Med Surg Chapters 19 - 20 Hematologic Functions and Disorders PPT and Questions
Med Surg Chapters 19 - 20 Hematologic Functions and Disorders PPT and Questions
Med Surg Chapters 19 - 20 Hematologic Functions and Disorders PPT and Questions
Blood
Life of Cells
RBS’s generally 120 days
WBC’s live from days to years depending on the type
Platelets live 7 – 10 days
Erythropoiesis
Erythroblasts arise from the primitive myeloid stem cells in bone marrow
Differentiation is stimulated by erythropoietin from the kidneys
Depends on adequate supplies of folic acid, vitamin B 12, and iron
Old RBCs are removed from the blood by the reticuloendothelial cells,
particularly in the liver and the spleen
Question
Which of the following situations would most likely prompt an increase in
erythropoietin synthesis?
A woman is admitted to the hospital with anemia.
A man with atrial fibrillation has begun taking anticoagulants to prevent a stroke.
A child fractures his ulna and radius in a playground accident.
A woman develops an infection in an arterial ulcer.
Rationale: If the kidney detects low levels of oxygen (as would occur in anemia, in which
fewer red cells are available to bind oxygen, or with people living at high altitudes), the
release of erythropoietin is increased. Anticoagulants, infections, and injury without
blood loss do not increase erythropoiesis.
2. Agranulocytes:
Monocytes
Lymphocytes
Platelets (Thrombocytes)
Play an essential role in the control of bleeding
Circulate freely in the blood in an inactive state
When vascular injury occurs, platelets collect at the site and are activated,
forming a platelet plug
Hemostasis
Involves primary and secondary phases
Can be activated by the intrinsic or the extrinsic pathway
Many factors are involved in the reaction cascade that forms fibrin
Question
An individual’s body is responding to a minor cut. What event will take place during
primary hemostasis?
• The severed blood vessels will constrict.
• Thrombopoietin will be synthesized.
• Platelets will begin to circulate.
• Plasma volume will increase.
Rationale: Primary hemostasis involves the severed vessel constricting and platelets
collecting at the injury site. Thrombopoietin is not synthesized in the immediate
response to an injury, and platelets are in constant circulation. Plasma volume does not
increase in response to bleeding.
• Patients with severe neutropenia are at significantly increased risk for developing
opportunistic infections and sepsis
Normally, the neutrophil count is greater than 2000/mm 3. The actual (or absolute)
neutrophil count (ANC) is calculated using this formula:
Total WBC X [%segs + %bands]
Ex: WBC – 3000/mm3 with 72% neutrophils and 3% bands
Calculate ANC – 3000 X [0.72 + 0.03] =
3000.75 =
2250/mm3
• Hematocrit:
Female: 37%–47%
Male: 40%–52%
• Platelets: 150–400,000/mm³
Patients with neutropenia are often not able to manifest the classic signs of
infection.
Question
A nurse is caring for a patient who is 73 years old with a platelet count of 5,000/mm3
resulting from myelodysplastic syndrome. At 10 p.m., the patient complains of a
headache. What should be the nurse’s immediate action to take?
Rationale: Platelet counts ≤10,000/ mm3 are associated with serious episodes of
spontaneous bleeding, including intracranial hemorrhage; thus complaints of headaches
or change in the level of consciousness necessitates immediate notification of the
health care provider.
Question
Mrs. S. presented to her primary care provider with a complaint of a “cold that just won’t
go away.” She has a CBC drawn, revealing the following: WBC 4.5: segs 5, bands 0,
lymphs 45, eosinophils 5, basophils 5, monocytes 5, blasts 35. What is the patient’s
absolute neutrophil count?
500
250
225
2,250
Rationale: The formula for determining the absolute neutrophil count (ANC) is the white
blood cell (WBC) count multiplied by the sum of the %neutrophil count (segs) and
%bands. An ANC <500 is severe neutropenia and is associated with high risk for
infection.
Question: What is the priority nursing diagnosis for a client experiencing anemia?
Risk for injury related to poor blood clotting
Fatigue related to decreased cellular oxygenation
Risk of infection related to decreased leukocyte
Imbalanced nutrition: less than body requirements related to anorexia
Rationale: A low red blood cell (RBC) count decreases oxygen availability to the
tissues, and fatigue, shortness of breath, and weakness may be noted.
