Medsurg Blood, Lymph & Immune

1. The LPN requests that an RN assists in beginning a blood transfusion. After successfully identifying the patient and confirming that the information on the blood bag is correct the infusion is started. What would be the appropriate action for the LPN to take next?

Check on your other patients while the transfusion is running

Remain with patient and take vital signs 15 minutes into the transfusion, observing for adverse reactions

Advise the CNA to remain with the patient and notify you of any observed changes

Administer O2 at 2Lvia nasal cannula to ensure that the patient's oxygen saturation levels remain stable

Only a small amount of blood will trigger a hemolytic transfusion reaction. Most adverse reactions occur within the first 15 minutes. Signs & symptoms include hypotension, fever, tachycardia and tachypnea which can be observed when taking vital signs. Remaining with the patient enables early detection which can minimize complications

Explanation

Only a small amount of blood will trigger a hemolytic transfusion reaction. Most adverse reactions occur within the first 15 minutes. Signs & symptoms include hypotension, fever, tachycardia and tachypnea which can be observed when taking vital signs. Remaining with the patient enables early detection which can minimize complications

2. An RN requests the LPNs assistance, as policy requires two nurses be involved in the administration of a blood transfusion. The LPN observes that the patient's date of birth on the blood bag is incorrect. What would be the appropriate action for the LPN?

Inform the RN, document the discrepancy, and continue with the transfusion

Advise the RN and leave her/him to administer the transfusion alone

Throw the blood bag out and request a new unit of blood from the blood bank

Any discrepancy between the patient information and the information on the blood bag requires that the blood is not administered, the blood bank is notified, and the blood is returned.

Explanation

Any discrepancy between the patient information and the information on the blood bag requires that the blood is not administered, the blood bank is notified, and the blood is returned.

3. An LPN is removing an IV from a patient with ITP. What action should be taken during the IV removal?

Avoid the use of band-aid

Maintain pressure to control bleeding

Clean IV site with NS

Send the IV catheter for testing after removal

Control of bleeding is essential in care of patients with bleeding disorders.

Explanation

Control of bleeding is essential in care of patients with bleeding disorders.

4. Due to an increase in WBCs, a person diagnosed with leukemia is NOT prone to infection.

True

False

Even though the WBC count in a patient with leukemia is high, the WBCs are immature and are not able to fight infection.

Explanation

Even though the WBC count in a patient with leukemia is high, the WBCs are immature and are not able to fight infection.

5. Which of the following is NOT part of the lymphatic system

Lymph nodes

Spleen

Hypothalamus

Lymphatic vessels

Lymphatic vessels help to return tissue fluid to the circulatory system. Lymph nodes and nodules are masses of lymphatic tissue. Macrophages in the spleen phagocytize pathogens.

Explanation

Lymphatic vessels help to return tissue fluid to the circulatory system. Lymph nodes and nodules are masses of lymphatic tissue. Macrophages in the spleen phagocytize pathogens.

6. What is true about B cells and T cells.

T cells are formed in the thymus

B cells are formed in the thymus

B cells and T cells are both formed in the spleen

B cells and T cells are both formed in the red bone marrow. T cells migrate to the thymus to mature before moving to the lymph nodes, nodules, and spleen. B cells remain in the bone marrow to mature and them move directly to the lymphatic tissue.

Explanation

B cells and T cells are both formed in the red bone marrow. T cells migrate to the thymus to mature before moving to the lymph nodes, nodules, and spleen. B cells remain in the bone marrow to mature and them move directly to the lymphatic tissue.

7. A blood transfusion is ordered for a patient with a peripheral IV infusion located in the right forearm running Lactated ringers at 80ml/hour. The nurse begins to prepare another line in the left a/c for the ordered transfusion. The patient requests that the nurse use the existing site. Which statement made by the nurse is correct?

I will need to infuse the blood transfusion using a separate line

I will ask the doctor if he will approve it

That is a good idea since I won't have to stick you again

I will just wait to start the blood transfusion

Blood transfusions must be administered via a separate IV line with NS and blood tubing containing a filter that removes harmful particles.

Explanation

Blood transfusions must be administered via a separate IV line with NS and blood tubing containing a filter that removes harmful particles.

8. A patient who was tested for HIV after a recent exposure had a negative result. During the post-test counseling session, the nurse tells the patient which of the following?

The test should be repeated in 6 months

This ensures that you are not infected with the HIV virus

You no longer need to protect yourself from sexual partners

You probably have immunity to the AIDS virus

Test should be repeated in 6 months due to a possible false-negative result early in the infection

Explanation

Test should be repeated in 6 months due to a possible false-negative result early in the infection

9. A patient is diagnosed with HIV. The nurse prepares a care plan for the patient knowing that HIV is primarily a condition in which?

Immunosuppression occurs and is indicated by a T4 lymphocyte count of less than 200/mm3

Bacterial infection occurs, causing weakness

Fungal infection occurs, causing a rash and pruritus

Protozoan infection occurs, causing a fever and non productive cough

HIV causes immunosuppression and is indicated by a T4 lymphocyte count of less than 200/mm3. Although bacterial, fungal, and protozoa infections can occur, these occur as opportunistic infection as a result of immunosuppression

Explanation

HIV causes immunosuppression and is indicated by a T4 lymphocyte count of less than 200/mm3. Although bacterial, fungal, and protozoa infections can occur, these occur as opportunistic infection as a result of immunosuppression

10. A patient with AIDS has a nursing diagnosis of imbalanced nutrition: less than body requirements. The nurse plans which of the following goals with this patient?

