Chapter 33: Hematologic Disorders
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. What should be a major focus in a teaching plan for a teenager with sickle cell anemia?
a.
Limit tobacco use to no more than two cigarettes a day.
b.
Eat foods high in iron and vitamin B.
c.
Maintain environmental temperature at 65° F to 68° F.
d.
Maintain adequate hydration.
2. Which is considered an approximate normal hematocrit value?
a.
Three times the hemoglobin value
b.
The same as the hemoglobin value
c.
Four times lower than the red blood cell count
d.
Same as the red blood cell count
3. A nurse is caring for a patient who is having radiation treatment for cancer. How many days
after the start of radiation should the nurse know that the threat of thrombocytopenia exists?
a.
2
b.
5
c.
9
d.
12
4. A nurse is caring for a patient receiving a transfusion and assesses that the patient is wheezing
and is complaining of back pain. What nursing action should take place after stopping the
transfusion?
a.
Discontinue the intravenous (IV) transfusion.
b.
Notify the charge nurse.
c.
Administer heparin.
d.
Raise the patient’s head.
5. A patient receiving Epogen asks how soon an increase in the red blood cell count will occur.
When should the nurse say that the initial increase in red blood cells should be seen?
a.
2 days
b.
1 week
c.
10 days
d.
2 weeks
6. What happens to the sickle-shaped red blood cells during a sickle cell crisis?
a.
Rupture
b.
Production of hemoglobin S
c.
Interference with blood production
d.
Obstruction of major arteries
7. A nurse is taking the history of a patient who has come in for evaluation of large areas of
purpura on her limbs. The patient reports using alternative therapy for her menopausal
symptoms. What alternative therapy is most likely responsible for the patient’s symptoms?
a.
Black cohosh
b.
Valerian
c.
Lavender
d.
Rosemary
8. What information should a nurse be sure to include when preparing discharge plans for a
patient recently diagnosed with pernicious anemia?
a.
Adding daily high-fat, low-fiber supplements
b.
Adding a rigorous daily workout
c.
Avoiding prolonged exposure to direct sunlight
d.
Providing sufficient rest periods throughout the day
9. What is the rationale for administering injections of vitamin B12 to patients with pernicious
anemia?
a.
The patient’s body does not normally manufacture enough vitamin B12.
b.
The patient may lack the intrinsic factor necessary for vitamin B12 absorption.
c.
Vitamin B12 is found in very small quantities in the patient’s body.
d.
Vitamin B12 is a mineral necessary to aid in the formation of strong bones.
10. Which foods should a nurse include in a nutrition teaching plan for a patient with
iron-deficiency anemia?
a.
Beans and dried fruit
b.
Apples and white rice
c.
Yogurt and cooked carrots
d.
Yellow squash and tortillas
11. Based on a nursing assessment, what is an appropriate nursing diagnosis for a patient with
hemophilia?
a.
Acute pain related to bleeding into closed spaces
b.
Impaired gas exchange related to decreased oxygen to the cells
c.
Excess fluid volume related to increased fluid within the cells
d.
Hypothermia related to inability to produce heat
12. A child with sickle cell anemia is prescribed the drug hydroxyurea. What effect from the drug
should the patient expect to have?
a.
Increase energy
b.
Decrease cardiomegaly
c.
Clean out obstructed vessels
d.
Produce a hemoglobin that resists sickling
13. A newborn infant has developed significant jaundice and has a positive Coombs test result
resulting from high levels of bilirubin. What should a nurse be aware that these symptoms
may indicate?
a.
Aplastic anemia
b.
Hemophilia
c.
Hemolytic anemia
d.
Sickle cell anemia
14. A 3-year-old African American child is diagnosed with sickle cell anemia. 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. What is the most accurate information to provide?
a.
At least one of the parents has to have the disease.
b.
Only one parent has to have the disease or the trait.
c.
Someone in previous generations had the disease.
d.
Both parents were carriers of the sickle cell trait.
15. To what level should the platelet count rise when the patient with a platelet count of
20,000/mm3 receives 1 unit of platelets?
a.
25,000 to 30,000/mm3
b.
35,000 to 40,000/mm3
c.
45,000 to 50,000/mm3
d.
55,000 to 100,000/mm3
16. When a nurse is preparing to give ferrous sulfate (Feosol) to a home health care patient, what
is the most appropriate nursing action to implement?
a.
Mix the drug with a high-protein milkshake.
b.
Give it undiluted with a small snack.
c.
Mix it with coffee or cola to disguise the bitter taste.
d.
Dilute it and offer through a straw and a few crackers.
