81 Hematology

Exams For Nursing NCLEX Nursing Exams - Hematologic Disorders

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MULTIPLE CHOICE

1. The nurse assesses the abnormal blood value for a young woman as:1. platelets, 200,000//mm³.2. hemoglobin, 14 g/dL.3. red blood cells, 2,000,000/mm³.4. iron, 68 µg/dL.

ANS: 3The RBCs are low. The normal value for RBCs is 4,500,000/mm³. The values for the otherblood components are normal.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 571OBJ: 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: 1Hematocrit is approximately three times the hemoglobin value.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 571

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OBJ: 3 TOP: Normal Laboratory Values KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. The nurse calls to the attention of the charge nurse the PT/INR of a patient onCoumadin. The value that needs attention is:1. control, 35; patient, 41; INR, 1.5.2. control, 35; patient, 52; INR, 1.8.3. control, 35; patient, 70; INR, 2.0.4. control, 35; patient, 85; INR, 2.5.

ANS: 3The therapeutic range of the PT/INR is 1.5 to 2 times the control with an INR of 1.5 to 2.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 578OBJ: 3 TOP: Laboratory Values KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

4. The nurse caring for a patient receiving a transfusion assesses that the patient iswheezing and is complaining of back pain. After the nurse stops the transfusion, thenurse should:1. discontinue the IV.2. notify the charge nurse.3. administer heparin.4. raise the patient’s head.

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ANS: 2The charge nurse should be notified immediately after the transfusion is stopped. The chargenurse will notify the physician and the lab or blood bank. The head of the bed should be raisedto aid in respiration and O2 should be administered in high doses. The blood tubing and the bagshould not be discarded because the blood bank will want it to check the accuracy of the typing.

PTS: 1 DIF: Cognitive Level: Application REF: 581OBJ: 4 TOP: Blood Transfusion Reactions KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

5. The patient receiving Epogen asks how soon there will be an increase in his red bloodcell count. The nurse’s best reply is that the initial increase in red cells should be seenin:1. 2 days.2. 1 weeks.3. 10 days.4. 2 weeks.

ANS: 3Epoetin alfa (Epogen) stimulates the bone marrow to produce more red blood cells in about 2days.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 581OBJ: 6 TOP: Colony-Stimulating Medication KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

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6. The nurse explains that sickle cell crisis occurs when the sickle-shaped red bloodcells:1. rupture.2. produce hemoglobin S.3. interfere with blood production.4. obstruct major arteries.

ANS: 4Circulatory obstruction causes severe pain in sickle cell anemia, which is the major symptom insickle cell crisis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 584OBJ: 5 TOP: Sickle Cell Anemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

7. The information that the nurse recognizes as pertinent patient self-care for a patientwith 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: 3It is important for the patient to consume adequate fluids daily to keep the circulating volumeadequate. This hydration is beneficial in preventing sickle cell crisis.

PTS: 1 DIF: Cognitive Level: Application REF: 586OBJ: 5 TOP: Sickle Cell Anemia KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

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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: 4Fatigue and weakness are seen in all anemias.

PTS: 1 DIF: Cognitive Level: Application REF: 583OBJ: 6 TOP: Pernicious Anemia KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

9. The rationale for administering injections of vitamin B12 to patients with perniciousanemia is that:1. the patient’s 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 patient’s body.4. vitamin B12 is a mineral necessary to aid in the formation of strong bones.

ANS: 2The patient with pernicious anemia lacks intrinsic factor, found in the stomach, which isessential for vitamin B12 absorption.

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PTS: 1 DIF: Cognitive Level: Analysis REF: 583OBJ: 5 TOP: Pernicious Anemia KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

10. The foods that the nurse would include in a nutrition teaching plan for aniron-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: 1Iron-rich foods include beans, dried fruit, liver, red meat, fish, and whole-grain breads.

PTS: 1 DIF: Cognitive Level: Application REF: 583OBJ: 6 TOP: Iron-Deficiency Anemia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

11. Based on the nursing assessment, an appropriate nursing diagnosis for a patientwith 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.

