Description

Brunner and Suddarths Medical Surgical Nursing 11^th Edition Smeltzer Bare Hinkle Cheever Test Bank

ISBN-13: 978-0781759786

ISBN-10: 0781759781

 

 

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Brunner: Medical-Surgical Nursing, 11^th Edition

 

Test Bank

Chapter 33: Assessment and Management of Patients With Hematologic Disorders

 

 

 

 

Multiple Choice

 

 

 

 

1. The nurse informs a patient who asks where the body forms blood cells responds that blood cells are formed in the:
2. A) Spleen
3. B) Kidneys
4. C) Bone marrow
5. D) Liver

 

Ans:  C

Chapter:  33

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  1

Patient Needs:  D-1

Feedback:  Bone marrow is the primary site for hematopoiesis. The spleen and liver may be involved during embryonic development or when marrow is destroyed. The kidneys release erythropoietin, which stimulates the marrow to increase production of RBCs.

 

 

 

 

2. A patient complains of a heavy menstrual flow. Because red blood cell production increases during menstruation, the nurse is aware that the patient may need to increase her daily intake of:
3. A) Vitamin C
4. B) Vitamin D
5. C) Iron
6. D) Magnesium

 

Ans:  C

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Patient Needs:  D-4

Feedback:  To replace blood loss, the rate of red blood cell production increases. Iron is incorporated into hemoglobin.

 

 

 

 

3. A patient receives an injury to the skin that causes minor blood loss. Primary hemostasis is activated, during which:
4. A) Severed blood vessels constrict.
5. B) Thromboplastin is released.
6. C) Prothrombin is converted to thrombin.
7. D) Fibrin is lysed.

 

Ans:  A

Chapter:  33

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Patient Needs:  D-4

Feedback:  Primary hemostasis involves the severed vessel constricting and platelets collecting at the injury site. Secondary hemostasis occurs when thromboplastin is released, prothrombin converts to thrombin, and fibrin is lysed.

 

 

 

 

4. A patient is diagnosed with a hypoproliferative anemia. The nurse is aware that this type of anemia is due to:
5. A) Lack of production of RBCs
6. B) Loss of RBCs
7. C) Injury to the RBCs in circulation
8. D) Abnormality of RBCs

 

Ans:  A

Chapter:  33

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  3

Patient Needs:  D-4

Feedback:  Hypoproliferative anemia is usually a result of inadequate numbers of RBCs being produced the bone marrow. A deficit of RBCs is usually a result of blood loss. Hemolytic anemia can be a result of injury to the RBCs in circulation, possibly due to heart valve hemolysis. Abnormality of RBCs can occur in sickle cell anemia.

 

 

 

 

5. A patient reports symptoms of fatigue and pica. Laboratory findings reveal a low serum iron level and a low ferritin level. Upon evaluation of this assessment and laboratory data, the nurse suspects that the patient will be diagnosed with:
6. A) Iron deficient anemia
7. B) Pernicious anemia
8. C) Sickle cell anemia
9. D) Hemolytic anemia

 

Ans:  A

Chapter:  33

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Patient Needs:  D-4

Feedback:  A low serum iron level, a low ferritin level, and symptoms of pica are associated with iron deficiency anemia. TIBC level may also be elevated.

 

 

 

 

6. A patient is admitted with sickle cell anemia. The nurse is aware that the care of this patient often requires:
7. A) Chronic transfusions with RBCs
8. B) Platelet transfusions
9. C) Vitamin B₁₂ replacement
10. D) Phlebotomy

 

Ans:  A

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Patient Needs:  D-1

Feedback:  Medical management of sickle cell anemia includes chronic transfusions with RBCs, use of hydroxyurea, and bone marrow transplantations.