Consume foods and beverages that are high in glucose

Plan large menus and cook meals in advance

Eat low-calorie snacks between meals

Eat small, frequent meals throughout the day

Patient with imbalance nutrition should eat small frequent meals throughout the day that are high calorie/high protein. Anti-emetics should be given for N/V as well as vitamin/nutritional supplements

Explanation

Patient with imbalance nutrition should eat small frequent meals throughout the day that are high calorie/high protein. Anti-emetics should be given for N/V as well as vitamin/nutritional supplements

11. Which of the following blood components is decreased in anemia

Erythrocytes

Granulocytes

Leukocytes

Platelets

Anemia is the decrease in red blood cells

Explanation

Anemia is the decrease in red blood cells

12. A patient is diagnosed with late stage HIV. She and her family are extremely upset about the diagnosis. The priority psychosocial nursing intervention for the client and family is to?

Tell the client and family to stop smoking because it will predispose the client to respiratory infections

Tell the client and family that raw or improperly washed foods can produce microbes

Encourage the patient and family to discuss their feelings about the disease

Advise the patient to avoid becoming pregnant because of the risk of transmission of the infection

Discussing feeling about the disease is a psychosocial intervention

Explanation

Discussing feeling about the disease is a psychosocial intervention

13. A blood transfusion is ordered for a patient. As the nurse explains the procedure, the patient advises that he has had an adverse reaction during a previous blood transfusion. What would be appropriate action for the nurse to take?

Inform the patient that the blood has been checked against his blood type and continue with the infusion

Hold the transfusion and inform the Doctor of previous reaction

Administer corticosteroids prior to giving the infusion

Flush the IV line with NS prior to administering the infusion

The appropriate action for the nurse to take would be to hold the transfusion and inform the doctor of the patient's previous adverse reaction. This is important because the patient's safety is paramount, and the doctor needs to be aware of the potential risk before proceeding with the transfusion.

Explanation

The appropriate action for the nurse to take would be to hold the transfusion and inform the doctor of the patient's previous adverse reaction. This is important because the patient's safety is paramount, and the doctor needs to be aware of the potential risk before proceeding with the transfusion.

14. A patient with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response?

"Your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid"

"Your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor."

"Your vitamin deficiency is due to an excessive excretion of the vitamin because of kidney dysfunction."

"Your vitamin deficiency is due to an increased requirement for the vitamin because of rapid red blood cell production."

Patients with pernicious anemia have deficient production of intrinsic factor in the stomach, which is needed for the body to absorb vitamin B12

Explanation

Patients with pernicious anemia have deficient production of intrinsic factor in the stomach, which is needed for the body to absorb vitamin B12

15. What are the functions of T cells in cell mediated immunity?

Helper T cells stimulate B cells

T cells attach to infected cells for transport to the kidneys in order to be excreted in urine

They alert WBCs of foreign objects

Cell-mediated immunity only involves T cells.

Explanation

Cell-mediated immunity only involves T cells.

16. A patient receiving clotting factor VIII has this hematologic disorder?

Thrombodytopenia

Anemia

Hemophilia A

Splenectomy

Hemophilia A is the correct answer because it is a hematologic disorder characterized by a deficiency or dysfunction of clotting factor VIII. This disorder leads to impaired blood clotting, resulting in prolonged bleeding and easy bruising. Thrombocytopenia refers to a low platelet count, anemia refers to a low red blood cell count, and splenectomy refers to the surgical removal of the spleen, none of which are specifically related to clotting factor VIII deficiency.

Explanation

Hemophilia A is the correct answer because it is a hematologic disorder characterized by a deficiency or dysfunction of clotting factor VIII. This disorder leads to impaired blood clotting, resulting in prolonged bleeding and easy bruising. Thrombocytopenia refers to a low platelet count, anemia refers to a low red blood cell count, and splenectomy refers to the surgical removal of the spleen, none of which are specifically related to clotting factor VIII deficiency.

17. An anemic patient would be fatigued due to what?

CO2 deficiency

Oxygen deficiency

Factor IX

B-cell antibodies

Anemia is the decrease of RBCs which causes a decrease in the O2 carried in the blood

Explanation

Anemia is the decrease of RBCs which causes a decrease in the O2 carried in the blood

18. One of the most important teaching for a patient with polycythemia is to drink at least 3 L of water daily.

True

False

Drinking at least 3 liters of water daily increases fluid volume and in turn reduces blood viscosity.

Explanation

Drinking at least 3 liters of water daily increases fluid volume and in turn reduces blood viscosity.

19. A patient arrives to the emergency room and has a normal blood volume but has a decrease in RBCs and Hgb, What type of blood transfusion would they need?

Packed red blood cells

Platelets

Plasma

Frozen red blood cells

Packed red blood cells contain no plasma and are used when blood volume is normal. Platelets are given to a patient with active bleeding and a low platelet count. Plasma is given to patients with bleeding disorders and are used to replace blood volume. Frozen red blood cells are taken from a patient prior to surgery.

Explanation

Packed red blood cells contain no plasma and are used when blood volume is normal. Platelets are given to a patient with active bleeding and a low platelet count. Plasma is given to patients with bleeding disorders and are used to replace blood volume. Frozen red blood cells are taken from a patient prior to surgery.