Question
A patient with thrombocytopenia due to chemotherapy develops a nose bleed
(epistaxis). What is the nurse’s expected response?
Apply ice to the anterior surface of the nose and place the patient in a
supine position
Apply pressure to the nares and position the patient in a high Fowler’s
position, leaning slightly forward
Squeeze the nares together firmly and position the patient in prone
position with mouth open
Ask the patient to blow the nose vigorously as the nurse applies firm
pressure to the nares
Rationale: Sitting upright decreases the risk of aspiration of blood and pressure is
applied for a minimum of five minutes. Ice may also be applied to the nares. The
patient’s mouth should be open so that blood can drain rather than be swallowed, which
may cause vomiting.
Question
The nurse recognizes which of the following as the most common hematological
condition associated with aging?
Thrombocytopenia
Leukopenia
Agranulocytosis
Anemia
Rationale: Anemia is the most common hematologic condition affecting elderly patients;
with each successive decade of life, the incidence of anemia increases. Anemia
frequently results from iron deficiency (in the case of blood loss) or from a nutritional
deficiency, particularly folate or vitamin B12 deficiency or protein–calorie malnutrition; it
may also result from inflammation or chronic disease.
NOT administer acetaminophen per prn order ... d/t masking manifestation
NOT administer aspirin per prn order ... d/t increased risk for bleeding
NOT admin non-pharm intervention, such as cool compress
Pt presents to HCP with complaint of a "cold that just wont go away". She has a CBC: WBCs
4500 (4.5), segs 5%, bands 0%, lymphs 45, eosinophils 5, basophils 5, monocytes 5, blasts 35.
What is the pt's ANC?ANC = WBC x (%segs + %bands)
1. The nurse is caring for a patient with a hematologic disorder. The patient asks the nurse
where the body forms blood cells. Where should the nurse tell the patient that blood
cells are formed?
A) In the spleen
B) In the kidneys
C) In the bone marrow
D) In the liver
2. An elderly adult trips over her dog and receives an injury to her skin that causes minor
blood loss. Primary hemostasis is activated in this patient. What occurs during primary
hemostasis?
A) Severed blood vessels constrict.
B) Thromboplastin is released.
C) Prothrombin is converted to thrombin.
D) Fibrin is lysed.
3. A patient has come to the Ob-Gyn clinic with complaints of a heavy menstrual flow.
The nurse knows that red blood cell production will be increased in the patient's body.
Because of this, the nurse is aware that the patient may need to increase her daily intake
of what?
A) Vitamin C
B) Vitamin D
C) Iron
D) Magnesium
4. A patient with renal failure has decreased erythropoietin production. Upon analysis of
the patient's complete blood count (CBC), the nurse will expect which of the following
CBC results?
A) An increased hemoglobin and hematocrit
B) A decreased hemoglobin and hematocrit
C) A decreased mean corpuscular volume (MCV) and mean corpuscular hemoglobin
(MCH)
D) An increased MCV and MCH
5. A patient has asked the nurse about the clotting cascade, and the nurse explains that
plasminogen is a component necessary in the clotting cascade. Where in the body is
plasminogen present?
A) Myocardial muscle tissue
B) All body fluids
C) Cerebral tissue
D) Renal cells
6. The nurse is caring for a patient whose bone marrow has been replaced by scar tissue in
much of the areas that produce blood cells for the body. What organs can become active
in blood cell production by the process of extramedullary hematopoiesis?
A) Spleen and kidneys
B) Kidneys and pancreas
C) Pancreas and liver
D) Liver and spleen
7. The nurse is working with a patient who has a hematological disorder. The nurse is
aware that, in the process of hematopoiesis, stem cells differentiate into either myeloid
or lymphoid stem cells. Into what broad cell types do myeloid stem cells differentiate?
Select all that apply.
A) Leukocytes
B) Mast cells
C) Thrombocytes
D) Platelets
E) Erythrocytes
8. A child has suffered a laceration in a playground accident. When a human body receives
an injury that causes blood loss, several processes are involved in maintaining
hemostasis. When a blood clot is no longer needed, what digests the fibrinogen and
fibrin?
