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Hematologic Disorders examination
A patient with a hematologic disorder asks the nurse how the body forms blood cells. The nurse should describe a process that takes place where? - Correct answer In the bone marrow A man suffers a leg wound which causes minor blood loss. As a result of bleeding, the process of primary hemostasis is activated. What occurs in primary hemostasis? - Correct answer Severed blood vessels constrict A patient has come to the OB/GYN clinic due to recent heavy menstrual flow. Because of the patients consequent increase in RBC production, the nurse knows that the patient may need to increase her daily intake of what substance? - Correct answer Iron The nurse is planning the care of a patient with a nutritional deficit and a diagnosis of megaloblastic anemia. The nurse should recognize that this patients health problem is due to what? - Correct answer Abnormalities in the structure and function RBCs A nurse is caring for a patient who undergoing preliminary testing for a hematologic disorder. What sign or symptom most likely suggests a potential hematologic disorder? - Correct answer Severe fatigue
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 complains of severe chest tightness. What is the most appropriate initial action for the nurse to take - Correct answer Stop the transfusion immediately The nurse is describing the role of plasminogen in the clotting cascade. Where in the body is plasminogen present? - Correct answer all body fluids The nurse is caring for a patient who has developed scar tissue in many of the areas that normally produce blood cells. What organs can become active in blood cell production by the process of extramedullary hematopoiesis? - Correct answer liver and spleen Through the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what do myeloid stem cells further differentiate? Select all that apply - Correct answer Leukocytes Platelets Erythrocytes A patients wound has begun to heal and the blood clot which formed is no longer necessary. When a blood clot is no longer needed, the fibrinogen and fibrin will be digested by which of the following? - Correct answer Plasmin A patient undergoing a hip replacement has autologous blood on standby if a transfusion is needed. What is the primary advantage of autologous transfusions? - Correct answer Prevention of viral infections from another persons blood
A nurse is educating a patient about the role of B lymphocytes. The nurses description will include which of the following physiologic processes? - Correct answer antibody production A patients most recent blood work reveals low levels of albumin. This assessment finding should suggest the possibility of what nursing diagnosis? - Correct answer A) Risk for imbalanced fluid volume related to low albumin An individual has accidentally cut his hand, immediately initiating the process of hemostasis. Following vasoconstriction, what event in the process of hemostasis will take place? - Correct answer Platelets will aggregate at the injury site The nurse is providing care for an older adult who has a hematologic disorder. What age-related change in hematologic function should the nurse integrate into care planning - Correct answer Older adults are less able to increase blood cell production when demand suddenly increase A clients health history reveals daily consumption of two to three bottles of wine. The nurse should plan assessments and interventions in light of the patients increased risk for what hematologic disorder? - Correct answer Anemia A patients diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin (Coumadin), an anticoagulant. When assessing the therapeutic response to this medication, what is the nurses most appropriate action? - Correct answer Review the patients international normalized ratio (INR).
A patient has been scheduled for a bone marrow biopsy and admits to the nurse that she is worried about the pain involved with the procedure. What patient education is most accurate? - Correct answer Most people feel some brief, sharp pain when the needle enters the bone A patient is scheduled for a splenectomy. During discharge education, what teaching point should the nurse prioritize? - Correct answer The need to report any signs or symptoms of infection promptly The nurses brief review of a patients electronic health record indicates that the patient regularly undergoes therapeutic phlebotomy. Which of the following rationales for this procedure is most plausible? - Correct answer The patient may chronically produce excess red blood cells. A nurse has participated in organizing a blood donation drive at a local community center. Which of the following individuals would most likely be disallowed from donating blood? - Correct answer A woman whose blood pressure is 88/51 mm Hg A nurse at a blood donation clinic has completed the collection of blood from a woman. The woman states that she feels lightheaded and she appears visibly pale. What is the nurses most appropriate action? - Correct answer Help her into a sitting position with her head lowered below her knees A patients low hemoglobin level has necessitated transfusion of PRBCs. Prior to administration, what action should the nurse perform? - Correct answer Assess the patients vital signs to establish baselines