 

 

 

 

7. To prevent abuse of analgesics in a patient with sickle cell anemia, the nurse encourages the patient to:
8. A) Seek care from a variety of sources for pain relief.
9. B) Seek care from a single provider for pain relief.
10. C) Accept chronic pain being continually present as a fact of the disease.
11. D) Limit the reporting of emergency department visits to the primary health care provider.

 

Ans:  B

Chapter:  33

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Teaching/Learning

Objective:  4

Patient Needs:  D-3

Feedback:  The patient should be encouraged to use a single primary health care provider to address health care concerns. Emergency department visits should be reported to the primary health care provider to achieve optimal management of the disease.

 

 

 

 

8. A patient with iron-deficiency anemia states that she has minimal energy and finds it difficult to manage the household and work. The most appropriate intervention for the nurse to take to manage the fatigue is to:
9. A) Encourage the patient to stop working.
10. B) Encourage the patient to do minimal to no physical activity.
11. C) Assist the patient to prioritize activities and establish an activity/rest schedule.
12. D) Instruct the patient to perform activities only in the evening.

 

Ans:  C

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  4

Patient Needs:  D-1

Feedback:  In managing fatigue, the nurse needs to assist the patient to develop a priority in activities and establish an activity/rest balance.

 

 

 

 

9. When assessing a patient with anemia, the nurse notes that the patient has developed peripheral numbness and poor coordination. The patient’s family states that the patient appears to be confused at times at home. Neurologic symptoms most often accompany which type of anemia?
10. A) Iron deficiency anemia
11. B) Folic acid deficiency
12. C) Pernicious anemia
13. D) Thalassemia major

 

Ans:  C

Chapter:  33

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Patient Needs:  D-4

Feedback:  Pernicious anemia can affect the central and peripheral nervous systems, so neurologic assessment is important to detect effects to these areas.

 

 

 

 

10. The nurse expects the patient diagnosed with polycythemia vera to display which of the following manifestations of the disease?
11. A) Elevated red blood cells and splenomegaly
12. B) Lowered hematocrit and splenomegaly
13. C) Lowered hematocrit and jaundice
14. D) Elevated red blood cells and jaundice

 

Ans:  A

Chapter:  33

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  4

Patient Needs:  D-3

Feedback:  Symptoms of splenomegaly, an elevation in red blood cells, headache, fatigue, dizziness, tinnitus, and a very ruddy complexion are associated with polycythemia vera.

 

 

 

 

11. A nurse is explaining to a patient the common feature of leukemia, which is:
12. A) Unregulated proliferation of white blood cells
13. B) Unregulated proliferation of red blood cell.
14. C) Decrease in production of white blood cells
15. D) Decrease in production of red blood cells

 

Ans:  A

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  5

Patient Needs:  D-4

Feedback:  Leukemia commonly involves unregulated proliferation of white blood cells. Decreased production of white blood cells is associated with leukopenia. Decreased production of red blood cells is associated with anemias.

 

 

 

 

12. A patient has been diagnosed with acute myeloid leukemia (AML). The nurse anticipates that the plan of care for this patient will most likely include:
13. A) Aggressive chemotherapy treatment
14. B) Chronic albumin transfusion
15. C) Treatment with vancomycin
16. D) Interferon injections

 

Ans:  A

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Patient Needs:  D-1

Feedback:  Medical management for a patient with AML includes aggressive chemotherapy and transfusions of RBCs and platelets. Antibiotic therapy is not used. Chronic myeloid leukemia (CML) treatment includes interferon injections.

 

 

 

 

13. A 70-year-old patient is diagnosed with chronic lymphocytic leukemia (CLL). The nurse assesses the patient for which condition that may be associated with CLL?
14. A) Confusion
15. B) Renal colic
16. C) Enlargement of lymph nodes
17. D) Hyperplasia of the gums

 

Ans:  C

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Patient Needs:  D-4

Feedback:  Lymphadenopathy can occur in CLL. Confusion may be a manifestation of chronic myeloid leukemia (CML). Renal colic and hyperplasia of the gums can be caused acute myeloid leukemia (AML).

