Immune And Hematologic Disorders

A client diagnosed with acquired immunodeficiency syndrome (AIDS) is experiencing end-stage Kaposi's sarcoma. Concerned that the health care team is investing too much energy in keeping him alive, he asks that they not attempt any more interventions. How should a nurse respond to this client?

• A.

  You might consider consulting with a therapist to be sure this is what you really want.

• B.

  AIDS is no longer an automatic death sentence. You might want to reconsider.

• C.

  We have to make sure you've signed an advance directive.

• D.

  I need to get your physician to make this recommendation and write an order.

A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used:

• A.

  To administer only blood products and I.V. fluids.

• B.

  In clients with infections in the blood.

• C.

  To provide long-term access to central veins.

• D.

  For 2 weeks without being replaced.

A nurse is teaching a female client, who is positive for human immunodeficiency virus, about pregnancy. The nurse should know more teaching is necessary when the client says:

• A.

  The baby can get the virus from my placenta.

• B.

  I'm planning on starting on birth control pills.

• C.

  Not everyone who has the virus gives birth to a baby who has the virus.

• D.

  I'll need to have a cesarean birth if I become pregnant and have a baby.

A client with acquired immunodeficiency syndrome (AIDS) is ordered zidovudine (azidothymidine, AZT [Retrovir]), 200 mg P.O. every 4 hours. When teaching the client about this drug, the nurse should provide which instruction?

• A.

  Take zidovudine with meals.

• B.

  Take zidovudine on an empty stomach.

• C.

  Take zidovudine every 4 hours around the clock.

• D.

  Take over-the-counter (OTC) drugs to treat minor adverse reactions.

A client is to receive a blood transfusion of packed red blood cells (RBCs) for severe anemia. The nurse identifies the client using two client identifiers, then prepares to administer the transfusion. Place the following steps in the order the nurse should follow to administer this product. Use all options.1. Flush the I.V. Tubing and line with NSS.2. Check blood bag against the client's information.3. Watch for a transfusion reaction.4. Record vital signs.5. Put on gloves, a gown, and a face shield.6. Check packed RBCs for the date and abnormalities

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?

• A.

  Platelet count, prothrombin time, and partial thromboplastin time

• B.

  Platelet count, blood glucose levels, and white blood cell (WBC) count

• C.

  Thrombin time, calcium levels, and potassium levels

• D.

  Fibrinogen level, WBC, and platelet count

After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first?

• A.

  Page an anesthesiologist immediately and prepare to intubate the client.

• B.

  Administer epinephrine, as ordered, and prepare to intubate the client, if necessary.

• C.

  Administer the antidote for penicillin, as ordered, and continue to monitor the client's vital signs.

• D.

  Insert an indwelling urinary catheter and begin to infuse I.V. fluids, as ordered.

A female client with human immunodeficiency virus (HIV) receives family-planning counseling. Which statement about safer sex practices for persons with HIV is accurate?

• A.

  If the client and her sexual partners are HIV-positive, unprotected sex is permitted.

• B.

  A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse.

• C.

  Contraceptive methods, such as hormonal contraceptives, implants, and injections, are recommended to prevent HIV transmission.

• D.

  The intrauterine device is recommended for a client with HIV.

A client with lymphoma tells the nurse that he's found an overseas holistic physician who can cure him with coffee enemas. What should the nurse say?

• A.

  That unproven alternative therapy can be very dangerous.

• B.

  You should ask your physician if this is a helpful approach.

• C.

  It's illegal for unlicensed physicians to prescribe your care.

• D.

  This treatment is questionable. It could be dangerous.

A client with systemic lupus erythematosus (SLE) has the classic rash of lesions on the cheeks and bridge of the nose. What term should the nurse use to describe this characteristic pattern?

• A.

  Butterfly rash

• B.

  Papular rash

• C.

  Pustular rash

• D.

  Bull's eye rash

A physician orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis?

• A.

  Increased total serum complement levels

• B.

  Negative antinuclear antibody test

• C.

  Negative lupus erythematosus cell test

• D.

  An above-normal anti-deoxyribonucleic acid (DNA) test

During chemotherapy for lymphocytic leukemia, a client develops abdominal pain, fever, and "horse barn"-smelling diarrhea. It would be most important for the nurse to advise the physician to order:

• A.

  An enzyme-linked immunosuppressant assay (ELISA) test.

• B.

  An electrolyte panel and a hemogram.

• C.

  Stools for a Clostridium difficile test.

• D.

  A flat plate X-ray of the abdomen.

A nurse on the hematology floor feels the charge nurse has been unfairly assigning complex clients to her by not dividing enough of the workload among the rest of the staff. This nurse is creating tension among the staff. What is the charge nurse's best approach?

• A.

  Instruct this staff member to bring her concerns to her directly.

• B.