20. The ability to destroy pathogens, foreign materials, or prevent future invasion by the same organism is called?

Neutralization

Auto-sensitivity

Immunity

Inflammation

Immunity refers to the body's ability to defend itself against pathogens, foreign materials, or prevent future invasion by the same organism. It involves the recognition and response to specific antigens, which can be achieved through the production of antibodies or activation of immune cells. Immunity plays a crucial role in protecting the body from infections and diseases, and can be acquired naturally or through vaccination.

Explanation

Immunity refers to the body's ability to defend itself against pathogens, foreign materials, or prevent future invasion by the same organism. It involves the recognition and response to specific antigens, which can be achieved through the production of antibodies or activation of immune cells. Immunity plays a crucial role in protecting the body from infections and diseases, and can be acquired naturally or through vaccination.

21. Many studies show that breastfeeding a newborn provides them with antibodies that help protect them against infection. What type of immunity is this?

Naturally acquired passive immunity

Artificially acquired passive immunity

Naturally acquired active immunity

Artificially acquired active immunity

Passive immunity occurs when antibodies are NOT produced by the person. Active immunity occurs when a person produces their own antibodies due to illness or vaccine. Naturally acquired passive immunity is a result in placental or breast milk transmission from a mother to newborn.

Explanation

Passive immunity occurs when antibodies are NOT produced by the person. Active immunity occurs when a person produces their own antibodies due to illness or vaccine. Naturally acquired passive immunity is a result in placental or breast milk transmission from a mother to newborn.

22. The nurse is assisting with data collection. Which of the following past surgeries found in the history may influence immune system dysfunction?

Splenectomy

Thyroidectomy

Pneumonectomy

Parathyroidectomy

Removal of the spleen results in altered lymphocyte and plasma cell production which affects the humoral ummune response.

Explanation

Removal of the spleen results in altered lymphocyte and plasma cell production which affects the humoral ummune response.

23. What is the MOST effective treatment for aplastic anemia?

Bone marrow transplant

Blood transfusion

Steroids

Colony-stimulating factors

Each treatment listed is used to treat aplastic anemia, but a bone marrow transplant is the most effective.

Explanation

Each treatment listed is used to treat aplastic anemia, but a bone marrow transplant is the most effective.

24. Before beginning a blood transfusion what assessment of the patient will the nurse make?

Hematocrit level

Urine output

Prothrombin time

Vital signs

Baseline vital signs should be taken for comparison in case of adverse reaction.

Explanation

Baseline vital signs should be taken for comparison in case of adverse reaction.

25. What would be the appropriate treatment for a patient whose spleen is enlarged or whose spleen function is causing too many RBCs & Platelets to be removed from the blood would?

Increase fluid intake

Blood transfusion

Chemotherapy

Splenectomy

Splenectomy would be the appropriate treatment for a patient whose spleen is enlarged or whose spleen function is causing too many RBCs and platelets to be removed from the blood. A splenectomy is the surgical removal of the spleen, which helps to alleviate the excessive removal of red blood cells and platelets from the bloodstream. This procedure can effectively treat conditions such as an enlarged spleen, certain blood disorders, and immune system disorders.

Explanation

Splenectomy would be the appropriate treatment for a patient whose spleen is enlarged or whose spleen function is causing too many RBCs and platelets to be removed from the blood. A splenectomy is the surgical removal of the spleen, which helps to alleviate the excessive removal of red blood cells and platelets from the bloodstream. This procedure can effectively treat conditions such as an enlarged spleen, certain blood disorders, and immune system disorders.

26. What would the nurse caring for a patient diagnosed with disseminated intravascular coagulation syndrome include in her patient teaching?

Eat green leafy vegetables

Increase fluid intake

Keep record of intake and output

Observe for bleeding and bruising

The nurse caring for a patient diagnosed with disseminated intravascular coagulation syndrome would include in her patient teaching to observe for bleeding and bruising. This is because disseminated intravascular coagulation syndrome is a condition characterized by abnormal blood clotting and excessive bleeding. Therefore, it is important for the patient to be aware of any signs of bleeding or bruising so that prompt medical attention can be sought if necessary.

Explanation

The nurse caring for a patient diagnosed with disseminated intravascular coagulation syndrome would include in her patient teaching to observe for bleeding and bruising. This is because disseminated intravascular coagulation syndrome is a condition characterized by abnormal blood clotting and excessive bleeding. Therefore, it is important for the patient to be aware of any signs of bleeding or bruising so that prompt medical attention can be sought if necessary.

27. Following a CBC result that showed low values of RBCs, WBCs, and Platelets, it is assumed that a patient suffers from aplastic anemia. What test would confirm this diagnosis?

Bleeding Time

Lymph Node Biopsy

Bone Marrow Biopsy

Prothrombin Time

The most definitive test is a bone marrow biopsy. The bone marrow will be dead, with only pale, fatty, yellow bone marrow extracted.

Explanation

The most definitive test is a bone marrow biopsy. The bone marrow will be dead, with only pale, fatty, yellow bone marrow extracted.

28. A nurse monitoring a postoperative patient after a splenectomy notes that the patient's temperature is 102. What would be the appropriate action for the nurse to take?

Encourage TCDB

Notify the MD

Continue monitoring VS

Give the patient tylenol

MD should be notified for any temperature over 101. TCDB would be appropriate for patients with a low grade fever.

Explanation

MD should be notified for any temperature over 101. TCDB would be appropriate for patients with a low grade fever.

29. A 69 y/o male arrives to the emergency department with a flu-like symptoms and a fever. His wife states that he has had a splenectomy in 14 years ago. You would assess that the patient is most likely suffering from?

