Chapter 30 Hematologic Problems PDF

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TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Chapter30:HematologicProblems TestBank MULTIPLECHOICE 1.A62-yearoldmanwithchronicanemiaisexperiencingincreasedfatigueandoccasionalpalpitationsatrest. Thenursewouldexpectthepatientslaboratoryfindingstoinclude a.

ahematocrit(Hct)of38%.

b.

anRBCcountof4,500,000/mL.

c.

normalredbloodcell(RBC)indices.

d.

ahemoglobin(Hgb)of8.6g/dL(86g/L).

ANS:D Thepatientsclinicalmanifestationsindicatemoderateanemia,whichisconsistentwithaHgbof6to10g/dL. Theothervaluesareallwithintherangeofnormal. DIF:CognitiveLevel:Understand(comprehension)REF:607 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 2.Whichmenuchoiceindicatesthatthepatientunderstandsthenursesteachingaboutbest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muffinandorangejuice

ANS:A Eggsandwholegrainbreadsarehighiniron.Theotherchoicesareappropriateforothernutritional deficienciesbutarenotthebestchoiceforapatientwithiron-deficiencyanemia. DIF:CognitiveLevel:Apply(application)REF:611 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 3.Apatientwhoisreceivingmethotrexateforsevererheumatoidarthritisdevelopsamegaloblasticanemia. Thenursewillanticipateteachingthepatientaboutincreasingoralintakeof a.

iron.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

b.

folicacid.

c.

cobalamin(vitaminB12).

d.

ascorbicacid(vitaminC).

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ANS:B Methotrexateusecanleadtofolicaciddeficiency.Supplementationwithoralfolicacidsupplementsisthe usualtreatment.Theothernutrientswouldnotcorrectfolicaciddeficiency,althoughtheywouldbeusedto treatothertypesofanemia. DIF:CognitiveLevel:Apply(application)REF:614 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 4.A52-year-oldpatienthasanewdiagnosisofperniciousanemia.Thenursedeterminesthatthepatient understandstheteachingaboutthedisorderwhenthepatientstates,I a.

needtostarteatingmoreredmeatandliver.

b.

willstophavingaglassofwinewithdinner.

c.

couldchoosenasalsprayratherthaninjectionsofvitaminB12.

d.

willneedtotakeaprotonpumpinhibitorlikeomeprazole(Prilosec).

ANS:C BecauseperniciousanemiapreventstheabsorptionofvitaminB12,thispatientrequiresinjectionsorintranasal administrationofcobalamin.Alcoholusedoesnotcausecobalamindeficiency.Protonpumpinhibitors decreasetheabsorptionofvitaminB12.EatingmorefoodsrichinvitaminB12isnothelpfulbecausethelack ofintrinsicfactorpreventsabsorptionofthevitamin. DIF:CognitiveLevel:Apply(application)REF:615 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 5.Anappropriatenursinginterventionforahospitalizedpatientwithseverehemolyticanemiaisto a.

provideadiethighinvitaminK.

b.

alternateperiodsofrestandactivity.

c.

teachthepatienthowtoavoidinjury.

d.

placethepatientonprotectiveisolation.

ANS:B

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Nursingcareforpatientswithanemiashouldalternateperiodsofrestandactivitytoencourageactivitywithou causingunduefatigue.Thereisnoindicationthatthepatienthasableedingdisorder,soadiethighinvitamin Korteachingabouthowtoavoidinjuryisnotneeded.Protectiveisolationmightbeusedforapatientwith aplasticanemia,butitisnotindicatedforhemolyticanemia. DIF:CognitiveLevel:Apply(application)REF:609 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 6.Whichpatientstatementtothenurseindicatesaneedforadditionalinstructionabouttakingoralferrous sulfate? a.

Iwillcallmyhealthcareproviderifmystools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fiberintakewhileIamtakingirontablets.

ANS:A Itisnormalforthestoolstoappearblackwhenapatientistakingiron,andthepatientshouldnotcallthe doctoraboutthis.Theotherpatientstatementsarecorrect. DIF:CognitiveLevel:Apply(application)REF:612 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 7.Whichcollaborativeproblemwillthenurseincludeinacareplanforapatientadmittedtothehospitalwith idiopathicaplasticanemia? a.

