1.

True or false: Hodgkin's lymphoma—formerly known as Hodgkin's disease—is a cancer of the

lymphatic system, which is part of the immune system.

True flase

2.Which type of Hodgkin’s lymphoma is more common?

 Hodgkin’s lymphoma
 Non-Hodgkin’s lymphoma
 Both are equally common
Which of the below are symptoms of Hodgkin’s lymphoma?

 Painless swelling
 Fever
 Night sweats
 Unexplained weight loss
 All of the above

Which of the below are a subtype of Classical Hodgkin’s lymphoma ?

 Nodular sclerosis Hodgkin’s lymphoma

 Mixed cellularity Hodgkin’s lymphoma
 Lymphocyte-depleted Hodgkin's lymphoma
 Lymphocyte-rich Hodgkin's lymphoma
 All of the above
Hodgkin’s lymphoma is usually diagnosed more in which age population?

 15 to 30 years old and those above 55 years of age

 10 to 15 years old and those above 45 years of age
 30 to 45 years old and those above 65 years of age
 None of the above

For patients treated for Hodgkin’s lymphoma, what is the approximate duration of radiation
therapy for each visit?
  15 minutes
 30 minutes
 45 minutes
 60 minutes

Bone marrow transplant for patients with Hodgkin’s lymphoma is:

 From the patient’s own blood

 From matching family member
 From friends or donors
Which of the below medications are used for Hodgkin’s lymphoma?

 Adriamycin (doxorubicin)
 Bleomycin
 Vinblastine
 Dacarbazine
 All of the above

Stanford V regimen, does not include which of the below medications?

 Doxorubicin (Adriamycin)
 Mechlorethamine (nitrogen mustard)
 Vincristine
 Vinblastine
 Cyclophosphamide

What are the most common types of indolent non-Hodgkin lymphomas?

These lymphoma types typically grow very slowly. People who have a form of indolent non-
Hodgkin lymphoma may not notice changes in their body that turn out to be symptoms of non-
Hodgkin lymphoma.

Indolent B-cell lymphomas

People diagnosed with indolent lymphoma may not need immediate treatment. Healthcare
providers instead may monitor your health until they determine that treatment is necessary. This
is sometimes called “watchful waiting”. Existing treatments often can’t cure this condition yet are
very effective. These treatments typically ease and sometimes eliminate symptoms for a long
time.

 Follicular lymphoma: This lymphoma type forms in your lymph nodes, bone marrow
and other organs. It’s the second most common form of non-Hodgkin lymphoma in the
U.S. and Europe.
 Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL): Although
the term CLL sounds different from the term lymphoma, CLL is similar to other indolent
B-cell lymphomas. Healthcare providers use the term CLL when you have large
numbers of abnormal B cells in your bloodstream. CLL is essentially the same disease
as SLL, in which the abnormal B cells are primarily in your tissues and lymph nodes.
 Marginal zone lymphoma: There are three types of marginal zone lymphoma — nodal
marginal lymphoma, splenic marginal zone lymphoma and extranodal marginal zone
lymphoma. This last type is sometimes known as mucosa-assisted lymphoid tissue
(MALT) lymphoma. MALT lymphoma affects organs other than lymph nodes including
the lining of your stomach, your lungs and the structure around your eyes.
 Waldenström macroglobulinemia (lymphoplasmacytic lymphoma): This lymphoma
type happens when genetic mutations change B cells that produce a particular type of
antibody called IgM. Both the lymphoma cells themselves and the IgM antibody that they
produce can cause specific signs and symptoms.

Indolent T–cell/NK-cell lymphomas

 Cutaneous T-cell lymphoma: This rare lymphoma type affects your skin. Mycosis
fungoides and Sézary syndrome are examples of cutaneous T-cell lymphomas.

Can children have a non-Hodgkin lymphoma?

Yes, this group of conditions can affect children. There are three

common types of non-Hodgkin lymphoma in children: Non-

Hodgkin lymphoma types
This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

THIS PAGE WAS UPDATED ON MAY 31, 2022.