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ANS: 1Patients with hemophilia have severe pain due to bleeding into the joints.

PTS: 1 DIF: Cognitive Level: Analysis REF: 587OBJ: 4 TOP: Hemophilia KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Physiological Integrity

12. A child with sickle cell anemia is placed on the drug hydroxyurea. The nurseexplains that this drug will:1. increase energy.2. decrease cardiomegaly.3. clean out obstructed vessels.4. produce a hemoglobin that resists sickling.

ANS: 4Hydroxyurea produces a hemoglobin that resists sickling.

PTS: 1 DIF: Cognitive Level: Analysis REF: 584OBJ: 3 TOP: Hydroxyurea KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

13. A newborn infant has developed marked jaundice and has a positive Coombs’ test

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result from high levels of bilirubin. The nurse has assessed the symptoms as beingindicative of:1. aplastic anemia.2. hemophilia.3. hemolytic anemia.4. sickle cell anemia.

ANS: 3Newborns can develop hemolytic anemias resulting from blood incompatibility to their mother.These are typical signs of hemolytic anemia in the newborn.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 583OBJ: 5 TOP: Hemolytic Anemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

14. A 3-year-old African-American child is diagnosed with sickle cell anemia. Theparents know that sickle cell anemia is hereditary but do not understand why their childhas 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: 4Sickle cell anemia is a genetic disease carried by the recessive genes of both parents, who willnot have any symptoms of the disease at all.

PTS: 1 DIF: Cognitive Level: Analysis REF: 583-584OBJ: 5 TOP: Anemia KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance

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15. When the patient with a platelet count of 20,000/mm3 receives 1 unit of platelets, theplatelet 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: 1Platelet transfusions are given when the platelet count falls below 20,000/mm3. One unit isexpected to raise the count by 5000 to 10,000/mm3.

PTS: 1 DIF: Cognitive Level: Application REF: 580OBJ: 3 TOP: Platelet Transfusion KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

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: 4Patients should avoid taking iron with milk or caffeine because it inhibits drug absorption. Thedrug is offered with food in a diluted form through a straw to prevent staining of the teeth.

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PTS: 1 DIF: Cognitive Level: Application REF: 582, Box 32-1OBJ: 6 TOP: Administration of Feosol KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

17. A 35-year-old man is seen in an urgent care clinic. He presents with symptoms ofpolycythemia vera. The laboratory value that would confirm the possible diagnosis is anextremely:1. high hemoglobin level.2. low white cell count.3. low platelet count.4. high iron level.

ANS: 1The symptoms of polycythemia vera are extremely high hemoglobin and hematocrit levels dueto the excessive production of red blood cells. These persons have 1 pint of blood taken fromthem until the blood values become more normal. The blood is collected as for a blood donationbut cannot be used for transfusion purposes.

PTS: 1 DIF: Cognitive Level: Analysis REF: 582OBJ: 5 TOP: Polycythemia Vera KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

18. A 52-year-old man has a diagnosis of aplastic anemia. The information that the nurserecognizes as being pertinent to this diagnosis is that the man:1. has a long family history of cancer.

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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: 3Exposure to toxic chemicals can cause aplastic anemia.

PTS: 1 DIF: Cognitive Level: Analysis REF: 582-583OBJ: 5 TOP: Aplastic Anemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

19. A nurse is completing an initial assessment on a new patient being seen in thehospital clinic. The female patient presents with vague symptoms of tiredness and largeareas 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: 2Bleeding gums are indicative of general bleeding tendencies. Sleep and frequency of periodsare not significant, but the heaviness of the period is significant. History can reveal informationpertinent to assisting the physician in making a diagnosis.

PTS: 1 DIF: Cognitive Level: Analysis REF: 573OBJ: 2 TOP: Assessment of Patients with Hematologic DisordersKEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

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20. At the end of a shift, a nurse documents the effectiveness of parent teachingconcerning the transmission of hemophilia. Which of the following statements by themother 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 isn’t 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: 1Women carry the trait and pass it on to their sons.

