Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 31

Chapter 31: Nursing Management: Hematologic Problems
Test Bank
MULTIPLE CHOICE
1. A 62-year old man with chronic anemia is experiencing increased fatigue and occasional
palpitations at rest. The nurse would expect the patients laboratory findings to include
a. a hematocrit (Hct) of 38%.
b. an RBC count of 4,500,000/mL.
c. normal red blood cell (RBC) indices.
d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).
ANS: D
The patients clinical manifestations indicate moderate anemia, which is consistent with a Hgb
of 6 to 10 g/dL. The other values are all within the range of normal.
DIF: Cognitive Level: Understand (comprehension) REF: 633

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. Which menu choice indicates that the patient understands the nurses teaching about best
dietary choices for iron-deficiency anemia?
a. Omelet and whole wheat toast
b. Cantaloupe and cottage cheese
c. Strawberry and banana fruit plate
d. Cornmeal muffin and orange juice
ANS: A
Eggs and whole grain breads are high in iron. The other choices are appropriate for other
nutritional deficiencies but are not the best choice for a patient with iron-deficiency anemia.
DIF: Cognitive Level: Apply (application) REF: 637

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
3. A patient who is receiving methotrexate for severe rheumatoid arthritis develops a

megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral
intake of
a. iron.
b. folic acid.
c. cobalamin (vitamin B12).
d. ascorbic acid (vitamin C).
ANS: B
Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid
supplements is the usual treatment. The other nutrients would not correct folic acid deficiency,
although they would be used to treat other types of anemia.

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
4. A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the
patient understands the teaching about the disorder when the patient states, I
a. need to start eating more red meat and liver.
b. will stop having a glass of wine with dinner.
c. could choose nasal spray rather than injections of vitamin B12.
d. will need to take a proton pump inhibitor like omeprazole (Prilosec).
ANS: C
Because pernicious anemia prevents the absorption of vitamin B12, this patient requires
injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin
deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods
rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the
vitamin.

5. An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is
to
a. provide a diet high in vitamin K.
b. alternate periods of rest and activity.
c. teach the patient how to avoid injury.
d. place the patient on protective isolation.
ANS: B
Nursing care for patients with anemia should alternate periods of rest and activity to
encourage activity without causing undue fatigue. There is no indication that the patient has a
bleeding disorder, so a diet high in vitamin K or teaching about how to avoid injury is not
needed. Protective isolation might be used for a patient with aplastic anemia, but it is not
indicated for hemolytic anemia.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
6. Which patient statement to the nurse indicates a need for additional instruction about taking
oral ferrous sulfate?
a. I will call my health care provider if my stools turn black.
b. I will take a stool softener if I feel constipated occasionally.
c. I should take the iron with orange juice about an hour before eating.
d. I should increase my fluid and fiber intake while I am taking iron tablets.
ANS: A
It is normal for the stools to appear black when a patient is taking iron, and the patient should
not call the doctor about this. The other patient statements are correct.

7. Which collaborative problem will the nurse include in a care plan for a patient admitted to the
hospital with idiopathic aplastic anemia?
a. Potential complication: seizures
b. Potential complication: infection
c. Potential complication: neurogenic shock
d. Potential complication: pulmonary edema
ANS: B
Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection
and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema.

8. It is important for the nurse providing care for a patient with sickle cell crisis to
a. limit the patients intake of oral and IV fluids.
b. evaluate the effectiveness of opioid analgesics.
c. encourage the patient to ambulate as much as tolerated.
d. teach the patient about high-protein, high-calorie foods.
ANS: B
Pain is the most common clinical manifestation of a crisis and usually requires large doses of
continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and
improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are
instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not
emphasized.
DIF: Cognitive Level: Apply (application) REF: 645-646

9. Which statement by a patient indicates good understanding of the nurses teaching about
prevention of sickle cell crisis?
a. Home oxygen therapy is frequently used to decrease sickling.
b. There are no effective medications that can help prevent sickling.
c. Routine continuous dosage narcotics are prescribed to prevent a crisis.
d. Risk for a crisis is decreased by having an annual influenza vaccination.
ANS: D
Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus
influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered.
Although continuous dose opioids and oxygen may be administered during a crisis, patients
do not receive these therapies to prevent crisis. Hydroxyurea (Hydrea) is a medication used to
decrease the number of sickle cell crises.