Non-Hodgkin lymphoma (NHL) is divided into more than 30 types, classified based on
the type of lymphocyte involved: B lymphocytes (B cells) or T lymphocytes (T cells).
Non-Hodgkin lymphoma is further classified by other factors, including whether it is
aggressive (fast-growing) or indolent (slow-growing).
Aggressive lymphomas
Aggressive lymphomas advance more quickly than indolent lymphomas. Patients with
aggressive lymphomas often develop symptoms sooner and require treatment
immediately after their diagnosis. Based on the subtype of lymphoma, symptoms may
vary from enlarged lymph nodes and weight loss to broader bone and skin issues. That
said, aggressive lymphomas tend to respond well to cancer treatments.

The subtypes of NHL that are usually considered aggressive include:

 Diffuse large B-cell lymphoma 

 Anaplastic large-cell lymphoma
 Burkitt lymphoma
 Lymphoblastic lymphoma
 Mantle cell lymphoma
 Peripheral T-cell lymphoma

Indolent lymphomas
Indolent lymphomas advance more slowly than aggressive lymphomas, and they often
don’t cause apparent symptoms early on.

Many indolent lymphomas respond well to treatment, but they are usually challenging
remove completely. Treatment may not need to be initiated right away for these
cancers. When treatment is delayed, your care team will closely monitor the cancer’s
progress and recommend starting treatment if any problems or complications arise.
Symptoms may vary widely based on the subtype of the disease.

The subtypes of NHL that are usually considered indolent include:

 Follicular lymphoma
 Cutaneous T-cell lymphoma
 Lymphoplasmacytic lymphoma
 Marginal zone B-cell lymphoma 
 MALT lymphoma
 Small-cell lymphocytic lymphoma

Burkitt lymphoma
Burkitt lymphoma is considered the most aggressive form of lymphoma and is one of
the fastest growing of all cancers. But it is very rare, accounting for about 2 percent of
all lymphoma diagnoses. The disease originates in mature B-lymphocytes, which are
cells of the acquired immune system that produce antibodies to help fight off disease.
Burkitt lymphoma, a type of non-Hodgkin lymphoma, is most often diagnosed in young
adults and children, especially male. But certain types of Burkitt lymphoma have been
diagnosed in adults, especially those with a weakened immune system. The disease is
named for Denis Burkitt, the British surgeon who first identified the cancer in African
children in the late 1950s.

The symptoms of Burkitt lymphoma vary greatly and depend on the disease’s type.

Symptoms may spread or worsen quickly as this aggressive cancer advances. Patients
with endemic Burkitt lymphoma may have swelling or disfigurement in the jaw or face.
Patients with sporadic Burkitt lymphoma may have swelling or pain in the abdomen. The
disease may also spread quickly to the central nervous system and brain, causing
severe neurological symptoms, including paralysis.

Other symptoms include:

 Swollen lymph nodes

 Night sweats
 Fever
 Fatigue
 Loss of appetite
 Weight loss

A biopsy, usually of an infected lymph node, is required for an accurate diagnosis if

Burkitt lymphoma is suspected.

Lymphoma and leukemia

Lymphoma and leukemia share a common origin—lymphocytes, the white blood cells
that originate in the bone marrow. B cells mature in the bone marrow, while T cells
mature in the thymus. These cells, which are critical soldiers in the immune system,
travel through the lymphatic system and bloodstream and fight off infection and disease.
Some types of blood cancer may be considered either leukemia or non-Hodgkin
lymphoma, depending on where the cancer originates, as well as other factors. These
types of cancer include:

 Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL): These

cancers affect the same cells, small lymphocytes, and are often considered
different versions of the same disease. If the cancerous lymphocytes are found in
the bone marrow or blood, it is considered CLL, a typically slow-growing cancer.
If the cells are located in the lymph nodes or spleen, it is considered SLL. About
5 percent of all non-Hodgkin lymphoma cases are diagnosed as SLL.
 Precursor T-lymphoblastic leukemia/lymphoma: This form of non-Hodgkin
lymphoma, similar to acute lymphocytic leukemia (ALL), is often found in the
thymus. This cancer occurs when immature T cells mutate and grow rapidly and
may form tumors.
 Adult T-cell lymphoma/leukemia (ATLL): This type of cancer is most often caused
by the human T-cell lymphotropic virus type I (HTLV-1). ATLL that is found in
 blood is considered leukemia. If it is found in lymph nodes, it is considered
lymphoma. ATLL may be aggressive and often affects bones and skin.
 Hairy cell leukemia: This slow-growing form of leukemia is sometimes considered
a type of non-Hodgkin lymphoma. Hairy cell leukemia is very rare, affecting only
about 700 patients a year.
 Can children have a non-Hodgkin lymphoma?

 Burkitt lymphoma.
 Diffuse large B-cell lymphoma.
 Primary mediastinal B-cell lymphoma.


1.You are preparing the client for a bone marrow aspiration and biopsy. Which of the
following statements, if made by the patient, indicates the need for further teaching?
A) After the procedure I should avoid ambulating for 24-48 hours
B) Pain and discomfort is expected after the surgery. I can take some Tylenol for the
discomfort.
C) I should not take a bath for about 24 hours
D) The surgeon will collect the samples from my hip bone
Answer: A. There is no need to avoid ambulation after the biopsy. Some discomfort at
the site can occur for about a day or two. Tylenol can be given in this case but aspirin
based medications should be avoid d/t risk for bleeding. The patient should be advised
to avoid taking a bath or submerging the site in any other way with water. The specimen
is typically taken from the iliac crest, part of the hip bone.

2.The patient who underwent a bone biopsy yesterday calls the office thinking
something is wrong. Which of the following would be cause for concern by the nurse?
SATA:
A) Swelling and redness at the site
B) Red streaks spreading away from the area
C) T of 99.5
D) Pain in the area
E) Small amount of blood on dressing
Answer: A and B. These are signs of possible bleeding or infection at the site. A
temperature of 99.5 is still considered WNL. Pain in the area would be expected
(unusual or increased pain should be reported). A small amount of blood on dressing
would be expected. Any pus found in the drainage should be reported.

3.Nurse Kelly is caring for a patient who is 65 years old with a platelet count of 7,000
resulting from myelodysplastic syndrome. At 10 p.m. the patient complains of a
headache. What should be the nurse's immediate action?
A) Administer aspirin per prn orders
B) Administer acetaminophen per orders
C) Notify the health care provider
D) Administer a nonpharmacological intervention like a cool compress
Answer: C. A platelet count less than 10,000 puts the client a severe risk for
spontaneous bleed. The nurse should be aware of any signs such as HA, changing
mentation, irritability, restlessness, changes in vision, abdominal distention, or any other
signs of bleeding anywhere in the body.

4.A young mother of three with history of Type 1 diabetes comes into the clinic c/o of
fatigue and says "my Fitbit has been rating my heart rate higher than it used to be" Her
Hgb is taken and found to be 11 g/dL. Which of the following factors most likely
influenced this patient's ability to feel anemia symptoms (fatigue)?
A) Hx of diabetes
B) Stressful lifestyle
C) Lack of exercise
D) Multipara status
Answer: B. People with stressful and active lifestyles are much more likely to feel
symptoms of anemia such as fatigue. Any increased demand for oxygen is going to
increase symptoms in a patient. A patient with a heart defect or pulmonary disease
would be more likely to experience symptoms of anemia rather than a patient with
hypothyroidism who has a decreased demand for O2

