Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 6th Edition Test Bank Chapter

42: Care of Patients with Hematologic Problems
MULTIPLE CHOICE 1. Which clinical manifestation is common to all types of anemia regardless of cause or pathologic mechanism? A. Jaundiced sclera and roof of the mouth B. Hypertension and peripheral edema C. Tachycardia at basal activity levels D. Increased PaCO2 ANS: C The client with anemia has some degree of tissue hypoxia. A compensatory mechanism to increase tissue oxygenation is to increase cardiac output by increasing heart rate. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity 2. Which laboratory value in a client alerts the nurse to the probability of sickle cell disease? A. Hgb A1: 97% B. Hgb F: 1.5% C. Hgb C: 0% D. Hgb S: 65% ANS: D Normal values for Hgb S should be 0%. Clients with an Hgb S value higher than 43% are considered to have sickle cell disease. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

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3. The client who has sickle cell trait has a sister with sickle cell disease and a husband with neither the disease nor the trait. She asks her nurse what her children’s chances are of having sickle cell disease. What is the nurse’s best response? A. “Because you have the trait and your husband does not, only your daughters can have sickle cell disease.” B. “Because you have the trait and your husband does not, none of your children will have the disease, but each child will have a 50% risk for having the trait.” C. “Because your sister actually has sickle cell disease, the risk for your children having sickle cell disease is 50% with each pregnancy.” D. “Because you are a woman, your daughters will each have a 50% risk for having the disease and all of your sons will be carriers of the trait.” ANS: B Sickle cell disease is an autosomal recessive disease. Thus, there are no gender differences or influences in having the disease. Because the disease is recessive, a person needs two mutated gene alleles (homozygous) to have the disease and only one mutated gene allele (heterozygous) to have the trait. This client's husband does not have the disease or the trait and can only contribute a normal hemoglobin gene allele to each child. The client has one abnormal gene allele and has a 50% risk of passing it on to her children with each pregnancy. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Physiological Integrity 4. The client in sickle cell crisis has effective pain management. What is now the priority nursing diagnosis? A. Deficient Knowledge related to contraception and pregnancy options B. Deficient Knowledge related to prevention of crisis episodes C. Risk for Injury related to decreased tissue oxygenation D. Risk for Infection related to decreased spleen function ANS: C During sickle cell crisis, when cells are sickled, blood flow is obstructed in the microcirculation and macrocirculation. Depending on which tissue is hypoxic or anoxic, ischemia can lead to tissue injury and cell death. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Analysis MSC: Client Needs Category: Safe, Effective Care Environment;

Effective Care Environment/Health Promotion and . B. The client’s blood pressure is 120/80. The client is sleeping. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity 6. D. C. Clubbed fingers C. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Psychosocial Integrity 7. The most reliable indicator of pain relief is the client's subjective response. Shoveling snow when the temperature is at 0 degrees C. Although these cells could still become sickled. Circumoral pallor D. Such individuals are most vulnerable to crisis during prolonged surgery under anesthesia. hypoxic conditions would have to be severe for this to occur to the level of sickle cell crisis. The client tells the nurse the pain is better. Which condition indicates that pain relief has been achieved? A. The client has anemia and all the following clinical manifestations. A nurse administered 8 mg of morphine intravenously 20 minutes ago to the client in sickle cell crisis. Headache B. ANS: D The adult client with sickle cell disease experiences pain so chronically that the associated physical changes usually seen with severe pain may be absent. Becoming pregnant B. Having a cast placed on the wrist after sustaining a simple fracture ANS: C The person who has sickle cell trait usually has less than 40% of his or her total hemoglobin as Hgb S. Orthostatic hypotension ANS: B Clubbing of the fingers requires prolonged hypoxia (many months to years) to develop. Having surgery under general anesthesia for colon cancer D. Which manifestation indicates to the nurse that the anemia is a long-standing problem? A.Test Bank 5. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Safe. Which problem or condition is most likely to stimulate a crisis in a person who has sickle cell trait? A. The client’s skin is warm and dry.

Oral temperature of 37.8o C (100o F) B. Diminished breath sounds unilaterally C. Diminished breath sounds. Darkened areas of skin on the lower extremities ANS: B The client with sickle cell disease is more susceptible to infections with encapsulated microorganisms such as Streptococcus pneumoniae. Which assessment finding alerts the home care nurse to the possibility of infection in the client with sickle cell disease who is recovering from a crisis episode? A. D. . B. The other manifestations are expected changes common to adult clients in sickle cell crisis. 8. nodular texture to the liver on palpation D. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe. Effective Care Environment. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Analysis MSC: Client Needs Category: Physiological Integrity 9.Test Bank Maintenance. especially if unilateral. Which intervention for the client with sickle cell disease prevents vascular occlusion? Assessing pulse oximetry every 2 hours Administering morphine sulfate every 6 hours Keeping the room temperature at or below 68o F. C. Maintaining an oral fluid intake of at least 4500 mL/day ANS: D Venous stasis causes vascular occlusion. A. Maintaining hydration prevents venous stasis and vascular occlusion. indicate possible pneumonia. Firm.

