NCLEX Practice Exam 18 (10 Questions)

1. A nurse is caring for a patient with a platelet count of 20.000/microliter. Which of the following is an important intervention?

Observe for evidence of spontaneous bleeding.

Limit visitors to family only.

Give aspirin in case of headaches.

Impose immune precautions.

Platelet counts under 30.000/microliter may cause spontaneous petechiae and bruising. particularly in the extremities. When the count falls below 15.000. spontaneous bleeding into the brain and internal organs may occur. Headaches may be a sign and should be watched for. Aspirin disables platelets and should never be used in the presence of thrombocytopenia. Thrombocytopenia does not compromise immunity. and there is no reason to limit visitors as long as any physical trauma is prevented.

Explanation

Platelet counts under 30.000/microliter may cause spontaneous petechiae and bruising. particularly in the extremities. When the count falls below 15.000. spontaneous bleeding into the brain and internal organs may occur. Headaches may be a sign and should be watched for. Aspirin disables platelets and should never be used in the presence of thrombocytopenia. Thrombocytopenia does not compromise immunity. and there is no reason to limit visitors as long as any physical trauma is prevented.

2. A patient is undergoing the induction stage of treatment for leukemia. The nurse teaches family members about infectious precautions. Which of the following statements by family members indicates that the family needs more education?

We will bring in books and magazines for entertainment.

We will bring in personal care items for comfort.

We will bring in fresh flowers to brighten the room.

We will bring in family pictures and get well cards.

During induction chemotherapy. the leukemia patient is severely immunocompromised and at risk of serious infection. Fresh flowers. fruit. and plants can carry microbes and should be avoided. Books. pictures. and other personal items can be cleaned with antimicrobials before being brought into the room to minimize the risk of contamination.

Explanation

During induction chemotherapy. the leukemia patient is severely immunocompromised and at risk of serious infection. Fresh flowers. fruit. and plants can carry microbes and should be avoided. Books. pictures. and other personal items can be cleaned with antimicrobials before being brought into the room to minimize the risk of contamination.

3. A patient is about to undergo bone marrow aspiration and biopsy and expresses fear and anxiety about the procedure. Which of the following is the most effective nursing response?

Warn the patient to stay very still because the smallest movement will increase her pain.

Encourage the family to stay in the room for the procedure.

Stay with the patient and focus on slow. deep breathing for relaxation.

Delay the procedure to allow the patient to deal with her feelings.

Slow. deep breathing is the most effective method of reducing anxiety and stress. It reduces the level of carbon dioxide in the brain to increase calm and relaxation. Warning the patient to remain still will likely increase her anxiety. Encouraging family members to stay with the patient may make her worry about their anxiety as well as her own. Delaying the procedure is unlikely to allay her fears.

Explanation

Slow. deep breathing is the most effective method of reducing anxiety and stress. It reduces the level of carbon dioxide in the brain to increase calm and relaxation. Warning the patient to remain still will likely increase her anxiety. Encouraging family members to stay with the patient may make her worry about their anxiety as well as her own. Delaying the procedure is unlikely to allay her fears.

4. A patient who has received chemotherapy for cancer treatment is given an injection of Epoetin. Which of the following should reflect the findings in a complete blood count (CBC) drawn several days later?

An increase in neutrophil count.

An increase in hematocrit.

An increase in platelet count.

An increase in serum iron.

Epoetin is a form of erythropoietin. which stimulates the production of red blood cells. causing an increase in hematocrit. Epoetin is given to patients who are anemic. often as a result of chemotherapy treatment. Epoetin has no effect on neutrophils. platelets. or serum iron.

Explanation

Epoetin is a form of erythropoietin. which stimulates the production of red blood cells. causing an increase in hematocrit. Epoetin is given to patients who are anemic. often as a result of chemotherapy treatment. Epoetin has no effect on neutrophils. platelets. or serum iron.

5. A nurse is caring for a patient with acute lymphoblastic leukemia (ALL). Which of the following is the most likely age range of the patient?

3-10 years.

25-35 years.

45-55 years.

Over 60 years.

The peak incidence of ALL is at 4 years (range 3-10). It is uncommon after the mid-teen years. The peak incidence of chronic myelogenous leukemia (CML) is 45-55 years. The peak incidence of acute myelogenous leukemia (AML) occurs at 60 years. Two-thirds of cases of chronic lymphocytic leukemia (CLL) occur after 60 years.

Explanation

The peak incidence of ALL is at 4 years (range 3-10). It is uncommon after the mid-teen years. The peak incidence of chronic myelogenous leukemia (CML) is 45-55 years. The peak incidence of acute myelogenous leukemia (AML) occurs at 60 years. Two-thirds of cases of chronic lymphocytic leukemia (CLL) occur after 60 years.