Potentialcomplication:seizures

b.

Potentialcomplication:infection

c.

Potentialcomplication:neurogenicshock

d.

Potentialcomplication:pulmonaryedema

ANS:B Becausethepatientwithaplasticanemiahaspancytopenia,thepatientisatriskforinfectionandbleeding. Thereisnoincreasedriskforseizures,neurogenicshock,orpulmonaryedema. DIF:CognitiveLevel:Apply(application)REF:616 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 8.Itisimportantforthenurseprovidingcareforapatientwithsicklecellcrisisto a.

limitthepatientsintakeoforalandIVfluids.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

b.

evaluatetheeffectivenessofopioidanalgesics.

c.

encouragethepatienttoambulateasmuchastolerated.

d.

teachthepatientabouthigh-protein,high-caloriefoods.

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ANS:B Painisthemostcommonclinicalmanifestationofacrisisandusuallyrequireslargedosesofcontinuous opioidsforcontrol.Fluidintakeshouldbeincreasedtoreducebloodviscosityandimproveperfusion.Restis usuallyorderedtodecreasemetabolicrequirements.Patientsareinstructedabouttheneedfordietaryfolic acid,buthigh-protein,high-caloriedietsarenotemphasized. DIF:CognitiveLevel:Apply(application)REF:619 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 9.Whichstatementbyapatientindicatesgoodunderstandingofthenursesteachingaboutpreventionofsickle cellcrisis? a.

Homeoxygentherapyisfrequentlyusedtodecreasesickling.

b.

Therearenoeffectivemedicationsthatcanhelppreventsickling.

c.

Routinecontinuousdosagenarcoticsareprescribedtopreventacrisis.

d.

Riskforacrisisisdecreasedbyhavinganannualinfluenzavaccination.

ANS:D Becauseinfectionisthemostcommoncauseofasicklecellcrisis,influenza,Haemophilusinfluenzae, pneumococcalpneumonia,andhepatitisimmunizationsshouldbeadministered.Althoughcontinuousdose opioidsandoxygenmaybeadministeredduringacrisis,patientsdonotreceivethesetherapiestoprevent crisis.Hydroxyurea(Hydrea)isamedicationusedtodecreasethenumberofsicklecellcrises. DIF:CognitiveLevel:Apply(application)REF:619 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 10.Whichinstructionwillthenurseplantoincludeindischargeteachingforthepatientadmittedwithasickle cellcrisis? a.

Takeadailymultivitaminwithiron.

b.

Limitfluidsto2to3quartsperday.

c.

Avoidexposuretocrowdswhenpossible.

d.

Drinkonlytwocaffeinatedbeveragesdaily.

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ANS:C Exposuretocrowdsincreasesthepatientsriskforinfection,themostcommoncauseofsicklecellcrisis.There isnorestrictiononcaffeineuse.Ironsupplementationisgenerallynotrecommended.Ahigh-fluidintakeis recommended. DIF:CognitiveLevel:Apply(application)REF:618 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 11.Thenursenotesscleraljaundiceinapatientbeingadmittedwithhemolyticanemia.Thenursewillplanto checkthelaboratoryresultsforthe a.

Schillingtest.

b.

bilirubinlevel.

c.

stooloccultbloodtest.

d.

gastricanalysistesting.

ANS:B Jaundiceiscausedbytheelevationofbilirubinlevelassociatedwithredbloodcell(RBC)hemolysis.The othertestswouldnotbehelpfulinmonitoringortreatingahemolyticanemia. DIF:CognitiveLevel:Apply(application)REF:607 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 12.Apatientwhohasbeenreceivingaheparininfusionandwarfarin(Coumadin)foradeepveinthrombosis (DVT)isdiagnosedwithheparin-inducedthrombocytopenia(HIT)whenherplateletleveldropsto110,000/L. Whichactionwillthenurseincludeintheplanofcare? a.

Uselow-molecular-weightheparin(LMWH)only.

b.

Administerthewarfarin(Coumadin)atthescheduledtime.

c.

Teachthepatientaboutthepurposeofplatelettransfusions.

d.