10. Which instruction will the nurse plan to include in discharge teaching for the patient admitted
with a sickle cell crisis?
a. Take a daily multivitamin with iron.
b. Limit fluids to 2 to 3 quarts per day.
c. Avoid exposure to crowds when possible.
d. Drink only two caffeinated beverages daily.
ANS: C
Exposure to crowds increases the patients risk for infection, the most common cause of sickle
cell crisis. There is no restriction on caffeine use. Iron supplementation is generally not
recommended. A high-fluid intake is recommended.
11. The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse
will plan to check the laboratory results for the
a. Schilling test.
b. bilirubin level.
c. stool occult blood test.
d. gastric analysis testing.
ANS: B
Jaundice is caused by the elevation of bilirubin level associated with red blood cell (RBC)
hemolysis. The other tests would not be helpful in monitoring or treating a hemolytic anemia.

12. A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein
thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her
platelet level drops to 110,000/L. Which action will the nurse include in the plan of care?
a. Use low-molecular-weight heparin (LMWH) only.
b. Administer the warfarin (Coumadin) at the scheduled time.
c. Teach the patient about the purpose of platelet transfusions.
d. Discontinue heparin and flush intermittent IV lines using normal saline.
ANS: D
All heparin is discontinued when the HIT is diagnosed. The patient should be instructed to
never receive heparin or LMWH. Warfarin is usually not given until the platelet count has
returned to 150,000/L. The platelet count does not drop low enough in HIT for a platelet
transfusion, and platelet transfusions increase the risk for thrombosis.

13. A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia
vera is to
a. place the patient on bed rest.
b. administer iron supplements.
c. avoid use of aspirin products.
d. monitor fluid intake and output.
ANS: D
Monitoring hydration status is important during an acute exacerbation because the patient is at
risk for fluid overload or underhydration. Aspirin therapy is used to decrease risk for
thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis
(DVT). Iron is contraindicated in patients with polycythemia vera.

14. Which intervention will be included in the nursing care plan for a patient with immune
thrombocytopenic purpura (ITP)?
a. Assign the patient to a private room.
b. Avoid intramuscular (IM) injections.
c. Use rinses rather than a soft toothbrush for oral care.
d. Restrict activity to passive and active range of motion.
ANS: B
IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft
toothbrush can be used for oral care. There is no need to restrict activity or place the patient in
a private room.

TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
15. Which laboratory result will the nurse expect to show a decreased value if a patient develops
heparin-induced thrombocytopenia (HIT)?
a. Prothrombin time
b. Erythrocyte count
c. Fibrinogen degradation products
d. Activated partial thromboplastin time
ANS: D
Platelet aggregation in HIT causes neutralization of heparin, so that the activated partial
thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic
levels. The other data will not be affected by HIT.

16. The nurse caring for a patient with type A hemophilia being admitted to the hospital with
severe pain and swelling in the right knee will
a. immobilize the joint.
b. apply heat to the knee.
c. assist the patient with light weight bearing.
d. perform passive range of motion to the knee.
ANS: A
The initial action should be total rest of the knee to minimize bleeding. Ice packs are used to
decrease bleeding. Range of motion (ROM) and weight-bearing exercise are contraindicated
initially, but after the bleeding stops, ROM and physical therapy are started.

17. A 28-year-old man with von Willebrand disease is admitted to the hospital for minor knee
surgery. The nurse will review the coagulation survey to check the
a. platelet count.
b. bleeding time.
c. thrombin time.
d. prothrombin time.
ANS: B
The bleeding time is affected by von Willebrand disease. Platelet count, prothrombin time,
and thrombin time are normal in von Willebrand disease.
DIF: Cognitive Level: Understand (comprehension) REF: 656

18. A routine complete blood count indicates that an active 80-year-old man may have
myelodysplastic syndrome. The nurse will plan to teach the patient about
a. blood transfusion
b. bone marrow biopsy.
c. filgrastim (Neupogen) administration.
d. erythropoietin (Epogen) administration.
ANS: B
Bone marrow biopsy is needed to make the diagnosis and determine the specific type of
myelodysplastic syndrome. The other treatments may be necessary if there is progression of
the myelodysplastic syndrome, but the initial action for this asymptomatic patient will be a
bone marrow biopsy.