A) Plasminogen
B) Thrombin
C) Prothrombin
D) Plasmin
9. The nurse is providing care for a patient with a diagnosis of cellulitis. What laboratory
value would the nurse assess most closely to gauge the patient's infection?
A) Creatinine levels
B) Hepatic function tests
C) Electrolyte levels
D) White blood cell (WBC) count
10. A patient with esophageal varices secondary to liver cirrhosis has received a transfusion
of frozen plasma. The nurse is aware of the fact that plasma:
A) Acts solely as a solvent for the cellular components of the blood
B) Accounts for the majority of the blood's volume in the body
C) Plays a regulatory role in the process of erythropoiesis
D) Primarily regulates the pH of blood and other body fluids
11. A patient's most recent blood work reveals an elevated level of reticulocytes. The nurse
recognizes that this assessment finding may be suggestive of:
A) An infectious process
B) A lack of oxygen-carrying capacity
C) Fluid volume deficit
D) Oxygen toxicity
12. A nurse is aware of the central role that erythropoietin plays in the initiation of
erythropoiesis. Which of the following individuals would be likely to require
administration of exogenous erythropoietin?
A) A woman who experienced a postpartum hemorrhage after spontaneous vaginal
delivery
B) A child who experienced severe blood loss during a motor vehicle accident
C) A woman who has been diagnosed with hepatic encephalopathy after a long history
of alcohol abuse
D) A man with a diagnosis of acute renal failure secondary to type 1 diabetes
13. A patient's most recent complete blood count (CBC) reveals that her mean corpuscular
volume (MCV) is well below reference ranges. The nurse should identify what potential
contributing factor for this phenomenon?
A) The woman has an iron deficiency.
B) The woman has been exposed to carbon monoxide at some point in the past.
C) The woman is experiencing nephrotoxicity.
D) The woman's oxygen demands are currently lower than normal.
14. A nurse is reviewing the admission blood work of an adult woman who presented with
complaints of progressive fatigue over the past several weeks. The woman's subsequent
blood work is indicative of iron-deficiency anemia. What assessment question by the
nurse most directly addresses the potential cause of the woman's iron deficiency?
A) “Would you say that you tend to eat a well-balanced diet?”
B) “Have you noticed lately that you are passing less urine or that your urine is quite
dilute?”
C) “Have you seen any blood when you have had a bowel movement in recent
weeks?”
D) “Have you had a bad cold or a case of the flu in the past few weeks?”
15. A 66-year-old man underwent a successful partial gastrectomy for the treatment of
stomach cancer 3 years ago. The man had a scheduled follow-up appointment with his
primary caregiver and had blood work completed. The results of the man's blood work
indicated anemia. The nurse who is contributing to the patient's care should recognize
that this patient's anemia may be attributable to what factor?
A) A recurrence of the man's cancer
B) Paralytic ileus
C) Infection
D) Decreased vitamin B12 absorption
16. A patient's health care provider has ordered blood work that included a white blood cell
(WBC) differential. The results of this blood test reveal a bandemia, in which the
patient's WBC count indicates a higher-than-normal proportion of band cells. What
should the nurse infer from this assessment finding?
A) The patient is currently fighting an infection.
B) The patient is deficient in folic acid and/or iron intake.
C) The patient's kidneys are under physiological duress.
D) The patient should be assessed for leukemia and Hodgkin's disease.
17. A patient with a diagnosis of HIV exhibits a decreased level of T lymphocytes. What
consequence does this state present for this patient?
A) The patient will be incapable of mounting a response to allergens.
B) The patient is particularly susceptible to infection.
C) The patient has diminished oxygen-carrying capacity.
D) The patient will be unable to maintain hemostasis.
18. A patient with a diagnosis of hepatitis C is being treated in the medical unit of the
hospital and has experienced a downward trend in albumin levels. In light of this
diagnostic finding, what assessments should the nurse prioritize?