 

 

 

 

14. When caring for a patient with acute myeloid leukemia (AML) who is neutropenic, the nurse is aware that, if possible, the patient should not be given which of the following medications?
15. A) Aspirin
16. B) Acetaminophen
17. C) Furosemide
18. D) Oral laxatives

 

Ans:  A

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  6

Patient Needs:  D-2

Feedback:  To prevent bleeding in a patient who is neutropenic, aspirin-containing medications should be avoided because they inhibit platelet functioning. Oral laxatives should be used to prevent straining and constipation.

 

 

 

 

15. When caring for a patient with acute leukemia, the nurse should monitor which of the following laboratory results to assess the risk for infection:
16. A) Creatinine levels
17. B) Hepatic function tests
18. C) Electrolyte levels
19. D) WBC count

 

Ans:  D

Chapter:  33

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  6

Patient Needs:  D-3

Feedback:  To monitor the risk of infection, the nurse should check the WBC count to assess the risk for infection.

 

 

 

 

16. A nurse is caring for a patient who is being discharged after treatment for acute leukemia. To manage mucositis and painful mucous membranes, the nurse should instruct the patient to eat:
17. A) Soft-textured food, such as meatloaf
18. B) Raw fruits, such as apples
19. C) Raw vegetables, such as eggplant
20. D) Foods with vitamin C, such as grapefruits

 

Ans:  A

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  6

Patient Needs:  D-1

Feedback:  Mucositis and sore mucous membranes are a complication of therapy for acute leukemia. The nurse should encourage the patient to eat soft-textured foods at a moderate temperature and to take nutritional supplements. Patients should avoid uncooked fruits and vegetables because there is a potential for infection. Foods high in acid content, such as grapefruits, should also be avoided.

 

 

 

 

17. When caring for a patient with terminal acute myeloid leukemia (AML) receiving supportive care at home, the home care nurse should ensure that the family:
18. A) Avoids grieving while the patient is living
19. B) Is informed about complications of infection and bleeding
20. C) Provides all levels of care all the time
21. D) Encourages the patient to seek other treatments

 

Ans:  B

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  6

Patient Needs:  D-4

Feedback:  The home care nurse should ensure that the patient and family have information regarding avoiding complications such as infection and bleeding. Anticipatory grieving is essential during this phase of patient care. Family members should be encouraged to seek assistance when required and to take care of themselves. Patient and family decisions about care and treatment of the disease should be supported and respected.

 

 

 

 

18. When caring for a patient with multiple myeloma who is experiencing bone destruction, the nurse should assess for signs of:
19. A) Hypercalcemia
20. B)
21. C) Elevated serum viscosity
22. D) Elevated RBC count

 

Ans:  A

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Patient Needs:  D-4

Feedback:  Hypercalcemia may occur when the disease process results in bone destruction. Elevated serum viscosity occurs when plasma cells excrete excess immunoglobulin. Hypercalcemia decreases RBC count.

 

 

 

 

19. A patient is diagnosed with thrombocytopenia. The nurse should explain to the patient that with this condition, there could be:
20. A) An attack on the platelets the antibodies
21. B) Decreased production of platelets
22. C) Elevated platelet production
23. D) Decreased white blood cell production

 

Ans:  B

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  8

Patient Needs:  D-4

Feedback:  Thrombocytopenia can result from decreased platelet production, increased platelet destruction, or increased consumption of platelets. Increased production of platelets is associated with thrombocythemia, and decreased white blood cell production is associated with leukopenia.

 

 

 

 

20. When caring for a patient with hemophilia, the nurse notes that the patient has developed joint pain in the left knee. Which of the following is an appropriate nursing intervention for the joint pain?
21. A) Apply heat to the joint.
22. B) Apply a cold compress to the joint.
23. C) Encourage the patient to exercise the joint.
24. D) Administer aspirin for pain.