000/mm3 ANS: C Clients with sickle cell disease are anemic but are not iron deficient. Monitor the client’s serum ferritin. How does the drug hydroxyurea benefit the client with sickle cell disease? Prevents crises by stimulating the RBCs to synthesize more hemoglobin F Prevents crises by decreasing blood viscosity and reducing vessel obstruction Prevents anemia by stabilizing RBC plasma membranes Prevents anemia by increasing cellular iron storage ANS: A Hydroxyurea (Droxia) has been successfully used to reduce the number of sickling and pain episodes.Test Bank 10. Hydroxyurea works by stimulating fetal hemoglobin (Hgb F) production. Effective Care Environment. Hgb F is present during fetal development. HgbS of 88% C. Transfusions are prescribed cautiously to prevent iron overload with repeated transfusions. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation/Analysis MSC: Client Needs Category: Safe. D. Hct of 32% B. and total iron-binding capacity (TIBC) during transfusion therapy. but production of Hgb F is turned off before birth. A. . Effective Care Environment/Health Promotion and Maintenance. liver and endocrine organs. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe. Iron overload damages the heart. 11. Serum iron level of 300 mcg/dL D. B. serum iron (Fe). Which laboratory test result in a client with sickle cell disease in crisis indicates that the packed red blood transfusion should be discontinued? A. Total WBC count of 12. Increasing the level of Hgb F reduces sickling of red blood cells in persons with sickle cell disease. C.

Caffeine D. 28-year-old woman whose grandfather had the disorder C.Test Bank 12. 13. the mutation is expressed as dominant. Which person should the nurse be most alert for the development of glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia? A. Men have only one X chromosome and. The affected grandfather could have passed his affected X chromosome to his daughter (who was then a carrier) who then passed it on to her son. 55-year-old man who had a myocardial infarction 5 years ago D. sulfonamide antibiotics. Women have two X chromosomes and. Laxatives B. Alcohol ANS: B Cells with reduced amounts of glucose-6-phosphate dehydrogenase are more susceptible to hemolysis on exposure to aspirin and other drugs (phenacetin. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment/Intervention MSC: Client Needs Category: Safe. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Health Promotion and Maintenance . 28-year-old man whose grandfather had the disorder B. 55-year-old woman who had a partial gastrectomy for stomach cancer last year ANS: A The disorder is inherited as an X-linked recessive trait. Aspirin C. quinine derivatives. if one X has the mutation. there are sufficient cells with a healthy X chromosome to avoid manifestations of the disease. and vitamin K derivatives). Effective Care Environment/Health Promotion and Maintenance. if they have the gene mutation. Which common agent(s) should the nurse teach the client with glucose-6-phosphate dehydrogenase deficiency anemia to avoid? A. thiazide diuretics.

boiled carrots. fatigue. Macrocytic red blood cells D. spinach salad B. Paresthesias of the hands and feet ANS: D Vitamin B12 is essential for peripheral nervous system function (folic acid is not). cream-style cottage cheese. in which the arteries of the distal extremities constrict profoundly in response to cold temperatures. Smooth. Do not take aspirin or aspirin-containing products. glossitis. pallor. Eggplant Parmesan. C. beefy-red tongue C. Avoid crowds and sick people.6° F) and is commonly associated with a Raynaud-like response. Which intervention should the nurse teach the client who has IgM-mediated immunohemolytic anemia? A. Fried liver and onions. ANS: C The IgM-mediated type of immunohemolytic anemia fixes complement at 30o C (–3. Use an electric shaver. Clients deficient in B12 will manifest nervous system problems. glass of white wine C. Dairy products are deficient in vitamin B12. Whole-grain pasta with cheese. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment . such as paresthesias. Weight loss B. Baked chicken breast. B. and jaundice. in addition to weight loss.Test Bank 14. apple sauce. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Health Promotion and Maintenance 16. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Health Promotion and Maintenance 15. D. Which menu selection made by the client with vitamin B12 deficiency anemia demonstrates adequate understanding of dietary management for this problem? A. Wear socks and gloves in cool weather. orange juice. iced tea D. glass of red wine ANS: A Organ meats and leafy green vegetables have the highest content of vitamin B12. Which feature is characteristic of vitamin B12 deficiency anemia but not characteristic of folic acid deficiency anemia? A.