5.The patient diagnosed with iron deficiency anemia tells you that she constantly feels
tired and exhausted. She tells you that she is concerned about this problem. What is the
nurse's best initial response?
A) Keep taking your supplements and report back to me in a couple to days
B) How has this affected your life?
C) You are going to need to take a break from those things for a period of time to rest
D) Try to help get rid of the stress in your life. This will help with the tired feeling
Answer: B. Asking this client explain how the fatigue is affecting her life will help open
up the conversation and build rapport. Fatigue is a real life-changing issue for patients
with anemia and should not be dismissed. Telling her that she must take a break from
"things" is not an understanding response and may not solve the underlying problem.
Clients should not be instructed to get rid of all the stress in life.
6.Which medication might the nurse question if administered to the client with anemia?
A) Cipro
B) Lisinopril
C) Acetaminophen
D) Ferrous sulfate
Answer: B. An antihypertensive medication such as an ACE inhibitor could decrease the
preload even further which could be detrimental for a patient with anemia. An antibiotic
or Tylenol should not affect the anemia problem directly. Ferrous sulfate is often
prescribed to patients with anemia to help bring up RBC.
7.The patient with anemia has been prescribed an iron supplement. With which
beverage should the nurse encourage the patient to take the supplement?
A) Milk
B) Water only
C) Orange Juice
D) Tea
Answer: C. Vitamin C helps aid in the absorption of iron. Therefore iron supplements
should be taken with a glass or orange juice or a vitamin C tablet.

8.The nurse is teaching the client prescribed with an iron supplement. Which statement,
if made by the patient, indicates the need for further teaching?
A) I should take this medication on an empty stomach
B) When I start taking this pill, I will start with only one tablet a day and then increase to
two
C) My stools can become really dark in color when I take this supplement
D) I need to watch out for diarrhea that can occur with this supplement
Answer: D. Constipation is expected with this supplement, not diarrhea. Increasing fiber
in the diet can prevent this problem. Food in the stomach impairs iron absorption so the
patient should take it on an empty stomach. Slowly increasing the amount of pills can
help prevent any GI discomfort. Stool is expected to become dark (almost black).

9’You, the super amazing nurse, is taking care of a 65 year old woman with ESRD. The
doctor has informed her that she has anemia. She asks you "My friend has some
anemia and she takes an iron pill every day. Why don't you just give me that?" What is
the best response by the nurse?
A) I'm sorry ma'am, but if you needed iron supplements the doctor would have
prescribed them
B) Those supplements are for anemia caused by blood loss or iron deficiency. They
wouldn't work for you
C) An iron supplement alone would not be enough to fix your specific type of anemia
D) You are going to be put on hemodialysis to treat your renal disease which should
alleviate the anemia
Answer: C. An iron supplement may be given to a patient with ESRD related anemia.
However, an iron supplement would be given in conjunction with erythropoietin. They
would help in this case, but not given alone. Hemodialysis does not fully fix anemia, in
fact, it can further lower iron and folic acid levels and worsen the anemic fatigue.
10.Imagine this. You enter the unit as an RN on your first day on the job. You breathe in
the smell of awesomeness and drink your Starbucks coffee. You see that you are taking
care of a Mr. Smith who has been diagnosed Polycythemia Vera. Because you are so
freakin' awesome, you know that Mr. Smith is at risk for which of the following
complications?
A) Excessive Bleeding
B) Pruritus
C) Hepatomegaly
D) Pancreatitis
Answer: A. Mr. Smith is at risk for bleeding because of overgrown, dysfunctional
platelets r/t his disease process. He is also at risk for clot formation and therefore at risk
for a CVA or MI. Pruritis would be an expected symptom of his disease, not a
complication. Splenomegaly, not hepatomegaly, is associated with this disorder.
Pancreatitis was a red herring, sorry.
11.Which of the following symptoms would be expected in the patient diagnosed with
Polycythemia Vera (PV)?
A) HA
B) Palpatable spleen
C) Angina
D) Polyuria
E) Dyspnea
Answer: A,B,C, and E. The patient with PV would have symptoms based on increased
blood volume and increased blood viscosity. HA, dizziness, tinnitus, fatigue,
paresthesia, and blurred vision are possible symptoms of increased blood volume.
Angina, claudication, dyspnea, and thrombophlebitis are possible symptoms of
increased blood viscosity. Splenomegaly (enlarged spleen) occurs as it takes on blood
producing responsibility. Polyuria is not associated with this disorder

