving outpatient chemotherapy and develops an absolute neutrophil count of 0.9 * 109/L. Which of the following actions by the nurse in the outpatient clinic is best?

Accepted Answer

A)  Discuss the need for hospital admission to treat the neutropenia.
B)  Plan to discontinue the chemotherapy until the neutropenia resolves.
C)  Teach the client how to administer filgrastim injections at home.
D)  Obtain a high-efficiency particulate air (HEP
A)   filter for the client for home use.E) A) and B)
F) A) and C)

Question 2

The nurse is teaching a client with a new diagnosis of pernicious anemia about the disorder. Which of the following client statements indicates that the teaching has been effective?

Accepted Answer

A)  "I need to start eating more red meat or liver."
B)  "I will stop having a glass of wine with dinner."
C)  "I will need to take a proton pump inhibitor like omeprazole."
D)  "I would rather use the nasal spray than have to get injections of vitamin B12."E) B) and C)
F) C) and D)

Question 3

The nurse is admitting a client with hemolytic anemia and notes jaundice of the sclerae. Which of the following laboratory results should the nurse assess?

Accepted Answer

A)  Schilling test
B)  Bilirubin level
C)  Stool occult blood test
D)  Gastric analysis testingE) B) and D)
F) B) and C)

Question 4

The nurse is caring for a client receiving a transfusion of packed red blood cells who develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, which of the following actions is priority?

Accepted Answer

A)  Draw blood for a new crossmatch
B)  Send a urine specimen to the laboratory
C)  Give the PRN diphenhydramine
D)  Administer the PRN acetaminophenE) C) and D)
F) B) and C)

Question 5

Which of the following newly admitted clients should the nurse assign as a roommate for a client who has aplastic anemia?

Accepted Answer

A)  A client with severe heart failure
B)  A client who has viral pneumonia
C)  A client who has right leg cellulitis
D)  A client with multiple abdominal drainsE) B) and C)
F) None of the above

Question 6

The nurse is caring for a client with neutropenia who is started on a cephalosporin. Which of the following common adverse effects should the nurse observe for in the client? (Select all that apply.)

Accepted Answer

A)  Nephrotoxicity
B)  Rash
C)  Ototoxicity
D)  Fever
E)  PruritusF) A) and D)
G) B) and D)

Question 7

The nurse is caring for a client with immune thrombo-cytopenic purpura (ITP)  who has a prescription for a platelet transfusion. Which of the following client information indicates that the nurse should consult with the health care provider before administering platelets?

Accepted Answer

A)  The platelet count is 42 * 109/L.
B)  Blood pressure is 94/56 mm Hg.
C)  Blood is oozing from the venipuncture site.
D)  Petechiae are present on the chest and back.E) B) and D)
F) B) and C)

Question 8

The nurse is caring for a client with acute myelogenous leukemia (AML)  who has induction therapy prescribed and the client asks the nurse whether the planned chemotherapy will be worth undergoing. Which of the following responses by the nurse is best?

Accepted Answer

A)  "If you do not want to have chemotherapy, there are other options for treatment such as stem cell transplantation."
B)  "The decision about chemotherapy is one that you and the doctor need to make rather than asking what I would do."
C)  "You don't need to make a decision about treatment right now since leukemias in adults tend to progress quite slowly."
D)  "The adverse effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy."E) B) and C)
F) None of the above

Question 9

The nurse has finished teaching a client about taking oral ferrous sulphate. Which of the following client statements indicates that additional instruction is needed?

Accepted Answer

A)  "I will call the doctor if my stools start to turn black."
B)  "I will take a stool softener if I feel constipated occasionally."
C)  "I should take the iron with orange juice about an hour before eating."
D)  "I should increase my fluid and fibre intake while I am taking the iron tablets."E) A) and C)
F) B) and D)

Question 10

The nurse is caring for a client who is hospitalized for treatment of severe hemolytic anemia. Which of the following actions should the nurse implement?