A) Assessment of the patient's integumentary system and assessment for skin
breakdown on dependent surfaces
B) Assessment of the patient's fluid balance and assessment for third-spacing and
edema
C) Assessment of the patient's urine output, creatinine levels, and blood urea nitrogen
(BUN) levels
D) Assessment for signs and symptoms of metabolic acidosis and metabolic alkalosis
19. A nurse administered a subcutaneous injection to a patient and noted a small amount of
bleeding from the administration site. After a minute, the bleeding ceased, a process that
the nurse attributed to hemostasis. Which of the following physiological phenomena
occurred during secondary hemostasis?
A) The patient's blood vessels surrounding the injection site constricted.
B) Platelets aggregated at the site where the bleeding occurred.
C) The patient's plasma fibrinolytic system was activated.
D) The patient's clotting cascade resulted in the formation of fibrin.
20. An 82-year-old resident of a long-term care facility has had a scheduled appointment
with his primary care provider and had blood work drawn thereafter. The results of the
resident's blood work are suggestive of anemia. How should the nurse best interpret this
laboratory finding?
A) Mild to moderate anemia is considered a normal, age-related change.
B) The resident's anemia is likely the result of psychological stressors.
C) The specific etiology of the resident's anemia should be investigated.
D) The resident would benefit from a high-iron diet and folic acid supplements.
21. An older adult with a history of decreased self-care has been admitted to the geriatric
medical unit after being found in state of dehydration and malnutrition by paramedics.
The admission assessment of the patient included a complete blood count, which
revealed several hematological abnormalities, including a hematocrit of 61%. The nurse
should consequently assess the patient for signs and symptoms of:
A) Gastrointestinal bleeding or other internal hemorrhage
B) Spontaneous clotting and thromboembolism
C) Confusion and decreased level of consciousness
D) Activity intolerance
22. A 44-year-old man with a longstanding diagnosis of AIDS has been admitted to the
hospital with an absolute neutrophil count (ANC) of 385/mm3. When planning the
patient's care, what action should the nurse prioritize?
A) Placing the patient on protective isolation precautions
B) Obtaining the patient's blood type and cross-match in anticipation of transfusion
C) Providing the patient with supplementary oxygen by simple face mask
D) Padding hard surfaces on the patient's bed to reduce the risk of injury
24. A patient with a recent history of hematologic abnormalities has been scheduled for a
bone marrow biopsy. The patient has expressed to the nurse, “That sounds like an
incredibly painful experience.” How should the nurse best respond to this patient's
concern?
A) “Actually, you won't feel anything other than the initial shot where the doctor
injects anesthetic.”
B) “A bone marrow biopsy can be a painful experience, but know that it is only
ordered when absolutely necessary.”
C) “There is some pressure and pain when the doctor removes the marrow, but this
should only be short-lasting.”
D) “The doctor will inject some anesthetic into your bone a few hours ahead of time
reduce the pain associated with the procedure.”
25. The nurse is providing patient education in anticipation of the patient's scheduled boned
marrow aspiration and biopsy. When teaching the patient about care after the procedure,
the nurse should encourage the patient to do which of the following?
A) Take aspirin to alleviate pain.
B) Remain on bed rest for 24 to 36 hours after the procedure.
C) Avoid bathing until the site heals.
D) Avoid the use of oral analgesics.
Answer Key
1. C
2. A
3. C
4. B
5. B
6. D
7. A, D, E
8. D
9. D
10. B
11. B
12. D
13. A
14. C
15. D
16. A
17. B
18. B
19. D
20. C
21. B
22. A
23. A
24. C
25. C
Chapter 20 : Nursing Management: Patients With Hematologic Disorders
Anemia
A decrease in the number of red blood cells (RBCs)
Usually classified by morphology (shape of the RBCs):
Types of Anemia
Iron deficiency anemia
Anemia in renal disease
Anemia of chronic disease
Aplastic anemia
Megaloblastic anemias:
Caused by deficiencies of either vitamin B12 or folic acid
Thalassemia
Immune hemolytic anemia
Question
A patient’s recent fatigue has been attributed to hypo proliferative anemia. You are
aware that this health problem is a result of:
Inadequate RBC production
Active loss of RBCs
Damage to the circulating RBCs
Distortions in the shape of RBCs
Polycythemia
- Means “too many cells in the blood” (ex: erythrocytes)
Leukemia
Neoplastic proliferation of one particular hematopoietic cell type (granulocytes,
monocytes, lymphocytes, or infrequently erythrocytes or megakaryocytes)
The common feature of the leukemias is an unregulated proliferation of
leukocytes in the bone marrow
Classified according to the stem cell line involved, either lymphoid (relating to
lymphatic tissue) or myeloid (relating to bone marrow)
Also classified as either acute or chronic
Question
When providing care for a patient who has a diagnosis of AML, the nurse should
prioritize which of the following actions?