12.A patient arrived to the clinic complaining of generalized pruritus and pain in the
extremities. He has a history of diabetes, HTN, dyslipidemia, COPD, and A-fib. His
blood pressure is 155/90. His face is a ruddy color. On palpation of his abdomen, his
spleen is palpable. His blood values indicate a Hgb of 18.5 and Hct of 60%. The nurse
suspects which diagnosis?
A) Polycythemia Vera
B) Multiple Myeloma
C) Thrombocytopenia
D) Secondary Polycythemia
Answer: D. based on a history of COPD, the nurse suspects that the polycythemia is
based on the secondary cause of chronic reduced oxygen intake. Other possible
causes of secondary polycythemia would include smoking history, cyanotic heart
disease, or even living in a high altitude. There are also several other causes. If a cause
is noted, polycythemia Vera (primary polycythemia) is ruled out

13.The patient with polycythemia Vera asks you "Why the **** am I taking aspirin!? I
never needed any medications before!" What is the best response by the nurse?
A) The aspirin is prescribed in order to treat HA, a common symptom of this disease
B) Aspirin has been proven to be effective in preventing all complications of this
disorder
C) This medication will help reduce the burning pain you have in your extremities
D) If I wanted you to ask a question, I would have let you know. Now shut up and take
your pill.
Answer: C. Aspirin is prescribed to help with erythromelalgia which is a problem caused
by PV which causes warmth, redness, and burning pain in the extremities. Cool
compresses may also help with this problem. It is important to monitor patients taking
aspirin for bleeding because patients with PV are already at an increased risk for
bleeding which could be exacerbated by aspirin use.

14.You are providing discharge teaching to the patient with polycythemia Vera about
treating pruritus. Which of the following statements indicates the need for further
teaching?
A) A cold ice pack can help relieve some of my itching
B) I will take some Benadryl to help relieve the itching
C) Water will probably make my itching worse rather than help it
D) My doctor may discuss the use of Interferon with me which could help relieve my
itching
Answer: B. Use of antihistamines are not effective in relieving pruritus caused by
polycythemia. Cold compresses may help relieve itching (avoid warm or hot). Water
often aggravates pruritus with polycythemia Vera (aquagenic pruritus). Interferon, a
myelosuppressive agent given to high risk patients could help relieve itching.
15.The nurse is providing teaching to the patient diagnosed with Polycythemia Vera.
Which statement, if made by the patient, indicates the need for further teaching?
A) I need to make sure I stay active to prevent clot formation
B) I guess I will have to stop drinking all my alcohol now. Poop.
C) I should limit my bath time to less than thirty minutes
D) I will need to take an iron supplement to help replace what is taken away by
therapeutic blood draws
Answer: D. The patient with polycythemia vera should NEVER take an iron supplement.
It will stimulate further RBC production which would be a negative effect. Staying active
to avoid clot formation is important as this is a major complication of this disorder.
Limiting or avoiding alcohol will help minimize risk for bleeding. Limiting baths will help
keep pruritus from being aggravated.

16.The nurse is taking care of the 73 year old patient with polycythemia vera. The nurse
is most concerned when the patient mentions which of the following?
A) I've had a UTI in the past so I've been drinking cranberry juice to prevent this from
happening again
B) I want to be healthy so I started taking a daily multivitamin
C) I had my last blood draw about a week ago now
D) My doctor started me on a blood pressure medication called Metroprolol
Answer: B. Multivitamins often contain iron which would further stimulate blood
production. It would be important to make sure the vitamin did not contain that
ingredient before the client continued with its use. All other statements are not
concerning
17.Which of the following symptoms is expected with hemoglobin of 10 g/dl?
a. None
b. Pallor
c. Palpitations
d. Shortness of breath
Answer: None. Symptoms are not expected with mild anemia

