LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)

Chapter 33 Nursing Care of Patients with Hematologic Disorders

1) The nurse is caring for a young female patient whose laboratory values indicate the presence of microcytic and hypochromic red blood cells. What should the nurse do to help this patient?

1. Enforce "nothing by mouth" in anticipation of emergency surgery.

2. Insert an intravenous access line for fluids.

3. Consult with the dietitian for a diet high in iron.

4. Assess the past history for risks of bleeding or menstrual changes.

Page Ref: 1162

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

2) A middle-aged female with numbness and tingling in the lower extremities and difficulty ambulating has large, oval-shaped, macrocytic red blood cells with thin membranes on the latest complete blood count. Which therapy would the nurse anticipate including in the discharge plan?

1. A diet high in green leafy vegetables, broccoli, wheat germ, and asparagus

2. A daily multivitamin with extra iron

3. Instructions about subcutaneous injections of erythropoietin for a few weeks

4. Instructions about intramuscular parenteral injections of vitamin B12 for the rest of her life

Page Ref: 1164, 1170

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with hematologic disorders.

3) A patient is admitted with the diagnosis of sickle-cell crisis. What action should the nurse take first if the patient has a temperature of 102°F, O2 saturation 89%, and severe abdominal pain?

1. Give Tylenol (acetaminophen) grains X (650 mg).

2. Administer oxygen as prescribed.

3. Administer morphine sulfate IM.

4. Assess and document peripheral pulses.

Page Ref: 1170

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

4) After several doses of chemotherapy, a patient complains of fatigue, pallor, progressive weakness, exertional dyspnea, headache, and tachycardia. Which problem should the nurse identify as a priority for this patient?

1. Change in nutritional status

2. Difficulty with activity

3. Feeling unable to control the disease process

4. Psychosocial issues dealing with the disease process

Page Ref: 1169

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with hematologic disorders.

5) The nurse instructs a patient on the dietary management of iron deficiency anemia. Which patient statement indicates a need for additional teaching?

1. "I will eat more fruits and vegetables, especially green leafy ones, to get more B12 in my diet."

2. "I will take vitamins with extra iron in addition to eating a balanced diet with meat to correct my anemia."

3. "I will add food high in vitamin C to improve my absorption of iron in both my vitamins."

4. "I will need to include more protein foods in my diet such as meats, dried beans, and whole-grain bread."

Page Ref: 1172

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

6) A patient diagnosed with acute myeloid leukemia (AML) has an absolute neutrophil count of 200. What action by the nurse would minimize the risk of complications from neutropenia?

1. Using strict aseptic technique when performing all procedures

2. Spacing frequent meals throughout the day to increase caloric intake

3. Restricting fluids and salts to reduce edema

4. Regulating the thermostat for a cooler environment

Page Ref: 1186

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33.2 Describe the pathophysiology and manifestations of white blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

7) A patient recently diagnosed with chronic myeloid leukemia (CML) says he does not want to leave the spouse alone with all the household finances. Which response should the nurse refrain from making at this time?

1. "I would encourage you to discuss your feelings with your spouse to participate in the decision-making process."

2. "I would like to make a referral for you and your spouse to a support group that may be helpful with some of the issues you are having."

3. "It must be very difficult for you to think of your spouse having to be alone with the household decisions."

4. "You had better get your affairs in order now before it is too late."

Page Ref: 1188

Cognitive Level: Applying

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Context and Environment; Practice-Know-How; Apply evidence to support decision making in situations characterized by ambiguity and uncertainty | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33.2 Describe the pathophysiology and manifestations of white blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

8) The nurse determines that a patient with heparin-induced thrombocytopenia is at risk for bleeding. Which intervention should the nurse include in this patient's plan of care?