Early ambulation
Education about deep breathing and coughing
Vigilant hand washing
Integumentary assessment
Rationale: Patients with AML have a high risk of infection; this risk underlies an
increased need to maintain infection control measures. This supersedes the patient’s
need for early activity, deep breathing, or frequent skin assessment.
Lymphomas
Neoplasms of lymphoid tissue, usually derived from B lymphocytes
Hodgkin’s lymphoma
Non-Hodgkin’s lymphomas (NHLs)
Multiple Myeloma
A malignant disease of the most mature form of B lymphocyte, the plasma cell:
Results in production of high levels of ineffective immunoglobulins
Most common presenting symptom is bone pain
No cure, but treatment focuses on corticosteroids and chemotherapy
Thorough nursing care is essential
Bleeding Disorders
All result from a disruption in the normal process of hemostasis
Signs, symptoms, and treatment vary depending on the type of defect
Primary Thrombocythemia
A marked increase in platelet production, with the platelet count consistently
greater than 600,000/mm3
Thrombosis is common
Because these platelets can be dysfunctional, minor or major hemorrhage can
also occur
Nursing care prioritizes the risks of hemorrhage and thrombosis
A reactive increase in platelets results in secondary thrombocythemia
Thrombocytopenia
Low platelet level
Numerous causes including malignancy, infection, medications, and
disseminated intravascular coagulation
Management focuses on correction or treatment of the underlying cause
Question
When assessing a patient who has a diagnosis of thrombocytopenia, the nurse should
understand that the patient may present with what sign or symptom of the disease?
Petechiae
Cherry angiomas
Alopecia
Pruritus
Rationale: Petechiae are pinpoint red or purple hemorrhagic spots on the skin that can
result from low platelet levels. Alopecia (hair loss), pruritus (itching), and cherry
angiomas (benign red spots on the skin surface) are not associated with
thrombocytopenia.
Signs include bruising, heavy menses, and petechiae on the extremities or trunk
Rationale: Priority lab results for the patient with DIC are those related to coagulation,
such as PT, aPTT and D-dimer.
Therapies for Blood Disorders
Splenectomy
Therapeutic apheresis: Blood is taken from the patient and passed through a
centrifuge to remove a specific component
Therapeutic phlebotomy: Removal of a certain amount of blood under controlled
conditions
Blood Donation
Directed donation
Standard donation
Autologous donation
Blood Transfusion
• Nursing care focuses on pretransfusion assessment, correct technique, and
monitoring for complications of transfusion
Febrile nonhemolytic transfusion reaction (FNHTR)
Acute hemolytic reaction
Delayed hemolytic reaction
Allergic reaction
Circulatory overload
Bacterial contamination
Questions
A patient’s 18-year-old son would like to donate blood. The nurse educates him
regarding eligibility requirements for blood donation. Which of the following statements
demonstrates that he does not understand the education provided?
Rationale: Living with a friend who has HIV is not a contraindication to blood product
donation. Living in close contact or having sexual contact with someone with hepatitis is
a contraindication to donation.
Questions
The nurse is explaining the potential signs and symptoms of a transfusion reaction to a
patient who is receiving his first blood transfusion. The nurse explains that she will do
which of the following to ensure safe blood product administration? Select all that
apply.
Check ABO compatibility by comparing the blood product label to the
patient’s medical record.
Use two patient identifiers, such as the patient’s date of birth and name to
verify the blood product.
Administer the blood product slowly for the first 15 minutes.
Administer acetaminophen and diphenhydramine, which are standard
premedication’s used in all transfused patients.
There is no data to support widespread use of premedication’s. Premedication’s are
reserved for patients with a history of transfusion reactions or for patients being
transfused with an incompatible blood product (due to multiple antibodies and difficulty
cross-matching).
