Hematologic Problems (Exam Mode) By Rnpedia.Com
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- 1.You are reviewing the complete blood count (CBC) for a client who has been admitted for knee arthroscopy. Which value is most important to report to the physician prior to surgery?
- A.
White blood cell count 16,000/mm3
- B.
Hematocrit 33%
- C.
Platelet count 426,000/ mm3
- D.
Hemoglobin 10.9 g/dL
- 2.A new RN is preparing to administer packed red blood cells (PRBCs) to a client whose anemia was caused by blood loss after surgery. Which action by the new RN requires that you, as charge nurse, intervene immediately?
- A.
The new RN waits 20 minutes after obtaining the PRBCs before starting the infusion.
- B.
The new RN starts an intravenous line for the transfusion using a 22-gauge catheter.
- C.
The new RN primes the transfusion set using 5% dextrose in lactated Ringer’s solution.
- D.
The new RN tells the client that the PRBCs may cause a serious transfusion reaction.
- 3.A 32-year-old client with a history of sickle cell anemia is admitted to the hospital during a sickle cell crisis. The physician orders all of these interventions. Which order will you implement first?
- A.
Give morphine sulfate 4-8 mg IV every hour as needed.
- B.
Start a large-gauge IV line and infuse normal saline at 200 mL/hour.
- C.
Immunize with Pneumovax and Haemophilus influenzae vaccines.
- D.
Administer oxygen at an F102 of 100% per non-rebreather mask.
- 4.A 78-year-old client admitted to the hospital with chronic anemia caused by possible gastrointestinal bleeding has all of these activities included in the care plan. Which activity is best delegated to an experienced nursing assistant (NA)?
- A.
Use Hemoccult slides to obtain stool specimens.
- B.
Have the client sign a colonoscopy consent form.
- C.
Administer PEG-ES (GoLYTELY) bowel preparation.
- D.
Check for allergies to contrast dye or shellfish.
- 5.As charge nurse, you are making the daily assignments on the medical-surgical unit. Which client is best assigned to a nurse who has floated from the post-anesthesia care unit (PACU)?
- A.
A 30-year-old client with thalassemia major who has an order for subcutaneous infusion of deferoxamine (Desferal)
- B.
A 43-year-old client with multiple myeloma who needs discharge teaching
- C.
A 52-year-old client with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy
- D.
A 65-year-old client with pernicious anemia who has just been admitted to the unit
- 6.You are making a room assignment for a newly arrived client whose laboratory testing indicates pancytopenia. All of these clients are already on the nursing unit. Which one will be the best roommate for the new client?
- A.
The client with digoxin toxicity
- B.
The client with viral pneumonia
- C.
The client with shingles
- D.
The client with cellulitis
- 7.A client admitted to the hospital with a sickle cell crisis complains of severe abdominal, hip, and knee pain. You observe an LPN accomplishing these client care tasks. Which one requires that you, as charge nurse, intervene immediately?
- A.
The LPN encourages the client to use the ordered PCA.
- B.
The LPN positions cold packs on the client’s knees.
- C.
The LPN places a “No Visitors” sign on the client’s door.
- D.
The LPN checks the client’s temperature every 2 hours.
- 8.A 67-year-old client who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. While you are taking the admission history, the client makes these statements. Which statement is of most concern?
- A.
“I’ve noticed that I bruise more easily since the chemotherapy started.”
- B.
“My bowel movements are soft and dark brown in color.”
- C.
“I take one aspirin every morning because of my history of angina.”
- D.
“My appetite has decreased since the chemotherapy strated.”
- 9.Following a car accident, a client with a Medic-Alert bracelet indicating hemophilia A is admitted to the emergency department (ED). Which physician order should you implement first?
- A.
Transport to radiology for C-spine x-rays.
- B.
Transfuse Factor VII concentrate.
- C.
Type and cross-match for 4 units RBCs.
- D.
Infuse normal saline at 250 mL/hour.
- 10.As home health nurse, you are taking an admission history for a client who has a deep vein thrombosis and is taking warfarin (Coumadin) 2 mg daily. Which statement by the client is the best indicator that additional teaching about warfarin may be needed?
- A.
“I have started to eat more healthy foods like green salads and fruit.”
- B.
“The doctor said that it is important to avoid becoming constipated.
- C.
“Coumadin makes me feel a little nauseated unless I take it with food.”
- D.
“I will need to have some blood testing done once or twice a week.”
- 11.A client is admitted to the intensive car unit (ICU) with disseminated intravascular coagulation (DIC) associated with a gram-negative infection. Which assessment information has the most immediate implications for the client’s care
- A.
There is no palpable radial or pedal pulse.
- B.
The client complains of chest pain.
- C.
The client’s oxygen saturation is 87
- D.
There is mottling of the hands and fee
- 12.A 22-year-old with stage I Hodgkin’s disease is admitted to the oncology unit for radiation therapy. During the initial assessment, the client tells you, “Sometimes I am afraid of dying.” Which response is most appropriate at this time?
- A.
“Many individuals with this diagnosis have some fears.”
- B.
“Perhaps you should ask the doctor about medication.”
- C.
“Tell me a little bit more about your fear of dying.”
- D.
“Most people with stage I Hodgkin’s disease survive.”
- 13.After receiving change-of-shift report about all of these clients, which one will you assess first?