Massage the site for a minimum of five minutes after the injection. Select a 22-gauge. Ten years of antacid therapy for peptic ulcer disease ANS: B Chronic alcohol abuse is strongly associated with malnutrition of many dietary essentials. Poorly controlled diabetes mellitus D. Effective Care Environment. Which technique should the nurse use to adhere to the Z-track method? A. including iron. C. D. 18. B. Ten years of chronic alcoholism C. folic acid. ANS: A The Z-track injection technique is reserved for irritating or staining medications to be administered intramuscularly. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity/Health Promotion and Maintenance . and vitamin B12. Take care to ensure that no air is present in the syringe. Inject medication only into the dorsal gluteal site. 1-inch needle to minimize tissue trauma. The medication must be injected deeply into the tissue of a large muscle to prevent leakage. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe.Test Bank MSC: Client Needs Category: Physiological Integrity 17. Which of the client's health problems alerts the nurse to the possibility of anemia related to dietary deficiency? A. Mild congestive heart failure B. The client is prescribed to receive iron dextran by the Z-track method of intramuscular injection.

0 million. ANS: D Epoetin alfa is a growth factor (erythropoietin) that is specific for red blood cell production. Platelet count has decreased from 80. Segmented neutrophils outnumber the band neutrophils. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A MSC: Client Needs Category: Physiological Integrity 21. A. B.2 million to 3. C. Risk for Injury D. B.Test Bank 19. What is the pathologic mechanism involved in aplastic anemia? Decreased intake of iron Increased rate of red blood cell lysis and destruction Decreased bone marrow production of red blood cells Increased (excessive) cellular metabolic oxygen demand ANS: C The term aplastic indicates arrested development.000 to 50. Which laboratory value indicates that the epoetin alfa (Procrit. Risk for Infection C. Constipation ANS: B Both prednisone and cyclophosphamide decrease immune function and increase the risk for infection. C. the bone marrow fails to perform its developmental function of producing blood cells. In the case of aplastic anemia. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity 20. Red blood cell count has increased from 2. What is the priority nursing diagnosis for the client with aplastic anemia who is being treated with a combination of prednisone and cyclophosphamide. Effective Care Environment/Physiological Integrity.000. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Analysis MSC: Client Needs Category: Safe. A. An increase in the red blood cell count indicates effectiveness of this therapy. Risk for Activity Intolerance B. D. Serum potassium level has increased from 3.5 mEq/L D.5 to 4. . Epogen) therapy is effective? A.

C. increasing the risk for venous stasis and obstruction.0% to 7. Which teaching intervention should the nurse use for the client with polycythemia vera to prevent injury as a result of the increased bleeding tendency? A. “Wear gloves and socks outdoors in cool weather. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Analysis MSC: Client Needs Category: Health Promotion and Maintenance/Safe.Test Bank 22. the reduction of red blood cells by phlebotomy is not able to keep pace with the bone marrow production of red blood cells. Segmented neutrophils outnumber the band neutrophils. and myocardial infarction. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Health Promotion and Maintenance 23. ANS: A Phlebotomy reduces the percentage of circulating red blood cells.” B. “Use a soft-bristled toothbrush. When the client's hematocrit increases during a regimen of phlebotomy. “Drink at least 3 liters of liquids per day. Hemoglobin A1c has decreased from 8. D.” D. Using a soft-bristled toothbrush minimizes trauma to the gums and prevents bleeding. 24. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity . “Exercise slowly and only on the advice of your physician.” ANS: A The other interventions focus on preventing venous stasis. Which laboratory finding in a client with polycythemia vera indicates that phlebotomy alone is no longer effective in managing this problem? A. Hematocrit has increased from 55% to 75% B. B.0% C. A.” C. What is the priority nursing diagnosis for the client with polycythemia vera? Adult Failure to Thrive related to increased energy demands Ineffective Thermoregulation related to excessive heat loss Risk for Injury related to thrombus formation Constipation related to dehydration ANS: C The blood of the client with polycythemia vera is viscous and slow-moving.000 D. clot formation.000 to 150. Platelet count has increased from 120. Effective Care Environment.

Sodium. Which serum electrolyte value in a client with polycythemia vera should the nurse report to the physician? A. the client is at risk for hyperkalemia because his or her RBCs are more fragile and break open easily. 98 mEq/L C. Chloride.Test Bank 25. Hodgkin’s lymphoma D. Potassium. Acute myocardial infarction ANS: A Although not “officially” a type of cancer. 26. Acute leukemia B. Higher levels of serum potassium can lead to heart block and death. releasing intracellular potassium. About 30% of all clients with MDS do eventually progress to acute leukemia. 8. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A MSC: Client Needs Category: Physiological Integrity . Effective Care Environment. and the client has hyperkalemia. Total calcium. 132 mEq/L B.7 mg/dL ANS: C The only abnormal electrolyte level is potassium.5 and 5. The extracellular potassium level should range between 3. MDS arises from a single population of abnormal cells. Polycythemia vera C. In polycythemia. The major cation in the intracellular fluid is potassium.0 mEq/L. 7. Like cancer. MDS has cancer-like features and is considered to be a precursor to cancer. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe. Which health problem is most likely to occur in people who have myelodysplastic syndrome? A.2 mEq/L D.