Overwhelming Post Splenectomy Infection

Food poisoning

Polycythemia

Hemophilia

OPSI begins with a fever and malaise and quickly progresses to sepsis and death within a few hours. Strep & Flu are the #1 causes

Explanation

OPSI begins with a fever and malaise and quickly progresses to sepsis and death within a few hours. Strep & Flu are the #1 causes

30. What equipment would be needed for the administration of a blood transfusion? (select all that apply)

Normal Saline

Lactated Ringers

Tubing with a filter

#18 or #20 gauge IV catheter

All blood is hung with Normal Saline and special tubing containing a filter that filters out harmful particles. An #18 or #20 gauge catheter is appropriate for the viscosity and amount to be transfused.

Explanation

All blood is hung with Normal Saline and special tubing containing a filter that filters out harmful particles. An #18 or #20 gauge catheter is appropriate for the viscosity and amount to be transfused.

Submit

31. What are IgE antibodies responsible for?

Provides passive immunity in newborns

First antibodies produces during an infection

Provide immunity following a vaccination or illness

Response to allergic reactions and cause release of histamine which cause an inflammatory response

IgE antibodies are important in allergic reactions. IgG antibodies cross the placenta to provide immunity to newborns and also provide immunity after a vaccine or illness. IgM antibodies are produced first during an infection.

Explanation

IgE antibodies are important in allergic reactions. IgG antibodies cross the placenta to provide immunity to newborns and also provide immunity after a vaccine or illness. IgM antibodies are produced first during an infection.

32. What would be the next course of action following a positive ELISA HIV test?

Advise the patient that they should begin to see symptoms within the next 2-3 weeks

Patient is started on antiretroviral agents

Western blot test is performed

None. A positive ELISA test is good news

The ELISA test is used to determine if HIV antibodies are present. A positive test will then need to beconfirmed by the Western Blot test which determines if HIV antigens are present.

Explanation

The ELISA test is used to determine if HIV antibodies are present. A positive test will then need to beconfirmed by the Western Blot test which determines if HIV antigens are present.

33. The nurse understands that the client with pernicious anemia will have which distinguishing laboratory finding?

Schilling's test, elevated

Intrinsic factor, absent

Sedimentation rate, 16 mm/hour

RBCs 5.0 million

Pernicious anemia is due to antibodies that destroy gastric parietal cells leading to a decreased production of intrinsic factor.

Explanation

Pernicious anemia is due to antibodies that destroy gastric parietal cells leading to a decreased production of intrinsic factor.

34. A nurse is giving discharge instruction to a patient that has had a splenectomy. What would NOT be part of the patient teaching given by the nurse?

Keep Flu & Pneumonia vaccinations current

Notify MD immediately if you have any new abdominal pain

The kidneys will now take over the functions of the spleen

You must notify the MD immediately if you have strep or flu

The liver and red bone marrow will remove RBCs from circulation. A person without a spleen is not more susceptible to infections such as flu and pneumonia. Abdominal pain may be due to formation of a fistula due to pancreatitis. Overwhelming Post Splenectomy Infection (OPSI) can occur up to 20 years post op which is caused by strep & flu

Explanation

The liver and red bone marrow will remove RBCs from circulation. A person without a spleen is not more susceptible to infections such as flu and pneumonia. Abdominal pain may be due to formation of a fistula due to pancreatitis. Overwhelming Post Splenectomy Infection (OPSI) can occur up to 20 years post op which is caused by strep & flu

35. Chemical markers that identify cells or molecules are called?

Antigens

Antibodies

Lymphocytes

Natural Killer Cells

The human body has "self" antigens that identify cells belonging to the body. If antigens of foreign cells do not match, they are recognized and destroyed.

Explanation

The human body has "self" antigens that identify cells belonging to the body. If antigens of foreign cells do not match, they are recognized and destroyed.

36. Which of the following results from a deficiency of factor VIII?

Sickle cell disease

Christmas disease

Hemophilia A

Hemophilia B

Hemophilia A results from a deficiency of factor VIII

Explanation

Hemophilia A results from a deficiency of factor VIII

37. The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. which of the following foods should be included in the diet?

Eggs

Lettuce

Citrus fruits

Cheese

Foods high in iron include eggs, organ and muscle meats, shellfish, shrimp, tuna, whole-grain and fortified cereals and breads, legumes, nuts, dried fruits, beans, oatmeal, and sweet potatoes

Explanation

Foods high in iron include eggs, organ and muscle meats, shellfish, shrimp, tuna, whole-grain and fortified cereals and breads, legumes, nuts, dried fruits, beans, oatmeal, and sweet potatoes

38. A patient receiving a blood transfusion begins to complain of low back pain. You observe that he begins to wheeze, has chills, and is SOB. The nurse would know that this is probably what type of reaction?

A normal reaction to receiving new blood

Hemolytic transfusion reaction

The blood is cold and needs to be warmed

Anaphylactic reaction

Signs and symptoms of a hemolytic transfusion reaction are low back or chest pain, hypotension, fever, chills, tachycardia, tachypnea, wheezing, edema, cough, hives, N/V. An anaphylactic reaction would result in narrowing of the bronchial, wheezing and respiratory arrest.

Explanation

Signs and symptoms of a hemolytic transfusion reaction are low back or chest pain, hypotension, fever, chills, tachycardia, tachypnea, wheezing, edema, cough, hives, N/V. An anaphylactic reaction would result in narrowing of the bronchial, wheezing and respiratory arrest.