1. Avoid invasive procedures, such as rectal temperatures, urinary catheterizations, and parenteral injections.

2. Apply pressure to puncture sites for 3-5 minutes for arterial blood gases aspiration.

3. Give enemas to help the patient avoid straining during bowel movements.

4. Encourage the patient to brush the teeth thoroughly and rinse with alcohol-based mouthwash after each meal.

Page Ref: 1204

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33.4 Describe the pathophysiology and manifestations of platelet and coagulation disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

9) A family member is identified as a donor for a patient's stem cell transplant. What should the family member learn about this procedure? Select all that apply.

1. Peripheral blood is removed.

2. Blood is removed from a central catheter.

3. White blood cells are added to the donor's blood.

4. A strict diet of low protein and fat must be consumed.

5. Hematopoietic growth factors will be administered for 4 to 5 days before the harvesting.

Page Ref: 1184

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 33.2 Describe the pathophysiology and manifestations of white blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with hematologic disorders.

10) Upon analysis, a patient's red blood cells (RBCs) appear microcytic and hypochromic. For which type of anemia should the nurse plan care for this patient?

1. Iron deficiency

2. Acute blood loss

3. Chronic blood loss

4. Vitamin B12 deficiency

Page Ref: 1162

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with hematologic disorders.

11) A patient with chronic gastritis is experiencing tingling in the hands. Which health problem should the nurse suspect is occurring with this patient?

1. Iron deficiency anemia

2. Acute blood loss anemia

3. Folic acid deficiency anemia

4. Vitamin B12 deficiency anemia

Page Ref: 1164

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with hematologic disorders.

12) The nurse is caring for a patient in sickle cell crisis. For which reason should the nurse suspect this patient is experiencing edema in the hands and feet?

1. Fluid overload

2. Poor venous return

3. Small vessel infarction

4. Dehydration

Page Ref: 1165

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with hematologic disorders.

13) A patient is being treated for acquired hemolytic anemia. Which assessment finding suggests that the health problem is severe?

1. Misshapen limbs due to pathological fractures

2. Enlarged spleen

3. Jaundice

4. Bradycardia

Page Ref: 1169

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with hematologic disorders.

14) At the completion of a physical examination, the nurse suspects that a patient is experiencing thalassemia. What did the nurse assess to make this clinical decision? Select all that apply.

1. Confusion

2. Muscle cramps

3. Slight splenomegaly

4. Bronze skin coloring

5. Spontaneous fractures

Page Ref: 1167

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with hematologic disorders.

15) The nurse is providing dietary instructions to a vegetarian patient with iron deficiency anemia. What should be included in these instructions?

1. Consider adding animal sources of iron and protein to the diet.

2. Ensure an adequate intake of vitamin C when consuming non-animal-based proteins.

3. Drink at least 12 glasses of water every day.

4. Avoid exercise at least 30 minutes after completing a meal or snack.

Page Ref: 1172

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

16) A patient is prescribed an oral iron preparation. What should the nurse instruct this patient about this medication? Select all that apply.

1. Take the medication with orange juice.

2. Nausea is expected with this medication.

3. Take the medication with an antacid.

4. Take the medication 2 hours before a scheduled tetracycline dose.

5. Take the medication with a vitamin E supplement.

Page Ref: 1171

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

17) The nurse is planning to instruct a patient with secondary polycythemia about ways to prevent blood stasis. What should be included in these instructions?

1. Leg pain is normal.

2. Elevate feet and legs when sitting.

3. Restrict fluids.

4. Black stools are to be expected.

Page Ref: 1178

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

18) A patient diagnosed with leukemia says, "If I have too many white blood cells, and white blood cells fight infections, why do I have to be careful not to be exposed to germs?" What would be an appropriate response for the nurse?

1. "With leukemia, you have the wrong kind of white blood cells."

2. "That's not what leukemia is."

3. "The white blood cells with leukemia aren't effective at fighting infections."

4. "Your bone marrow can become infected."

Page Ref: 1178

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation

Learning Outcome: 33.2 Describe the pathophysiology and manifestations of white blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with hematologic disorders.

19) An adolescent patient has edematous lymph nodes and headaches. Which health problem should the nurse suspect is occurring with this patient?