action? - Correct answer Slow the infusion rate and monitor the patient closely A patient lives with a diagnosis of sickle cell anemia and receives frequent blood transfusions. The nurse should recognize the patients consequent risk of what complication of treatment - Correct answer iron overload A patient is receiving the first of two ordered units of PRBCs. Shortly after the initiation of the transfusion, the patient complains of chills and experiences a sharp increase in temperature. What is the nurses priority action? - Correct answer Discontinue the transfusion. Fresh-frozen plasma (FFP) has been ordered for a hospital patient. Prior to administration of this blood product, the nurse should prioritize what patient education? - Correct answer Signs and symptoms of a transfusion reaction The nurse is preparing to administer a unit of platelets to an adult patient. When administering this blood product, which of the following actions should the nurse perform - Correct answer Administer the platelets as rapidly as the patient can tolerate Which of the following circumstances would most clearly warrant autologous blood donation? - Correct answer The patient has elective surgery pending A patients electronic health record states that the patient receives regular transfusions of factor IX. The nurse would be justified in suspecting that this patient has what diagnosis? - Correct answer hemophilia
A nurse is caring for a patient who has sickle cell anemia and the nurses assessment reveals the possibility of substance abuse. What is the nurses most appropriate action? - Correct answer Encourage the patient to seek care from a single provider for pain relief A patient newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the patient asks the nurse to explain the disease. What should the nurse explain to this patient? - Correct answer There could be decreased production of platelets. A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and his condition is now becoming life threatening. The nurse is aware that a treatment option in this case may include what? - Correct answer splenectomy A nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education - Correct answer Iron will cause the stools to darken in color The nurse is assessing a new patient with complaints of overwhelming fatigue and a sore tongue that is visibly smooth and beefy red. This patient is demonstrating signs and symptoms associated with what form of what hematologic disorder? - Correct answer megaloblastic anemia A patient with renal failure has decreased erythropoietin production. Upon analysis of the patients
A nurse is admitting a patient with immune thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function? Select all that apply - Correct answer Sulfa-containing medications Aspirin-based drugs NSAIDs A patient, 25 years of age, comes to the emergency department complaining of excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged PT but a vitamin K deficiency is ruled out. When assessing the patient, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the patients signs and symptoms - Correct answer hepatic dysfunction A patient with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to order for this patient? - Correct answer packed RBCs (PRBCs) The nurse on the pediatric unit is caring for a 10-year-old boy with a diagnosis of hemophilia. The nurse knows that a priority nursing diagnosis for a patient with hemophilia is what? - Correct answer ineffective coping A group of nurses are learning about the high incidence and prevalence of anemia among different populations. Which of the following individuals is most likely to have anemia - Correct answer An 81-year-old woman who has chronic heart failure
An adult patient has been diagnosed with iron-deficiency anemia. What nursing diagnosis is most likely to apply to this patients health status - Correct answer Fatigue related to decreased oxygen-carrying capacity A patient has been living with a diagnosis of anemia for several years and has experienced recent declines in her hemoglobin levels despite active treatment. What assessment finding would signal complications of anemia? - Correct answer Ascites and peripheral edema A woman who is in her third trimester of pregnancy has been experiencing an exacerbation of iron- deficiency anemia in recent weeks. When providing the patient with nutritional guidelines and meal suggestions, what foods would be most likely to increase the womans iron stores - Correct answer Beef liver accompanied by orange juice A patient with poorly controlled diabetes has developed end-stage renal failure and consequent anemia. When reviewing this patients treatment plan, the nurse should anticipate the use of what drug? - Correct answer Epoetin alfa A nurse is planning the care of a patient with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. What nursing diagnosis should the nurse prioritize in the patients plan of care? - Correct answer Ineffective tissue perfusion related to thrombosis A patient is being treated on the medical unit for a sickle cell crisis. The nurses most recent assessment
A nurse is providing discharge education to a patient who has recently been diagnosed with a bleeding disorder. What topic should the nurse prioritize when teaching this patient? - Correct answer Avoiding activities that carry a risk for injury A nurse is a long-term care facility is admitting a new resident who has a bleeding disorder. When planning this residents care, the nurse should include which of the following? - Correct answer Implementing of a plan for fall prevention The results of a patients most recent blood work and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This patient should undergo testing for which of the following potential causes? Select all that apply. - Correct answer Hepatitis HIV A patient with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, I have low platelets, so why not give me a transfusion of exactly what Im missing? How should the nurse best respond? - Correct answer Transfused platelets usually arent beneficial because theyre rapidly destroyed in the body A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the patients previous medication regimen may have contributed to the development of this disorder? - Correct answer aspirin A young man with a diagnosis of hemophilia A has been brought to emergency department after