39. A nurse would monitor for changes in which of the following when caring for a patient diagnosed with aplastic anemia?

Bleeding tendencies

Intake and output

Peripheral sensation

Bowel function

Aplastic anemia decreases the bone marrow production of RBCs, WBCs and platelets. Due to platelet decrease, the patient is at an increased risk for bleeding and bruising.

Explanation

Aplastic anemia decreases the bone marrow production of RBCs, WBCs and platelets. Due to platelet decrease, the patient is at an increased risk for bleeding and bruising.

40. How long does passive immunity last?

Temporary

For life

15 minutes

None of the above

Passive immunity is acquired through the transfer of antibodies from another source, such as through breastfeeding or receiving a vaccine. Unlike active immunity, which is developed by the body's own immune system, passive immunity is temporary because the transferred antibodies eventually break down and are eliminated from the body. Therefore, the correct answer is "Temporary."

Explanation

Passive immunity is acquired through the transfer of antibodies from another source, such as through breastfeeding or receiving a vaccine. Unlike active immunity, which is developed by the body's own immune system, passive immunity is temporary because the transferred antibodies eventually break down and are eliminated from the body. Therefore, the correct answer is "Temporary."

41. A 14 y/o that had chicken pox when she was 9 has developed what type of immunity?

Artificially acquired passive immunity

Naturally acquired passive immunity

Naturally acquired active immunity

Artificially acquired active immunity

The 14-year-old who had chickenpox when she was 9 has developed naturally acquired active immunity. This means that her immune system has produced antibodies in response to the infection, providing long-term protection against future chickenpox infections.

Explanation

The 14-year-old who had chickenpox when she was 9 has developed naturally acquired active immunity. This means that her immune system has produced antibodies in response to the infection, providing long-term protection against future chickenpox infections.

42. What type of anemia is due to bone marrow not producing adequate RBCs?

Polycythemia

Pernicious anemia

Aplastic anemia

Iron deficiency anemia

Also known as hypoplastic anemia, the bone marrow becomes fatty and is unable to produce the needed amount of RBCs. Pancytopenia is also a result.

Explanation

Also known as hypoplastic anemia, the bone marrow becomes fatty and is unable to produce the needed amount of RBCs. Pancytopenia is also a result.

43. A patient with a Hemoglobin level of 20 mg/dL, and a Hematocrit level of 61% will be undergoing phlebotomy treatment. What is the purpose of this treatment?

To remove RBCs and decrease the viscosity

To remove RBCs, WBCs and platelets which decreases the viscosity

To increase the amount of RBCs

To increase fluid volume

The removal of the concentration of RBC will decrease the thickness of the patients blood

Explanation

The removal of the concentration of RBC will decrease the thickness of the patients blood

44. A patient suspected of having leukemia has a CBC that shows there is an increase of immature WBC. What test would be performed to confirm the diagnosis?

Urinalysis

PTT

ELISA

Bone marrow aspiration

A bone marrow aspiration would be performed to confirm the diagnosis of leukemia in a patient with an increase of immature white blood cells (WBC) in their complete blood count (CBC). This test involves taking a sample of the patient's bone marrow, usually from the hip bone, and examining it under a microscope to assess the presence of abnormal cells or other signs of leukemia. This procedure is considered the gold standard for diagnosing leukemia and can provide important information about the type and stage of the disease.

Explanation

A bone marrow aspiration would be performed to confirm the diagnosis of leukemia in a patient with an increase of immature white blood cells (WBC) in their complete blood count (CBC). This test involves taking a sample of the patient's bone marrow, usually from the hip bone, and examining it under a microscope to assess the presence of abnormal cells or other signs of leukemia. This procedure is considered the gold standard for diagnosing leukemia and can provide important information about the type and stage of the disease.

45. How would a nurse administer clotting factors to a patient with severe hemophilia?

Mix into applesauce and give to the patient PO

Reconstitute with water and administer via IV

Subcutaneous injection

Sublingual

Clotting factors are available as a freeze-dried powder that must be reconstituted with water.

Explanation

Clotting factors are available as a freeze-dried powder that must be reconstituted with water.

46. A patient has an order for a unit of packed RBCs to be administered. At 0600 the transfusion is started. At 1000, it is noted that the IV line has clotted with only 80% of the transfusion complete. What intervention should the nurse take?

Call the blood bank and order another unit of blood

Flush the line with NS and continue to infuse the remaining 20%

Discontinue the blood infusion, notify the blood bank and document the findings

Start another IV line and continue to infuse the remaining 20%

Blood must be infused within 4 hours or be discontinued. Blood and packaging should be returned to the blood bank.

Explanation

Blood must be infused within 4 hours or be discontinued. Blood and packaging should be returned to the blood bank.

47. A patient is pre-op for a splenectomy. What would most likely be administered prior to surgery?

Blood transfusion

Normal saline

Vitamin K

Both A and C

Pre-op care for a patient having a splenectomy include blood transfusion if they anemic and vitamin K for bleeding.

Explanation

Pre-op care for a patient having a splenectomy include blood transfusion if they anemic and vitamin K for bleeding.

48. The destruction of platelets by the immune system that results in an increased risk for bleeding is called?

Anemia

Leukemia

Idopathic Thrombocytopenic Purpura

Hemophilia

ITP is an immune system dysfunction that results in antibodies causing the destruction of platelets

Explanation

ITP is an immune system dysfunction that results in antibodies causing the destruction of platelets

49. The hematologic disorder in which there is a overabundance of red blood cells causing the blood to become thick is known as?