19. Which action will the admitting nurse include in the care plan for a 30-year old woman who is
neutropenic?
a. Avoid any injections.
b. Check temperature every 4 hours.
c. Omit fruits or vegetables from the diet.
d. Place a No Visitors sign on the door.
ANS: B
The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although
unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or
cooked are acceptable. Injections may be required for administration of medications such as
filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable
diseases should be avoided, but a no visitors policy is not needed.

20. Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is
effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy?
a. Platelet count
b. Reticulocyte count
c. Total lymphocyte count
d. Absolute neutrophil count
ANS: D
Filgrastim increases the neutrophil count and function in neutropenic patients. Although total
lymphocyte, platelet, and reticulocyte counts also are important to monitor in this patient, the
absolute neutrophil count is used to evaluate the effects of filgrastim.
DIF: Cognitive Level: Apply (application) REF: 660 | 662
21. A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the
planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate?
a. If you do not want to have chemotherapy, other treatment options include stem
cell transplantation.
b. The side effects of chemotherapy are difficult, but AML frequently goes into
remission with chemotherapy.
c. The decision about treatment is one that you and the doctor need to make rather
than asking what I would do.
d. You dont need to make a decision about treatment right now because leukemias
in adults tend to progress quite slowly.
ANS: B
This response uses therapeutic communication by addressing the patients question and giving
accurate information. The other responses either give inaccurate information or fail to address
the patients question, which will discourage the patient from asking the nurse for information.
DIF: Cognitive Level: Apply (application) REF: 668 | 669

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
22. A patient with a history of a transfusion-related acute lung injury (TRALI) is to receive a
transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the
risk for TRALI for this patient?
a. Infuse the PRBCs slowly over 4 hours.
b. Transfuse only leukocyte-reduced PRBCs.
c. Administer the scheduled diuretic before the transfusion.
d. Give the PRN dose of antihistamine before the transfusion.
ANS: B
TRALI is caused by a reaction between the donor and the patient leukocytes that causes
pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory
problems caused by circulatory overload or by allergic reactions, but they will not prevent
TRALI.

23. A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with
a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the
patient with a treatment decision is to
a. emphasize the positive outcomes of a bone marrow transplant.
b. discuss the need for adequate insurance to cover post-HSCT care.
c. ask the patient whether there are any questions or concerns about HSCT.
d. explain that a cure is not possible with any other treatment except HSCT.
ANS: C
Offering the patient an opportunity to ask questions or discuss concerns about HSCT will
encourage the patient to voice concerns about this treatment and also will allow the nurse to
assess whether the patient needs more information about the procedure. Treatment of AML
using chemotherapy is another option for the patient. It is not appropriate for the nurse to ask
the patient to consider insurance needs in making this decision.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
24. Which action will the nurse include in the plan of care for a 72-year-old woman admitted with
multiple myeloma?
a.Monitor fluid intake and output.
b.Administer calcium supplements.
c.Assess lymph nodes for enlargement.
d.Limit weight bearing and ambulation.
ANS: A
A high fluid intake and urine output helps prevent the complications of kidney stones caused
by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal
tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph
nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the
patients calcium level and are not used.

25. An appropriate nursing intervention for a patient with non-Hodgkins lymphoma whose
platelet count drops to 18,000/L during chemotherapy is to
a. check all stools for occult blood.
b. encourage fluids to 3000 mL/day.
c. provide oral hygiene every 2 hours.
d. check the temperature every 4 hours.
ANS: A
Because the patient is at risk for spontaneous bleeding, the nurse should check stools for
occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is
important, but it is not necessary to provide oral care every 2 hours. The low platelet count
does not increase risk for infection, so frequent temperature monitoring is not indicated.

26. A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count
of 850/L while receiving outpatient chemotherapy. Which action by the outpatient clinic
nurse is most appropriate?
a. Discuss the need for hospital admission to treat the neutropenia.
b. Teach the patient to administer filgrastim (Neupogen) injections.
c. Plan to discontinue the chemotherapy until the neutropenia resolves.
d. Order a high-efficiency particulate air (HEPA) filter for the patients home.
ANS: B
The patient may be taught to self-administer filgrastim injections. Although chemotherapy
may be stopped with severe neutropenia (neutrophil count less than 500/L), administration of
filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at
higher risk for infection when exposed to other patients in the hospital. HEPA filters are
expensive and are used in the hospital, where the number of pathogens is much higher than in
the patients home environment.