Accepted Answer

A)  Provide a diet high in vitamin K.
B)  Place the client on protective isolation.
C)  Alternate periods of rest and activity.
D)  Teach the client how to avoid injury.E) All of the above
F) A) and C)

Question 11

All of these clients call the outpatient clinic and ask to make an appointment as soon as possible. Which of the following clients should the nurse schedule to be seen first?

Accepted Answer

A)  19-year-old with no previous health problems who has a nontender lump in the axilla
B)  46-year-old with sickle cell anemia who says "that my eyes always look sort of yellow"
C)  21-year-old with hemophilia who wants to learn how to self-administer factor VII replacement
D)  50-year-old with early-stage chronic lymphocytic leukemia who has complaints of chronic fatigueE) A) and D)
F) B) and C)

Question 12

Which of the following menu choices indicate that the client understands the nurse's teaching about best dietary choices for iron-deficiency anemia?

Accepted Answer

A)  Omelette and whole wheat toast
B)  Cantaloupe and cottage cheese
C)  Strawberry and banana fruit plate
D)  Cornmeal muffin and orange juiceE) None of the above
F) A) and B)

Question 13

All of these clients are waiting to be admitted by the emergency department nurse. Which one of the following requires the most rapid assessment and care by the nurse?

Accepted Answer

A)  The client with hemochromatosis who has symptoms of abdominal pain
B)  The client with thrombo-cytopenia who has blood oozing after having a tooth extracted
C)  The client with chemotherapy-induced neutropenia who has a temperature of 38.2°C (100.8°F) 
D)  The client with a history of sickle cell anemia who has had nausea and diarrhea for 24 hoursE) C) and D)
F) None of the above C

Question 14

The nurse is caring for a client with idiopathic aplastic anemia. Which of the following collaborative problems should the nurse include when developing the care plan?

Accepted Answer

A)  Potential complication: seizures
B)  Potential complication: infection
C)  Potential complication: neurogenic shock
D)  Potential complication: pulmonary edemaE) B) and D)
F) B) and C)

Question 15

When a febrile episode occurs in a client with neutropenia, at what time should antibiotic therapy be initiated?

Accepted Answer

A)  Within 1 hour
B)  After the causative agent is identified from the culture
C)  Once the fever drops below 38°C (100.4°F) 
D)  For long-term therapy over 3 monthsE) C) and D)
F) None of the above A

Question 16

Which of the following laboratory information should the nurse monitor to detect heparin-induced thrombo-cytopenia (HIT)  in a client who is receiving a continuous heparin infusion?

Accepted Answer

A)  Prothrombin time
B)  Erythrocyte count
C)  Fibrinogen degradation products
D)  Activated partial thromboplastin timeE) B) and C)
F) A) and B)

Question 17

The nurse is caring for a client with a sickle cell crisis. While caring for the client during the crisis, which of the following actions is priority?

Accepted Answer

A)  Limit the client's intake of oral and IV fluids.
B)  Evaluate the effectiveness of opioid analgesics.
C)  Encourage the client to ambulate as much as tolerated.
D)  Teach the client about high-protein, high-calorie foods.E) C) and D)
F) A) and B)

Question 18

Which of the following assessment data obtained by the nurse when caring for a client with thrombo-cytopenia should be immediately communicated to the health care provider?

Accepted Answer

A)  The platelet count is 52 * 109/L.
B)  The client is difficult to arouse.
C)  There are large bruises on the back.
D)  There are purpura on the oral mucosa.E) C) and D)
F) A) and C)

Question 19

The hemophilia clinic nurse receives a call from a client with hemophilia to discuss all of these problems. Which of the following problems is most important to communicate to the health care provider?

Accepted Answer

A)  Skin abrasions
B)  Bleeding gums
C)  Multiple bruises
D)  Dark tarry stoolsE) B) and C)
F) All of the above D

Question 20

The nurse is admitting a client with type A hemophilia who has severe pain and swelling in the right knee. Which of the following actions should the nurse implement initially?