Hematocrit of 65% B. Bilateral darkening of the conjunctiva C. Blood pressure change from 180/150 to 160/90 D. Which precaution has the highest priority for instruction of the client going home with thrombocytopenia? A. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A MSC: Client Needs Category: Physiological Integrity 29. Unplanned weight loss of 6 lb over a month’s time ANS: C Measures that effectively reduce erythrocyte concentration and blood viscosity also reduce blood pressure. The abnormal hemoglobin in the erythrocytes inadequately oxygenates the myocardium. even with slight injury. B.” C. Why is the client with polycythemia vera at an increased risk for a myocardial infarction? A. C. “Avoid flossing your teeth until platelets return to normal.” D.” B. The rapid synthesis of cells greatly increases metabolism.” ANS: B Decreased platelet counts increase the risk for prolonged bleeding. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity . The increased number of erythrocytes increases blood viscosity and the workload of the heart. The disease is most prevalent among men in their 60s and 70s who have other conditions that damage the heart. increasing the demand of the pumping action of the heart.Test Bank 27. “Avoid drinking alcoholic beverages until your CBC is normal. D. Which clinical manifestation or assessment finding indicates effectiveness of the therapy for the client with polycythemia vera? A. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Health Promotion and Maintenance 28. “Drink at least 3 liters of fluid each day. “Avoid the use of salt substitutes that contain potassium chloride. ANS: C Blood viscosity is increased with the hypercellularity.

“How old was your mother when you were born?” ANS: C A major risk factor for acute leukemia is exposure to high amounts of radiation. Both women and men who are taking this drug are urged to use multiple forms of contraception to prevent exposing a fetus to this drug. Which question is appropriate when exploring the risk factors for the client newly diagnosed with acute leukemia? A. “Drink plenty of fluids to prevent the development of diabetes mellitus.” C. “Have you ever worked around radioactive materials?” D. “How many packs of cigarettes do you smoke per day and for how many years have you smoked?” B.” D. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Health Promotion and Maintenance 31.” ANS: B Thalidomide is a potent teratogen and has been known to cause severe birth defects after even one exposure of the drug. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity/Health Promotion and Maintenance . Which precaution should the nurse teach the client who is prescribed to take thalidomide (Thalomid) as part of her treatment plan for multiple myeloma? A. “Have you ever been treated for a sexually transmitted disease?” C.Test Bank 30. “Avoid high-fiber foods to prevent diarrhea. “Use multiple forms of birth control to prevent birth defects. “Avoid crowds and sick people to prevent contraction of contagious infections.” B.

” C. “Which bone will the surgeon insert the marrow into?” B. “After the bone marrow transplant grows in me. “Until the marrow transplant takes. it is not placed into any bone. “Even though you have a lot of white blood cells. “How long will it be before we know if the transplant is successful?” D. “It is the platelets. not the white blood cells.” C. The excessive bone marrow production of these cells limits production of mature leukocytes that can mount appropriate responses to protect the client from infection.” ANS: A The transplanted marrow is delivered intravenously. they are immature and not able to prevent or fight infection. my blood type will be the same as the donor's. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Health Promotion and Maintenance/Psychosocial Integrity . “Your white blood cells have been poisoned by chemotherapy and are now nonfunctional. Which question or statement by the client about to undergo allogeneic bone marrow transplantation indicates a need for further discussion regarding the procedure? A. I should have few visitors. What is the nurse’s best response? A.” ANS: B Leukemia represents an overproduction of very immature white blood cells that have not yet acquired functional status. that protect you from infection. “The number of white blood cells is falsely high because of the severe dehydration that accompanies leukemia.” D. The client with leukemia asks his nurse why he is so susceptible to infection when his white blood cell count is so high. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Health Promotion and Maintenance 33.Test Bank 32.” B.