- A.
A 26-year-old with thalassemia major who has a short-stay admission for a blood transfusion
- B.
A 44-year-old who was admitted 3 days previously with a sickle cell crisis and has orders for a CT scan
- C.
A 50-year-old with newly diagnosed stage IV non-Hodgskin’s lymphoma who is crying and stating “I’m not ready to die.”
- D.
A 69-year-old with chemotherapy-induced neutropenia who has an elevated oral temperature
- 14.A long-term-care client with chronic lymphocytic leukemia has a nursing diagnosis of Activity Intolerance related to weakness and anemia. Which of these nursing activities is most appropriate for you, as the charge nurse, to delegate to a nursing assistant?
- A.
Evaluate the client’s response to normal activities of daily living.
- B.
Check the client’s blood pressure and pulse rate after ambulation.
- C.
Determine which self-care activities the client can do independently.
- D.
Assist the client in choosing a diet that will improve strength
- 15.A transfusion of PRBCs has been infusing for 5 minutes when the client becomes flushed and tachypneic and says, “I am having chills. Please get me a blanket.” Which action should you take first?
- A.
Obtain a warm blanket for the client
- B.
Check the client’s oral temperature
- C.
Stop the medication.
- D.
Administer oxygen.
- 16.A group of clients is assigned to an RN-LPN/LVN team. The LPN/LVN is most likely to be assigned to provide client care and administer medications to which of these clients?
- A.
A 36-year-old client with chronic renal failure who will need a subcutaneous injection of epoetin (Procrit)
- B.
A 39-year-old client with hemophilia B who has been admitted for a blood transfusion
- C.
A 50-year-old client with newly diagnosed polycythemia vera who is scheduled for phlebotomy
- D.
A 55-year-old client with a history of stem cell transplantation who will have a bone marrow aspiration
- 17.You obtain the following data about a client admitted with multiple myeloma. Which information has the most immediate implications for the client’s care?
- A.
The client complains of chronic bone pain.
- B.
The blood uric acid level is very elevated.
- C.
The 240hour urine shows Bence-Jones protein.
- D.
The client is unable to plantarflex the feet.
- 18.The nurse in the outpatient clinic is assessing a 22-year-old with a history of a recent splenectomy after a motor vehicle accident. Which information obtained during the assessment will be of most immediate concern to the nurse?
- A.
The client engages in unprotected sex.
- B.
The client has an oral temperature of 99.7o F
- C.
The client has abdominal pain with light palpation.
- D.
The client admits to occasional marijuana use.
- 19.A client with graft-versus-host disease (GVHD) after a bone marrow transplant is being cared for on the medical unit. Which of these nursing activities is best delegated to a newly graduated RN who has had a 6-week orientation to the unit?
- A.
Administration of methotrexate and cyclosporine to the client
- B.
Assessment of the client for signs of infection caused by GVH
- C.
Infusion of D5.45% normal saline at 125 mL/hour to the client
- D.
Education of the client about ways to prevent infection
- 20.You are the charge nurse in an oncology unit. A client with an absolute neutrophil count (ANC) of 300/mm3 is placed in protective isolation. Which staff member should you assign to provide care for this client, under the supervision of an experienced oncology RN?
- A.
An LPN who has floated from the same-day-surgery unit
- B.
An RN from the float pool who usually works on the surgical unit
- C.
An LPN with 2 years of experience on the oncology unit
- D.
An RN who transferred recently from the ED
- 21.You are transferring a client with newly diagnosed chronic myeloid leukemia to a long-term-care (LTC) facility. Which information is most important to the LTC charge nurse prior to transferring the client?
- A.
The Philadelphia chromosome is present in the blood smear
- B.
Glucose is elevated as a result of prednisone therapy
- C.
There has been a 20-pound weight loss over the past year
- D.
The client’s chemotherapy has resulted in neutropenia
- 22.A client with acute myelogenous leukemia is receiving induction phase chemotherapy. Which assessment information is of most concern?
- A.
Serum potassium level of 7.8 mEq
- B.
Urine output less than intake by 400 mL
- C.
Inflammation and redness of oral mucos
- D.
Ecchymoses present on anterior trunk
- 23.A client who has been receiving cyclosporine following an organ transplant is experiencing these symptoms. Which one is of most concern?
- A.
Bleeding of the gums while brushing the teeth
- B.
Non-tender swelling in the right groin
- C.
Occasional nausea after taking the medication
- D.
Numbness and tingling of the fee
- 24.You have developed the nursing diagnosis Risk for Impaired Tissue Integrity related to effects of radiation for a client with Hodgkin’s lymphoma who is receiving radiation to the groin area. Which nursing activity is best delegated to a nursing assistant caring for the client?
- A.
Check the skin for signs of redness or peeling.
- B.
Apply alcohol-free lotion to the area after cleaning.
- C.
Explain good skin care to the client and family.
- D.
Clean the skin over daily with a mild soap.
- 25.After receiving the change-of-shift report, which client will you assess first?
- A.
A 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit
- B.
A 38-year-old with aplastic anemia who needs teaching about decreasing infection risk prior to discharge
- C.
A 40-year-old with lymphedema who requests help to put on compression stockings before getting out of
- D.
A 60-year-old with non-Hodgkin’s lymphoma who is refusing the ordered chemotherapy regime
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