Hemophilia

Disseminated Intravascular Coagulation

Polycythemia

Multiple Myeloma

Poly = many, cyt = cells, emia = in the blood

Explanation

Poly = many, cyt = cells, emia = in the blood

50. Which abnormal test result would a nurse interpret as being and indication of hemophilia?

Bone marrow biopsy

CBC

Clot retraction test

Partial Thromboplastin Time (PTT)

Hemophilia results from a lack of clotting factor. If clotting factor is deficient, PTT is prolonged

Explanation

Hemophilia results from a lack of clotting factor. If clotting factor is deficient, PTT is prolonged

51. A patient's CBC results show that she has a RBC level of 3.2 million/mm3. The nurse knows that this is called?

Leukopenia

Polycythemia

Leukemia

Erythropenia

Erythropenia is the decrease in RBC level. Leukopenia is the decrease of WBCs. Polycythemia is the excess of RBCs. Leukemia is an increase in immature WBCs

Explanation

Erythropenia is the decrease in RBC level. Leukopenia is the decrease of WBCs. Polycythemia is the excess of RBCs. Leukemia is an increase in immature WBCs

52. Which abnormal laboratory tests would the LPN expect to see in a patient with Disseminated Intravascular Coagulation syndrome?

Decrease PT

Elevated platelet

Elevated PT and PTT

Elevated RBC

Due to a decrease in clotting factor and platelets, the time that it will take the blot to clot will be longer. PT and PTT test will be elevated.

Explanation

Due to a decrease in clotting factor and platelets, the time that it will take the blot to clot will be longer. PT and PTT test will be elevated.

53. Which of the following is a sign or symptom of pernicious anemia?

Glossitis

Itching

Kyphosis

Lower back spasms

Glossitis refers to the inflammation of the tongue, which can be a sign or symptom of pernicious anemia. Pernicious anemia is a condition characterized by a deficiency in vitamin B12, which can lead to various symptoms including glossitis. The inflammation of the tongue can cause it to appear swollen, red, and smooth. It may also be painful and can affect a person's ability to speak and eat. Therefore, glossitis is a relevant sign or symptom of pernicious anemia.

Explanation

Glossitis refers to the inflammation of the tongue, which can be a sign or symptom of pernicious anemia. Pernicious anemia is a condition characterized by a deficiency in vitamin B12, which can lead to various symptoms including glossitis. The inflammation of the tongue can cause it to appear swollen, red, and smooth. It may also be painful and can affect a person's ability to speak and eat. Therefore, glossitis is a relevant sign or symptom of pernicious anemia.

54. Which of the following is NOT a late symptom of aplastic anemia?

Tachycardia and heart failure

Weakness and fatigue

Ecchymoses and petechiae

Infection and death

Weakness and fatigue are both early signs of anemia due to low O2 in the blood. Tachycardia and heart failure result from insufficient O2 in blood. Ecchymoses and petechiae results from decreased platelet count. Infection leading to death may be a result of decreased WBC count.

Explanation

Weakness and fatigue are both early signs of anemia due to low O2 in the blood. Tachycardia and heart failure result from insufficient O2 in blood. Ecchymoses and petechiae results from decreased platelet count. Infection leading to death may be a result of decreased WBC count.

55. Excessive clotting which leads to a decrease of clotting factors and platelets that results in excessive bleeding is known as what?

Disseminated Intravascular Coagulation

Hemophilia

Anemia

Idiopathic Thrombocytopenia Purpura

Due to the depletion of clotting factors and platelets, new clots are unable to form resulting in excessive bleeding.

Explanation

Due to the depletion of clotting factors and platelets, new clots are unable to form resulting in excessive bleeding.

56. A patient suffering from dehydration would be expected to have which abnormal CBC result?

63% Hematocrit level

12 g/100 mL Hemoglobin level

4.2 million/mm3 RBC level

39% Hematocrit level

The normal Hematocrit level is 38 - 49%. An elevated percentage of hematocrit would indicate dehydration.

Explanation

The normal Hematocrit level is 38 - 49%. An elevated percentage of hematocrit would indicate dehydration.

57. A patient with AIDS is experiencing shortness of breath related to Pneumocystis jiroveci pneumonia. Which measure should the nurse include in the plan of care to assist the patient in performing activities of daily living?

Provide supportive care with hygiene needs

Provide meals and snakes with high-protein, high calorie, and high-nutritional value

Provide small, frequent meals

Offer low microbial foods

Providing supportive care with hygiene needs reduces the patient's physical and emotional energy demands and conserves energy resources for breathing.

Explanation

Providing supportive care with hygiene needs reduces the patient's physical and emotional energy demands and conserves energy resources for breathing.

58. What are the function of Helper T cells (CD4) in humoral immunity?

Helper T cells stimulate B cells to divide and become specialized

Helper T cells lyse infected or foreign cells

Helper T cells attach to B cells to create a super cell

Helper T cells are not involved in humoral immunity

Humoral immunity involves both T cells and B cells. Killer T cells lyse foreign antigens

Explanation

Humoral immunity involves both T cells and B cells. Killer T cells lyse foreign antigens

59. A vegetarian patient meets with a nutritional counselor for anemia. What statement indicates that further counseling is needed?

"I can add dried fruit to cereal and baked goods."

"I should cook tomato-based foods in iron pots."

"I can drink coffee or tea with meals."