What is the nurse’s best response? A. only controlled with lifelong injections of chemotherapy. “Your disease is probably more widespread and advanced than your cousin's was. but leukemic cells are more widespread. 38-year-old who has used combination oral contraceptives without a break for 15 years ANS: A Cyclophosphamide is a cytotoxic agent that damages bone marrow and has been known to induce leukemia. Both surgery and radiation are local or regional treatments and would not be successful in treating systemic disease. when his 16-year-old female cousin only had chemotherapy for leukemia. 20-year-old with cystic fibrosis who has been on continuous enzyme replacement therapy since age 3 months D. requiring additional types of intensive therapy for cure. 55-year-old with diabetes mellitus type 1 who has received insulin injections for 43 years C. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Psychosocial Integrity/Health Promotion and Maintenance 35. is needed for leukemia.Test Bank 34. although the site of malignant cell production is initially the bone marrow. Chemotherapy. “Lymphomas can be cured using multiple therapies and leukemia cannot be cured. “Lymphomas can form discrete tumors that can be removed by surgery or treated locally with radiation. “Radiation is not used as therapy in girls and women so as not to disrupt their childbearing ability. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity .” C.” D. Which client is at greatest risk for development of acute leukemia? A. 50-year-old being treated with cyclophosphamide (Cytoxan) for a chronic autoimmune disease B. Lymphomas are solid tumors that may be confined to one body area and. as systemic treatment.” B. local or regional treatment can be effective. The client with lymphoma asks his nurse why his disease treatment regimen includes radiation and surgery as well as chemotherapy.” ANS: B Leukemia is cancer of the blood and it is present throughout the body. therefore.

D. This drug prevents the activation of an enzyme (tyrosine kinase) needed for the growth of CML cells that overexpress the abl oncogene. The client with acute lymphocytic leukemia who has relapsed B. To ensure all chemotherapy is cleared and cannot exert killing effects on the transplanted cells D. Why is the transplantation of bone marrow cells separated from the preconditioning chemotherapy regimen by at least 2 days? A. For which client with leukemia should the nurse be prepared to teach about maintenance therapy? A. B. Clinical trials indicate that clients with acute myelogenous leukemia are not helped by maintenance therapy. To give the client a rest period before the vigorous therapeutic regimen begins C. The client with acute myelogenous leukemia who is in remission ANS: B The purpose of maintenance therapy is to maintain an achieved remission. . C. The client with acute myelogenous leukemia who has relapsed D. To prevent a more profound neutropenic response B. it is not appropriate for a client whose leukemia has relapsed. Therefore. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A MSC: Client Needs Category: Safe. Residual chemotherapy could kill off the transplanted cells. To allow the client to recover from the severe nausea and vomiting caused by the conditioning chemotherapy ANS: C Chemotherapy is systemic and nonspecific in its cytotoxic effects. A. For which type of leukemia has imatinib mesylate (Gleevec) proven most effective? Acute lymphocytic leukemia that has normal chromosomes Acute myelogenous leukemia that has abnormal chromosomes Chronic myelogenous leukemia that is Philadelphia chromosome–positive Chronic lymphocytic leukemia that is Philadelphia chromosome–negative ANS: C Imatinib mesylate (Gleevec) is targeted therapy for chronic myelogenous leukemia (CML) that is Philadelphia chromosome–positive. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A MSC: Client Needs Category: Physiological Integrity 38. Effective Care Environment. The client with acute lymphocytic leukemia who is in remission C.Test Bank 36. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Analysis MSC: Client Needs Category: Physiological Integrity 37. This expression is associated with the presence of one or more Philadelphia chromosomes in the leukemia cells.

” C. What is the nurse’s best response? A. a bone marrow transplant is a stem cell transplant. but cells for a bone marrow transplant must come from a blood relative.” B. “Cells for a stem cell transplant can come from a person other than a family member related by blood. Effective Care Environment/Health Promotion and Maintenance. The risk for infection is no greater than with any invasive procedure performed on an immunocompetent person. The bone marrow is a major source for stem cells. Other sources for stem cells are the peripheral blood and umbilical cord of newborn infants. The procedure is not associated with an increased risk for leukemia. The only difference is the source of the stem cells. Ineffective Coping D. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Psychosocial Integrity 40. The donor has usually undergone extensive psychological assessment and counseling before he or she agrees to donate. but a bone marrow transplant is needed for lymphoma.Test Bank 39. Thus. “A stem cell transplant is useful for solid tumor cancers. Risk for Infection C. “Bone marrow transplantation requires more chemotherapy and radiation than does stem cell transplantation.” ANS: B The purpose of a stem cell transplant for cancer is to transplant undifferentiated stem cells into a client whose own stem cells for making blood cells have been destroyed by cytotoxic therapy. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Analysis MSC: Client Needs Category: Safe. These areas usually cause the donor considerable discomfort for the first few days after the procedure. . Acute Pain B. Which nursing diagnosis or collaborative problem has the highest priority for the bone marrow donor during the first 48 hours after the donation procedure? A. “A bone marrow transplant is one type of stem cell transplant. Potential for leukemia ANS: A The donor of bone marrow has numerous punctures beneath the skin through the bone into the marrow.” D. The client with lymphoma who is considering a stem cell transplant asks what is the difference between a stem cell transplant and a bone marrow transplant.