17. A 35-year-old man is examined in an urgent care clinic. His presenting symptoms suggest
polycythemia vera. Which extreme laboratory value would confirm this possible diagnosis?
a.
High hemoglobin level
b.
Low white cell count
c.
Low platelet count
d.
High iron level
18. A 52-year-old man has a diagnosis of aplastic anemia. What information in the patient history
is pertinent to this diagnosis?
a.
Long family history of cancer
b.
Regular blood donor
c.
25-year employee in a chemical plant
d.
Gain of 5 lb in the last 2 years
19. A nurse is completing an initial assessment on a new patient being seen in the hospital clinic.
The presentation of this female patient includes vague symptoms of tiredness and large areas
of ecchymosis. Which question is most important for the nurse to ask?
a.
“Are you allergic to anything?”
b.
“Do your gums easily bleed?”
c.
“How many hours do you sleep?”
d.
“How frequent are your periods?”
20. At the end of a shift, a nurse documents the effectiveness of parent teaching concerning the
transmission of hemophilia. Which statement by the mother would best indicate an accurate
parental perception?
a.
“Hemophilia is a genetic disorder, and I am a carrier, although I do not have the
disease.”
b.
“My son developed hemophilia because I had measles while I was pregnant.”
c.
“Because my husband isn’t affected by the disease, our daughter will not be a
carrier.”
d.
“I know it is not necessary to have my two daughters tested for the disease.”
21. What should a nurse be careful to observe for when assessing a patient with
thrombocytopenia?
a.
Distended neck veins and skin discoloration
b.
Discoloration of the nails and sclera
c.
Petechiae on the skin and bleeding gums
d.
Enlarged thyroid gland and excitability
22. A nurse is helping prepare a nursing care plan for a 90-lb, 82-year-old woman with
iron-deficiency anemia with a hemoglobin of 5.2. What is the most appropriate nursing
diagnosis?
a.
Impaired tissue integrity related to immobility
b.
Disturbed body image related to weight loss
c.
Anxiety related to an unfamiliar hospital environment
d.
Activity intolerance related to fatigue
23. A nurse is assessing a patient 20 minutes after a bone marrow biopsy. Which statement by the
patient is cause for the most concern?
a.
“There is fresh blood on my dressing.”
b.
“I am thirsty.”
c.
“My hip feels bruised where they stuck the needle.”
d.
“I had a sharp pain in my leg when they pulled the needle out.”
24. A nurse caring for a patient with crushing injuries from an automobile accident notes that the
patient is bleeding profusely from the nose, mouth, and rectum, as well as from the injuries.
What should the nurse suspect as the cause of this patient’s bleeding?
a.
Hemophilia
b.
Disseminated intravascular coagulation (DIC)
c.
Leukemia
d.
Thrombocytopenia
25. At 1000 a nurse receives 2 units of blood for a patient to be transfused. What is the most
appropriate nursing action?
a.
Set up 1 unit for the infusion to start by 1030 and send the other unit back until the
first one has infused
b.
Set up both units to infuse at the same time and to start at 1100.
c.
Set up one unit for infusion and place the other in the refrigerator for the later
infusion.
d.
Send both units back and ask for a reissue of 1 unit only.
26. A nurse is giving iron dextran intramuscularly (IM). Why should the nurse implement the
Z-track method?
a.
Makes the injection less painful
b.
Prevents staining of the skin
c.
Prevents postinjection pain
d.
Allows another injection to be given at the same location
27. What is the major difference between fresh-frozen plasma (FFP) and cryoprecipitate (CPP)?
a.
FFP contains more albumin.
b.
FFP has a longer infusion time.
c.
FFP contains no platelets.
d.
FFP has a very high probability of causing an allergic reaction.
MULTIPLE RESPONSE
28. What medical history information is significant to potential bleeding problems? (Select all
that apply.)
a.
Drinks two glasses of wine a day
b.
Eats red meat three times a week
c.
Takes nonsteroidal antiinflammatory drugs (NSAIDs) for the relief of arthritic pain
four times a day
d.
Has hepatitis B
e.
Had a cardiac valve replaced 6 months earlier
OTHER
29. A nurse plans the interventions to prepare a patient for a bone marrow aspiration. (Place the
options in the correct sequence. Separate letters by a comma and space as follows: A, B, C,
D.)
a. Assist the patient to lie on his or her abdomen and drape the hip and lower limbs.
b. Confirm the presence of laboratory personnel to stain the specimen.
c. Apply a pressure dressing and help the patient lie on his or her back.
d. Ensure that a signed permission form is obtained.
e. Explain that the procedure will take about 30 minutes.