Questions
Mrs. Jones is being treated for sepsis. On the second day caring for her, she
experiences epistaxis and persistent bleeding from a venipuncture site. The nurse
suspects DIC. Which of the following lab results supports the nurse’s suspicion?
Questions
The nurse provides patient education related to the management of iron deficiency
anemia. Which of the following statements made by the patient signifies understanding
of the education provided?
Review Questions
The nurse is caring for a patient diagnosed with ALL receiving initial treatment. The
patient has been complaining of a dry cough. She also has diminished breath sounds
upon auscultation. Which of the following should the nurse monitor as priority with
regards to potential complications in this patient?
Hemoglobin
Absolute neutrophil count (ANC)
Hematocrit
Urine
• NCLEX-Style Review Questions
Rationale: During the initial treatment of acute leukemia, the ANC often drops below
100/mm3, placing the patient at very high risk for infection. Empiric antibiotics are used
to preemptively treat infection when the patient has a fever of 100.4°F or greater.
1. The nurse is caring for a patient with a diagnosis of hypoproliferative anemia. When
planning this patient's care, the nurse should be aware that this type of anemia is due to
what?
A) Lack of production of red blood cells (RBCs)
B) Loss of RBCs
C) Injury to the RBCs in circulation
D) Abnormality of RBCs
2. A 12-year-old girl on the oncology unit at children's hospital tells the nurse that she has
discovered that there are several different kinds of leukemia. The child asks the nurse to
explain what makes them all “leukemia.” What should the nurse reply?
A) The different leukemias all have unregulated proliferation of white blood cells.
B) The different leukemias all have unregulated proliferation of red blood cells.
C) The different leukemias all have decrease in production of white blood cells.
D) The different leukemias all have decrease in production of red blood cells.
3. The nurse is currently planning the care of a patient with multiple myeloma who is
experiencing bone destruction. When reviewing the patient's most recent blood work,
what value would the nurse pay particular attention to?
A) Hypercalcemia
B) Hyperproteinemia
C) Elevated serum viscosity
D) Elevated red blood cell (RBC) count
5. A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The
patient is not responding to conservative treatments, and her condition is now becoming
life-threatening. The nurse is aware that a treatment option in this case may include
what?
A) Hepatectomy
B) Vitamin K administration
C) Platelet transfusion
D) Splenectomy
6. The nurse caring for a patient receiving a transfusion notes that 15 minutes after the
infusion of packed red blood cells (PRBCs) has begun, the patient is having difficulty
breathing and is experiencing chest tightness. What is the most appropriate initial action
for the nurse to take?
A) Notify the patient's health care provider.
B) Stop the transfusion immediately.
C) Remove the patient's IV access.
D) Assess the patient's chest sounds and vital signs.
7. A male patient with advanced leukemia is responding poorly to treatment. The nurse
finds the patient tearful and trying to express his feelings, but he is clearly having
difficulty. What would be the nurse's best response?
A) Tell him that she'll leave for now but she'll be back in while.
B) Offer to call pastoral care.
C) Ask if he would like her to sit with him while he collects his thoughts.
D) Tell him that she can understand how he's feeling.
8. The nurse is providing education to a patient with iron deficiency anemia who has been
prescribed iron supplements. What statement should the nurse include in patient
education?
A) “Take the iron with dairy products to enhance your body's absorption of it.”
B) “You should increase your intake of vitamin E while you're taking iron.”
C) “Iron will likely cause your stools to darken in color.”
D) “Limit foods high in fiber due to the risk for diarrhea.”
9. A nurse is caring for a patient with acute myeloid leukemia (AML) who is preparing to
undergo induction therapy. In preparing a plan of care for this patient, the nurse should
assign the highest priority to which nursing diagnoses?
A) Activity intolerance
B) Risk for infection
C) Ineffective coping
D) Risk for spiritual distress
10. A patient with renal failure is experiencing decreased erythropoietin production. Upon
analysis of the patient's complete blood count (CBC), the nurse will expect which of the
following results?