Fever B.Test Bank 41. Shortness of breath is not an expected client response and may indicate an adverse reaction. Red urine is expected as a consequence of hemolyzed red blood cells in the transfused product. Hematocrit of 25% D. Red urine C. Total white blood cell count of 8000/mm3 B. Which clinical manifestation during the actual bone marrow transplantation alerts the nurse to the possibility of an adverse reaction? A. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity 42. Total white blood cell count of 0/mm3 C. A circulating white blood cell count of 0 indicates successful conditioning. Effective Care Environment. Hematocrit of 50% ANS: B The purpose of pretransplantation conditioning is to "wipe out" the client's existing bone marrow cells. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Analysis MSC: Client Needs Category: Safe. . Shortness of breath ANS: D Fever and hypertension are expected responses to the preservative used in the storage of the bone marrow stem cells. What laboratory value indicates to the nurse that the conditioning regimen for bone marrow transplantation is successful? A. Hypertension D.

Effective Care Environment/Health Promotion and Maintenance. The client’s skin needs to be assessed and biopsied as soon as possible to initiate appropriate therapy. The client has a systemic infection. Document the observation as the only action. feet. D. B. erythrocyte. At 6 weeks after bone marrow transplantation. rising white blood cell. D. a nurse observe that the client has rising white blood cell. . ANS: D Peeling skin is an early indication of graft-versus-host disease. ANS: A Because the pretransplantation conditioning regimen has destroyed the client's own functional bone marrow. Request a humidifier to increase the moisture of the room. Without intervention. in which the transplanted cells attack host cells. causing extensive tissue damage and death. The transplant has engrafted. and legs. What is the nurse’s interpretation of these findings? A. Apply lanolin-based creams to the client's skin.Test Bank 43. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation/Analysis MSC: Client Needs Category: Safe. Effective Care Environment/Physiological Integrity. erythrocyte. Notify the physician. and platelet counts. What is the nurse’s best first action? A. this process can progress. Approximately 6 weeks after the client has received an allogeneic bone marrow transplant. The leukemia is no longer in remission. C. 44. a nurse notes that the client has peeling skin on the hands. B. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation/Implementation/Intervention MSC: Client Needs Category: Safe. and platelet counts indicate that the transplanted marrow has successfully implanted itself in the client's bones and is reproducing (engraftment). C. The client has graft-versus-host disease.

Which additional clinical manifestation supports the possibility of veno-occlusive disease (VOD)? A. Effective Care Environment/Physiological Integrity. . ANS: D The central venous catheter provides a direct line to the internal environment of a client at great risk for infection and bleeding. Clamp the catheter proximal to the break. increased abdominal girth. D. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe. What is the nurse’s best first action? A. Remove the central venous catheter. The home care nurse observes a break in the catheter lumen while changing the central venous catheter dressing of a client after bone marrow transplantation. liver enlargement. 46. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment/Evaluation MSC: Client Needs Category: Safe. The client is 22 days post transplant from an allogeneic bone marrow transplantation. C.Test Bank 45. Hard. Total white blood cell count of 2000 per mm3 C. Weight gain of 8 pounds in the last 3 days B. B. and pain in the right upper quadrant. The nurse observes that the client's sclera and hard palate are yellow. The resulting decreased liver function causes the formation of ascites. Six to 10 watery stools per day for the last 3 days D. Protecting the client from infection after discharge is just as important as when the client was hospitalized. ropelike consistency of the peripheral vein proximal to the IV site ANS: A VOD occludes hepatic venules through thrombosis and phlebitis. Cover the break with sterile tape. weight gain. Effective Care Environment/Physiological Integrity. Document the observation.

” ANS: C Such great progress has been made in the treatment regimen that Hodgkin's lymphoma is now one of the most curable types of cancer. “Trauma is likely to result in loss of skin integrity. because the most appropriate treatment regimen is determined by the extent of the disease. “Platelet recovery is slower than white blood cell recovery and you remain at risk longer for bleeding than you do for infection.” B.Test Bank 47. so it is first necessary to determine the exact sites. making healing after any injury more difficult. The client who has been diagnosed with Hodgkin's lymphoma is scheduled for numerous tests. “The transplanted bone marrow cells are very fragile and trauma could result in rejection of the transplant. “Different treatments are used depending on where the cancer is.” ANS: C Platelets recover more slowly than other blood cells after bone marrow transplantation. Staging procedures for determining disease location and extent are detailed and must be accurate. increasing the risk for infection when you are already immunosuppressed. because it is possible to have two different kinds of cancer at the same time. “The doctors want to be very sure. “The medication regimen after transplantation includes drugs that slow down cell division. Thus. What is the nurse’s best response? A.” C.” B.” D. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Health Promotion and Maintenance/Psychosocial Integrity 48.” D. What is the nurse’s best response? A. “It is best to determine how healthy your major organs are before undergoing the strenuous and uncomfortable therapies for cancer. the client is still thrombocytopenic at home and remains at risk for excessive bleeding after any trauma of injury. “You may be eligible for new and experimental therapy. The client asks if these tests are really necessary. because the exact type of cancer has already been established. The client being discharged home after a bone marrow transplantation for leukemia asks why protection from injury is so important.” C. These tests will determine whether or not you would qualify for such treatment. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Psychological Integrity .