DiscontinueheparinandflushintermittentIVlinesusingnormalsaline.

ANS:D AllheparinisdiscontinuedwhentheHITisdiagnosed.Thepatientshouldbeinstructedtoneverreceive heparinorLMWH.Warfarinisusuallynotgivenuntiltheplateletcounthasreturnedto150,000/L.The plateletcountdoesnotdroplowenoughinHITforaplatelettransfusion,andplatelettransfusionsincreasethe riskforthrombosis. DIF:CognitiveLevel:Apply(application)REF:627

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TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 13.Acriticalactionbythenursecaringforapatientwithanacuteexacerbationofpolycythemiaveraisto a.

placethepatientonbedrest.

b.

administerironsupplements.

c.

avoiduseofaspirinproducts.

d.

monitorfluidintakeandoutput.

ANS:D Monitoringhydrationstatusisimportantduringanacuteexacerbationbecausethepatientisatriskforfluid overloadorunderhydration.Aspirintherapyisusedtodecreaseriskforthrombosis.Thepatientshouldbe encouragedtoambulatetopreventdeepveinthrombosis(DVT).Ironiscontraindicatedinpatientswith polycythemiavera. DIF:CognitiveLevel:Apply(application)REF:624 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 14.Whichinterventionwillbeincludedinthenursingcareplanforapatientwithimmunethrombocytopenic purpura(ITP)? a.

Assignthepatienttoaprivateroom.

b.

Avoidintramuscular(IM)injections.

c.

Userinsesratherthanasofttoothbrushfororalcare.

d.

Restrictactivitytopassiveandactiverangeofmotion.

ANS:B IMorsubcutaneousinjectionsshouldbeavoidedbecauseoftheriskforbleeding.Asofttoothbrushcanbe usedfororalcare.Thereisnoneedtorestrictactivityorplacethepatientinaprivateroom. DIF:CognitiveLevel:Apply(application)REF:625 TOP:NursingProcess:PlanningMSC:NCLEX:SafeandEffectiveCareEnvironment 15.Whichlaboratoryresultwillthenurseexpecttoshowadecreasedvalueifapatientdevelopsheparininducedthrombocytopenia(HIT)? a.

Prothrombintime

b.

Erythrocytecount

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

c.

Fibrinogendegradationproducts

d.

Activatedpartialthromboplastintime

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ANS:D PlateletaggregationinHITcausesneutralizationofheparin,sothattheactivatedpartialthromboplastintime willbeshorterandmoreheparinwillbeneededtomaintaintherapeuticlevels.Theotherdatawillnotbe affectedbyHIT. DIF:CognitiveLevel:Apply(application)REF:625 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 16.ThenursecaringforapatientwithtypeAhemophiliabeingadmittedtothehospitalwithseverepainand swellingintherightkneewill a.

immobilizethejoint.

b.

applyheattotheknee.

c.

assistthepatientwithlightweightbearing.

d.

performpassiverangeofmotiontotheknee.

ANS:A Theinitialactionshouldbetotalrestofthekneetominimizebleeding.Icepacksareusedtodecreasebleeding Rangeofmotion(ROM)andweight-bearingexercisearecontraindicatedinitially,butafterthebleedingstops, ROMandphysicaltherapyarestarted. DIF:CognitiveLevel:Apply(application)REF:631 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 17.A28-year-oldmanwithvonWillebranddiseaseisadmittedtothehospitalforminorkneesurgery.The nursewillreviewthecoagulationsurveytocheckthe a.

plateletcount.

b.

bleedingtime.

c.

thrombintime.

d.

prothrombintime.

ANS:B ThebleedingtimeisaffectedbyvonWillebranddisease.Plateletcount,prothrombintime,andthrombintime arenormalinvonWillebranddisease.

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341

DIF:CognitiveLevel:Understand(comprehension)REF:630 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 18.Aroutinecompletebloodcountindicatesthatanactive80-year-oldmanmayhavemyelodysplastic syndrome.Thenursewillplantoteachthepatientabout a.

bloodtransfusion

b.

bonemarrowbiopsy.

c.

filgrastim(Neupogen)administration.

d.

erythropoietin(Epogen)administration.