A) An increased hemoglobin and hematocrit
B) A decreased hemoglobin and hematocrit
C) A decreased mean corpuscular volume (MCV) and mean corpuscular hemoglobin
concentration (MCHC)
D) An increased MCV and MCHC
11. A 50-year-old woman recently sought care from her primary care provider and was
diagnosed with hypoproliferative anemia following a diagnostic workup. The nurse at
the clinic has been charged with the responsibility for organizing the woman's care and
is consequently creating a nursing care plan. When planning this woman's care, what
nursing diagnosis should the nurse prioritize?
A) Decreased cardiac output
B) Risk for fatigue
C) Acute pain
D) Risk for hypothermia
12. A patient with megaloblastic anemia is being treated in an inpatient setting and has daily
blood work ordered. This morning's blood work has become available, and the patient's
hemoglobin and hematocrit are continuing to trend downward. The nurse has contacted
the patient's health care provider to determine whether the health care provider wants to
order a transfusion of packed red blood cells (PRBCs). When considering the efficacy of
this treatment the nurse should understand that:
A) A transfusion of PRBCs may have the potential to create fluid volume overload
and pulmonary edema.
B) The patient's body is likely to destroy the transfused red cells soon after they are
transfused.
C) The patient is deficient in oxygen-carrying capacity more than in the absolute
number of RBCs.
D) The patient will require multiple transfusions over several days to achieve an
increase in Hgb and Hct.
13. A 63-year-old woman has been diagnosed with polycythemia vera (PV) after
undergoing a series of diagnostic tests. When the woman's nurse is providing health
education, what subject should the nurse prioritize?
A) Maintenance of long-term vascular access device
B) Nutritional modifications necessary for maintaining a low-iron diet
C) Strategies for managing activity
D) Lifestyle modifications and techniques for preventing thromboembolism
14. An otherwise healthy 33-year-old woman experienced debilitating and persistent fatigue
over a period of several weeks and was subsequently diagnosed with acute myeloid
leukemia (AML). The woman has been admitted to the hospital for treatment. The nurse
who is providing care for this patient should prioritize which of the following
assessments?
A) Assessing the woman for thrombosis and embolism
B) Assessing the woman for signs and symptoms of infection
C) Assessing the woman's heart rate, rhythm, and circulation
D) Assessing the woman for signs and symptoms of fluid volume overload
15. A 20-year-old man has been admitted to the emergency department with a femoral
fracture as a result of a motorcycle accident. When the nurse is taking the patient's
history, he states, “I had leukemia when I was little kid but they managed to cure it.”
The nurse should suspect that this patient likely had what type of leukemia?
A) Acute lymphoid leukemia (ALL)
B) Chronic lymphoid leukemia (CLL)
C) Acute myeloid leukemia (AML)
D) Chronic myeloid leukemia (CML)
16. A 70-year-old man attended a scheduled check-up with his primary care provider,
during which he exhibited lymphadenopathy and splenomegaly. The man's primary care
provider has ordered blood work to assess the man for chronic lymphocytic leukemia
(CLL). The nurse at the clinic would recognize that a diagnosis of CLL would be most
consistent with what laboratory finding?
A) Increased hemoglobin and hematocrit
B) Increased lymphocytes
C) Decreased platelets
D) Decreased leukocytes
17. The nurse has completed a plan of care for a patient who has been hospitalized for the
treatment of acute leukemia. When planning this patient's care, the nurse has specified
that assessments be performed more often than is the unit norm. Frequent, thorough
assessments are indicated in the treatment of patients with acute leukemia because:
A) Changes in condition must be identified early because treatment options do not
normally exist.
B) Patients with leukemia are often unable to accurately describe their symptoms.
C) Leukemia has characteristics of chronic diseases as well as acute illnesses.
D) Patients with leukemia often experience clinical changes that may be subtle and
nonspecific.
18. A 50-year-old woman was recently diagnosed with non-Hodgkin's lymphoma (NHL)
and has begun a treatment regimen that includes simultaneous radiation therapy and
chemotherapy. The combination of severe symptoms and aggressive therapy has
necessitated admission to the hospital. When providing care for this patient, which of
the following actions should the nurse implement?