What long-term side effect of this therapy should the nurse be sure that he understands? A. C. placing the client at great risk for bleeding. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Analysis MSC: Client Needs Category: Safe. Constipation will be continuous throughout therapy. ANS: A Only tissues in the actual radiation path are affected by this therapy. This treatment increases the risk for prostate cancer later in life. B. Risk for Injury D. Radiation to the gonad area permanently damages the ability of the testes to produce fertile sperm. Sperm production will be permanently disrupted. The 27-year-old male client with Hodgkin's lymphoma in the abdominal and pelvic regions is about to start radiation therapy. Impaired Gas Exchange B. What is the priority nursing diagnosis for a client newly diagnosed with autoimmune thrombocytopenic purpura? A. D. Impaired Skin Integrity C. . Bleeding occurs with even minor trauma and may occur spontaneously. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Psychosocial Integrity/Health Promotion and Maintenance 50. Diarrhea is more likely than constipation and no evidence has suggested that the client’s risk for prostate cancer will be increased. Pain is not a common manifestation at this stage of the disease. Effective Care Environment. Acute Pain ANS: C This client has greatly decreased numbers of platelets because of their rapid and excessive destruction. Baldness from radiation therapy is likely to be permanent.Test Bank 49.

Standard transfusion sets are not used with platelets because the filter traps the platelets. the activated partial thromboplastin time is within the normal range. Activated partial thromboplastin time of less than 30 seconds ANS: D The specific clotting problem resulting from insufficient amounts of factor VIII cause the activated partial thromboplastin time to be prolonged in clients with hemophilia. Administer the platelet solution by rapid IV push instead of as an infusion. Platelet count of 200. When administration of cryoprecipitated factor VIII is effective. Prothrombin time of 15 seconds (INR of 1. Hematocrit of 43% B. C. How should the nurse modify the standard transfusion therapy procedure when administering a platelet transfusion? A. A special transfusion set with a smaller filter and shorter tubing is used. and the longer tubing increases platelet adherence to the lumen. Co-administer amphotericin B as prophylaxis against fungal contamination. usually over a 15.000/mm3 C. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe. Effective Care Environment.to 30-minute period. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Safe. Which laboratory test result indicates to the nurse that the factor VIII cryoprecipitate therapy for the client with hemophilia is effective? A.Test Bank 51. Use a transfusion set that has short tubing and no filter. . B. 52. Effective Care Environment/Physiological Integrity.3) D. D. ANS: A Platelets are fragile and must be infused immediately after being brought to the client's room. Warm the platelets to body temperature before initiating the transfusion.

a visitor cannot be assumed to know which client is which. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe. The transfusion can proceed. The room and bed number are never considered as a means of positive identification. Stop the transfusion and keep the IV open. Likewise. B. ANS: B Clients with AB-negative blood types can receive O-negative blood because they do not have antibodies against this type of blood. Ask the client if his name is the one on the blood product tag. C. Call the blood bank. D. ANS: C The safest way to determine whether the blood product is about to be given to the correct client is to check the client’s hospital ID band and compare the information on it with that on the blood product tag.Test Bank 53. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe. Compare the bed and room number of the client with the bed and room number listed on the blood product tag. What is the nurse’s best first action? A. C. 54. whose blood type is AB negative. D. is receiving a transfusion with type O negative packed red blood cells. Document the observation as the only action. . Compare the name and ID number on the blood product tag with the name and ID number on the client’s ID band. What identification means should the nurse use to ensure that a blood transfusion is administered to the correct client? A. A nurse observes that the client. Effective Care Environment. Ask the client’s spouse if the client is the correct person who is to have the transfusion. Asking the client who he or she is might result in an error if the client is confused. Effective Care Environment. B. The nurse monitors the client’s vital signs as if he or she were receiving type AB-negative packed red blood cells. Take and record the client's vital signs.

B. What is the nurse’s best first action? A. B. Effective Care Environment/Physiological Integrity.Test Bank 55. the client is cyanotic and complains of chest pain. C. Other solutions hemolyze or clot the blood. Hang the blood with the currently infusing solution. to prevent a more severe reaction. 56. Stop the transfusion. ANS: C Blood and blood products can only be administered with normal saline. a nurse notes that the client's current IV is infusing Ringer's lactate solution. Call the emergency team. Administer oxygen. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe. What should the nurse do in this situation? A. Change the intravenous solution to dextrose 5% in water. The infusion should be stopped immediately. Effective Care Environment. Fifteen minutes into the infusion. D. The client is receiving a unit of packed red blood cells. even before administering oxygen or calling the emergency team. The client is prescribed to receive two units of packed red blood cells. ANS: B It is most likely that the client is having a hemolytic transfusion reaction. . D. Change the intravenous solution to normal saline. Increase the infusion flow rate. Start an additional intravenous infusion site. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe. C. When the blood products arrive.