1. Acute lymphocytic leukemia (ALL)

2. Chronic lymphocytic leukemia (CLL)

3. Acute myeloid leukemia (AML)

4. Chronic myeloid leukemia (CML)

Page Ref: 1182

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.2 Describe the pathophysiology and manifestations of white blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with hematologic disorders.

20) A patient who is undergoing treatment for leukemia is scheduled for a bone marrow transplant. In which phase of treatment is this patient?

1. Induction

2. Maintenance

3. Rehabilitative

4. Postremission

Page Ref: 1184

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.2 Describe the pathophysiology and manifestations of white blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with hematologic disorders.

21) The nurse is preparing an analgesic for a patient with leukemia. Which route is preferred for this patient?

1. Intramuscular

2. Intravenous

3. Oral

4. Subcutaneous

Page Ref: 1186

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.2 Describe the pathophysiology and manifestations of white blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

22) A patient is diagnosed with stage II Hodgkin lymphoma. How should the nurse interpret the extent of this patient's illness?

1. A single lymph node with systemic symptoms

2. Two or more lymph nodes on the same side of the diaphragm

3. Upper abdominal lymph nodes without systemic symptoms

4. An extranodal site involvement with systemic symptoms

Page Ref: 1192

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.3 Describe the pathophysiology and manifestations of lymphoid tissue disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with hematologic disorders.

23) A college-age patient who is in the hospital for treatment for Hodgkin disease is visited by friends who bring a pizza and cola. What should the nurse do to ensure the patient's comfort?

1. Ask the visitors to leave.

2. Ask the visitors to eat the pizza in the lounge.

3. Encourage the patient to eat as much pizza as possible.

4. Provide the patient with an antiemetic and suggest something else for the patient to eat with the visitors.

Page Ref: 1195

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 33.3 Describe the pathophysiology and manifestations of lymphoid tissue disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

24) A patient with idiopathic thrombocytopenia purpura continues to experience symptoms of the disease after completing several courses of prednisone therapy. Which treatment will most likely be recommended for this patient?

1. Lifelong prednisone therapy

2. Splenectomy

3. Aspirin therapy

4. Weekly platelet transfusions

Page Ref: 1203

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.4 Describe the pathophysiology and manifestations of platelet and coagulation disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with hematologic disorders.

25) A patient with hemophilia is admitted with acute bleeding. Until the cause of the bleeding is determined, which intervention should the nurse anticipate for the patient?

1. Infusing packed red blood cells

2. Infusing normal saline

3. Infusing heparin

4. Infusing fresh-frozen plasma

Page Ref: 1206

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.4 Describe the pathophysiology and manifestations of platelet and coagulation disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with hematologic disorders.

26) A patient with disseminated intravascular coagulation (DIC) is not responding to infusions of fresh-frozen plasma and platelets. Which intervention might be indicated for this patient? Select all that apply.

1. Heparin injections

2. Heparin infusion

3. Factor VIII infusion

4. Normal saline infusion

5. Bone marrow biopsy

Page Ref: 1210

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.4 Describe the pathophysiology and manifestations of platelet and coagulation disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with hematologic disorders.

27) A patient who is undergoing chemotherapy for lymphoma says, "I thought I was ugly before this all started. Now I know for sure I'm disgusting to look at." What is this patient most at risk for developing related to these comments?

1. Changed body image perception

2. Reduced sexual response

3. Altered taste sensation

4. Inability to cope with the diagnosis and treatment

Page Ref: 1195

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Coping Mechanisms

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.3 Describe the pathophysiology and manifestations of lymphoid tissue disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

28) A patient who is being treated for malignant lymphoma is experiencing pruritus. What intervention would be appropriate for this patient? Select all that apply.

1. Bathing with cool water

2. Vigorously rubbing the skin after bathing

3. Applying lavender-scented body lotion

4. Keeping the room temperature above normal

5. Cleansing bedding and clothing in mild detergent with a second rinse cycle

Page Ref: 1196

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 33.3 Describe the pathophysiology and manifestations of lymphoid tissue disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

29) The nurse suspects that a patient being treated with deferoxamine (Desferal) is experiencing adverse effects of the medication. What did the nurse assess to come to this conclusion? Select all that apply.