PTS: 1 DIF: Cognitive Level: Analysis REF: 587OBJ: 5 TOP: Hemophilia KEY: Nursing Process Step: EvaluationMSC: 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: 3Symptoms of thrombocytopenia include petechiae, purpura, bleeding gums, and epistaxis.

PTS: 1 DIF: Cognitive Level: Analysis REF: 587OBJ: 5 TOP: Thrombocytopenia

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KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

22. The nurse uses a common nursing diagnosis for patients with disorders of thehematologic system, which is:1. Impaired Tissue Integrity.2. Disturbed Body Image.3. Ineffective Tissue Perfusion.4. Activity Intolerance.

ANS: 4Fatigue and activity intolerance are common complaints of patients with hematologic disorders.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 573OBJ: 6 TOP: Hematologic Nursing Diagnosis KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Physiological Integrity

23. The nurse assessing a patient 20 minutes after a bone marrow biopsy is concernedwhen 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: 1Fresh blood on the pressure dressing 20 minutes after the aspiration needs to be addressed.

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Usually, redressing with a pressure dressing and an ice pack are sufficient. Feelings of bruisingand pain on extraction are to be expected. Thirst is of no clinical significance.

PTS: 1 DIF: Cognitive Level: Analysis REF: 577, Table 32-1OBJ: 3 TOP: Diagnostic Tests KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

24. The nurse caring for a patient with crushing injuries from an auto accident ishorrified to find the patient bleeding profusely from the nose, mouth, and rectum, as wellas from the injuries. The nurse assesses this emergency situation as:1. hemophilia.2. disseminated intravascular coagulation (DIC).3. leukemia.4. thrombocytopenia.

ANS: 2DIC occurs in massive crushing injuries, burns, and allergic responses. The body’s clottingability is exhausted because trying to repair so many areas with coagulation. When the plateletsupply is gone, the clotting ability is lost and massive hemorrhaging occurs.

PTS: 1 DIF: Cognitive Level: Analysis REF: 587OBJ: 4 TOP: DIC KEY: Nursing Process Step: AssessmentMSC: NCLEX: Physiological Integrity

25. At 10:00 AM, the nurse receives 2 units of blood for a patient to be transfused. Thenurse should:

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1. set up 1 unit for the infusion to start at 10:30 AM and send the other unit back until the firstone 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: 1Blood must be started within 30 minutes of its receipt after it has been checked by two licensedstaff members. In many settings, LPNs do not start the blood, but can set the infusion up. Thebest option is to send the second unit back immediately, with an explanation that it will be calledfor later. A unit of blood usually takes about 2 to 4 hours to run.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 580, Box 32-5OBJ: 1 TOP: Transfusion Protocol KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

MULTIPLE RESPONSE

1. The nurse notes the past medical history information that is significant to potentialbleeding 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, 5NSAIDs and liver disorders enhance the probability of bleeding. The valve replacement of a fewmonths ago suggests that the patient is using anticoagulant drugs.

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PTS: 1 DIF: Cognitive Level: Comprehension REF: 573OBJ: 2 TOP: Factors Predisposing to Bleeding Tendency KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

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: 3All the Z-track method ensures is that there will be no iron staining the skin after injection. Theamount 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: 1 DIF: Cognitive Level: Application REF: 582, Table 32-1OBJ: 6 TOP: Z-Track Method KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

3. The nurse explains that the major difference between fresh frozen plasma (FFP) andcryoprecipitate (CPP) is that FFP (select all that apply):1. contains more albumin.2. has a longer infusion time.

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3. contains no platelets.4. has a very high probability of causing an allergic reaction.5. can cause dangerous blood pressure elevation.

ANS: 3FFP contains no platelets.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 579, Table 32-1OBJ: 5 TOP: FFP versus CPP KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

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 limbs2. 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, 3The appropriate sequence is the following: explain the procedure; when the patient indicatesunderstanding, get the permission form signed; assist the patient to abdomen and drape hipand 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.

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PTS: 1 DIF: Cognitive Level: Analysis REF: 577, Table 32-2OBJ: 3 TOP: Bone Marrow Aspiration Preparation KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

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81 Hematology