18.A 72 year old male walks into the clinic complaining of lower back pain. He says he
feels fine in the morning but that his Alieve doesn't work well enough at night time. His
serum protein levels are elevated. Which of the following assessment findings is most
concerning to the nurse?
A) The patient tells you "I have felt more weak and tired lately too"
B) My mother had a history of osteoporosis
C) The patient says he has been constipated
D) The patient says "I haven't peed as much in the past week as I used to"
Answer: D. This is a sign of decreasing renal function and possible renal failure, a
complication of multiple myeloma. Multiple Myeloma is suspected in patients with back
pain and protein elevations. Weakness and tired feeling may be d/t associated anemia.
Constipation can be caused by hypercalcemia and should be investigated. Renal
function is the priority as failure can occur

19.The nurse is discharging the patient with multiple myeloma. Which of the following
teaching should be included during the discharge?
A) You will need to avoid the use of NSAID's
B) It may be necessary to limit fluid intake
C) You will need to get your Pneumonia vaccine
D) Here are the signs of hypocalcemia you will need to know
Answer: C. Patients with multiple myeloma are at an increased risk for infection r/t
impaired antibody production. Teaching would include avoiding sick indviduals, hand
hygiene, calling for fever/signs of infection, getting vaccines such as pneumonia and flu.
Increasing fluid intake will help prevent complications such as hypercalcemia and renal
failure. NSAID's may be used to help relieve pain. Hypercalcemia, not hypocalcemia, is
a common complication of multiple myeloma

20.Which of the following abnormal lab results would the nurse expect to see in the
patient with multiple myeloma?
A) K 5.4
B) Ca 11.5
C) Positive proteinuria
D) Serum M protein
E) Platelets 80,000
Answer: B, C, and D. Protein levels in urine are an expected result of the disease
process. Because bones are being destroyed, an excess calcium level may also be
expected. Serum M (Monocolonal protein) in the blood is the main protein created d/t
multiple myeloma. There would be no expected changes in potassium or platelet counts

21.The patient with multiple myeloma is taking dexamethasone. Which of the following
would be a complication of the therapy?
A) Dehydration
B) Hypoglycemia
C) Osteoporosis
D) Leukopenia
Answer: C. Osteoporosis can be caused by corticosteroids and would be even more so
likely to happen because of the multiple myeloma. This would be an important
assessment for the nurse taking care of the patient

22.The patient with multiple myeloma and lytic lesions has been prescribed a
bisphosphonate called pmidronate (Arendia). He says, "Why am I taking this
medication?" What is the nurse's best response?
A) This medication is to help lower your overactive immune system
B) Hopefully this medication will help kill the malignant cells in your body
C) This medication should help protect renal function from damage
D) This medication will help prevent bone fracture and lower calcium levels
Answer: C. Bisphosphonates are often prescribed the patients with multiple myeloma in
order to maintain the bone and prevent breakdown and fracture. It can caused locked
jaw in patients with multiple myeloma so the nurse should be wary to assess for that
complication

23.Which of the following complications would the nurse know to monitor for in the
patient with primary thrombocythemia?
A) bleeding and clot formation
B) HA and dizziness
C) Stroke and syncope
D) Infection and DVT
Answer: A. Bleeding and clot formation are two common complications of primary
thrombocytopenia. In this disorder, platelet levels are high (600,000+) and platelets are
often dysfunctional. Because of this clots leading to possible DVT, MI, or CVA may
occur as well as possible hemorrhage. HA and dizziness are two common symptoms of
the disease. Syncope and infection would not be associated complications.