"I should add vitamin C to all my meals."

Coffee and tea increase GI motility and inhibit absorption of nonheme iron. Dried fruits are a nonanimal iron source. Cooking acid-based foods in iron cookware adds iron to the diet. Iron absorption is increased when foods high in vitamin C are consumed.

Explanation

Coffee and tea increase GI motility and inhibit absorption of nonheme iron. Dried fruits are a nonanimal iron source. Cooking acid-based foods in iron cookware adds iron to the diet. Iron absorption is increased when foods high in vitamin C are consumed.

60. A patient diagnosed with polycythemia is scheduled for a phlebotomy treatment. Which statement made by the patient indicates that further teaching is necessary?

"I will need phlebotomy treatment every other day until my condition is under control"

"I may need chemotherapy or radiation therapy after treatments"

"I should take low dose aspirin "

"I will only need to have this treatment done once"

Patients that undergo phlebotomy treatment will have 350-500 mL of blood removed every other day until their hematocrit level is 45% or below and then every 2-3 months. Chemotherapy & radiation therapy will be needed to control bone marrow production of WBC and platelets. Low-dose aspirin is given to reduce the risk of blood clots.

Explanation

Patients that undergo phlebotomy treatment will have 350-500 mL of blood removed every other day until their hematocrit level is 45% or below and then every 2-3 months. Chemotherapy & radiation therapy will be needed to control bone marrow production of WBC and platelets. Low-dose aspirin is given to reduce the risk of blood clots.

61. Which of the following is NOT a function of blood?

Transportation

Filter pathogens

Body temperature regulation

Provide body protection

The lymphatic system is responsible for filtering pathogens. Blood transports oxygen, nutrients, and waste products. Blood regulates body temperature. Blood also is involved with providing transport of WBCs and platelets for protection against foreign antigens and bleeding.

Explanation

The lymphatic system is responsible for filtering pathogens. Blood transports oxygen, nutrients, and waste products. Blood regulates body temperature. Blood also is involved with providing transport of WBCs and platelets for protection against foreign antigens and bleeding.

62. A nurse devises a teaching plan for a patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance?

Eat animal protein and dark leafy vegetables each day

Avoid exposure to others with acute infection

Practice yoga and meditation to decrease stress and anxiety

Get 8 hours of sleep at night and take naps during the day

Patients with aplastic anemia are severely immunocompromised and at risk for infection and death related to bone marrow suppression. Strict aseptic technique and Isolation precautions to prevent infection are highest priority

Explanation

Patients with aplastic anemia are severely immunocompromised and at risk for infection and death related to bone marrow suppression. Strict aseptic technique and Isolation precautions to prevent infection are highest priority

63. A patient with a scheduled surgery in which blood loss is expected would most likely receive what type of blood transfusion?

Frozen red blood cells

Packed red blood cells

Plasma

Platelets

Frozen red blood cells are taken from the patient and saved for surgery in order to help prevent hemolytic transfusion reaction. This process is called auto transfusion

Explanation

Frozen red blood cells are taken from the patient and saved for surgery in order to help prevent hemolytic transfusion reaction. This process is called auto transfusion

64. A nurse is assisting a patient diagnosed with pernicious anemia in selecting dinner. What would supply the best source of vitamin B12?

Whole grains

Green leafy vegetables

Broccoli and Brussels sprouts

Meats and dairy products

Good sources of vitamin B12 include meats and dairy products. whole grains are a good source of thiamine. Green leafy vegetables are a good source of niacin and folate. Broccoli and brussel sprouts are a good source of vitamin C

Explanation

Good sources of vitamin B12 include meats and dairy products. whole grains are a good source of thiamine. Green leafy vegetables are a good source of niacin and folate. Broccoli and brussel sprouts are a good source of vitamin C

65. Exposure to a small amount of live antigens or a large number of dead antigens results in this type of immunity?

Artificially acquired passive immunity

Artificially acquired active immunity

Naturally acquired passive immunity

Naturally acquired active immunity

Artificially acquired active immunity refers to the immunity that is developed when a person is intentionally exposed to a small amount of live antigens or a large number of dead antigens. This exposure stimulates the person's immune system to produce antibodies and memory cells, providing long-term protection against future infections. This type of immunity is different from naturally acquired active immunity, which occurs when a person is exposed to antigens through natural infection.

Explanation

Artificially acquired active immunity refers to the immunity that is developed when a person is intentionally exposed to a small amount of live antigens or a large number of dead antigens. This exposure stimulates the person's immune system to produce antibodies and memory cells, providing long-term protection against future infections. This type of immunity is different from naturally acquired active immunity, which occurs when a person is exposed to antigens through natural infection.

66. What would determine if a Western Blot test is positive?

Western Blot is positive only after confirmation using the ELISA test

At least one HIV antigen is present

HIV antibodies are present

The presence of two or more HIV antigens

A positive Western Blot is determined if there are at least two of more HIV antigens present. Western Blot is used as a confirmation test.

Explanation

A positive Western Blot is determined if there are at least two of more HIV antigens present. Western Blot is used as a confirmation test.

67. Which cells are responsible for producing antibodies?

T cells

B cells and T cells

Natural killer cells

B cells

B cells that become plasma cells are capable of producing millions of different antibodies. T cells directly attach a foreign antigen. Natural killer cells release toxins that result in cytolysis.

Explanation

B cells that become plasma cells are capable of producing millions of different antibodies. T cells directly attach a foreign antigen. Natural killer cells release toxins that result in cytolysis.