suffering a workplace accident resulting in bleeding. Rapid assessment has revealed the source of the patients bleeding and established that his vital signs are stable. What should be the nurses next action? - Correct answer Prepare for the administration of factor VIII A nurse is planning the care of a patient who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurses choice of interventions? - Correct answer NSAIDs are contraindicated due to the risk for bleeding A night nurse is reviewing the next days medication administration record (MAR) of a patient who has hemophilia. The nurse notes that the MAR specifies both oral and subcutaneous options for the administration of a PRN antiemetic. What is the nurses best action? - Correct answer Contact the prescriber to have the subcutaneous option discontinued A patient with Von Willebrand disease (vWD) has experienced recent changes in bowel function that suggest the need for a screening colonoscopy. What intervention should be performed in anticipation of this procedure? - Correct answer The patient should be given necessary clotting factors before the procedure A patients low prothrombin time (PT) was attributed to a vitamin K deficiency and the patients PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize - Correct answer The need for adequate nutrition
addresses the most common cause of death among patients with leukemia? - Correct answer Monitoring for infection An oncology nurse is caring for a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patients most recent blood tests, the nurse should anticipate what imbalance? - Correct answer hypercalcemia A nurse is planning the care of a patient who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the patients care plan, the nurse has identified a diagnosis of Risk for Injury. What pathophysiologic effect of multiple myeloma most contributes to this risk - Correct answer Decreased bone density A 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 is the nurses most appropriate action? - Correct answer Ask if he would like you to sit with him while he collects his thoughts. A nursing student is caring for a patient with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnoses? - Correct answer risk for infection A 77-year-old male is admitted to a unit with a suspected diagnosis of acute myeloid leukemia (AML). When planning this patients care, the nurse should be aware of what epidemiologic fact? - Correct answer Five-year survival for patients over 75 years old is less than 2%
A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what? - Correct answer ALL A patient with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the patient? - Correct answer Chew with care to avoid inadvertently biting the tongue A patient diagnosed with acute myelogenous leukemia has just been admitted to the oncology unit. When writing this patients care plan, what potential complication should the nurse address? - Correct answer hemorrhage An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem? - Correct answer multiple myeloma A home health nurse is caring for a patient with multiple myeloma. Which of the following interventions should the nurse prioritize when addressing the patients severe bone pain - Correct answer Helping the patient manage the opioid analgesic regime A nurse is caring for a patient with Hodgkin lymphoma at the oncology clinic. The nurse should be
the oncology unit. What nursing action should be prioritized in the patients care plan? - Correct answer Protective isolation and vigilant use of standard precautions A nurse is caring for a patient who has been diagnosed with leukemia. The nurses most recent assessment reveals the presence of ecchymoseson the patients sacral area and petechiae in her forearms. In addition to informing the patients primary care provider, the nurse should perform what action - Correct answer Check the patients most recent platelet level A 60-year-old patient with chronic myeloid leukemia will be treated in the home setting and the nurse is preparing appropriate health education. What topic should the nurse emphasize - Correct answer The importance of adhering to the prescribed drug regimen An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL?
- Correct answer increased lymphocyte levels A patient has been found to have an indolent neoplasm. The nurse should recognize what implication of this condition? - Correct answer The patient faces a significant risk of malignancy A nurse is caring for a patient who is being treated for leukemia in the hospital. The patient was able to maintain her nutritional status for the first few weeks following her diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement
what intervention? - Correct answer Provide the patient with several small, soft-textured meals each day A patient who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this patients needs for physical activity - Correct answer Assist the patient to a chair during awake times, as tolerated An oncology nurse recognizes a patients risk for fluid imbalance while the patient is undergoing treatment for leukemia. What relevant assessments should the nurse include in the patients plan of care? Select all that apply - Correct answer Monitoring the patients electrolyte levels Measuring the patients weight on a daily basis Measuring and recording the patients intake and output Auscultating the patients lungs frequently After receiving a diagnosis of acute lymphocytic leukemia, a patient is visibly distraught, stating, I have no idea where to go from here. How should the nurse prepare to meet this patients psychosocial need - Correct answer Assess the patients specific needs for education and support A patient has completed the full course of treatment for acute lymphocytic leukemia and has failed to respond appreciably. When preparing for the patients subsequent care, the nurse should perform what action? - Correct answer Identify the patients specific wishes around end-of-life care Following an extensive diagnostic workup, an older adult patient has been diagnosed with a secondary