 

Ans:  B

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  8

Patient Needs:  D-1

Feedback:  Cold therapy should be used for pain that develops in joints because heat application can accentuate bleeding into the joint. Increasing movement of the joint may also increase bleeding. Aspirin can interfere with platelet aggregation.

 

 

 

 

21. A patient with autoimmune hemolytic anemia is not responding to conservative treatments. His condition is now becoming life threatening. The nurse is aware that a treatment option in this case may include:
22. A)
23. B) Vitamin K administration
24. C) Platelet transfusion
25. D) Splenectomy

 

Ans:  D

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  9

Patient Needs:  D-4

Feedback:  A splenectomy may be an acceptable course of treatment if autoimmune hemolytic anemia does not respond to conservative treatment. Vitamin K administration is treatment for vitamin K deficiency. Platelet transfusion may be the course of treatment for some bleeding disorders.

 

 

 

 

22. Fifteen minutes after the infusion of packed red blood cells (RBCs) has begun, the patient complains of difficulty breathing and chest tightness. The most appropriate initial action for the nurse to take is:
23. A) Notify the patient’s physician.
24. B) Stop the transfusion immediately.
25. C) Remove the patient’s intravenous access.
26. D) Assess the patient’s chest sounds and vital signs.

 

Ans:  B

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  9

Patient Needs:  D-3

Feedback:  Vascular collapse, bronchospasm, laryngeal edema, shock, fever, chills, and jugular vein distension are severe reactions. The nurse should discontinue the transfusion immediately, monitor the patient’s vital signs, and notify the physician. The blood container and tubing should be sent to the blood bank. A blood and urine specimen may be needed if a transfusion reaction or a bacterial infection is suspected.

 

 

 

 

23. The nurse is preparing to administer a unit of blood to a patient diagnosed with anemia. After removing the blood from the refrigerator, the nurse should administer the blood within:
24. A) 1 hour
25. B) 2 hours
26. C) 4 hours
27. D) 6 hours

 

Ans:  C

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Patient Needs:  D-3

Feedback:  After the blood is removed from the refrigerator, it must be administered within 4 hours. Refrigeration delays the growth of bacteria in the blood. Extended time out of refrigeration increases the risk of contamination and growth of bacteria. The patient could experience fluid overload if the blood is administered too rapidly.

 

 

 

 

24. A patient is undergoing diagnostic testing for multiple myeloma. Diagnostic test findings indicative of multiple myeloma include:
25. A) A decreased serum creatinine level
26. B) Hypocalcemia
27. C) Bence-Jones protein in the urine
28. D) A low serum protein level

 

Ans:  C

Chapter:  33

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  7

Patient Needs:  D-4

Feedback:  Presence of Bence-Jones protein in the urine almost always confirms the disease, but absence doesn’t rule it out. Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum. Serum electrophoresis shows elevated globulin spike. The serum creatinine level may also be increased.

 

 

 

 

25. The nurse assessing a patient with multiple myeloma should keep in mind that patients with multiple myeloma are at risk for:
26. A) Chronic liver failure
27. B) Acute heart failure
28. C) Pathologic bone fractures
29. D) Hypoxemia

 

Ans:  C

Chapter:  33

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Patient Needs:  D-4

Feedback:  Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, patients are at risk for renal failure secondary to myeloma proteins causing renal tubular obstruction. Liver failure and heart failure aren’t usually sequelae of multiple myeloma. Hypoxemia isn’t usually related to multiple myeloma.

 

 

 

 

26. A patient is receiving chemotherapy for cancer. The nurse reviews the laboratory data and notes that he has thrombocytopenia. Which nursing diagnosis should be given the highest priority?
27. A) Activity intolerance
28. B) Impaired tissue integrity
29. C) Impaired oral mucous membranes
30. D) Ineffective tissue perfusion (cerebral, cardiopulmonary, GI)

 

Ans:  D

Chapter:  33

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  8

Patient Needs:  D-3

Feedback:  These are all appropriate nursing diagnoses for the patient with thrombocytopenia (reduced platelet count); however, cerebral and GI hemorrhage and hypotension pose the greatest risk to the patient’s physiologic integrity.