  Assure the staff member that the she is being as fair as possible and that the nurse needs to pull her weight.

• C.

  Meet with this nurse privately and give her an opportunity to further express her concerns.

• D.

  Write the nurse up, then sit down to counsel her in a private setting.

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

• A.

  I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear.

• B.

  I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal.

• C.

  I will receive parenteral vitamin B12 therapy monthly for 6 months to a year.

• D.

  I will receive parenteral vitamin B12 therapy for the rest of my life.

A client diagnosed with metastatic cancer is preparing for discharge. The physician orders morphine sulfate controlled-release tablets 100 mg every 12 hours as needed after discharge. What legal rights and responsibilities should the nurse address when teaching the client about morphine sulfate use?

• A.

  You must avoid driving or other activities that require alertness while taking controlled-release morphine sulfate.

• B.

  Morphine sulfate is an opioid and you may develop tolerance. This is an expected response and isn't harmful.

• C.

  Federal law prevents refills of this medication. Your physician will give you a new prescription when you need more medicine.

• D.

  If you no longer require the morphine sulfate controlled-release tablets for your cancer pain, don't take any leftover pills for other disorders.

A nurse is caring for a client with acquired immunodeficiency syndrome. To adhere to standard precautions, the nurse should:

• A.

  Maintain strict isolation.

• B.

  Keep the client in a private room, if possible.

• C.

  Wear gloves when providing mouth care.

• D.

  Wear a gown when delivering the client's food tray.

A nurse is planning care for a client with human immunodeficiency virus (HIV). She's being assisted by a licensed practical nurse (LPN). Which statements by the LPN indicate her understanding of HIV transmission? Select all that apply.

• A.

  I'll wear a gown, mask, and gloves for all client contact.

• B.

  I don't need to wear any personal protective equipment because nurses have a low risk of occupational exposure.

• C.

  I'll wear a mask if the client has a cough caused by an upper respiratory infection.

• D.

  I'll wear a mask, gown, and gloves when splashing of body fluids is likely.

• E.

  I'll wear a mask, gown, and gloves when splashing of body fluids is likely.

Which one do you like?

• A.

  Rinse her eyes with water, record the incident on the client's chart, and see Employee Health.

• B.

  Wash her hands, complete an incident report, and see a physician as soon as possible.

• C.

  Rinse her eyes with water, report the incident, and go to Employee Health.

• D.

  Rinse her eyes, contact Employee Health and document their findings.

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?

• A.

  Nights sweats, weight loss, and diarrhea

• B.

  Dyspnea, tachycardia, and pallor

• C.

  Nausea, vomiting, and anorexia

• D.

  Itching, rash, and jaundice

A client with rheumatoid arthritis is being discharged with a prescription for aspirin (Ecotrin), 600 mg P.O. every 6 hours. Which statement by the client indicates understanding of the adverse effects of the medication?

• A.

  I'll call my physician if I have difficulty voiding.

• B.

  I'll call my physician if I have ringing in the ears.

• C.

  I'll call my physician if I have leg cramps.

• D.

  I'll call my physician if I have fewer bowel movements than normal.

Which client is most at risk for developing disseminated intravascular coagulation (DIC)?

• A.

  A client admitted with suspected cocaine overdose

• B.

  A client with an amniotic fluid embolism

• C.

  A client with a stage IV pressure ulcer

• D.

  A client with heart failure and renal failure

A client has had heavy menstrual bleeding for 6 months. Her physician diagnoses microcytic hypochromic anemia and orders ferrous sulfate (Feosol), 300 mg P.O. daily. Before initiating iron therapy, the nurse reviews the client's medical history. The nurse should question this order when she notes that the client:

• A.

  Is pregnant.

• B.

  Has asthma.

• C.

  Has ulcerative colitis.

• D.

  Has severely impaired liver function.

A nurse is monitoring a client who developed facial edema after receiving a medication. Which white blood cells stimulated the edema?

• A.

  Basophils

• B.

  Eosinophils

• C.

  Monocytes

• D.

  Neutrophils

The wife of a client with end-stage acquired immunodeficiency syndrome (AIDS) is caring for her husband at home. The hematologist recommends hospice care and the couple agrees. During the initial admission visit, the hospice nurse provides information to the client and his family about an advance directive. During the next day's visit, the client states that since he and his wife filled out the advance directive form, he feels abandoned by his physician. Which statement by the hospice nurse best addresses the client's concerns?

• A.

  Your physician will continue to care for you. The advance directive simply puts in writing the care you want, so he will be able to provide it if you can't tell him yourself.

• B.

  You don't need to feel that way. Your physician is required by law to sign your orders and the hospice nurses will be contacting him with updates on your condition.

• C.

  Many people first feel that way when they are admitted into hospice. Although the focus of your care has changed from curative to supportive, your physician will still continue directing it.