24.You are a proud nursing teacher of 20 years. You are really pushing hard for your
students to be as awesome as you are. Ok, let's not push it here. You really just need
them to pass the NCLEX. You are teaching about the difference between primary
thrombocythemia and secondary thrombocytosis. Which nursing student is the
smartest?
A) Thrombocytosis is much more severe than thromboycthemia and is caused by
smoking
B) Thrombocythemia can lead to complications such as bleeding and clotting while
platelet levels in thrombocytosis rarely get high enough to cause such problems
C) Thrombocytosis is a drop in platelet counts with thrombocythemia is a rise
D) Thrombocythemia is caused by cancer while thrombocytosis does not have a cause
Answer: B. Page 553

25.Which of the following statements, if made by the patient diagnosed with immune
thrombocytopenic purpura (ITP) would be most concerning to the nurse?
A) My menstrual periods are really heavy
B) I've been taking prednisone every day
C) I started taking some vitamins and herbs to be healthy
D) I've been taking Metamucil every morning
Answer: C. Herbal supplements can increase bleeding time (garlic, ginseng, kava kava,
etc.) and should not be taken if platelet levels are already low (as in ITP) Menstrual
periods would be expected to be heavy. Prednisone is often prescribed for ITP to
reduce immune destruction of platelets. Metamucil may be prescribed to prevent
constipation (which could lead to GI bleeding)
26.A nurse has just begun an 8 hour shift and is presented with the following patients.
Which patient is the nurse's priority at this time?
a) A 43 year-old female just transferred to the floor who is complaining of generalized
weakness for the past 3 weeks and appears pale and thin. No labs have been drawn.
Vital signs are 109/65, T98.8, P72, R19, O2 94%, pain 0/10.
b) A 66 year-old male with a history of polycythemia vera who has a ruddy complexion,
whose wife pressed the call bell because her husband has developed weakness on the
L side of his body with accompanying slurred speech.
c) A 19 year-old female who has had bloody stools and unexplained bruising for the
past 2 days. Hgb is 9, Hct is 27, RBC count is 3.9, WBC count is 7,000, Platelets are
145,000.
d) A 75 year-old male who has a history of mutiple myeloma who has a Ca+ level of
12.3
Answer: B. Patients with polycythemia vera are at an increased risk for clot formation.
This patient appears to be having symptoms of a stroke.

27.A patient with ITP is scheduled for a splenectomy. He asks you "Why would I want to
have my spleen removed? How will this help me?" What is the nurse's best response?
a) "Tell me more about what is causing your anxiety"
b) "The splenectomy is going to cure your disorder by increasing platelet production"
c) "Many times platelet cells get trapped inside the spleen. When we remove the spleen
they suddenly become free again to help prevent bleeding"
d) "Your spleen is a recycling plant for platelet cells, when remove it, we won't have so
many platelets circulating in the blood"
Answer: C. Splenectomy is removal the spleen which is a platelet "trap". When removed
it allows the platelets to go back into the bloodstream and hopefully normalize overtime.

28.The nurse is taking care of a patient after a splenectomy. Which of the following
would the nurse report immediately to the physician?
A) T 100.1
B) Platelets 600,000
C) BP 155/78
D) RR 22
Answer: A. Infection is a serious complication of a splenectomy because the spleen
plays an important role for the patients immune system. Any sign of infection should be
reported immediately. Platelet count would be expected to be high directly following a
splenectomy, as the spleen is a storage center for platelets and when removed, the
platelets are freed into the bloodstream. A low blood pressure would be a cause for
concern, as this would be an indication of hemorrhage. RR 22 is normal.

29.Which of the following would be allowed to give blood?