68. A 3 day post-op patient has a hematocrit level of 34%. The nurse observes that the hematocrit level the prior day was 36%. RBC and hemoglobin levels have remained at 4.5 million/mm3 and 11.9 g/dL, respectively. Which intervention is appropriate?

Check the dressing and drains for bleeding

Call the physician

Continue to monitor vital signs

Start O2 at 2L/min

The decrease in hematocrit level is a normal response. Immediately after surgery a patient's hematocrit level indicated a false high value due to the body compensating for the sudden loss of fluid. By the 3rd day post-op bleeding is not likely.

Explanation

The decrease in hematocrit level is a normal response. Immediately after surgery a patient's hematocrit level indicated a false high value due to the body compensating for the sudden loss of fluid. By the 3rd day post-op bleeding is not likely.

69. Which of the following is a late symptom of polycythemia vera?

Headache

Dizziness

Pruritus

Shortness of breath

Pruritus is a late symptom that results from abnormal histamine metabolism. Headache, dizziness and shortness of breath are early signs

Explanation

Pruritus is a late symptom that results from abnormal histamine metabolism. Headache, dizziness and shortness of breath are early signs

70. A patient with hemophilia would receive what type of transfusion?

Frozen red blood cells

Cryoprecipitates

Platelets

Plasma

Cryoprecipitates have a concentration of specific clotting factors that are used for patients with hemophilia

Explanation

Cryoprecipitates have a concentration of specific clotting factors that are used for patients with hemophilia

71. Desmopressin is ordered to help stimulate the release of more clotting factors. How is it administered?

PO

Injection or nasal inhalation

Sublingual

IV

Desmopressin is administered through injection or nasal inhalation because it helps stimulate the release of more clotting factors. These methods allow for direct delivery of the medication into the bloodstream or nasal passages, where it can quickly and effectively stimulate the release of clotting factors. The sublingual route is not appropriate for desmopressin administration as it is not designed to be absorbed through the mucous membranes under the tongue. IV administration may be used in certain cases, but injection or nasal inhalation are the preferred routes for desmopressin.

Explanation

Desmopressin is administered through injection or nasal inhalation because it helps stimulate the release of more clotting factors. These methods allow for direct delivery of the medication into the bloodstream or nasal passages, where it can quickly and effectively stimulate the release of clotting factors. The sublingual route is not appropriate for desmopressin administration as it is not designed to be absorbed through the mucous membranes under the tongue. IV administration may be used in certain cases, but injection or nasal inhalation are the preferred routes for desmopressin.

72. What observation of a patient diagnosed with hemophilia would indicate they are suffering from hemarthrosis?

Reluctance to move a body part

Cool, pale, clammy extremity

Eccymosis formation around joint

Instability of a long bone in passive movement

Bleeding into the joint causes pain and tenderness resulting in decreased range of motion. bleeding into the joints would cause the are to be warm, swollen and immobile. Ecchymosis around joints is difficult to assess. Bone instability is not associated with hemarthrosis.

Explanation

Bleeding into the joint causes pain and tenderness resulting in decreased range of motion. bleeding into the joints would cause the are to be warm, swollen and immobile. Ecchymosis around joints is difficult to assess. Bone instability is not associated with hemarthrosis.

73. The LPN is caring for a patient diagnosed with pernicious anemia. Which nursing interventions would be appropriate? (select all that apply)

Monitor O2 Sat & keep HOB elevated

Keep patient on isolation precautions

Assist with ambulation

Provide frequent rest periods

Provide iron supplements

Patients O2 should be monitored due to lack of oxygen in the blood and tissues. Fatigue due to lack of oxygen will occur, so ensure that patient has frequent rest periods. Assisting with ambulation will help to prevent falls due to fatigue.

Explanation

Patients O2 should be monitored due to lack of oxygen in the blood and tissues. Fatigue due to lack of oxygen will occur, so ensure that patient has frequent rest periods. Assisting with ambulation will help to prevent falls due to fatigue.

Submit

74. Who would be more likely to develop acute idiopathic thrombocytopenic purpura?

A 25 y/o man with the flu

A 5 y/o girl recovering from chickenpox

A 52 y/o menopausal woman

A 72 y/o man with pneumonia

Acute ITP usually affects children between the ages of 2-6 after an acute viral illness such as chickenpox or rubella. Chronic ITP usually affects adults over the age of 60.

Explanation

Acute ITP usually affects children between the ages of 2-6 after an acute viral illness such as chickenpox or rubella. Chronic ITP usually affects adults over the age of 60.

75. Which laboratory results would you expect to see an abnormal result in a person with ITP? (select all that apply)

Platelet count less than 20,000 mm3

Prolonged bleeding time

Elevated Hematocrit

Decreased Hemoglobin

ITP is due to platelet destruction by the immune system. A decrease in platelets would be expected. Bleeding time would be longer due to the decrease in clot forming platelets.

Explanation

ITP is due to platelet destruction by the immune system. A decrease in platelets would be expected. Bleeding time would be longer due to the decrease in clot forming platelets.

Submit

76. A nurse is going to administer an epogen injection. What laboratory value should the nurse assess before giving the injection?

Hematocrit

Partial thromboplastin time

Hemoglobin

Prothrombin time

Epogen is a form of erythropoietin, which stimulated production of RBCs which would cause the hematocrit level to rise.

Explanation

Epogen is a form of erythropoietin, which stimulated production of RBCs which would cause the hematocrit level to rise.