• D.

  It's understandable to feel that way. But clients with end-stage AIDS who have advanced directives generally experience a less painful death that those individuals who don't.

A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?

• A.

  Facial erythema, pericarditis, pleuritis, fever, and weight loss

• B.

  Photosensitivity, polyarthralgia, and painful mucous membrane ulcers

• C.

  Weight gain, hypervigilance, hypothermia, and edema of the legs

• D.

  Hypothermia, weight gain, lethargy, and edema of the arms

A client with autoimmune thrombocytopenia and a platelet count of 8,000/μl develops epistaxis and melena. Treatment with corticosteroids and immunoglobulins has been unsuccessful, and the physician recommends a splenectomy. The client states, "I don't need surgery — this will go away on its own." In considering her response to the client, the nurse must depend on the ethical principle of:

• A.

  Beneficence.

• B.

  Autonomy.

• C.

  Advocacy.

• D.

  Justice.

A pregnant client who developed deep vein thrombosis (DVT) in her right leg is receiving heparin I.V. on the medical floor. Physical therapy is ordered to maintain her mobility and prevent additional DVT. A nursing assistant working on the medical unit helps the client with bathing, range-of-motion exercises, and personal care. Which collaborative multidisciplinary considerations should the care plan address?

• A.

  The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include sequential compression device application and strict bed rest.

• B.

  The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include reporting evidence of bleeding or easy bruising.

• C.

  The client is at risk for developing another DVT; therefore, the care plan should include reporting redness, tenderness, or edema in the other lower extremity.

• D.

  The client is pregnant and receiving I.V. heparin, placing her at risk for premature labor; therefore, the care plan should include reporting signs of premature labor.

Which nonpharmacologic interventions should a nurse include in a care plan for a client who has moderate rheumatoid arthritis (RA)? Select all that apply.

• A.

  Massaging inflamed joints

• B.

  Avoiding range-of-motion (ROM) exercises

• C.

  Applying splints to inflamed joints

• D.

  Using assistive devices at all times

• E.

  Selecting clothing that has Velcro fasteners

• F.

  Applying moist heat to joints

A nurse preparing to discharge a child with leukemia observes a family member who has a cold sharing a meal with the child. How should the nurse approach the situation?

• A.

  Instruct family members not share food because it isn't healthful.

• B.

  Offer a face mask to the person with the cold and use this as an opportunity for further teaching.

• C.

  Tell family members to be careful to avoid the child if they're sick.

• D.

  Post isolation signs on the child's door and carefully assess the health status of all visitors.

A nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to promote optimal immunologic function. Which snacks have the greatest probability of stimulating autoimmunity?

• A.

  Raisins and carrot sticks

• B.

  Potato chips and chocolate milk shakes

• C.

  Fruit salad and mineral water

• D.

  Applesauce and saltine crackers

A client involved in a motor vehicle accident arrives at the emergency department unconscious and severely hypotensive. The nurse suspects he has several fractures in the pelvis and legs. Which parenteral fluid is the best choice for the client's current condition?

• A.

  Fresh frozen plasma

• B.

  Normal saline solution

• C.

  Lactated Ringer's solution

• D.

  Packed red blood cells (RBCs)

The couple with the lowest risk of having a child with sickle cell anemia disease is the one in which the:

• A.

  Father is HbS and the mother is HbS.

• B.

  Father is HbS and the mother is HbAS.

• C.

  Father is HbA and the mother is HbS.

• D.

  Father is HbAS and the mother is HbAS.

When a relief charge nurse posts assignments, a nurse notes that she is no longer assigned to a client whom she has cared for the previous 2 nights. How should the nurse respond to this assignment?

• A.

  Tell the charge nurse that she'd like to continue with the same assignment.

• B.

  Ask the nurse if there's a reason she changed the assignment.

• C.

  Accept the assignment and discuss the situation with the charge nurse at a later time.

• D.

  Tell the charge nurse she feels she's the best person to care for this particular client.

Which client is most likely to develop systemic lupus erythematosus (SLE)?

• A.

  A 25-year-old white male

• B.

  A 25-year-old Jewish female

• C.

  A 27-year-old black female

• D.

  A 35-year-old Hispanic male

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless temporary change?

• A.

  Purplish stools

• B.

  Bluish urine

• C.

  Redness of the upper part of the feet

• D.

  Coldness of the soles

A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient?

• A.

  Blood relationship

• B.

  Sex and size

• C.

  Compatible blood and tissue types

• D.

  Need

A client newly diagnosed with acute lymphocytic leukemia has a right subclavian central venous catheter in place. The nurse who's caring for the client is teaching a graduate nurse about central venous catheter care. The nurse should instruct the graduate nurse to change the central venous catheter dressing every:

• A.

  Shift.

• B.