1. Urticaria

2. Ecchymosis

3. Upper body rash

4. Pink urine

5. Blood in the stool

Page Ref: 1176

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with hematologic disorders.

30) A patient has developed folic acid deficiency anemia. The nurse notes that the patient weighed 52.72 kilograms 1 year ago and weighs 44.23 kilograms today. Calculate the patient's weight loss in pounds. Round to the nearest tenth decimal place.

Page Ref: 1164

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with hematologic disorders.

31) A patient with polycythemia vera is admitted for treatment. What should the nurse expect to be prescribed for this patient? Select all that apply.

1. Aspirin

2. Antibiotics

3. Phlebotomy

4. Hydroxyurea

5. Antihistamines

Page Ref: 1178

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.1 Describe the pathophysiology and manifestations of red blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with hematologic disorders.

32) A patient with multiple ecchymoses and occult blood in the stool has a decreased level of Factor VIII. Which should the nurse expect for this patient? Select all that apply.

1. Normal platelet count

2. Elevated prothrombin time

3. Diagnosis of hemophilia B

4. Administer fresh-frozen plasma as prescribed

5. Bleeding time within normal limits

Page Ref: 1205-1206

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.4 Describe the pathophysiology and manifestations of platelet and coagulation disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with hematologic disorders.

33) The nurse teaches to the spouse and patient with Hodgkin disease about the disease process. Which patient statement indicates the need for further education? Select all that apply.

1. "The physician is ordering radiation therapy for me."

2. "My white blood cell count was low and my red blood cell count was high, and that helped the physician diagnose me."

3. "The doctor has classified my Hodgkin disease as stage III because I have involved lymph nodes in my liver and in my spleen."

4. "One out of every four patients without symptoms of Hodgkin disease dies of this disease."

5. "Because I had a heart attack in the past, the physician will probably prescribe rituximab for me."

Page Ref: 1192-1193

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 33.3 Describe the pathophysiology and manifestations of lymphoid tissue disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with hematologic disorders.

34) A patient with acute lymphocytic leukemia will be starting chemotherapy. For which medication should the patient receive teaching? Select all that apply.

1. Prednisone

2. Cytarabine (Cytoxan)

3. Vincristine (Oncovin)

4. Asparaginase (Elspar)

5. Daunorubicin (Cerubidine)

Page Ref: 1183

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Planning/Teaching/Learning

Learning Outcome: 33.2 Describe the pathophysiology and manifestations of white blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with hematologic disorders.

35) After completing a medication history, the nurse is concerned that a patient is at risk for secondary thrombocytopenia. Which medication did the nurse learn that the patient takes that increases this risk? Select all that apply.

1. Digoxin

2. Warfarin

3. Penicillin

4. Cimetidine

5. Furosemide

Page Ref: 1202

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.4 Describe the pathophysiology and manifestations of platelet and coagulation disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with hematologic disorders.

36) While reviewing preoperative orders, the nurse notes that a patient is prescribed desmopressin acetate (DDAVP). For which health problem should the nurse plan care? Select all that apply.

1. Hemophilia A

2. Mononucleosis

3. Iron deficiency anemia

4. von Willibrand disease

5. Heparin-induced thrombocytopenia

Page Ref: 1206

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 33.4 Describe the pathophysiology and manifestations of platelet and coagulation disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with hematologic disorders.

37) After reviewing laboratory results, the nurse is concerned that a patient being treated for leukemia is developing tumor lysis syndrome. What did the nurse assess to make this clinical decision? Select all that apply.

1. Hyperkalemia

2. Hyponatremia

3. Hypocalcemia

4. Hypermagnesemia

5. Hyperphosphatemia

Page Ref: 1187

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33.2 Describe the pathophysiology and manifestations of white blood cell disorders, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with hematologic disorders.