A) Encouraging frequent mobilization and independence in activities of daily living
B) Applying standard precautions conscientiously to reduce the patient's risk of
infection
C) Providing meticulous skin care and turning the patient at least once every 2 hours
D) Monitoring the patient's bowel pattern and facilitating a high-fiber diet
19. The nurse is providing palliative care for a 69-year-old patient who has a diagnosis of
multiple myeloma. The patient states that she enjoyed good health for most of her life
and rarely had to visit her family health care provider until she experienced the first
signs and symptoms of her current illness. Which of the following complaints most
likely prompted the patient to initially seek care?
A) Lymphadenopathy
B) Bone pain
C) Recurrent infections
D) Fatigue and activity intolerance
20. A woman's routine complete blood count (CBC) revealed a highly elevated platelet
level, and subsequent diagnostic testing has resulted in a diagnosis of primary
thrombocythemia. The nurse has begun the relevant health education with the patient.
What should the nurse teach this woman about her health problem?
A) “Primary thrombocythemia creates potential problems at both ends of the clotting
spectrum: inappropriate clotting or inappropriate bleeding.”
B) “Your doctor will likely order a series of blood transfusions for you over the next
several months.”
C) “It's very important that you try to adopt a diet that's high in organ meats and leafy
green vegetables.”
D) “Primary thrombocythemia makes you quite vulnerable to hemorrhage, so you'll
need regular injections of some important clotting factors.”
21. A patient with a diagnosis of immune thrombocytopenic purpura (ITP) is currently
receiving IVIG for the treatment of her health condition. The nurse who is
providing this patient's care is aware that ITP is a consequence of:
A) Inappropriate platelet aggregation on the walls of the great vessels
B) Impaired liver function and the sequestering of platelets by hepatocytes
C) Hemolysis of platelets in individuals who lack immunity to the Epstein-Barr virus
D) Platelet destruction and impaired platelet production resulting from an autoimmune
process
22. A 71-year-old woman with a history of rheumatoid arthritis and chronic heart failure has
been admitted to the hospital for the treatment of a suspected upper gastrointestinal
bleed. When performing an assessment of this patient, which of the following questions
most directly addresses a likely cause of the woman's bleeding disorder?
A) “How closely do you tend to monitor your blood pressure when you're at home?”
B) “Has your doctor prescribed a water pill for your heart failure?”
C) “Do you ever take aspirin to treat the pain of your arthritis?”
D) “Did either of your parents or siblings have problems with bleeding?”
23. An elderly patient has been admitted to the emergency department (ED) after
accidentally overdosing on warfarin, and the patient's initial blood work reveals a
dangerously high international normalized ratio (INR). The ED nurse should anticipate
the need to administer:
A) Calcium gluconate
B) Fresh frozen plasma
C) Low-molecular weight heparin
D) Vitamin K
24. A nurse in the intensive care unit is caring for a patient who is being treated for
urosepsis. Over the past several hours, the patient's condition has deteriorated, and the
care team believes that the patient is experiencing disseminated intravascular
coagulation (DIC). What assessment should the nurse prioritize in the immediate care of
this patient?
A) Close observation for signs of internal or external hemorrhage
B) Monitoring the patient for signs of fluid overload due to polycythemia
C) Assessment of the patient's arterial blood gases (ABGs)
D) Assessing the patient's passive range of motion to gauge thrombus formation
25. The nurse has been monitoring a patient's vital signs closely after initiating a transfusion
of packed red blood cells (PRBCs). The nurse has observed that the patient's
temperature is trending upward, and the patient is complaining of chills. The nurse has
stopped the transfusion and informed the patient's health care provider, who believes
that the patient is experiencing a febrile nonhemolytic transfusion reaction (FNHTR).
What course of action should the nurse anticipate?
A) Administering a bolus of normal saline
B) Monitoring the patient closely and administering antipyretics
C) Initiating apheresis and administering IV antihistamines
D) Performing a stat cross-match and beginning a transfusion of the correct blood type
Answer Key
1. A
2. A
3. A
4. B
5. D
6. B
7. C
8. C
9. B
10. B
11. B
12. A
13. D
14. B
15. A
16. B
17. D
18. B
19. B
20. A
21. D
22. C
23. D
24. A
25. B