Hematologic Disorders

Chapter 32: Hematologic Disorders
MULTIPLE CHOICE
1. The nurse assesses the abnormal blood value for a young woman as:
1. platelets, 200,000//mm.
2. hemoglobin, 14 g/dL.
3. red blood cells, 2,000,000/mm.
4. iron, 68 g/dL.
ANS: 3
The RBCs are low. The normal value for RBCs is 4,500,000/mm. 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 explains that a normal hematocrit value is approximately:
1. three times the hemoglobin value.
2. the same as the 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
REF: 571
OBJ: 3
TOP: Normal Laboratory Values
3. The nurse calls to the attention of the charge nurse the PT/INR of a patient on Coumadin.
The value that needs attention is:
1. control, 35; patient, 41; INR, 1.5.
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:
OBJ:
KEY:
MSC:
1
DIF: Cognitive Level: Comprehension
3
TOP: Laboratory Values
Nursing Process Step: Implementation
NCLEX: Physiological Integrity
REF: 578
4. The nurse caring for a patient receiving a transfusion assesses that the 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 patients head.
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:
OBJ:
KEY:
MSC:
1
DIF: Cognitive Level: Application
4
TOP: Blood Transfusion Reactions
REF: 581
5. The patient receiving Epogen asks how soon there will be an increase in his red blood cell
count. The nurses 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
6. The nurse explains that sickle cell crisis occurs when the 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
OBJ: 5
TOP: Sickle Cell Anemia
7. The information that the nurse recognizes as pertinent patient 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:
OBJ:
KEY:
MSC:
1
5
TOP: Sickle Cell Anemia
Nursing Process Step: Planning
NCLEX: Health Promotion and Maintenance
REF: 586
8. In preparing discharge plans for a patient recently diagnosed with 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:
OBJ:
KEY:
MSC:
1
6
TOP: Pernicious Anemia
Nursing Process Step: Planning
REF: 583
9. The rationale for administering injections of vitamin B12 to patients with pernicious anemia
is that:
1. the patients 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 patients 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.
PTS:
OBJ:
KEY:
MSC:
1
DIF: Cognitive Level: Analysis
5
TOP: Pernicious Anemia
Nursing Process Step: Evaluation
REF: 583
10. The foods that the nurse would include in a nutrition teaching plan for 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:
OBJ:
KEY:
MSC:
1
6
TOP: Iron-Deficiency Anemia
REF: 583
11. Based on the nursing assessment, an appropriate nursing diagnosis for a 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.
ANS: 1
Patients with hemophilia have severe pain due to bleeding into the joints.
PTS:
OBJ:
KEY:
MSC:
1
4
TOP: Hemophilia
Nursing Process Step: Nursing Diagnosis
REF: 587
12. A child 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:
OBJ:
KEY:
MSC:
1
3
TOP: Hydroxyurea
REF: 584
13. A newborn infant has developed marked jaundice and has a positive Coombs test 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 the newborn.
PTS: 1
OBJ: 5
TOP: Hemolytic 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. 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
REF: 583-584
OBJ: 5
TOP: Anemia
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
15. When the patient with a platelet count of 20,000/mm3 receives 1 unit of 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
REF: 580
OBJ: 3
TOP: Platelet Transfusion
16. When the nurse prepares to give ferrous sulfate (Feosol) to a home health 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.
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 a straw to prevent staining of the
teeth.
PTS:
OBJ:
KEY:
MSC:
1
6
TOP: Administration of Feosol
REF: 582, Box 32-1
17. A 35-year-old man is seen in an urgent care clinic. He presents with 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:
OBJ:
KEY:
MSC:
1
5
TOP: Polycythemia Vera
Nursing Process Step: Assessment
REF: 582
18. A 52-year-old man has a diagnosis of aplastic anemia. The information that the nurse
recognizes as being pertinent to this diagnosis is that the man:
1. has a long family history of cancer.
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
REF: 582-583
OBJ: 5
TOP: Aplastic Anemia
19. A nurse is completing an initial assessment on a new patient being seen in 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
REF: 573
OBJ: 2
TOP: Assessment of Patients with Hematologic Disorders
20. At the end of a shift, a nurse documents the effectiveness of 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 isnt 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
REF: 587
OBJ: 5
TOP: Hemophilia KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
21. When assessing the patient with thrombocytopenia, the nurse 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
REF: 587
OBJ: 5
TOP: Thrombocytopenia
22. The nurse uses a common nursing diagnosis for patients with 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:
OBJ:
KEY:
MSC:
1
6
TOP: Hematologic Nursing Diagnosis
Nursing Process Step: Nursing Diagnosis
REF: 573
23. The nurse assessing a patient 20 minutes after a bone marrow biopsy is 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.
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:
OBJ:
KEY:
MSC:
1
3
TOP: Diagnostic Tests
REF: 577, Table 32-1
24. The nurse caring for a patient with crushing injuries from an 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 bodys 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
REF: 587
OBJ: 4
TOP: DIC
KEY: Nursing Process Step: Assessment
25. At 10:00 AM, the nurse receives 2 units of blood for a patient to be transfused. The nurse
should:
1. set up 1 unit for the infusion 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:
OBJ:
KEY:
MSC:
1
1
TOP: Transfusion Protocol
NCLEX: Safe, Effective Care Environment
REF: 580, Box 32-5
MULTIPLE RESPONSE
1. The nurse notes the past medical history information that is significant to potential 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 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.
PTS:
OBJ:
KEY:
MSC:
1
2
TOP: Factors Predisposing to Bleeding Tendency
Nursing Process Step: Assessment
2. The nurse giving iron dextran IM will use the Z-track method because this 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, the needle is cleaned on
withdrawal. Injections are never given at recent injection sites.
PTS:
OBJ:
KEY:
MSC:
1
6
TOP: Z-Track Method
3. The nurse explains that the major difference between fresh frozen plasma (FFP) and
cryoprecipitate (CPP) is that FFP (select all that apply):
1. contains more albumin.
2. has a longer infusion time.
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
OBJ: 5

TOP: FFP versus CPP
KEY: Nursing Process Step: Implementation

OTHER
1. The nurse plans the interventions to prepare a patient for a bone marrow 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 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.
PTS:
OBJ:
KEY:
MSC:
1
3
TOP: Bone Marrow Aspiration Preparation
NCLEX: Safe, Effective Care Environment

Hematologic Disorders

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Hematologic Disorders

Uploaded by

Copyright:

Available Formats

Chapter 32: Hematologic Disorders

2. notify the charge nurse.

4. rest 10 to 12 hours each day.

REF: 582, Box 32-1

REF: 577, Table 32-1

REF: 580, Box 32-5

REF: 582, Table 32-1

DIF: Cognitive Level: Comprehension

REF: 579, Table 32-1

KEY: Nursing Process Step: Implementation

You might also like