6. The Hodgkin's disease patient described in the question above undergoes a lymph node biopsy for definitive diagnosis. If the diagnosis of Hodgkin's disease were correct. which of the following cells would the pathologist expect to find?

Reed-Sternberg cells.

Lymphoblastic cells.

Gaucher’s cells.

Rieder’s cells

A definitive diagnosis of Hodgkin’s disease is made if Reed-Sternberg cells are found on pathologic examination of the excised lymph node. Lymphoblasts are immature cells found in the bone marrow of patients with acute lymphoblastic leukemia. Gaucher’s cells are large storage cells found in patients with Gaucher’s disease. Rieder’s cells are myeloblasts found in patients with acute myelogenous leukemia.

Explanation

A definitive diagnosis of Hodgkin’s disease is made if Reed-Sternberg cells are found on pathologic examination of the excised lymph node. Lymphoblasts are immature cells found in the bone marrow of patients with acute lymphoblastic leukemia. Gaucher’s cells are large storage cells found in patients with Gaucher’s disease. Rieder’s cells are myeloblasts found in patients with acute myelogenous leukemia.

7. A patient is admitted to the oncology unit for diagnosis of suspected Hodgkin's disease. Which of the following symptoms is typical of Hodgkin's disease?

Painful cervical lymph nodes.

Night sweats and fatigue.

Nausea and vomiting.

Weight gain.

Symptoms of Hodgkin’s disease include night sweats. fatigue. weakness. and tachycardia. The disease is characterized by painless. enlarged cervical lymph nodes. Weight loss occurs early in the disease. Nausea and vomiting are not typically symptoms of Hodgkin’s disease.

Explanation

Symptoms of Hodgkin’s disease include night sweats. fatigue. weakness. and tachycardia. The disease is characterized by painless. enlarged cervical lymph nodes. Weight loss occurs early in the disease. Nausea and vomiting are not typically symptoms of Hodgkin’s disease.

8. A nurse is caring for patients in the oncology unit. Which of the following is the most important nursing action when caring for a neutropenic patient?

Change the disposable mask immediately after use.

Change gloves immediately after use.

Minimize patient contact.

Minimize conversation with the patient.

The neutropenic patient is at risk of infection. Changing gloves immediately after use protects patients from contamination with organisms picked up on hospital surfaces. This contamination can have serious consequences for an immunocompromised patient. Changing the respiratory mask is desirable. but not nearly as urgent as changing gloves. Minimizing contact and conversation are not necessary and may cause nursing staff to miss changes in the patient’s symptoms or condition.

Explanation

The neutropenic patient is at risk of infection. Changing gloves immediately after use protects patients from contamination with organisms picked up on hospital surfaces. This contamination can have serious consequences for an immunocompromised patient. Changing the respiratory mask is desirable. but not nearly as urgent as changing gloves. Minimizing contact and conversation are not necessary and may cause nursing staff to miss changes in the patient’s symptoms or condition.

9. A patient is admitted to the hospital with suspected polycythemia vera. Which of the following symptoms is consistent with the diagnosis? Select all that applies.

Weight loss.

Increased clotting time.

Hypertension.

Headaches.

Polycythemia vera is a condition in which the bone marrow produces too many red blood cells. This causes an increase in hematocrit and viscosity of the blood. Patients can experience headaches. dizziness. and visual disturbances. Cardiovascular effects include increased blood pressure and delayed clotting time. Weight loss is not a manifestation of polycythemia vera.

Explanation

Polycythemia vera is a condition in which the bone marrow produces too many red blood cells. This causes an increase in hematocrit and viscosity of the blood. Patients can experience headaches. dizziness. and visual disturbances. Cardiovascular effects include increased blood pressure and delayed clotting time. Weight loss is not a manifestation of polycythemia vera.

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10. A nurse in the emergency department assesses a patient who has been taking long-term corticosteroids to treat renal disease. Which of the following is a typical side effect of corticosteroid treatment? Note: More than one answer may be correct.

Hypertension.

Cushingoid features.

Hyponatremia.

Low serum albumin.

Side effects of corticosteroids include weight gain. fluid retention with hypertension. Cushingoid features. a low serum albumin. and suppressed inflammatory response. Patients are encouraged to eat a diet high in protein. vitamins. and minerals and low in sodium. Corticosteroids cause hypernatremia and not hyponatremia.

Explanation

Side effects of corticosteroids include weight gain. fluid retention with hypertension. Cushingoid features. a low serum albumin. and suppressed inflammatory response. Patients are encouraged to eat a diet high in protein. vitamins. and minerals and low in sodium. Corticosteroids cause hypernatremia and not hyponatremia.

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