Accepted Answer

A)  Immobilize the knee
B)  Apply heat to the joint
C)  Assist the client with light weight bearing
D)  Perform passive range of motion to the kneeE) A) and B)
F) B) and D)

Exam 33: Nursing Management Hematological Problems

The nurse is caring for a client with acute myelogenous leukemia who is receiving outpatient chemotherapy and develops an absolute neutrophil count of 0.9 * 109/L. Which of the following actions by the nurse in the outpatient clinic is best?

Correct AnswerverifiedShow Answer

The nurse is teaching a client with a new diagnosis of pernicious anemia about the disorder. Which of the following client statements indicates that the teaching has been effective?

Correct AnswerverifiedShow Answer

The nurse is admitting a client with hemolytic anemia and notes jaundice of the sclerae. Which of the following laboratory results should the nurse assess?

Correct AnswerverifiedShow Answer

The nurse is caring for a client receiving a transfusion of packed red blood cells who develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, which of the following actions is priority?

Correct AnswerverifiedShow Answer

Which of the following newly admitted clients should the nurse assign as a roommate for a client who has aplastic anemia?

Correct AnswerverifiedShow Answer

The nurse is caring for a client with neutropenia who is started on a cephalosporin. Which of the following common adverse effects should the nurse observe for in the client? (Select all that apply.)

Correct AnswerverifiedShow Answer

The nurse is caring for a client with immune thrombo-cytopenic purpura (ITP) who has a prescription for a platelet transfusion. Which of the following client information indicates that the nurse should consult with the health care provider before administering platelets?

Correct AnswerverifiedShow Answer

The nurse is caring for a client with acute myelogenous leukemia (AML) who has induction therapy prescribed and the client asks the nurse whether the planned chemotherapy will be worth undergoing. Which of the following responses by the nurse is best?

Correct AnswerverifiedShow Answer

The nurse has finished teaching a client about taking oral ferrous sulphate. Which of the following client statements indicates that additional instruction is needed?

Correct AnswerverifiedShow Answer

The nurse is caring for a client who is hospitalized for treatment of severe hemolytic anemia. Which of the following actions should the nurse implement?

Correct AnswerverifiedShow Answer

All of these clients call the outpatient clinic and ask to make an appointment as soon as possible. Which of the following clients should the nurse schedule to be seen first?

Correct AnswerverifiedShow Answer

Which of the following menu choices indicate that the client understands the nurse's teaching about best dietary choices for iron-deficiency anemia?

Correct AnswerverifiedShow Answer

All of these clients are waiting to be admitted by the emergency department nurse. Which one of the following requires the most rapid assessment and care by the nurse?

Correct AnswerverifiedC

The nurse is caring for a client with idiopathic aplastic anemia. Which of the following collaborative problems should the nurse include when developing the care plan?

Correct AnswerverifiedShow Answer

When a febrile episode occurs in a client with neutropenia, at what time should antibiotic therapy be initiated?

Correct AnswerverifiedA

Which of the following laboratory information should the nurse monitor to detect heparin-induced thrombo-cytopenia (HIT) in a client who is receiving a continuous heparin infusion?

Correct AnswerverifiedShow Answer

The nurse is caring for a client with a sickle cell crisis. While caring for the client during the crisis, which of the following actions is priority?

Correct AnswerverifiedShow Answer

Which of the following assessment data obtained by the nurse when caring for a client with thrombo-cytopenia should be immediately communicated to the health care provider?

Correct AnswerverifiedShow Answer

The hemophilia clinic nurse receives a call from a client with hemophilia to discuss all of these problems. Which of the following problems is most important to communicate to the health care provider?

Correct AnswerverifiedD

The nurse is admitting a client with type A hemophilia who has severe pain and swelling in the right knee. Which of the following actions should the nurse implement initially?

Correct AnswerverifiedShow Answer

The nurse is caring for a client with acute myelogenous leukemia who is receiving outpatient chemotherapy and develops an absolute neutrophil count of 0.9 * 10⁹/L. Which of the following actions by the nurse in the outpatient clinic is best?

Correct Answer
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C

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A

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D

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