ANS:B Bonemarrowbiopsyisneededtomakethediagnosisanddeterminethespecifictypeofmyelodysplastic syndrome.Theothertreatmentsmaybenecessaryifthereisprogressionofthemyelodysplasticsyndrome,but theinitialactionforthisasymptomaticpatientwillbeabonemarrowbiopsy. DIF:CognitiveLevel:Apply(application)REF:637 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 19.Whichactionwilltheadmittingnurseincludeinthecareplanfora30-yearoldwomanwhois neutropenic? a.

Avoidanyinjections.

b.

Checktemperatureevery4hours.

c.

Omitfruitsorvegetablesfromthediet.

d.

PlaceaNoVisitorssignonthedoor.

ANS:B Theearliestsignofinfectioninaneutropenicpatientisanelevationintemperature.Althoughunpeeledfresh fruitsandvegetablesshouldbeavoided,fruitsandvegetablesthatarepeeledorcookedareacceptable. Injectionsmayberequiredforadministrationofmedicationssuchasfilgrastim(Neupogen).Thenumberof visitorsmaybelimitedandvisitorswithcommunicablediseasesshouldbeavoided,butanovisitorspolicyis notneeded. DIF:CognitiveLevel:Apply(application)REF:635 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 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

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

b.

Reticulocytecount

c.

Totallymphocytecount

d.

Absoluteneutrophilcount

342

ANS:D Filgrastimincreasestheneutrophilcountandfunctioninneutropenicpatients.Althoughtotallymphocyte, platelet,andreticulocytecountsalsoareimportanttomonitorinthispatient,theabsoluteneutrophilcountis usedtoevaluatetheeffectsoffilgrastim. DIF:CognitiveLevel:Apply(application)REF:634 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 21.A68-year-oldwomanwith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celltransplantation.

b.

Thesideeffectsofchemotherapyaredifficult,butAMLfrequentlygoesintoremissionwith chemotherapy.

c.

ThedecisionabouttreatmentisonethatyouandthedoctorneedtomakeratherthanaskingwhatI woulddo.

d.

Youdontneedtomakeadecisionabouttreatmentrightnowbecauseleukemiasinadultstendto progressquiteslowly.

ANS:B Thisresponseusestherapeuticcommunicationbyaddressingthepatientsquestionandgivingaccurate information.Theotherresponseseithergiveinaccurateinformationorfailtoaddressthepatientsquestion, whichwilldiscouragethepatientfromaskingthenurseforinformation. DIF:CognitiveLevel:Apply(application)REF:642 TOP:NursingProcess:ImplementationMSC:NCLEX:PsychosocialIntegrity 22.Apatientwithahistoryofatransfusion-relatedacutelunginjury(TRALI)istoreceiveatransfusionof packedredbloodcells(PRBCs).WhichactionbythenursewilldecreasetheriskforTRALIforthispatient? a.

InfusethePRBCsslowlyover4hours.

b.

Transfuseonlyleukocyte-reducedPRBCs.

c.

Administerthescheduleddiureticbeforethetransfusion.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

d.

343

GivethePRNdoseofantihistaminebeforethetransfusion.

ANS:B TRALIiscausedbyareactionbetweenthedonorandthepatientleukocytesthatcausespulmonary inflammationandcapillaryleaking.Theotheractionsmayhelppreventrespiratoryproblemscausedby circulatoryoverloadorbyallergicreactions,buttheywillnotpreventTRALI. DIF:CognitiveLevel:Apply(application)REF:653 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 23.A54-year-oldwomanwithacutemyelogenousleukemia(AML)isconsideringtreatmentwitha hematopoieticstemcelltransplant(HSCT).Thebestapproachforthenursetoassistthepatientwitha treatmentdecisionisto a.

emphasizethepositiveoutcomesofabonemarrowtransplant.

b.

discusstheneedforadequateinsurancetocoverpost-HSCTcare.

c.

askthepatientwhetherthereareanyquestionsorconcernsaboutHSCT.

d.

explainthatacureisnotpossiblewithanyothertreatmentexceptHSCT.

ANS:C OfferingthepatientanopportunitytoaskquestionsordiscussconcernsaboutHSCTwillencouragethepatien tovoiceconcernsaboutth...