 

 

 

 

27. While monitoring a patient for the development of disseminated intravascular coagulation (DIC), the nurse should take note of what assessment parameters?
28. A) Platelet count, prothrombin time (PT), and partial thromboplastin time (PTT)
29. B) Platelet count, blood glucose level, and white blood cell (WBC) count
30. C) Thrombin time, calcium level, and potassium level
31. D) Fibrinogen level, WBC count, and platelet count

 

Ans:  A

Chapter:  33

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  8

Patient Needs:  D-4

Feedback:  The diagnosis of DIC is based on the results of laboratory studies of platelet count, PT, thrombin time, PTT, and fibrinogen level, as well as patient history and other assessment factors. Blood glucose level, WBC count, calcium level, and potassium level aren’t used to confirm a diagnosis of DIC.

 

 

 

 

28. When teaching safety precautions to a patient with thrombocytopenia, the nurse should include which of the following directives?
29. A) Eat foods high in iron.
30. B) Avoid products that contain aspirin.
31. C) Avoid people with respiratory tract infections.
32. D) Eat only cooked vegetables.

 

Ans:  B

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  8

Patient Needs:  D-3

Feedback:  Patients with a low platelet count should avoid products that contain aspirin because they increase the tendency to bleed. Option A would be important to teach the patient with anemia. Options C and D are correct for the patient with leukopenia.

 

 

 

 

29. A 50-year-old male with a diagnosis of leukemia is responding poorly to treatment. He’s tearful and trying to express his feelings, but he’s having difficulty. The nurse’s first action should be to:
30. A) Tell him that she’ll leave for now but she’ll be back.
31. B) Offer to call pastoral care.
32. C) Ask if he would like her to sit with him while he collects his thoughts.
33. D) Tell him that she can understand how he’s feeling.

 

Ans:  C

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  6

Patient Needs:  C-1

Feedback:  The patient needs to feel that people are concerned with his situation. Option A is incorrect because leaving the patient doesn’t show acceptance of his feelings. Option B is incorrect because offering to call pastoral care may be helpful for some patients but should be done only after the nurse has spent time with the patient. Option D is incorrect because telling the patient that she understands how he’s feeling is inappropriate because it doesn’t help him express his feelings.

 

 

 

 

30. A patient with renal failure has decreased erythropoietin production. Upon analysis of the patient’s complete blood count, the nurse will expect which of the following complete blood count results?
31. A) Increased hemoglobin and hematocrit
32. B) Decreased hemoglobin and hematocrit
33. C) Decreased MCV and MCH
34. D) Increased MCV and MCH

 

Ans:  B

Chapter:  33

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  1

Patient Needs:  D-4

Feedback:  The decreased production of erythropoietin will result in a decreased hemoglobin and hematocrit. The patient will have normal MCV and MCH values.

 

 

 

 

31. Which of the following values will be decreased in a patient with disseminated intravascular coagulation (DIC)?
32. A) Platelet count and fibrinogen
33. B) Prothrombin time and partial thromboplastin time
34. C) Thrombin time and fibrinogen
35. D) D-dimer and fibrin degradation products

 

Ans:  A

Chapter:  33

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  8

Patient Needs:  D-4

Feedback:  Platelet count and fibrinogen are decreased in DIC. Prothrombin time, partial thromboplastin time, thrombin time, D-dimer, and fibrin degradation products are increased in DIC.

 

 

 

 

32. A patient with iron deficiency anemia has been prescribed iron supplements. When providing information to the patient on iron administration, which of the following statements will the nurse include in her teaching?
33. A) Take the iron with dairy products to enhance absorption.
34. B) Increase the intake of vitamin E to enhance absorption.
35. C) Iron will cause the stools to darken in color.
36. D) Limit foods high in fiber due to the risk for diarrhea.