27. Which information obtained by the nurse caring for a patient with thrombocytopenia should
be immediately communicated to the health care provider?
a. The platelet count is 52,000/L.
b. The patient is difficult to arouse.
c. There are purpura on the oral mucosa.
d. There are large bruises on the patients back.
ANS: B
Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life threatening
and requires immediate action. The other information should be documented and reported but
would not be unusual in a patient with thrombocytopenia.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
28. The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a
patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate
to unlicensed assistive personnel (UAP)?
a. Verify the patient identification (ID) according to hospital policy.
b. Obtain the temperature, blood pressure, and pulse before the transfusion.
c. Double-check the product numbers on the PRBCs with the patient ID band.
d. Monitor the patient for shortness of breath or chest pain during the transfusion.
ANS: B
UAP education includes measurement of vital signs. UAP would report the vital signs to the
registered nurse (RN). The other actions require more education and a larger scope of practice
and should be done by licensed nursing staff members.

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
29. A postoperative patient receiving a transfusion of packed red blood cells develops chills,
fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the
transfusion, what action should the nurse take?
a. Draw blood for a new crossmatch.
b. Send a urine specimen to the laboratory.
c. Administer PRN acetaminophen (Tylenol).
d. Give the PRN diphenhydramine (Benadryl).
ANS: C
The patients clinical manifestations are consistent with a febrile, nonhemolytic transfusion
reaction. The transfusion should be stopped and antipyretics administered for the fever as
ordered. A urine specimen is needed if an acute hemolytic reaction is suspected.
Diphenhydramine (Benadryl) is used for allergic reactions. This type of reaction does not
indicate incorrect crossmatching.

30. A patient in the emergency department complains of back pain and difficulty breathing 15
minutes after a transfusion of packed red blood cells is started. The nurses first action should
be to
a. administer oxygen therapy at a high flow rate.
b. obtain a urine specimen to send to the laboratory.
c. notify the health care provider about the symptoms.
d. disconnect the transfusion and infuse normal saline.
ANS: D
The patients symptoms indicate a possible acute hemolytic reaction caused by the
transfusion. The first action should be to disconnect the transfusion and infuse normal saline.
The other actions also are needed but are not the highest priority.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
31. Which patient should the nurse assign as the roommate for a patient who has aplastic anemia?
a. A patient with chronic heart failure
b. A patient who has viral pneumonia
c. A patient who has right leg cellulitis
d. A patient with multiple abdominal drains
ANS: A
Patients with aplastic anemia are at risk for infection because of the low white blood cell
production associated with this type of anemia, so the nurse should avoid assigning a
roommate with any possible infectious process.

OBJ: Special Questions: Multiple Patients
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
32. Which patient requires the most rapid assessment and care by the emergency department
nurse?
a. The patient with hemochromatosis who reports abdominal pain
b. The patient with neutropenia who has a temperature of 101.8 F
c. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours
d. The patient with thrombocytopenia who has oozing after having a tooth extracted
ANS: B
A neutropenic patient with a fever is assumed to have an infection and is at risk for rapidly
developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed.
The other patients also require rapid assessment and care but not as urgently as the
neutropenic patient.
DIF: Cognitive Level: Analyze (analysis) REF: 662-663

OBJ: Special Questions: Multiple Patients; Prioritization
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
33. A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a
platelet transfusion. Which information indicates that the nurse should consult with the health
care provider before obtaining and administering platelets?
a. The platelet count is 42,000/mL.
b. Petechiae are present on the chest.
c. Blood pressure (BP) is 94/56 mm Hg.
d. Blood is oozing from the venipuncture site.
ANS: A
Platelet transfusions are not usually indicated until the platelet count is below 10,000 to
20,000/mL unless the patient is actively bleeding. Therefore the nurse should clarify the order
with the health care provider before giving the transfusion. The other data all indicate that
bleeding caused by ITP may be occurring and that the platelet transfusion is appropriate.