  24 hours.

• C.

  48 hours.

• D.

  72 hours.

A client with acquired immunodeficiency syndrome is receiving zidovudine (azidothymidine, AZT [Retrovir]). Which laboratory value indicates an adverse reaction to zidovudine?

• A.

  Red blood cell (RBC) count of 1.8 million/μl

• B.

  Fasting blood glucose of 104 mg/dl

• C.

  Serum calcium level of 8.9 mg/dl

• D.

  Platelet count of 240,000/mm3

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

• A.

  Pallor, bradycardia, and reduced pulse pressure

• B.

  Pallor, tachycardia, and a sore tongue

• C.

  Sore tongue, dyspnea, and weight gain

• D.

  Option 4

A client is diagnosed with human immunodeficiency virus (HIV). After recovering from the initial shock of the diagnosis, the client expresses a desire to learn as much as possible about HIV and acquired immunodeficiency syndrome (AIDS). When teaching the client about the immune system, the nurse states that humoral immunity is provided by which type of white blood cell?

• A.

  Neutrophil

• B.

  Basophil

• C.

  Monocyte

• D.

  Lymphocyte

A client newly diagnosed with multiple sclerosis worries that his employer will fire him now that he has a condition that might interfere with his work. How should the nurse respond?

• A.

  Groups like the National Multiple Sclerosis Society can assist with this issue.

• B.

  I'm sure your physician can assist you with your work limitations.

• C.

  You aren't required to tell your employer you have a chronic health problem.

• D.

  The Americans with Disabilities Act protects you in relation to issues like this.

A client with human immunodeficiency virus undergoes intradermal anergy testing using Candida and mumps antigen. During the 3 days following the tests, there is no induration or evidence of reaction at the intradermal injection sites. The most accurate conclusion the nurse can make is:

• A.

  The client has no previous exposure to the antigens injected.

• B.

  The client has antibodies to the antigens.

• C.

  The client is immunodeficient and won't have a skin response.

• D.

  The client isn't allergic to the antigens and therefore doesn't react.

Which finding should a nurse identify as requiring further investigation?

• A.

  Red blood cell (RBC) count of 4.9 million/μl

• B.

  Platelet count of 115,000/μl

• C.

  White blood cell (WBC) count of 7,000/μl

• D.

  Hematocrit of 45%

Which nursing diagnosis should a nurse expect to see in a care plan for a client in sickle cell crisis?

• A.

  Imbalanced nutrition: Less than body requirements related to poor intake

• B.

  Disturbed sleep pattern related to external stimuli

• C.

  Impaired skin integrity related to pruritus

• D.

  Acute pain related to sickle cell crisis

A client has been taking a decongestant for allergic rhinitis. During a follow-up visit, which finding suggests that the decongestant has been effective?

• A.

  Increased salivation

• B.

  Increased tearing

• C.

  Reduced sneezing

• D.

  Headache

What nursing interventions should a nurse expect to implement when caring for a child in acute sickle cell crisis? Select all that apply.

• A.

  Maintaining adequate hydration

• B.

  Providing adequate pain control

• C.

  Assessing family education needs

• D.

  Encouraging healthful eating habits

• E.

  Frequently monitoring vital signs

• F.

  Anticipating play needs

A client is admitted to the facility with an exacerbation of her chronic systemic lupus erythematosus (SLE). She gets angry when her call bell isn't answered immediately. The nurse's most appropriate response is:

• A.

  You seem angry. Would you like to talk about it?

• B.

  Calm down. You know that stress will make your symptoms worse.

• C.

  Would you like to talk about the problem with the nursing supervisor?

• D.

  I can see you're angry. I'll come back when you've calmed down.

A nurse is teaching high school students about transmission of the human immunodeficiency virus (HIV). Which comment by a student warrants clarification by the nurse?

• A.

  A man should wear a latex condom during intimate sexual contact.

• B.

  I've heard about people who got AIDS from blood transfusions.

• C.

  I won't donate blood because I don't want to get AIDS.

• D.

  I.V. drug users can get HIV from sharing needles.

A nurse is poviding care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis?

• A.

  Risk for impaired skin integrity

• B.

  Constipation

• C.

  Ineffective thermoregulation

• D.

  Risk for imbalanced nutrition: More than body requirements

Nurses were identified by the Centers for Disease Control and Prevention (CDC) as the people most likely to care for clients infected after the intentional release of the smallpox virus. Based on CDC guidelines, which group should volunteer to receive the smallpox vaccine?

• A.

  Nurses age 50 and older who work in the emergency departments of community hospitals.

• B.

  Nurses who served in the military and are now working in public health settings.

• C.

  Nurses born after 1971 who are employed as triage nurses in large medical center emergency departments.

• D.

  Nurses vaccinated against smallpox as children who are now working in a pediatric unit.