 

Ans:  C

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  4

Patient Needs:  D-2

Feedback:  The nurse will inform the patient that iron causes the stools to become dark in color. Iron should be taken on an empty stomach, as its absorption is affected food, especially dairy products. Patients should be instructed to increase their intake of vitamin C to enhance iron absorption. Foods high in fiber should be consumed to minimize problems with constipation, as it is a common side effect associated with iron therapy.

 

 

 

 

33. A patient with acute myeloid leukemia requires neutropenic precautions. Upon inspection of his dinner tray, the nurse determines that which of the following foods should be removed from the tray due to the neutropenic precautions?
34. A) Mashed potatoes
35. B) Baked chicken
36. C) Lettuce and tomato salad
37. D) Jell-O with whipped cream

 

Ans:  C

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  6

Patient Needs:  A-2

Feedback:  The patient requiring neutropenic precautions should receive a low microbial diet. Fresh salads and unpeeled fresh fruits or vegetables should be avoided.

 

 

 

 

34. While administering a packed red blood cell transfusion, the patient becomes restless, febrile, and complains of nausea. The nurse’s initial response to these symptoms is to:
35. A) Stop the transfusion
36. B) Notify the physician
37. C) Decrease the drip rate of the blood transfusion
38. D) Obtain the patient’s vital signs

 

Ans:  A

Chapter:  33

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  9

Patient Needs:  D-3

Feedback:  Restlessness, fever, and nausea are symptoms that may indicate a transfusion reaction. If a transfusion reaction occurs, the nurse’s initial response is to stop the blood transfusion. After stopping the transfusion, vital signs should be obtained and the physician should be notified.

 

 

 

 

35. Plasminogen is a component necessary in the clotting cascade. Plasminogen is present in:
36. A) Myocardial muscle tissue
37. B) All body fluids
38. C) Cerebral tissue
39. D) Renal tissue

 

Ans:  B

Chapter:  33

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  2

Patient Needs:  D-4

Feedback:  Plasminogen, which is present in all body fluids, circulates with fibrinogen.

 

 

 

 

36. Upon assessment, the nurse observes the patient’s tongue to be red and smooth. The patient complains that the tongue is sore. Based upon assessment findings, the nurse is aware that he is demonstrating symptoms associated with:
37. A) Sickle cell anemia
38. B) Hemolytic anemia
39. C) Megaloblastic anemia
40. D) Aplastic anemia

 

Ans:  C

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Patient Needs:  D-4

Feedback:  A red, smooth tongue is a symptom associated with megaloblastic anemia. Iron deficiency anemia also may be characterized a smooth, red tongue.

 

 

 

 

37. A patient with symptoms related to secondary polycythemia caused renal cell carcinoma is not a surgical candidate and has elected not to start chemotherapy or radiation therapy due to the low success rates of these treatment modalities. The nurse recognizes that management of the symptoms of secondary polycythemia will likely require:
38. A) A transfusion of packed red blood cells
39. B) Therapeutic phlebotomy
40. C) High-dose vitamin and iron therapy
41. D) Administration of corticosteroid therapy

 

Ans:  B

Chapter:  33

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  8

Patient Needs:  D-3

Feedback:  If the cause of secondary polycythemia cannot be corrected, therapeutic phlebotomy may be necessary in symptomatic patients to reduce blood viscosity and volume.

 

 

 

 

38. A patient with acute myeloid leukemia is preparing to undergo induction therapy. In preparing a care plan for this patient, the nurse will assign the highest priority to which of the following nursing diagnoses?
39. A) Activity intolerance
40. B) Risk for infection
41. C) Disturbed processes
42. D) Risk for spiritual distress

 

Ans:  B

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Patient Needs:  D-4

Feedback:  Induction therapy places the patient at risk for infection; this is the priority nursing diagnosis. During the time of induction therapy, the patient is very ill with bacterial, fungal, and occasional viral infections, bleeding, and severe mucositis, which causes diarrhea and a marked decline in the patient’s ability to maintain adequate nutrition. Supportive care consists of administering blood products and promptly treating infections.