34. Which problem reported by a patient with hemophilia is most important for the nurse to
communicate to the physician?
a.Leg bruises
b.Tarry stools
c.Skin abrasions
d.Bleeding gums
ANS: B
Melena is a sign of gastrointestinal bleeding and requires collaborative actions such as
checking hemoglobin and hematocrit and administration of coagulation factors. The other
problems indicate a need for patient teaching about how to avoid injury, but are not indicators
of possible serious blood loss.

35. A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in
the stools. Which action is most important for the nurse to take?
a. Avoid venipunctures.
b. Notify the patients physician.
c. Apply sterile dressings to the sites.
d. Give prescribed proton-pump inhibitors.
ANS: B
The patients new onset of bleeding and diagnosis of sepsis suggest that disseminated
intravascular coagulation (DIC) may have developed, which will require collaborative actions
such as diagnostic testing, blood product administration, and heparin administration. The other
actions also are appropriate, but the most important action should be to notify the physician so
that DIC treatment can be initiated rapidly.

36. A patient with possible disseminated intravascular coagulation arrives in the emergency
department with a blood pressure of 82/40, temperature 102 F (38.9 C), and severe back
pain. Which physician order will the nurse implement first?
a. Administer morphine sulfate 4 mg IV.
b. Give acetaminophen (Tylenol) 650 mg.
c. Infuse normal saline 500 mL over 30 minutes.
d. Schedule complete blood count and coagulation studies.
ANS: C
The patients blood pressure indicates hypovolemia caused by blood loss and should be
addressed immediately to improve perfusion to vital organs. The other actions also are
appropriate and should be rapidly implemented, but improving perfusion is the priority for
this patient.

37. Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to
delegate to a licensed practical/vocational nurse (LPN/LVN)?
a. Assessing the patient for signs and symptoms of infection
b. Teaching the patient the purpose of neutropenic precautions
c. Administering subcutaneous filgrastim (Neupogen) injection
d. Developing a discharge teaching plan for the patient and family
ANS: C
Administration of subcutaneous medications is included in LPN/LVN education and scope of
practice. Patient education, assessment, and developing the plan of care require RN level
education and scope of practice.

OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
38. Several patients call the outpatient clinic and ask to make an appointment as soon as possible.
Which patient should the nurse schedule to be seen first?
a. 44-year-old with sickle cell anemia who says my eyes always look sort of
yellow
b. 23-year-old with no previous health problems who has a nontender lump in the
axilla
c. 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic
fatigue
d. 19-year-old with hemophilia who wants to learn to self-administer factor VII
replacement
ANS: B
The patients age and presence of a nontender axillary lump suggest possible lymphoma,
which needs rapid diagnosis and treatment. The other patients have questions about treatment
or symptoms that are consistent with their diagnosis but do not need to be seen urgently.
DIF: Cognitive Level: Analyze (analysis) REF: 670

OBJ: Special Questions: Multiple Patients
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
39. After receiving change-of-shift report for several patients with neutropenia, which patient
should the nurse assess first?
a. 56-year-old with frequent explosive diarrhea
b. 33-year-old with a fever of 100.8 F (38.2 C)
c. 66-year-old who has white pharyngeal lesions
d. 23-year old who is complaining of severe fatigue
ANS: B
Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic
shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are
needed. The other patients also need to be assessed but do not exhibit symptoms of potentially
life-threatening problems.

OBJ: Special Questions: Prioritization; Multiple Patients
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
40. Which action will the nurse include in the plan of care for a patient who has thalassemia
major?
a.Teach the patient to use iron supplements.
b.Avoid the use of intramuscular injections.
c.Administer iron chelation therapy as needed.
d.Notify health care provider of hemoglobin 11g/dL.
ANS: C
The frequent transfusions used to treat thalassemia major lead to iron toxicity in patients
unless iron chelation therapy is consistently used. Iron supplementation is avoided in patients
with thalassemia. There is no need to avoid intramuscular injections. The goal for patients
with thalassemia major is to maintain a hemoglobin of 10 g/dL or greater.