58. Slow the infusion rate. even before the client's circulatory status is assessed. especially when receiving multiple units of packed red blood cells. One hour into the third transfusion. D. Pooled donor platelets C. a nurse observes the client to have distended neck veins in the sitting position. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Safe. Effective Care Environment/Physiological Integrity. What is the nurse’s best first action? A. The older adult client is receiving the third unit of packed red blood cells that have been administered in the last 8 hours. Discontinue the transfusion. Single-donor platelets B. C. Granulocytes ANS: C Plasma contains AB antibodies and would be capable of causing a hemolytic transfusion reaction if the plasma were not ABO-compatible with the recipient’s blood type. For which of the following blood products is ABO compatibility a requirement for administration? A. Fresh frozen plasma D.Test Bank 57. which have a high osmotic pressure. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A MSC: Client Needs Category: Safe. B. Document the observation as the only action. The infusion rate should be slowed as low as possible. Effective Care Environment/Physiological Integrity. Check the type of infusing blood with the client's blood type. ANS: A Older adult clients are at risk for developing fluid overload during transfusion therapy. to prevent worsening of the problem. .

allergic reactions.” ANS: C The client's rights and wishes should be respected while providing accurate information for reassurance. “Transfusions are not routine and there are now good alternatives to transfusions if you should lose an excessive amount of blood. “Your chances of needing a transfusion during or after surgery are so small that this is not really a problem. “If you are worried about contamination. Which type of transfusion reaction should the nurse assess for in the client who is receiving an autologous blood transfusion? A. “You should allow the health care professionals to do whatever is needed to save your life. However.” D. Febrile ANS: B When a client receives his or her own blood in a transfusion. Hemolytic B. Directed donations from family members neither ensure safe blood products nor are sanctioned by the client’s religion. . DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Safe. Allergic D. this blood can become contaminated and cause a bacterial transfusion reaction. and febrile transfusion responses are eliminated.” B. a Jehovah's Witness scheduled for surgery. compatibility problems. an act condemned by her religion. Effective Care Environment/Physiological Integrity.” C. Bacterial C. The client. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Implementation/Intervention MSC: Client Needs Category: Psychosocial Integrity 60. you could have members of your family make blood donations ahead of time specifically for you. has expressed concern that she might receive blood products.Test Bank 59. What is the nurse’s best response? A.

For which client receiving a blood transfusion should the nurse remain especially alert for the possible development of transfusion-associated graft-versus-host disease (TA-GVHD)? A. Effective Care Environment/Physiological Integrity. and both CLL and CML usually do not occur in people under age 50. OTHER 1. 56-year-old woman who is AB-positive receiving a transfusion with O-negative blood products ANS: B Transfusion-associated graft-versus-host disease is rare but most likely to occur either in immunosuppressed transfusion recipients or immunocompetent recipients receiving blood donated by first-degree relatives. DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Safe. 68-year-old man receiving an autologous transfusion after hip replacement surgery D. AML is the most common type of leukemia occurring in young adults. Chronic lymphocytic leukemia D. Acute myelogenous leukemia C. Indicate whether the following conditions or characteristics are most commonly associated with A. Chronic myelogenous leukemia _____ Philadelphia chromosome _____ Most common type of leukemia among young adults _____ Responds to maintenance therapy _____ Has a familial or genetic predisposition _____ Occurs equally among men and women _____ CALLA-positive ANS: __C__ Philadelphia chromosome __B__ Most common type of leukemia among young adults __A__ Responds to maintenance therapy __D__ Has a familial or genetic predisposition __B__ Occurs equally among men and women __A__ CALLA-positive Rationale: The Philadelphia chromosome structural rearrangement is a marker for the diagnosis of CML and is a predictor of prognosis.Test Bank 61. ALL is the most common type of leukemia found in children. Acute lymphocytic leukemia B. 27-year-old pregnant woman with sickle cell anemia B. those clients whose CML is Philadelphia chromosome–positive are more likely to respond to Gleevec as targeted therapy. Additionally. The only type of leukemia that appears to be able to be . 45-year-old man on immunosuppressant therapy after a kidney transplant C.

Test Bank kept in remission with maintenance therapy is ALL. and CLL occur more frequently in males than among females. Of all the types of leukemia. DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity . CML. Concordance among identical twins is relatively high. There is no gender specificity associated with the development of AML. the only one that consistently shows the presence of CALLA (common acute lymphoblastic leukemia antigen) proteins on its cell surfaces is ALL. CLL has a genetic predisposition that appears to have an autosomal dominant pattern of inheritance. ALL.

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