A) The pregnant 23 year old mother of 2 who got a tattoo 14 months ago
B) The patient who says "I don't have HIV or syphilis. Heck the only thing wrong with me
was that tooth I got removed 2 days ago!"
C) The eager beaver who says he gave six months ago who says "I got my flu shot
yesterday too!"
D) The patient who says "I used to be an alcoholic, but thanks to AA, I'm clean and
ready to help someone else!"
Answer: D. Pregnant patient should not give blood d/t increased nutritional needs during
pregnancy. The tattoo is 14 months old and would not affect blood donation. HIV or
syphilis infection would be a contraindication to blood donation, and having a tooth
extraction up to 72 hours ago is also a contraindication. Having a recent vaccine would
be a contraindication to blood donation. There is no reason stated why patient D cannot
give blood

30.The nurse is preparing the client for a blood transfusion. While performing the pre-
transfusion assessment, which of the following questions are the most important for the
nurse to ask?
A) Have you had any previous blood transfusions?
B) Have you had children or ever been pregnant?
C) Do you have a history of diabetes?
D) Have you had any recent head trauma?
E) What is your pain level?
Answer: A, B. During the pre-transfusion assessment, the nurse needs to be assessing
any possibility of reaction that could occur. Patients who have had blood transfusions in
the past are at a higher risk for blood transfusion reaction. Patients with a high number
of pregnancies are at a higher risk for blood transfusion reactions d/t antibody
development from exposure to fetal circulation. All other questions are good to ask, but
are not the most critical to ask at this time.

31.You are transfusing a unit of blood into this awesome patient you have. It's pretty
cool cuz they are almost as awesome as you are! It's not every day that happens.
Anyway, suddenly your patient complains of low back pain and feels a little short of
breath. You look at the vitals and see that the blood pressure has dropped and the
patient is running a mild fever. The patient tells you they feel really anxious. You stop
the transfusion (cuz you so smart!). What type of transfusion reaction do you suspect?
A) Febrile, nonhemolytic reaction
B) Acute Hemolytic Reaction
C) Circulatory Overload
D) Allergic Reaction
Answer: B. Acute hemolytic reaction often manifests with dyspnea, fever, anxiety,
hypotension, back pain, nausea and vomiting, chest tightness, and bleeding.

32.Well, you are transfusing blood to a patient today named Mr. Guinea. He's been
losing blood through a GI bleed and he's kind of grumpy. You finish the transfusion and
everything seems fine. Suddenly, the patient says "I feel cold" and begins to experience
chills. His temperature is 100.4. What transfusion reaction does the nurse suspect?
A) Febrile, nonhemolytic reaction
B) Hemolytic Reaction
C) Circulatory Overload
D) Allergic Reaction
Answer: A. Febrile nonhemolytic reaction is the most common type of blood transfusion
reaction ocuring d/t donor antibodies remaining in the blood reacting in the patient's
blood. Symptoms include fever and chills (minimal to severe). Antipyretics can be given
before the transfusion to prevent this reaction

33.You are working yet another awesome amazing day in the ED when in comes a
trauma patient. You find yourself administering blood to this patient. You carefully run
the fluid really slowly at 5ml/min for the first fifteen minutes before you raise the rate
some. Suddenly your patient's heart rate jumps up to 135. The patient sits up a little bit
and says I feel like there is something heavy in my chest. He's having labored
breathing. You stop the transfusion and hear crackles in the lung bases. What reaction
do you suspect?
A) Allergic Reaction
B) Delayed Hemolytic Reaction
C) Hemolytic Reaction
D) Circulatory Overload
Answer: D. Circulatory overload manifests as tachycardia, feelings of fullness in chest,
crackles, JVD, dyspnea, orthopnea, and sudden anxiety. Diuretics may be administered
prophylactically to prevent circulatory overload in patients at risk. HINT: priority action =
stop transfusion + apply O2
34.The patient's platelet count is at 45,000. Which of the the following orders would the
nurse question?
A) Tylenol prn pain
B) Indwelling Foley Catheter
C) Colace
D) Flu shot
E) IV insertion
Answer: B, D. Foley catheters should and IM injections should be avoided d/t increased risk for
trauma and excess bleeding. Tylenol is not contraindicated in this condition. Colace will soften
the stool and prevent damage in the rectum from straining which could cause bleeding. IV's may
still be inserted in order to have emergency access to the bloodstream. Pressure should be held
for 5-10 minutes after insertion or until bleeding stops.