41. Which patient information is most important for the nurse to monitor when evaluating the
effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis?
a. Skin color
b. Hematocrit
c. Liver function
d. Serum iron level
ANS: D
Because iron chelating agents are used to lower serum iron levels, the most useful information
will be the patients iron level. The other parameters will also be monitored, but are not the
most important to monitor when determining the effectiveness of deferoxamine.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Evaluation
42. Which finding about a patient with polycythemia vera is most important for the nurse to
report to the health care provider?
a. Hematocrit 55%
b. Presence of plethora
c. Calf swelling and pain
d. Platelet count 450,000/mL
ANS: C
The calf swelling and pain suggest that the patient may have developed a deep vein
thrombosis, which will require diagnosis and treatment to avoid complications such as
pulmonary embolus. The other findings will also be reported to the health care provider but
are expected in a patient with this diagnosis.

43. Following successful treatment of Hodgkins lymphoma for a 55-year-old woman, which
topic will the nurse include in patient teaching?
a. Potential impact of chemotherapy treatment on fertility
b. Application of soothing lotions to treat residual pruritus
c. Use of maintenance chemotherapy to maintain remission
d. Need for follow-up appointments to screen for malignancy
ANS: D
The chemotherapy used in treating Hodgkins lymphoma results in a high incidence of
secondary malignancies; follow-up screening is needed. The fertility of a 55-year-old woman
will not be impacted by chemotherapy. Maintenance chemotherapy is not used for Hodgkins
lymphoma. Pruritus is a clinical manifestation of lymphoma, but should not be a concern after
treatment.

44. A patient who has non-Hodgkins lymphoma is receiving combination treatment with
rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most
rapid action by the nurse?
a. Anorexia
b. Vomiting
c. Oral ulcers
d. Lip swelling
ANS: D
Lip swelling in angioedema may indicate a hypersensitivity reaction to the rituximab. The
nurse should stop the infusion and further assess for anaphylaxis. The other findings may
occur with chemotherapy, but are not immediately life threatening.

45. Which information obtained by the nurse assessing a patient admitted with multiple myeloma
is most important to report to the health care provider?
a. Serum calcium level is 15 mg/dL.
b. Patient reports no stool for 5 days.
c. Urine sample has Bence-Jones protein.
d. Patient is complaining of severe back pain.
ANS: A
Hypercalcemia may lead to complications such as dysrhythmias or seizures, and should be
addressed quickly. The other patient findings will also be discussed with the health care
provider, but are not life threatening.

46. When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse
include in the preoperative plan of care?
a. Discourage deep breathing to reduce risk for splenic rupture.
b. Teach the patient to use ibuprofen (Advil) for left upper quadrant pain.
c. Schedule immunization with the pneumococcal vaccine (Pneumovax).
d. Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery.
ANS: C
Asplenic patients are at high risk for infection with Pneumococcus and immunization reduces
this risk. There is no need to avoid acetaminophen use before surgery, but nonsteroidal
antiinflammatory drugs (NSAIDs) may increase bleeding risk and should be avoided. The
enlarged spleen may decrease respiratory depth and the patient should be encouraged to take
deep breaths.

47. The nurse has obtained the health history, physical assessment data, and laboratory results
shown in the accompanying figure for a patient admitted with aplastic anemia. Which
information is most important to communicate to the health care provider?
a. Neutropenia
b. Increasing fatigue
c. Thrombocytopenia
d. Frequent constipation
ANS: A
The low white blood cell count indicates that the patient is at high risk for infection and needs
immediate actions to diagnose and treat the cause of the leucopenia. The other information
may require further assessment or treatment, but does not place the patient at immediate risk
for complications.
DIF: Cognitive Level: Analyze (analysis) REF: 676

SHORT ANSWER
1. A patient is to receive an infusion of 250 mL of platelets over 2 hours through tubing that is
labeled: 1 mL equals 10 drops. How many drops per minute will the nurse infuse?
ANS:
21
To infuse 250 mL over 2 hours, the calculated drip rate is 20.8 drops/minute or 21
drops/minute.


Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 31

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Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 31

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Chapter 31: Nursing Management: Hematologic Problems

DIF: Cognitive Level: Understand (comprehension) REF: 633

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3. A patient who is receiving methotrexate for severe rheumatoid arthritis develops a

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DIF: Cognitive Level: Apply (application) REF: 674-675

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