 

 

 

 

39. The nurse is preparing to administer oral care to a patient with mucositis. Which of the following supplies will she gather?
40. A) Sponge-tipped applicator
41. B) Antibacterial mouthwash
42. C) Medium-bristled toothbrush
43. D) Lemon-glycerin swabs

 

Ans:  A

Chapter:  33

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Caring

Objective:  6

Patient Needs:  D-1

Feedback:  Oral care is very important to diminish bacteria within the mouth, maintain moisture, and provide comfort. Soft-bristled toothbrushes should be used until the neutrophil and platelet count become very low, at which time, sponge-tipped applicators may be substituted. Lemon-glycerin swabs and commercial mouthwashes should never be used because the glycerin and alcohol within them dry the oral tissues.

 

 

 

 

40. While performing a physical assessment on a patient diagnosed with agnogenic myeloid metaplasia, the nurse will anticipate palpating enlargement of which organ(s)?
41. A) Heart
42. B) Liver
43. C) Kidneys
44. D) Spleen

 

Ans:  D

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Patient Needs:  D-4

Feedback:  Agnogenic myeloid metaplasia is characterized splenomegaly.

 

 

 

 

41. An oncology nurse is aware that which of the following individuals is at the greatest risk for the development of Hodgkin’s disease?
42. A) The spouse of a patient with Hodgkin’s disease
43. B) A patient with a liver transplant on immunosuppressive therapy
44. C) A patient with heart failure on diuretic therapy
45. D) A patient who works on a fishing boat

 

Ans:  B

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Patient Needs:  D-4

Feedback:  The patient on immunosuppressive therapy is at an increased risk for the development of Hodgkin’s disease. No increased incidence for non-blood relatives (spouses) has been documented. Patients who are woodworkers or who have been exposed to Agent Orange demonstrated an increased incidence of Hodgkin’s disease.

 

 

 

 

42. What classic presenting symptom associated with multiple myeloma would the nurse assess for?
43. A) Liver dysfunction
44. B) Bone pain
45. C) Serum hypocalcemia
46. D) Nausea

 

Ans:  B

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Patient Needs:  D-4

Feedback:  The classic presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Bone pain is reported two-thirds of all patients at diagnosis. Extensive bone destruction leads to an excessive ionized calcium loss from the bone and results in hypercalcemia as it enters the serum. Renal failure may occur as the circulating immunoglobulin molecules damage the renal tubules.

 

 

 

 

43. Upon analysis of laboratory data of a patient with multiple myeloma, the nurse expects to observe which of the following findings?
44. A) Serum hypokalemia
45. B) Serum hypercalcemia
46. C) Serum hyponatremia
47. D) Serum hypermagnesemia

 

Ans:  B

Chapter:  33

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  7

Patient Needs:  D-4

Feedback:  Extensive bone destruction will leave to an excessive ionized calcium loss from the bone and results in hypercalcemia as it enters the serum.

 

 

 

 

44. During a teaching session with a patient diagnosed with primary thrombocythemia, the nurse correctly instructs the patient to:
45. A) Decrease cardiac risks drinking a glass of red wine nightly
46. B) Take Coumadin daily
47. C) Administer interferon-alfa-2b subcutaneously
48. D) Take NSAIDs at the earliest sign of pain

 

Ans:  C

Chapter:  33

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  8

Patient Needs:  D-2

Feedback:  The nurse will instruct the patient on the correct administration of interferon-alfa-2b subcutaneously. Coumadin, NSAIDs, and alcohol intake should be avoided, as they increase the patient’s risk of bleeding.